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Re: Diagnosed with chronic insomnia twinch42085

Posted by yxibow on July 1, 2008, at 19:14:58

In reply to Diagnosed with chronic insomnia, posted by twinch42085 on June 25, 2008, at 13:33:38

> Psycho Babblers,
>
> Went to pdoc yesterday and he pescribed me 10mg of Sonata.
>
> What are peoples experience with this sedative hypnotic?
>
> How does it relate to other sedative hypnotics?
>
>
> Thank You ; )
>
> Twinch


Chronic insomnia is ultimately tackled in a diagnostic and mm... dare I say it, sort of holistic manner (that is, resetting the sleep clock may mean staying up and not taking naps.)

I know, I have a serious sleep disorder and its hard -- but its also intertwined with other things so it may not be what you're experiencing.

In the short run, a pseudbenzodiazepine agent such as Sonata (as you described) -- it is the weakest, Lunesta being the strongest and tested for longer term use (but you seem to be allergic to it -- or were you taking other medications at the time?), and Ambien being about similar but not intended, just like Sonata for long term use.

Of the two a pseudobenzodiazepine is far better than a benzodiazepine intended for sleep (Restoril -- temazepam, a metabolite of Valium), ProSom (estazolam), (Halcion -- triazolam), because habituation can come far sooner with short acting agents. They're typically prescribed for about 4-6 weeks of use.

For longer term, Trazodone (an old antidepressant) is one choice although it can make -some- people extremely groggy, prescribed at about 50 to 150mg, it too can become less useful over time and one has to backpedal and start over again with a lower dose. It also can cause in -some- people priapisms although this may be infrequent and for those who are prone to psychosis, its metabolite mCPP may or may not affect that, at a low dose it probably wouldn't make a difference.


Then you have the tetracyclic Remeron, which some say has more REM restorative properties, as little as half of a 7.5mg tablet or maybe 7.5mg, depending on how much you need. Generally, weight gain is dosal related and hunger related as well, so something to watch.

Finally, there are two tricyclics that may help, Sinequan (doxepin) and Elavil (amitriptyline). Of the two, doxepin tends to be weaker though if you have never had a tricyclic or a related compound, you may be flattened for a few days -- try these on a weekend. Continous use of it tends to quickly become ineffective for falling asleep though it may have properties that will allow you to fall asleep again if you wake up. Amitriptyline, which is used offlabel for a variety of conditions, at 10mg, may give you a longer range of sleep. I personally use it to augment other agents because I also have trouble sleeping.


There are the augmenters l-Tryptophan and 5-HTP, which may allow better sleep. I don't know if they are effective on their own (1g and 50-100mg, respectively). These are OTC.


And then there are the two related antihistamines, diphenhydramine and doxylamine succinate, Benadryl and Unisom (the one that contains doxylamine) -- for short term use they can be dosed probably safely up to 75mg depending on your metabolism.


Some will add choral hydrate, that has basically disappeared from conventional use because, well a)it is basically alcohol, and b) it can be exceedingly dangerous. Its manufacture is through CFCs as far as I know so it may disappear anyhow.


But the real danger will robinson is stacking sleep aids. You can point to real world examples, who knows what was in Heath Ledger's mind, but regardless of suicide or lack of knowledge of medications, there were too many things going on.


So while it might be safe to use "augmenters" like dietary supplements, stacking Benadryl on top of Amitriptyline and god knows what is a recipe for respiratory depression or coma. I don't want to be dour about that, but its just common sense and your doctor should or will tell you that.


So there's a pretty much exhaustive list, I'm sure there are esoterica beyond that, but those are among the list one would try.


-- best of luck

Jay

 

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