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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by bark2323 on November 11, 2004, at 18:04:30
This might be too late to even ask, as my dr's appt is tomorrow, but I need help with sleeping meds. Ok, first Ill say what Im on: zyprexa 10mg, klonopin 4mg, provigil 400mg. I know decreasing the provigil is probably the first thing that pops into peoples minds, but Ive done that before and it hasnt really helped, and actually the times Ive done it Ive found out how much provigil really helps.
My problem falling asleep is mainly because my mind races and obsesses the minute I hit the bed. Zyprexa used to help me sleep, but doesnt seem to cut it anymore. When not on zyprexa I have used a combo of seroquel and neurontin to sleep. Ive tried adding neurontin back, but it doesnt seem to be enough anymore. All that helps now is 3 or 4 beers, but I have a tendency towards excess in that department and so (obviously) dont really want to rely on alcohol for sleep.
Because I seem to consistently need an AP plus a GABAergic (Im lumping neurontin in this category which might not be completely true) drug to sleep, and since Ive got the AP, I am interested in hearing suggestions on drugs which affect gaba and/or reduce the release of glutamate, although any med options which reduce thinking (as opposed to just producing drowsiness, which zyprexa helps with) would be appreciated. I would also be interested to hear about tolerance issues in regards to adding another benzo, ambien, or even a barbiturate if I skip weekends. Of course, in order to fall asleep on weekends I will be using alcohol (not healthy I know, but part of my unhealthy college lifestyle) which is cross-tolerant to the three types of meds above, but it does more than potentiate GABA, so Im hoping not fully cross-tolerant. Ive tried ambien and benzos to sleep before (and of course am on one now for other reasons) and grew tolerant quickly, but that was on a daily basis, so Im hoping non-daily would be better. Also, short acting anticonvulsant med experiences as far as sleep goes would also be appreciated.
Im doing well during the day, so Im looking more for short half-life meds if possible and dont really want to increase the zyprexa.Right now I am thinking about ativan 2-3mg (which helps when used sporadically anyway), ambien 10-20mg (which was the dose range I used years ago before it became totally useless), gabitril (which Ive never tried), or some barbiturate (I seem to remember reading that although they are more addictive and deadly, tolerance to the sedative effect was not as common as with say benzos, although looking around I cant find that info again). I havent had much success with sedating ADs, probably because they produce drowsiness instead of slowing my thinking down.
Ok well sorry for the length and total lack of organization to this message, but any help would be appreciated.
thanks,
matt
Posted by MKB on November 11, 2004, at 18:49:25
In reply to help- sleeping meds, posted by bark2323 on November 11, 2004, at 18:04:30
I don't know anything about those meds, but 500-1000 mg of the amino acid L-Tryptophan about 30min. before bed will help with sleep. You can purchase it from www.healthrecovery.com. I would not know how this might interact with your medications, so hopefully, someone else will be able to tell you that.
Posted by King Vultan on November 11, 2004, at 21:48:27
In reply to help- sleeping meds, posted by bark2323 on November 11, 2004, at 18:04:30
Ambien, along with Sonata, which is a very similar med with an even shorter half life, seem to have a minimal tendency to cause tolerance to their effects, but this can still be a problem for some susceptible individuals. The benzo sleep med with the least tendency to induce tolerance is probably Halcion/triazolam, which has a mean half life of 3.5 hours (Ambien is about 2.6, and Sonata is only 1 hour), but it seems clear that Halcion is not nearly as good as the other two meds in this respect. FWIW, though, it does seem to be more powerful.
One thing you can do to reduce tolerance is to alternate these benzo-type sleep meds with other drugs that are sedating. I alternated Halcion and Benadryl while I was on Nardil, taking each every other night, and found this to work relatively well. Unfortunately, now that I am on Parnate and am suffering even worse insomnia, the Benadryl is proving inadequate. In my case, I have now started alternating between Ambien and Halcion, which I know won't work for you because of tolerance issues, but I also use sleep/relaxation CDs that I find incredibly helpful. Particularly, they seem to keep my thoughts from racing in the middle of the night when I wake up, and this allows me to get back to sleep. They also seem to improve the quality of my sleep.
There are some powerful drugs available that are almost guaranteed to knock you out, but some of them, such as chloral hydrate, really should not be used with alcohol. I believe the same is true of the barbituates. My understanding is that even mixing benzos and alcohol can be problematic, but I am not an expert on that particular interaction. I don't know what sedating ADs you've tried, but the tricyclics doxepin and Surmontil/trimipramine are both extremely powerful antihistamines and might be worth considering. I believe that doxepin is the strongest antihistamine known, and it is extremely sedating, while Surmontil seems to provide extremely high quality sleep. Amitriptyline is another sedating TCA, but I almost never recommend it because it is so anticholinergic (dry mouth, constipation, etc.).
However, perhaps the brain fog that anticholinergic drugs also tend to produce might be helpful in slowing down your thoughts (doxepin and Surmontil are also relatively anticholinergic), but that is just a thought that may have nothing to it. FWIW, other antihistaminic, anticholinergic drugs are diphenhydramine (Benadryl, Simply Sleep, etc.), doxylamine succinate (Unisom tablets), and promethazine/Phenergan, the first two being OTC drugs in the US.
Todd
Posted by KaraS on November 11, 2004, at 23:06:25
In reply to Re: help- sleeping meds, posted by King Vultan on November 11, 2004, at 21:48:27
Todd,
Weren't you trying hydroxyzine for sleep? Did that not work out? Also, what exactly is chloral hydrate? If it's so powerful for insomnia, why isn't it used more? I read one post here that called it a last resort. Why is that?
Thanks,
Kara
Posted by King Vultan on November 12, 2004, at 8:07:46
In reply to Re: help- sleeping meds » King Vultan, posted by KaraS on November 11, 2004, at 23:06:25
> Todd,
>
> Weren't you trying hydroxyzine for sleep? Did that not work out? Also, what exactly is chloral hydrate? If it's so powerful for insomnia, why isn't it used more? I read one post here that called it a last resort. Why is that?
>
> Thanks,
> Kara
>I did try the hydroxyzine at 25 mg (which did almost nothing), then at 50 mg, then at 100 mg, and the more I tried, the more it kept me awake. Perhaps it's a paradoxical reaction, but I get the impression that the stuff is not the world's greatest sleeping aid. I found it inferior to 50 mg of Benadryl; however, the Benadryl does seem to be more anticholinergic.
Chloral hydrate was one of the first hypnotic agents invented, and I believe it was developed around 1868. It is extremely powerful but has significant abuse and dependency issues and is a Schedule IV controlled substance. I believe chloral hydrate + alcohol is a Mickey Finn (sp). My pdoc says that at his facility, they prescribe chloral hydrate only for people who have the very, very worst insomnia and basically can't sleep at all. He was concerned that I would not be able to wake up at the proper time because of the fairly long half life of the stuff. Personally, I am actually less concerned about that than what I've read about chloral hydrate causing cancer in mice. However, I have not really researched the topic thoroughly.
Todd
Posted by dove on November 12, 2004, at 9:15:49
In reply to Re: help- sleeping meds » KaraS, posted by King Vultan on November 12, 2004, at 8:07:46
Remeron before bed has done wonders for me. I have also taken Amitriptyline in small amounts, and that settled my racing brain down quite nicely. To be honest however, what I rely on every night, and it never fails me, is sublingual melatonin. Nothing works as well and as gently as that stuff.
dove
Posted by anxiety_free on November 12, 2004, at 12:42:08
In reply to help- sleeping meds, posted by bark2323 on November 11, 2004, at 18:04:30
Hey! I would NOT recommend barbiturates...they're really crude, addictive, unpleasant drugs in general, so they are a true last resort. In the benzo arena you could use anyone of your choosing, or one specifically designed for sleep- Restoril, ProSom, Halcion, etc. come to mind. Ambien and Sonata are benzo-like but highly refined; I personally prefer ambien (longer half-life, more potent in general). As far as sedating ADs, trazadone (brand name is Desyrel or something like that) is the classic sleep solution. I personally found seroquel QUITE sedating; many docs will Rx a small amount along with your current AP, and a small amount is usually all you'll need. My final suggestion would be 50-100mgs 5-HTP...its available at health food stores. It raises serotonin levels quickly, so it will make you drowsy, kind of like the post-Thanksgiving day meal drowsiness. When I take it, I take it an hour or 30min before my desired sleep time. All of these drugs can do bad, bad things when mixed with booze, so be careful. Good luck!
Posted by KaraS on November 12, 2004, at 13:21:34
In reply to Re: help- sleeping meds » KaraS, posted by King Vultan on November 12, 2004, at 8:07:46
> > Todd,
> >
> > Weren't you trying hydroxyzine for sleep? Did that not work out? Also, what exactly is chloral hydrate? If it's so powerful for insomnia, why isn't it used more? I read one post here that called it a last resort. Why is that?
> >
> > Thanks,
> > Kara
> >
>
> I did try the hydroxyzine at 25 mg (which did almost nothing), then at 50 mg, then at 100 mg, and the more I tried, the more it kept me awake. Perhaps it's a paradoxical reaction, but I get the impression that the stuff is not the world's greatest sleeping aid. I found it inferior to 50 mg of Benadryl; however, the Benadryl does seem to be more anticholinergic.
>Benadryl makes me groggy and yet stimulated (my heart was racing) at the same time. It's a horrible experience. Perhaps that what you experienced with the hydroxyzine?
> Chloral hydrate was one of the first hypnotic agents invented, and I believe it was developed around 1868. It is extremely powerful but has significant abuse and dependency issues and is a Schedule IV controlled substance. I believe chloral hydrate + alcohol is a Mickey Finn (sp). My pdoc says that at his facility, they prescribe chloral hydrate only for people who have the very, very worst insomnia and basically can't sleep at all. He was concerned that I would not be able to wake up at the proper time because of the fairly long half life of the stuff. Personally, I am actually less concerned about that than what I've read about chloral hydrate causing cancer in mice. However, I have not really researched the topic thoroughly.
>
> Todd
>Thanks. I'll definitely stay away from it.
K
Posted by bark2323 on November 12, 2004, at 23:59:38
In reply to Re: help- sleeping meds » King Vultan, posted by KaraS on November 12, 2004, at 13:21:34
Just wanted to say thanks for all the suggestions. My doc decided to try ambien first, which wasnt all that great in the past, but I understand going for a conservative choice. Oh and just to clarify, I wouldnt drink with these pills. To stop drinking (during the weekdays anyway) is one of the reasons I want to find a med that works. So well see how it goes.
Thanks again,
matt
Posted by midwestgirl on November 14, 2004, at 2:20:18
In reply to Re: help- sleeping meds, posted by bark2323 on November 12, 2004, at 23:59:38
Hi,
I'm new but I saw your post and wanted to add something if thats ok. I know its too late for your immediate sleeping problem, but for a long-term sleeping aid I agree with the post on trazodone. It works really well and doesn't make you feel hung over once you've taken it for a couple of days and gotten used to it. Ambien is not recommended for long-term use b/c it can be habit forming and cause awful withdrawls - i know. My doc said you can only use it 7-10 days safely and it made me sick stopping it. You can take trazodone lomg-term even if you have past addition problems and it works. Sometimes I get crazy dreams on it and I feel like I can't move my legs but I always had crazy dreams. All I know is it makes you sleep and sleep all night long and still be able to wake up when your alarm clock goes off.
Just a thought.
midwestgirl
(who is out of trazodone so still awake at 3:30am)
Posted by bark2323 on November 14, 2004, at 13:22:29
In reply to Re: help- sleeping meds, posted by midwestgirl on November 14, 2004, at 2:20:18
Unfortunately trazodone doesnt work for me. It makes me tired, but my mind is still going full speed. And thank you for your concern regarding addiction to ambien. I dont plan on taking it everyday, so hopefully that wont be an issue. Im not too hopeful that it will even work though, since the last time I was on it I did become tolerant very quickly (faster than with benzos, which is kind of ironic). Im hoping Ill only need to use it for a little while, to kind of reset myself, and then hopefully zyprexa will go back to working for sleep for me.
matt
Posted by midwestgirl on November 14, 2004, at 19:10:17
In reply to Re: help- sleeping meds, posted by bark2323 on November 14, 2004, at 13:22:29
Sorry that trazodone doesnt work for you bark2323- its weird how drugs are like that. Good luck finding something to give you a restful nights sleep. Anyone who has problems sleeping knows what a miserable thing it is to stay up all night long and knowing that you have to go to sleep or else you're a mess the next day. In college we got a cable channel called the NASA channel - if the shuttle was up it just showed an animated version of where it was with slow blips of it moving in space. That was an excellent sleep aid.
midwestgirl
Posted by Barbaracat on November 16, 2004, at 1:53:31
In reply to Re: help- sleeping meds, posted by bark2323 on November 14, 2004, at 13:22:29
Bark,
I'm currently withdrawing from Ambien. It worked very well at first and I've been taking it for around 2 years. But it does cause tolerance and I found myself needing 1.5 and sometimes 2 to fall asleep. It's very expensive and I no longer have prescription coverage so I decided to try without.The first few days I stayed awake until 3am and finally took 1/2 a few nights when I couldn't stand it anymore. After 1 week of not sleeping but a few hours, it's now getting a little easier. I agree that a very good help is to use some kind of sleepy CD or tape. I find something with soft hypnotic words or vocals that partially engage my mind more helpful than just music, but anything that distracts focus from your overactive fretting mind will help.
I also have a paradoxcal reaction to antihistmines if I take too much, and I don't like the feeling the next day (same with Trazodone) but I've depended on benedryl in a pinch when nothing else was available. I also sleep much better when I'm off alcohol. It tends to raise blood sugar and cortisol which is what we don't want at bedtime. Good luck. Insomnia is bad enough when you're in the middle of it, but the next day... yuck.
Posted by Sad Panda on November 16, 2004, at 10:17:54
In reply to Re: help- sleeping meds » King Vultan, posted by KaraS on November 12, 2004, at 13:21:34
>Benadryl makes me groggy and yet stimulated (my heart was racing) at the same time. It's a horrible experience.
>
>Probably antimuscarinic side effects causing your heart racing. Benadryl has significant ACh antagonism & is used for movement disorders.
Cheers,
Paul.
Posted by KaraS on November 18, 2004, at 2:20:53
In reply to Re: help- sleeping meds » KaraS, posted by Sad Panda on November 16, 2004, at 10:17:54
This is the end of the thread.
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