Sedative-Hypnotics Medicines

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simplytranquil
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So I am prescribed Lunesta (2mg daily) in addition to gabapentin (100mg 2x daily) and clonazepam (3mg daily). The Lunesta increase to 2mg worked great for the first few weeks, but with things amplified in my life recently, I am getting less and less sleep.

Ive tried rotations and taking breaks, to retain efficacy. But I have some doubts. Any superior sleep aids to Lunesta? Thus far, zolpidem and melatonin have failed me, and I do not tolerate antihistamines at the H1 receptors well, so I avoid them. Im thinking promethazine, DPH, dimenhydrinate, hydroxyzine. I also have had my run with trazodone and mirtazapine. Awful experiences.

So what other options are at my disposal?
Ambien CR? temazepam? talk to my doc about upping clonazepam?

I imagine Sonata will not be enough. No barbs will be offered, neither the opposite, any wakefullness promoting agents/stimulants as I am on a sedative (clinic policy). Though, I know duloxetine is an option, if I really wanted to pursue another A/D, after SSRIs have been ruled out.

Thoughts, ideas, comments?

Thanks,
tranquil

gm2 LirtoviR
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There are plenty of options...

Hopefully within your physicians scope of practice. Typically the doctors that will prescribe something for sleep, and then the Dx of insomnia is a psychiatrist. PCP, GP will USUALLY have a low threshold for sleep aids. I take 1-2 Xanax XR tabs TID (panic-disorder). For sleep I take trazadone 150mg, seroquel XR 50mg, and temazepam 30mg (2 caps). I have a great relationship with my psych doc. Before I ended up where I am with my psychiatrist, my PCP/GP stopped when i exhasted the z-drugs and 15mg of temazepam. So I have a high dose, however i don't need to take all 60mgs of temazepam some days or any of the meds. I am in no way proud of my Rx. It's just what works for ME. Doral, Prosom, Restoril, and Dalmane are all great for sleep, I wouldn't ask your doctor about upping the clonazapam though. I have been through all the mentioned benzodiazepines for sleep, and actually I rather like to rotate them just to change tolerance even though they are crossed. Plecebo mind effect I guess..

penny for thoughts

simplytranquil
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quite obviously

Quite obviously this is under my psychiatrists supervision/guidance. I just wanted to hear some second thoughts, perhaps I am overlooking something. Because beyond meds, I have tried my best to find a healthy routine with "what is supposed to work." And as for clonazepam, Im sure it wouldn't be best, to ask, but to entertain a discussion is not outrageous.

As for z drugs, Ive been thinking about Lunesta at 2mg, is still below the average adult dose, 3mg. I guess my question in specific is with regard to temazepam. Does it keep you asleep? How about sleep onset? And as for next day grogginess? Reading encyclopedic entries on these substances is fine, but only gives me so much a perspective. And because abandoning one for another, clinically, is a risky endeavour without exposure, this is but one outlet I must turn to.

tranquil

gm2 LirtoviR
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Temazepam

Z-drugs and benzos have a bit of cross tolerance however they are different in their own respects. Temazepam has a relatively medium to long half life. You probably will feel groggy in the morning for a few days, then you'll peel through the fog and get used to it. As I'm sure you know tolerance is always going to be an issue, so thats another discussion. On an empty stomach, which sleep aids are usually intended to be taken, you will have a quicker onset than taken with a meal you just ate an hour before. But on an empty stomache for me I can fall asleep in about 30-45mins (my experience). Temazepam is also probably one of the more potent sleep aids on the benzo side with a disregard of barbituates. 3mg of Lunesta I really don't think is much difference since I think you probably have the tolerance to the medication's mechanism of action. Hey, its worth a shot, my PCP went as far as two(2) 2mg Lunesta bedtime (4mg total). Didn't do much difference. Your sleep aid discussion with your doctor should also include whether or not you are anxious at night, have trouble staying asleep, having trouble falling asleep, and frequent nightly awakenings due to whatever reason. There are better meds for each and all of those issues of sleep all together. Maybe a combination of medications will work as well. Depending on your situation, sometimes off-labeled meds can be good for sleep too. Seroquel XR for me at its lowest dose (50mgs) works for me. It indeed makes me feel stupid if I don't try to sleep when I take it but it still works to help me STAY asleep. The Trazadone in my medicine cocktail is for helping sleep but since I am on high doses of benzos, my doctor feels he needs to put me on SOME kind of anti-depressant to keep me from becoming depressed. As we know that benzos can have a depressing mood effect being a tranquilizer anyway. That is another discussion worth having with your doctor (possible depression issues).

Non-medicinally speaking, try working out, that will make you tired, not eating late at night, reading a book, waking up earlier and falling asleep a bit later, try and give yourself atleast 8hrs of sleep though.

simplytranquil
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Thanks

I am indeed aware of the obvious cross tolerance between GABAergics (nonbenzos and benzos), in this case. I know temaz half life is supposed to be something like 8-22hrs, so that confirms what I knew of it. I figured it might leave a groggy residual feeling in the day following. However, I imagine that temazepam offers added anxiolytic relief, given that it is a benzo. Not sure how my clinic feels about someone on two benzos, at once. I'd probably have to concede to some serotonergic, potentially duloxetine (Cymbalta). I truly wish that some new NDRIs would be introduced. Or clinical research would open more quickly toward the NMDA-glutamate receptor system (as the current MAPS trials reveal about Ketamine and the NMDA receptor sites) I really cannot see myself settling for off label use of any antipsychotics, including Risperdal, Zyprexa, Seroquel, or any variation, as mentioned. 5HT antagonists are simply too much for me. As my crossing with trazodone and mirtazapine indicate. I know Abilify is a bit different. And I understand Seroquel and Risperdal, among others, to be of particular difficulty with their side effects. Though, like I said Im open to the discussion of a concomitant regimen of some A/D/stimulant-like substance, to offset depressive moments.

As for non medical... I can assure you that the bases are covered. We will go with your list to start things 1.) I work out, for one 60 push ups in the first hour I wake up, every day. I also walk on average over 2 mi a day. 2.) I read. That is what I live to do. 3.) I can afford to allott myself up to 10hrs at this point in my life. As for eating late, I am guilty of this. But to account for that phenomenon is to also understand I have a personal preference of eating later, precisely because I combat nauseating issues with my GI tract. Perhaps, you are starting to get a better perspective of the scope of stress I place upon myself/that is placed upon me.

You may be right though about Lunesta. Maybe I am just tolerant to its MOA now. Though, I have my doubts, that a higher dose 'wouldn't' help.

On the flip side, any experience with Cymbalta? or any other stimulant/wakefulness-promoting agents?

Thanks,

tranquil

T. Calderone
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Frustrated too

I've been prescribed so many different meds, including the off-label pysch meds for sleep. The trouble with lunesta, ambien and restoril is they worked well for a while. I could sleep nice for maybe 3-4 hours and then I'm up again, struggling to sleep. The zyprexa and risperidol made me hyper-forget trying to sleep. Seroquel helped me sleep-knocked me out to the point I couldn't wake up in the morning and had horrific side effects. That is one drug I would never take again because one morning I woke and had trouble speaking. My tongue was messed up.

Cymbalta helps with my fibromyalgia pain somewhat. That's all I'm taking at the moment besides melatonin. It's pretty mild and doesn't affect my ability to either sleep or stay awake. Dalmane was very helpful back in the 80's and I didn't know it was still prescribed. That would be ideal if your doctor would be willing to write you a script for it. It can't hurt to ask. Hang in there.  ~Theresa

 

 

gm2 LirtoviR
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Dalmane

That is typically the benzo sleep aid that I rotate out of my sleep medicine cocktail. It's pretty much temazpam except with a WAY longer half life. Once I start to feel the temazepam not working so well anymore. Thats when I will ask my Doc if he can just change my Temazepam to Flurazepam for a few months and then go back. Be warned. Flurazepam is almost at the end of the sleep aid meds they will try (because of its long half life) before they start adding on other off label meds. It's really rare I have seen people walk out of a doctors office with a barbituate Rx. And if it was, it was for maybe a month at most. Even with my benzo tolerance, flurazepam still feels like its active for atleast a good 12hrs after taken IME.

 

quincy
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T. Calderone . . .

You can add Xanax to your list of 3-4 hour sleep aids as far as I'm concerned. However, I have found a remedy, I keep a Science or Scientific American by the bed so that when I do wake up those interesting, but dense, articles put me right back to sleep. Really, it does work . . . Q

sonicwhite
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I would suggest tamizipam

I would suggest tamizipam even tho I'm on Abien it poopes out quick so I don't use it all the time but I use my remrone every night cuz that just knocks me out. Hope you find some closer with your sleeping meds.

norcalquit
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My friend's mother is

My friend's mother is probably one of the very few people in the US who are prescribed Sodium Oxybate (Xyrem), which is the same thing as gamma-hydroxybutyric acid (the dreaded "date rape" drug GHB).  No pharmacies carry it, she receives it by mail.  She's been a diagnosed narcoleptic and has run the gamut of off-label SSRI's, TCA's, Z drugs, and benzos and this was the last resort.  She spent a week at some special sleep clinic before they decided to initiate therapy, and so far it's done wonders for her.  The only downside is that you have to dose right before you go to sleep, then wake up again in the middle of the night and take the other half of the dose.  At least she can function after suffering for many years.

I take 3mg of Klonopin per day, and I have a prescription for 30mg temezapam which I take probably 3 to 4 nights per week and it works like a charm.  I wouldn't recommed upping your Klonopin dose, as you'll bee adding undue tolerance for a minimal result.  If it's as serious as you describe, ask your doctor about temazepam, midazolam (Versed), or even triazolam (Halcion) if that's even still available.  Short of gunning for Xyrem, hypnotic benzodiazepines are probably your best bet if you can't try to change your sleep cycle using non-medical methods.  I know you said you tried melatonin, and it didn't work.  Most commercially available preparations are 3mg, but the 10mg caps made by Nature's Bounty work way better than what I thought was a homeopathic gimmick; I was just taking too low of a dose.  I'd try that before going for more sleep meds and raising your tolerance if you don't need to.

gm2 LirtoviR
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I think the OP

is trying (I'm assuming) to try and stay at lower doses and other alternatives. But GHB is not commonly prescribed for insomnia. It is because I know when I used to work in a mental health clinic for 2 years I saw it on a patients chart maybe 4 different times. These people were narcoleptic except for one that I remember. He was actually addicted to GHB so he was put on it to be weened off. Halcion is good to be put to sleep but not to stay asleep, very short half life. Versed is typically used in the hospital setting for pre-op surgeries to take an edge off of the patient, lorazepam being another commonly used one. I wouldn't dare mention Xyrem to my psychiatrist, that might set off a red flag. IF it ever came to that I think IMO I would have to let him bring up that med.

 

penny for thoughts