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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by super on January 9, 2001, at 13:20:25
Hello,
I'm seeing my p-doc this week and I am going to ask her for something to help me sleep. I'd appreciate it if you could share your experience and/or recommendations concerning sleep meds. I have taken Xanax off and on for nearly two years and have developed a slight tolerance to it. I could just increase my Xanax dose, but I don't want to become addicted. Generally, when Xanax has worked, I've been happy with it and I wake up in a much better mood, and with much more alertness than when I don't take it. But I've heard so many horror stories about Xanax that I would like to switch to something else if possible. I don't want something that will make it difficult for me to wake up, or something that will knock me out immediately, or something that will play with my memory (which is already very poor).
Thanks in advance for any suggestions you may have.
Posted by Greg on January 9, 2001, at 14:40:55
In reply to options for sleep meds, posted by super on January 9, 2001, at 13:20:25
I take Ambien (10mg) for insomnia and have for nearly two years. It has worked very well for me. Being very disciplined with it and your sleep patterns seem to be very key. I always try to take it at the same time every night and about 20-30 minutes before going to bed. I also try to be very consistant with my bedtimes, this seems to help.
A potential side-effect, there always seems to be one of those... A lot of people I've talked to report some degree of memory loss with Ambien. Mine is confined to things like being woken up after falling asleep on the couch and not being able to remember the conversation I had with my wife. I've never had anything long term. On the other hand, I rec'd an e-mail from someone a few days ago who had taken Ambien for the first time. He said that he woke up at 1am and informed his wife he was going to the grocery store to shop for that evening's dinner. He proceeded to get into his car and totaled it by driving into a tree. He doesn't remember anything about what happened. So as with most meds, Ambien is not for everyone. I hope some others will give you ideas for some alternatives so that you can make an informed choice with your doc. Please let me know what you decide to do.
Good luck,
Greg> Hello,
>
> I'm seeing my p-doc this week and I am going to ask her for something to help me sleep. I'd appreciate it if you could share your experience and/or recommendations concerning sleep meds. I have taken Xanax off and on for nearly two years and have developed a slight tolerance to it. I could just increase my Xanax dose, but I don't want to become addicted. Generally, when Xanax has worked, I've been happy with it and I wake up in a much better mood, and with much more alertness than when I don't take it. But I've heard so many horror stories about Xanax that I would like to switch to something else if possible. I don't want something that will make it difficult for me to wake up, or something that will knock me out immediately, or something that will play with my memory (which is already very poor).
>
> Thanks in advance for any suggestions you may have.
Posted by stjames on January 9, 2001, at 15:12:46
In reply to options for sleep meds, posted by super on January 9, 2001, at 13:20:25
A small dose of a sedating AD, like Remeron, has worked well for me for 16 years. This avoids addictive sleep meds and one does not build tolerence.
James
Posted by Noa on January 9, 2001, at 15:21:16
In reply to Re: options for sleep meds, posted by stjames on January 9, 2001, at 15:12:46
Ditto for me--for a long time, low dose of trazodone helped a lot. When I needed more AD effect, pdoc added Serzone, and since serzone also is sedating (much less intensely, imho, than trazodone), I stopped the trazodone when I started the serzone. Serzone does help, esp since the effexor makes it hard to sleep.
Posted by super on January 10, 2001, at 8:01:40
In reply to Re: options for sleep meds, posted by Noa on January 9, 2001, at 15:21:16
Do these ADs make you tired during the day? And other side effects for them (sexual, weight gain, etc)? More AD effect is welcome:)
> Ditto for me--for a long time, low dose of trazodone helped a lot. When I needed more AD effect, pdoc added Serzone, and since serzone also is sedating (much less intensely, imho, than trazodone), I stopped the trazodone when I started the serzone. Serzone does help, esp since the effexor makes it hard to sleep.
Posted by MarkinBoston on January 10, 2001, at 14:25:44
In reply to Re: options for sleep meds, posted by super on January 10, 2001, at 8:01:40
> Do these ADs make you tired during the day? And other side effects for them (sexual, weight gain, etc)? More AD effect is welcome:)
Serzone had no sexual downside for me, but 100mg @6pm left me a little foggy waking. I'll try it again as the Effexor has me waking briefly @3am.
Posted by JohnL on January 10, 2001, at 17:37:35
In reply to options for sleep meds, posted by super on January 9, 2001, at 13:20:25
Hi,
I'm kind of in the same boat as you. I would like a better sleep med. I've sampled Xanax before, just now and then. Not enough to really get familiar with it. A friend gave me one Valium pill which worked real good. I especially liked waking without any hangover feeling.Sedating antidepressants are an option. Like St James, I've taken Remeron for quite a while. I only take 7.5mg, which is actually more sedating than a higher dose. Serzone left me too tired during the day. Trazodone gave me horrible nightmares, restless sleep, and a headache. I had real good sleep when I was on the tricyclic Nortriptyline, but the daytime constipation and dry mouth was just too much for me live with longterm. Other tricyclics are even more sedating, but that damn constipation dry mouth thing. Yuck. A small dose of Zyprexa (2.5mg) is very sedating and doesn't carry over too much into the next day.
The problem I've discovered with all of the sedating antidepressants is that they all have one thing in common...the morning hangover effect. I've discovered that Remeron is the friendliest in this regard. The hangover feeling is always there when I wake, but it is completely gone in an hour and there is no daytime sedation (after adjusting to it for a week or so). Yet, every morning, relentless, there it is again. But the good part is that Remeron 7.5mg will knock you out within an hour.
I am taking a cocktail of drugs that are all stimulative. Adrafanil, Amisulpride, and Prozac. Even the sedation of Remeron isn't enough to overcome. I fall asleep fast. But I wake early. My wife will say, "Hey, you're snoring!" And I'll think, "Huh? I'm wide awake. How could I be snoring?" So even when I'm asleep I must not be sleeping very good. But I feel fine during the day. I suspect though that Remeron will work a lot better for most other people who aren't taking a cocktail of stimulating medicines.
I would like to sample Xanax again, Klonopin, and Valium, and maybe Ambien. I'm going to ask my doctor let me try each of these for about 5 days each to see if there is one I like. If not, then I guess Remeron is as good as it gets for me.
John
Posted by Noa on January 11, 2001, at 7:37:34
In reply to Re: options for sleep meds, posted by MarkinBoston on January 10, 2001, at 14:25:44
I take the serzone around 6 pm, and feel drowsy, beginning about 30 minutes afterward, for about an hour. Then it lightens up. I have no problems waking up in the morning and no sedation during the day.
Posted by dove on January 11, 2001, at 11:08:16
In reply to Re: options for sleep meds, posted by super on January 10, 2001, at 8:01:40
I've had a few different battles with the sandman versus the red-eyed insomniac. I've used Melatonin, in sublingual form when nothing else was working, but I prefer to use other meds on a daily basis.
The best med I've found that enables me to fall asleep faster and does something wonderful to the quality is Amitriptyline (Elavil). It has the dry-mouth effects, and the slow-down of internal processing (to include bowels, and metabolism), but, when taken in small amounts (nothing near anti-depressant doses) it can really help. Another important aspect of this med, at least for me, was the fact that it combatted the SSRI's (Prozac in my case) very negative effects on my sleep quality.
I've used Amitriptyline in doses ranging from 25mgs to 200mgs, depending on the meds I was currently taking. This month I'm taking 100mgs of Amitriptyline and 300mgs of Serzone one half hour before bed. This combo initially caused morning hang-over effect, but that ended after 2-3 weeks.
Serzone: Some people find this med very sedating, and initially I think this is true. I take 75% of my dosage during the day without negative or sedating effects. It quiets my mind at bedtime, which has been my biggest struggle sleep-wise, shutting my brain down. Serzone actually has great effects on my libido, which was a wonderful surprise after my term with Prozac!
Klonopin: I've only used this med a handful of times before bed, and I didn't find it helpful, though I find it very beneficial calming my moodiness during the day. So, no real comment on this one, other than to say that it's supposedly addictive and very beneficial for many sleepless people.
Neurontin: A newer AED with mood-calming or mood-brightening effects, depending on which abstract one reads and who one asks. Initially, I found Neurontin sedating, and was instructed to initiate the med in one dose near bedtime. This did nothing beneficial for me during the day, but did knock me out at night. I no longer take it at bedtime but throughout the day, and it no longer sedates me unless I take 150mgs with my Serzone (300mgs) and the Amitriptyline (100mgs) before bed. They seem to work synergistically and I usually sleep quite well, though I find myself a little groggy in the morning.
I always keep Melatonin (sublingual form only) on hand for any emergencies. When nothing else works, Melatonin always pulls through.
Best wishes,
dove
Posted by super on January 15, 2001, at 14:35:46
In reply to Re: options for sleep meds, posted by dove on January 11, 2001, at 11:08:16
I tried Serzone the other night and it made me giddy, hungry, chilly, thirsty, and very hyper for the first five hours (11PM-4AM). Then, I took some Xanax and fell asleep, slept through my alarm, and woke up at 10:30AM with a terrible migraine. I couldn't keep any food down all day and slept on and off for the next 24 hours. I felt like I had the hangover from hell. BTW, I took 100mg Serzone I think.
It seems like there's so many options for drugs to make you sleepy, but for some reason, after the Serzone failure, my p-doc wants to stick with Xanax and an increased Depakote dose. I'll keep the meds you recommend in mind in case the Xanax/Depakote approach doesn't work.
Thanks!
> I've had a few different battles with the sandman versus the red-eyed insomniac. I've used Melatonin, in sublingual form when nothing else was working, but I prefer to use other meds on a daily basis.
>
> The best med I've found that enables me to fall asleep faster and does something wonderful to the quality is Amitriptyline (Elavil). It has the dry-mouth effects, and the slow-down of internal processing (to include bowels, and metabolism), but, when taken in small amounts (nothing near anti-depressant doses) it can really help. Another important aspect of this med, at least for me, was the fact that it combatted the SSRI's (Prozac in my case) very negative effects on my sleep quality.
>
> I've used Amitriptyline in doses ranging from 25mgs to 200mgs, depending on the meds I was currently taking. This month I'm taking 100mgs of Amitriptyline and 300mgs of Serzone one half hour before bed. This combo initially caused morning hang-over effect, but that ended after 2-3 weeks.
>
> Serzone: Some people find this med very sedating, and initially I think this is true. I take 75% of my dosage during the day without negative or sedating effects. It quiets my mind at bedtime, which has been my biggest struggle sleep-wise, shutting my brain down. Serzone actually has great effects on my libido, which was a wonderful surprise after my term with Prozac!
>
> Klonopin: I've only used this med a handful of times before bed, and I didn't find it helpful, though I find it very beneficial calming my moodiness during the day. So, no real comment on this one, other than to say that it's supposedly addictive and very beneficial for many sleepless people.
>
> Neurontin: A newer AED with mood-calming or mood-brightening effects, depending on which abstract one reads and who one asks. Initially, I found Neurontin sedating, and was instructed to initiate the med in one dose near bedtime. This did nothing beneficial for me during the day, but did knock me out at night. I no longer take it at bedtime but throughout the day, and it no longer sedates me unless I take 150mgs with my Serzone (300mgs) and the Amitriptyline (100mgs) before bed. They seem to work synergistically and I usually sleep quite well, though I find myself a little groggy in the morning.
>
> I always keep Melatonin (sublingual form only) on hand for any emergencies. When nothing else works, Melatonin always pulls through.
>
> Best wishes,
>
> dove
Posted by Ron Hill on January 15, 2001, at 18:23:12
In reply to Re: options for sleep meds, posted by stjames on January 9, 2001, at 15:12:46
This thread is timely for my situation. I'm BP II and only recently hit upon a med combo that works well for me (300 mg b.i.d. Lithobid, 50 mg b.i.d. Wellbutrin, and 20 mg once per day Prozac). My one remaining issue is that I periodically have sleep disturbance problems.
When the sleep problem presents itself, I have difficulty falling asleep and I wake about every three hours (i.e.; after two sleep cycles). After awakening, it is very hard for me to get back to sleep. Further, I suspect Prozac is adversely affecting my sleep architecture because I often do not feel fully refreshed after a nights rest.
It is important that I find a solution to this problem because a lack of sleep pushes me into hypomania and the hypomania worsens the insomnia. Clearly, this snowball effect adversely affects my work productivity and quality of life.
I invite any and all with an opinion to post your input to me regarding the approaches I should try in solving this problem. I have already implemented good sleep hygiene protocol. Further, natural OTC products such as kava kava, valerian root, and GABA sometimes work, but not always.
Melatonin tablets (3 mg) help, but again, it is not always "powerful" enough. After reading a previous post on this thread, I plan to try sublingual melatonin. Is it ok to take melatonin three times each night (once at bedtime and once each time I wake during the night)? Will this multiple dosing technique allow me to get back to sleep in the middle of the night?
After extensive research on the web, I have come up with the following list of possible solutions for my sleep problem. The list starts with what I consider the most likely best solution and continues rank ordered downward.
1. Add 7.5 mg Remeron prior to bedtime
2. Replace Prozac with about 15 to 30 mg Remeron
3. Add small amount Serzone prior to bedtime
4. Replace Prozac with adequate amount of Serzone
5. Add Sonata on as needed only basis, 10 mg at bedtime or, if necessary, 5 mg at bedtime and 5 mg in the middle of the night.
6. Add 10 mg Ambien at bedtime as needed
7. Increase amount of Lithobid or augment Lithobid with very slow upward titration of Lamictal.I value the time any and all of you spend responding with your opinion on this case. Thank you.
-- Ron
--------------------------------------------------
> A small dose of a sedating AD, like Remeron, has worked well for me for 16 years. This avoids addictive sleep meds and one does not build tolerence.
>
> James
Posted by JohnL on January 17, 2001, at 3:00:13
In reply to Re: options for sleep meds » stjames, posted by Ron Hill on January 15, 2001, at 18:23:12
Hi Ron,
I'm not sure I can be of much help, but here is my two cents worth...
> After extensive research on the web, I have come up with the following list of possible solutions for my sleep problem. The list starts with what I consider the most likely best solution and continues rank ordered downward.
>
> 1. Add 7.5 mg Remeron prior to bedtime....good choice, however there is always a short morning hangover with this med. It's not bad, and not long, but just the fact that it's there day after day is annoying to me. I also take some Prozac. Remeron puts me to sleep fast, but still my sleep is not all that good.
> 2. Replace Prozac with about 15 to 30 mg Remeron....mmmm, I don't like this idea. That is, unless you aren't liking Prozac at all and it's not helping you.
> 3. Add small amount Serzone prior to bedtime....I don't like this idea either. Serzone has sedation, but maybe not enough to overcome Prozac, and it carries over considerably into the next day. Not to mention it sometimes reacts adversely with Prozac.
> 4. Replace Prozac with adequate amount of Serzone....if you at all like Prozac, I don't think you would like Serzone. Results with Serzone seem spotty at best.
> 5. Add Sonata on as needed only basis, 10 mg at bedtime or, if necessary, 5 mg at bedtime and 5 mg in the middle of the night....don't know about this one.
> 6. Add 10 mg Ambien at bedtime as needed....good choice, but Xanax or Valium might be a better choice as long as you keep a lid on possible temptations to increase dose over time.
> 7. Increase amount of Lithobid or augment Lithobid with very slow upward titration of Lamictal....would probably make sleep even worse. Especially Lamictal. It is not a sleep friendly med.In order of priority, my votes would be as follows:
Ambien first.
Then Xanax,
Valium,
Remeron last.
Until these had all been tried, I wouldn't consider other alternatives.
John
Posted by Ron Hill on January 17, 2001, at 8:43:23
In reply to Re: options for sleep meds, posted by JohnL on January 17, 2001, at 3:00:13
John,
Thank you very much for your input. I truely appreciate your taking the time to post!
-- Ron
--------------------------------------
> Hi Ron,
> I'm not sure I can be of much help, but here is my two cents worth...
> > After extensive research on the web, I have come up with the following list of possible solutions for my sleep problem. The list starts with what I consider the most likely best solution and continues rank ordered downward.
> >
> > 1. Add 7.5 mg Remeron prior to bedtime....good choice, however there is always a short morning hangover with this med. It's not bad, and not long, but just the fact that it's there day after day is annoying to me. I also take some Prozac. Remeron puts me to sleep fast, but still my sleep is not all that good.
> > 2. Replace Prozac with about 15 to 30 mg Remeron....mmmm, I don't like this idea. That is, unless you aren't liking Prozac at all and it's not helping you.
> > 3. Add small amount Serzone prior to bedtime....I don't like this idea either. Serzone has sedation, but maybe not enough to overcome Prozac, and it carries over considerably into the next day. Not to mention it sometimes reacts adversely with Prozac.
> > 4. Replace Prozac with adequate amount of Serzone....if you at all like Prozac, I don't think you would like Serzone. Results with Serzone seem spotty at best.
> > 5. Add Sonata on as needed only basis, 10 mg at bedtime or, if necessary, 5 mg at bedtime and 5 mg in the middle of the night....don't know about this one.
> > 6. Add 10 mg Ambien at bedtime as needed....good choice, but Xanax or Valium might be a better choice as long as you keep a lid on possible temptations to increase dose over time.
> > 7. Increase amount of Lithobid or augment Lithobid with very slow upward titration of Lamictal....would probably make sleep even worse. Especially Lamictal. It is not a sleep friendly med.
>
> In order of priority, my votes would be as follows:
> Ambien first.
> Then Xanax,
> Valium,
> Remeron last.
> Until these had all been tried, I wouldn't consider other alternatives.
> John
Posted by SLS on January 17, 2001, at 10:28:48
In reply to Re: options for sleep meds » stjames, posted by Ron Hill on January 15, 2001, at 18:23:12
> This thread is timely for my situation. I'm BP II and only recently hit upon a med combo that works well for me (300 mg b.i.d. Lithobid, 50 mg b.i.d. Wellbutrin, and 20 mg once per day Prozac). My one remaining issue is that I periodically have sleep disturbance problems.
>
> When the sleep problem presents itself, I have difficulty falling asleep and I wake about every three hours (i.e.; after two sleep cycles). After awakening, it is very hard for me to get back to sleep. Further, I suspect Prozac is adversely affecting my sleep architecture because I often do not feel fully refreshed after a nights rest.
>
> It is important that I find a solution to this problem because a lack of sleep pushes me into hypomania and the hypomania worsens the insomnia. Clearly, this snowball effect adversely affects my work productivity and quality of life.
>
> I invite any and all with an opinion to post your input to me regarding the approaches I should try in solving this problem. I have already implemented good sleep hygiene protocol. Further, natural OTC products such as kava kava, valerian root, and GABA sometimes work, but not always.
>
> Melatonin tablets (3 mg) help, but again, it is not always "powerful" enough. After reading a previous post on this thread, I plan to try sublingual melatonin. Is it ok to take melatonin three times each night (once at bedtime and once each time I wake during the night)? Will this multiple dosing technique allow me to get back to sleep in the middle of the night?
>
> After extensive research on the web, I have come up with the following list of possible solutions for my sleep problem. The list starts with what I consider the most likely best solution and continues rank ordered downward.
>
> 1. Add 7.5 mg Remeron prior to bedtime
> 2. Replace Prozac with about 15 to 30 mg Remeron
> 3. Add small amount Serzone prior to bedtime
> 4. Replace Prozac with adequate amount of Serzone
> 5. Add Sonata on as needed only basis, 10 mg at bedtime or, if necessary, 5 mg at bedtime and 5 mg in the middle of the night.
> 6. Add 10 mg Ambien at bedtime as needed
> 7. Increase amount of Lithobid or augment Lithobid with very slow upward titration of Lamictal.
>
> I value the time any and all of you spend responding with your opinion on this case. Thank you.
>
> -- Ron
>
> --------------------------------------------------
>
>
> > A small dose of a sedating AD, like Remeron, has worked well for me for 16 years. This avoids addictive sleep meds and one does not build tolerence.
> >
> > James
Thankfully, there are quite a few options. As has been mentioned, you can add one of the sedating antidepressants to be taken at bedtime. These would include Remeron (mirtazapine), Serzone (nefazodone), Desyrel (trazodone), Elavil (amitriptyline), and Sinequan (doxepin). Generally speaking, the dosages of these drugs that are effective to produce sleep are much lower than those used for depression. Another option is to use a longer-acting hypnotic such as Ambien or Ativan that will help you get to sleep and stay asleep..You have two aspects to your insomnia:
- Falling asleep
- Staying asleep
You can take one of the potent short-acting drugs to initially get you to sleep.
- Halcion (triazolam)
- Sonata (Zaleplon)
- Ambien (zolpidem)
- Imovane (zopiclone)To stay asleep, you can either use low dosages of one of the previously listed soporific antidepressants or a longer-acting hypnotic.
- Ativan ( lorazepam)
- Restoril (temazepam)
- Klonopin (clonazepam)
- Ambien (zolpidem)
- Dalmane (flurazepam)* With the exception of Restoril, each of these longer-acting drugs is capable of helping you get to sleep. You may want to try Ambien or Ativan first to see if they are also capable of getting you to sleep. I have had trouble staying asleep. I use Ativan. I try to take it every second or third day. It prevents me from becoming unacceptably sleep-deprived. It is my hope that this kind of dosing will help prevent tolerance and perhaps even entrain my sleeping pattern. This is only an experiment. I just started taking Ativan this past week. I’ll let you know how it goes.
Perhaps you can find a way of optimizing a single drug by discovering the best way to utilize melatonin. I think Dove had mentioned that it is not advisable to take melatonin beyond 3:00am. I think that is even too late based upon what I know about the natural course of melatonin secretion. I think you are better off not taking it any later than 1:00am
I used to have success with a Halcion / Ativan combination when I could not get to sleep at all for days. (Parnate + desipramine combination)
I would be curious to know what you decide. I have a hunch that your doctor already has a good idea as to how to handle the situation.
Good luck.
- Scott
Posted by stjames on January 18, 2001, at 18:15:23
In reply to Re: options for sleep meds » stjames, posted by Ron Hill on January 15, 2001, at 18:23:12
> > A small dose of a sedating AD, like Remeron, has worked well for me for 16 years. This avoids addictive sleep meds and one does not build tolerence.
> >
> > JamesJames here
Hmmm.......
7.5 mgs Remeron is not enough for me, I use 15 mgs for sleep. I did not notice that you were BP, AD's can throw you into manic phase unless countered with other meds. It seems you have things well ballanced now so adding a small amount of Remeron or replacing an AD with a higher dose of Remeron might not be a good idea.
Scott gave you a good overview of the sleep meds, it is common for BP folks to take them as good sleep very important in BP. The benzos also help with cyclying. Try adding a benzo.
James
Posted by Ron Hill on January 18, 2001, at 19:56:43
In reply to Re: options for sleep meds, posted by stjames on January 18, 2001, at 18:15:23
James,
Thank you very much for your input. I agree that if it is not broke don't fix it, which is one of the main reasons I solicited input before implementing a change. It took four years to get my meds figured out. Now that I've got a combo that works well for me, I plan to go slow, easy, and cautiously with any further changes.
James, thanks again for taking the time to post.
-- Ron
------------------------------------------>
> > > A small dose of a sedating AD, like Remeron, has worked well for me for 16 years. This avoids addictive sleep meds and one does not build tolerence.
> > >
> > > James
>
> James here
>
> Hmmm.......
>
> 7.5 mgs Remeron is not enough for me, I use 15 mgs for sleep. I did not notice that you were BP, AD's can throw you into manic phase unless countered with other meds. It seems you have things well ballanced now so adding a small amount of Remeron or replacing an AD with a higher dose of Remeron might not be a good idea.
>
> Scott gave you a good overview of the sleep meds, it is common for BP folks to take them as good sleep very important in BP. The benzos also help with cyclying. Try adding a benzo.
>
> James
This is the end of the thread.
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