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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Larry Hoover on May 14, 2006, at 11:34:41
Over the last few days, the quality of my sleep has declined precipitously, and for no apparent reason. I am having difficulty even observing myself adequately, as restorative sleep is so very essential to my well-being. When the sleep goes to the cr*pper, I can't even tell you what is wrong. My brain just fails me. Help me brainstorm, please?
Nothing has changed, med wise. But it feels like my drugs are different now. I need sleep, but I'm not getting it, so this isn't a mood swing as in bipolar. I'm not experiencing any of the hyper symptoms of mood. I need sleep, and I'm not getting it. It's not like I don't need the sleep.
Meds:
25 nortriptyline, a.m.
200 lyrica, through the day
80-100 oxycodone, p.r.n.
30 temazepam, q.h.s.
20 doxepin (or 25 trimipramine), q.h.s.
oral cannabis, p.r.n.
10 cetirizine, OTC antihistamineNothing changed, though. Maybe the sleep-inductive tricyclic? Stick to one? (I've been going by intuition, which one to use.)
Last night, I got sleepy like usual. Went to bed at midnight, more or less, as usual. Saw 1, 2, 3, a.m. go by. Took some taurine (intuitive thing). Brain less busy, I think, but 4, 5, 6, go by. Hear my son getting up for the day. Think f*ck f*ck f*ck, then next thing I know it's 11, and I'm getting a late start.
Sleep has been deteriorating only for like 4 days. Before that, was adequate to full restorative.
Sleep difficulty, historically, due to increase in day length. Might just be a bad year? Go live in cave?
Pain is really bad, since the nerve conduction study last Saturday, but sleep didn't get messed up right then, either. I know the pain is significant factor, but such is life. The pain isn't new.
Thoughts? Ideas?
TIA,
Lar
Posted by Guy on May 14, 2006, at 12:38:01
In reply to I need help....insomnia, posted by Larry Hoover on May 14, 2006, at 11:34:41
Larry, with the support fo your doctor, you could try dumping the tricyclics and substituting 5 - 10 mg of Zyprexa. You will definitely sleep well, but get set for increased appetite and posible weight gain. Other than that, have you tried clonazepam as opposed to the benzo you are currently taking. A lot of people have had good luck with clonazepam. You could also bump up your dose of doxepin...you are on a very small dose.
Posted by john berk on May 14, 2006, at 12:47:10
In reply to I need help....insomnia, posted by Larry Hoover on May 14, 2006, at 11:34:41
Hi Larry,
Have you tried or considered "ambien",
My quality of sleep on ambien is good to excellent, and i have had sleep problems since i was a teen. i also take magnesium at 5 p.m., [glycinate] and again at 9, this seems to be quite relaxing.
I had luck in the past with serzone at night, 100 mgs., but cut that out when i went to ambien.
restorative sleep is such an issue, i feel i have only been getting it since starting ambien 8 month's ago, i hope you are able to sleep better soon....john btw, i also make sure to get at least 30 minutes of sunlight daily, preferably in the morning, either by walking or in my yard gardening, it resets the carcadian rythms supposedly!!
Posted by Larry Hoover on May 14, 2006, at 12:52:38
In reply to Re: I need help....insomnia, posted by Guy on May 14, 2006, at 12:38:01
> Larry, with the support fo your doctor, you could try dumping the tricyclics and substituting 5 - 10 mg of Zyprexa.
I can't remember if I've tried that, or not. For sure, I tried Seroquel. I slept one night. Then, I developed paradoxical alertness.
> You will definitely sleep well, but get set for increased appetite and posible weight gain.
Right now, weight gain is not something that would trouble me. I've lost 35 lbs. since Xmas. I have almost no appetite.
> Other than that, have you tried clonazepam as opposed to the benzo you are currently taking. A lot of people have had good luck with clonazepam.
I am super-sensitive to clonazepam. Ultra-sensitive. I can't handle roughly 1/8 of a 0.5 mg tablet. It gives me the whirley-twirlies, really bad.
> You could also bump up your dose of doxepin...you are on a very small dose.
I know that. I'm taking it because of the high H1 affinity. It's an easily conducted experiment, though, as I have the drug on hand. I am very sensitive to meds. Almost brittle, as an analogy to brittle diabetes.
I really appreciate your input. Thanks.
Lar
Posted by ed_uk on May 14, 2006, at 13:04:28
In reply to Re: I need help....insomnia » Guy, posted by Larry Hoover on May 14, 2006, at 12:52:38
Hi Larry
>I am super-sensitive to clonazepam. Ultra-sensitive. I can't handle roughly 1/8 of a 0.5 mg tablet. It gives me the whirley-twirlies, really bad.
That's interesting, especially as you don't have similar symptoms on temazepam. Perhaps you could stop temazepam and replace it with a different benzo? Nitrazepam (Mogadon) is a powerful hypnotic. It does, however, tend to cause residual sedation in the morning. It could be worth a try though. Triazolam (Halcion) is very potent so be careful if you try that one! Triazolam doesn't normally cause a hangover. Lorazepam (Ativan) works well as a hypnotic for some people.
Take care
Ed
Posted by Larry Hoover on May 14, 2006, at 13:10:16
In reply to Re: I need help....insomnia » Larry Hoover, posted by john berk on May 14, 2006, at 12:47:10
>
> Hi Larry,
> Have you tried or considered "ambien",Tried and rejected, thanks.
> My quality of sleep on ambien is good to excellent, and i have had sleep problems since i was a teen. i also take magnesium at 5 p.m., [glycinate] and again at 9, this seems to be quite relaxing.
Thank you. I would recommend magnesium to another person in my place, yet I have trouble thinking of it for myself. Magnesium will be on tonight's menu.
> I had luck in the past with serzone at night, 100 mgs., but cut that out when i went to ambien.
I can't do Serzone. I can't do mirtazepine, either.
> restorative sleep is such an issue, i feel i have only been getting it since starting ambien 8 month's ago, i hope you are able to sleep better soon....john
Yes, it is a huge deal for me, to be able to say restorative (or not). Thanks.
> btw, i also make sure to get at least 30 minutes of sunlight daily, preferably in the morning, either by walking or in my yard gardening, it resets the carcadian rythms supposedly!!
In Canada, with the higher latitudes, you get exaggerated seasonal changes in day length. Anybody north of the Tropic of Cancer sees exaggerated seasons. I know the season messes me up. But usually in a gradual way.
I will try to be more conscious of my sun exposure. Thanks.
Lar
Posted by Phillipa on May 14, 2006, at 13:13:57
In reply to Re: I need help....insomnia » john berk, posted by Larry Hoover on May 14, 2006, at 13:10:16
Lar, valium, luvox,xanax? God I hate the feeling of no sleep. How do you help someone with all the knowledge you have. Love Phillipa
Posted by SLS on May 14, 2006, at 13:35:37
In reply to Re: I need help....insomnia » Guy, posted by Larry Hoover on May 14, 2006, at 12:52:38
You might be having a paradoxical reaction to histamine H1 antagonism.
- Scott
Posted by Tom Twilight on May 14, 2006, at 15:14:37
In reply to I need help....insomnia, posted by Larry Hoover on May 14, 2006, at 11:34:41
I find that Lyrica can worsen my insomnia, since it kind of has a stimulant effect on me (bizarly)
Just a thought
Posted by Larry Hoover on May 14, 2006, at 16:59:19
In reply to Re: I need help....insomnia » Larry Hoover, posted by Phillipa on May 14, 2006, at 13:13:57
> Lar, valium, luvox,xanax? God I hate the feeling of no sleep. How do you help someone with all the knowledge you have. Love Phillipa
If I can't think, then my knowledge is of little use, eh? I'm in a vicious circle, spin spin spin.
I've always found it easier to help look after others than to look after myself. Easier, in more than one context. Sometimes, you really can't see the forest for the darn trees.
Lar
Posted by Larry Hoover on May 14, 2006, at 17:00:39
In reply to Re: I need help....insomnia » Larry Hoover, posted by SLS on May 14, 2006, at 13:35:37
> You might be having a paradoxical reaction to histamine H1 antagonism.
>
>
> - ScottI considered it. But, out of the blue? And, not taking the H1 drug makes it worse. It's very confusing.
Lar
Posted by Larry Hoover on May 14, 2006, at 17:05:00
In reply to Could it be the Lyrica?, posted by Tom Twilight on May 14, 2006, at 15:14:37
> I find that Lyrica can worsen my insomnia, since it kind of has a stimulant effect on me (bizarly)
>
> Just a thoughtYa, it certainly could be. I very much load my dose in a.m., to avoid late Lyrica doses. It very clearly adversely affected my sleep, when I first started on it. I've been on it for eight months, I think. Why problems now? That's the mystery.
My sense is that my drug regime has become unbalanced somehow, despite it being stable. I can't figure out what's out of whack. Maybe the cannabis products are inconsistent in content/quality? I'm afraid to mess around too much, also. The pain is such a limiting thing, already.
:-/
Thanks for all the ideas, everyone.
Lar
Posted by Phillipa on May 14, 2006, at 19:41:39
In reply to Re: I need help....insomnia » SLS, posted by Larry Hoover on May 14, 2006, at 17:00:39
Taurine? Love Phillipa
Posted by Cairo on May 14, 2006, at 20:13:38
In reply to I need help....insomnia, posted by Larry Hoover on May 14, 2006, at 11:34:41
Lyrica by itself is too stimulating to use as a sole sleep aid for me. Adding only 50mg trazodone knocks me out and prevents awakening. I'd say that it seems like the combo gives deeper sleep, but I'm not sure. I still wake up after 9 hours totally unrefreshed, stiff and in pain. I'm going for another sleep study to see what that's all about. I've had to decrease the daytime Lyrica dose as the cognitive side effects are too much and muscle tightness increases, so I've never gotten up to the 450mg daily dose in the FMS trials.
Neurontin + trazodone always gave me more dreams, but, alas, never helped with my morning stiffness and pain.
Cairo
Posted by UgottaHaveHope on May 15, 2006, at 1:00:03
In reply to Re: I need help....insomnia, posted by Cairo on May 14, 2006, at 20:13:38
u wont have any problems sleeping
Posted by Larry Hoover on May 15, 2006, at 10:01:53
In reply to I need help....insomnia, posted by Larry Hoover on May 14, 2006, at 11:34:41
I felt really silly, setting my alarm last night, but I couldn't allow myself to sleep in today. Good thing I did.
I got 9 hours!!!!!!!!
YaY!!!!!
I changed three variables, though.
I do appreciate all the ideas people offered me, and the support behind them.
Lar
Posted by Larry Hoover on May 15, 2006, at 10:03:49
In reply to Take 25mg of Seroquel, posted by UgottaHaveHope on May 15, 2006, at 1:00:03
> u wont have any problems sleeping
I am a mutant, or something. I had a paradoxical reaction to Seroquel. I could not sleep a wink on it.
There are other possible explanations for that effect, though, and I didn't try to exclude them yet. I still have the rest of that prescription, I think, so I still could do the experiment again.
Thanks.
Lar
Posted by Declan on May 15, 2006, at 18:15:57
In reply to Success., posted by Larry Hoover on May 15, 2006, at 10:01:53
Hey Larry, what did you change?
Posted by Larry Hoover on May 15, 2006, at 22:41:05
In reply to Re: Success. » Larry Hoover, posted by Declan on May 15, 2006, at 18:15:57
> Hey Larry, what did you change?
I didn't take my evening cannabis. I did take melatonin, and I did take magnesium. All else remained the same as usual.
Thanks for asking. I forgot the melatonin. Back in a sec....
There.
Thanks, mate.
Lar
Posted by Larry Hoover on May 16, 2006, at 10:13:50
In reply to Re: I need help....insomnia, posted by Guy on May 14, 2006, at 12:38:01
> Larry, with the support fo your doctor, you could try dumping the tricyclics and substituting 5 - 10 mg of Zyprexa.
I've been thinking about my apparent paradoxical reaction to Seroquel, in the context of the H1 receptor activity. When I tried Seroquel, and found myself unable to sleep, I was greatly surprised. My pdoc virtually dismissed me. Like I wasn't telling him the truth.
I wonder, though, if it wasn't because I was doing a drug substitution, rather than a straight forward drug trial. I took Seroquel instead of the Restoril (temazepam), and I was alert the whole night.
So, I'm wondering if the two agents don't bind to different parts of the receptor. I presume that nobody knows that for sure. But, really, I was doing two changes, changing two variables, and attributing all of the outcome to just one of the drugs. I don't think that I took Seroquel with temazepam. It was long enough ago that I don't remember. I'm almost certain I substituted meds, one for the other. I'm almost certain that's what my pdoc told me to do.
Is the combination contra-indicated in any way? Is it safe to take an atypical (Zyprexa or Seroquel) with the benzo, and then begin a taper?
Any opinions out there?
Lar
Posted by ed_uk on May 16, 2006, at 14:06:45
In reply to Re: I need help....insomnia » Guy, posted by Larry Hoover on May 16, 2006, at 10:13:50
Hi Lar
>I took Seroquel instead of the Restoril (temazepam), and I was alert the whole night.
After a benzo has been taken regularly, insomnia is virtually guaranteed if it is withdrawn abruptly.
>Is the combination contra-indicated in any way?
No, not at all.
Regards
Ed
Posted by Larry Hoover on May 16, 2006, at 16:31:28
In reply to Re: I need help....insomnia » Larry Hoover, posted by ed_uk on May 16, 2006, at 14:06:45
> Hi Lar
>
> >I took Seroquel instead of the Restoril (temazepam), and I was alert the whole night.
>
> After a benzo has been taken regularly, insomnia is virtually guaranteed if it is withdrawn abruptly.Indeed. And what happens to the "guarantee" that Seroquel will induce sleep, if both occur at the same time?
I was in a bad space back then, or I'd not have been messing around with my sleep meds in the first place. Just as I was a few nights ago. I only now gave any thought to my attribution, whenever it was that I did that substitution experiment.
> >Is the combination contra-indicated in any way?
>
> No, not at all.
>
> Regards
>
> EdThank you, so very much. If necessary, I shall conduct the proper experiment, i.e. Seroquel plus temazepam.
I had to think it through, which can be a greater challange than all the rest.
Lar
Posted by ed_uk on May 16, 2006, at 16:47:13
In reply to Re: I need help....insomnia » ed_uk, posted by Larry Hoover on May 16, 2006, at 16:31:28
Hi Lar
>And what happens to the "guarantee" that Seroquel will induce sleep, if both occur at the same time?
Following the abrupt withdrawal of a benzo, sleep is *never* guaranteed!
Ed
This is the end of the thread.
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