Posted by Elizabeth on April 21, 1999, at 5:30:30
In reply to Re: SLEEP--does anything work for long term, posted by Sally on April 21, 1999, at 2:13:36
Elizabeth's sleep ideas (bound to include *something* you haven't tried yet!)
Ambien - short-acting but good for falling asleep; unlikely to stop working, even after a pretty long time. Most people only need 10mg, but if that doesn't work, consider trying 20.
benzodiazepines - various durations of action, tend to stop working within a couple weeks or so. I've heard especially favorable things about nitrazepam (Mogadon - not available in the U.S.).
zopiclone (Imovane, Rhovane, Zimovane) - seems to stop working with time more than Ambien does, but may be less likely to do so than a benzo. Otherwise, similar to Ambien, but longer lasting. Not available in U.S.
antihistamines - diphenhydramine (Benadryl), hydroxyzine (Atarax, Vistaril), chlorpheniramine (ChlorTrimeton), doxcylamine, others - a reasonable choice, and several of the sedating
antihistamines are over-the-counter (hydroxyzine isn't).tricyclic antidepressants - amitriptyline (Elavil), doxepin (Sinequan), and trimipramine (Surmontil) are probably the most sedating ones, but some people need one that's only moderately
sedating, such as imipramine (Tofranil) or nortriptyline (Pamelor). They have various side effects (Elavil usually being the worst) in addition to sedation, including dry mouth, constipation, orthostatic hypotension, and weight gain.other antidepressants - trazodone (Desyrel), mirtazapine (Remeron/Zipsin), nefazodone (Serzone/Dutonin). Often sedating in low doses
(Remeron becomes less sedating at higher doses). Tend to have fewer side effects than the tricyclics.anticonvulsants - valproate (Depakote, Epival), gabapentin (Neurontin), and carbamazepine (Tegretol, Epitol) have all been used, as they tend to be rather sedating. Gabapentin is the newest and safest of these.
clonidine (Catapres) - an antihypertensive with sedating effects, this can also work for anxiety. For some reason, it's widely used for kids with ADD who have Ritalin-induced insomnia. I'm not convinced this is a wise practice, but it's safe enough in adults.
atypical antipsychotics - olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel). At the low doses required for insomnia (for most people), these lack the risk of movement disorders that older antipsychotics, such as Haldol and Thorazine, are notorious for. Aside from sedation, the main side effect is appetite stimulation. Zyprexa is too long-lasting to use as a sleep aid for many people.
tryptophan - works pretty well, not available in U.S. Also an antidepressant.
melatonin - unless you can't afford a doctor, this would be very low on my list. It seems to work sometimes, but often it does not (some people even get insomnia on it), and it may
interact in a bad way with some antidepressants. Might be a good choice for people with certain circadian rhythm problems, though.
poster:Elizabeth
thread:4804
URL: http://www.dr-bob.org/babble/19990401/msgs/5112.html