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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 G-man885858 on April 19, 2009, at 1:48:40
Hey everyone,
I have severe, unresponsive insomnia... I already take 300 mg Seroquel, 10 mg Valium, 12.5 Ambien CR, and still can't sleep for Sh*t.
The insomnia is driving f*cking nuts. My parents think "it's all in my head".
I know percocet is a bit extreme... But my insomnia IS EXTREME!
Posted by Sigismund on April 19, 2009, at 1:56:22
In reply to Severe insomnia, considering Percocet, posted by G-man885858 on April 19, 2009, at 1:48:40
>I know percocet is a bit extreme
Oh yes, probably, but why the hell not?
Posted by Ceres on April 19, 2009, at 4:46:40
In reply to Severe insomnia, considering Percocet, posted by G-man885858 on April 19, 2009, at 1:48:40
G-Man, I'd guess if the other stuff isn't working, Perc probably won't. Of course, everyone's different & drugs interact. ..also have to consider the GI issues w/ Perc
I had Percocet post-surgery, & was miserable w/ insomnia. I even managed complex distant driving & a job interview on Percocet, not that I should have.
I finally got some relief from a 5-month jag by going back on lithium & taking a melatonin & Theanine supplement 5 hr's before bed. --Also, regulating light (bright in the morning & dim the last hours before bed) helps. Sometimes getting out of bed & sleeping somewhere else works.
But, hopefully your doctor can help you with this bout of insomnia. It is the pits, but hopefully temporary. -Ceres
Posted by linkadge on April 19, 2009, at 6:11:06
In reply to Re: Severe insomnia, considering Percocet, posted by Ceres on April 19, 2009, at 4:46:40
Reduce the seroquel. Seroquel isn't always a miracle for insomnia, and I have often heard that higher doses can worsen insomnia, especially after the antihistamine effect wears off.
If sleep is the core issue, I think less than 75mg of serquel is optimal.
Linkadge
Posted by Zana on April 19, 2009, at 10:59:52
In reply to Re: Severe insomnia, considering Percocet, posted by linkadge on April 19, 2009, at 6:11:06
I agree about the effects of seroquel. I added it to Remeron, which made me sleep like the dead after trying lots of other meds to no avail. After I added seroquel I started waking up early and anxious. I would consider Remeron unless you're on a MOAI.
Zanz
Posted by bleauberry on April 19, 2009, at 12:17:09
In reply to Severe insomnia, considering Percocet, posted by G-man885858 on April 19, 2009, at 1:48:40
I agree with others here. Seroquel may need to come down. Its sleep promoting effects are in the 25mg to 50mg range. My doctor prescribes it in higher doses when someone does NOT want to have sleepiness.
I don't like the idea of adding more meds either when the ones you are on are causing more problems than good. It is better to get rid of those and do something else. Otherwise, months later, you realize you are on 4 to 7 meds, you are still not much better off than you were on 2, and now you're in deep water. Percocet has its own set of problems, like whenever you need to come off it, nasty.
About 30% of people I've talked to get wired on Ambien instead of sleepy. It kinds of helps make them groggy for bed, but in a couple hours they are wide awake and wired.
For sleep meds that are intended to be sleep meds, I have found nothing better than Lunesta, with klonopin taking second place.
Try reducing or eliminating seroquel, unless it is doing you considerable good.
Remeron in a tiny 7.5mg or even 4ish mg dose induces a long deep sleep. Any higher and the norepinephrine thing kicks in, sort of like seroquel does, and it becomes less sedating, and even activating.
Posted by Phillipa on April 19, 2009, at 12:24:40
In reply to Re: Severe insomnia, considering Percocet, posted by bleauberry on April 19, 2009, at 12:17:09
Where are all these non benzophobic docs? Phillipa
Posted by G-man885858 on April 19, 2009, at 16:04:55
In reply to Re: Severe insomnia, considering Percocet, posted by Zana on April 19, 2009, at 10:59:52
> I agree about the effects of seroquel. I added it to Remeron, which made me sleep like the dead after trying lots of other meds to no avail. After I added seroquel I started waking up early and anxious. I would consider Remeron unless you're on a MOAI.
>I've tried Remeron. I got a catatonic-like allergic reaction to it which is really nasty and I cannot just ignore... I get this same reaction to all other Serotonin-enhancers like Paxil, Buspar, L-Tryptophan, Sam-E, & Luvox. These brutal reactions started after I Cold-turkeyed off Lexapro back in Summer of 2005. The withdrawal brutalized my nervous system, ESPECIALLY my Serotonin receptors.... And I haven't been able to tolerate a serotonergic antidepressant since then.
Posted by Neal on April 19, 2009, at 21:03:54
In reply to Re: Severe insomnia, considering Percocet, posted by Sigismund on April 19, 2009, at 1:56:22
> >I know percocet is a bit extreme
>
> Oh yes, probably, but why the hell not?Sigi . . . you feeling all right?
Posted by raisinb on April 20, 2009, at 16:11:21
In reply to Re: Severe insomnia, considering Percocet, posted by G-man885858 on April 19, 2009, at 16:04:55
If you haven't already, give Lunesta a shot. It has worked consistently for me for 3 years, and my insomnia is pretty bad.
Posted by G-man885858 on April 20, 2009, at 22:27:34
In reply to Re: Severe insomnia, considering Percocet » G-man885858, posted by raisinb on April 20, 2009, at 16:11:21
I've tried Lunesta & SOnata... they were even more wiring than Ambien...
I wanna try some Unorthodox treatments. I've been trying these mainstream drugs for 7 years now. By unorthodox I mean: Librium, Dalmane, Methaqualone, Seconal, Nembutal....
Having severe unresponsive insomnia makes you ready to go to ANY length to fix it!
Posted by bleauberry on April 21, 2009, at 17:27:50
In reply to Severe insomnia, considering Percocet, posted by G-man885858 on April 19, 2009, at 1:48:40
Ok then, I've been following this thread. The clues are popping up.
What is happening is we have been looking in all the wrong places. We've been looking in the places that make the most sense, yes, but in your case those are the wrong places.
We've been focusing on stuff like benzo-like actions, antihistamine-like actions, dopamine blocking-like actions. All make perfect sense. Usually.
So what does makes sense when those things don't work? To me, from personal experience and observation of others, that is easy.
Norepinephrine.
Yikes. Norepinephrine? Isn't that like adrenaline? Isn't that like the opposite of sedative?
Well, in simplistic theory, maybe. In a stimulant action where norepinephrine is released, that is not what you want. That is one of the things Seroquel does. But in a reuptake inhibition action of norepinephrine, now you have just entered a totally different ballpark. Now you've got all kinds of feedback mechanisms kicking in that modulate hypo or hyper adrenals, which in turn modulates thyroid, and on downstream effects everything else.
Here are some different strategies for you to try that make a ton of sense, at least to me. Based on my own experience and observations of others...
Amitriptyline 10mg-25mg (3 hours before bed)
The new drug Savella 25mg-50mg (split once at breakfast and once in mid-afternoon).
Savella caused me, and does most people, worsening of insomnia in the early days, with a profound improvement of sleep kicking in within a week. It is not a sedative.
It somehow resets things so the sleep mechanisms work. You actually get sleepy when you are supposed to, and you sleep deep like you are supposed to, without taking a sedative to do it. And those don't work for, so even mentioning them is a mute ridiculous pursuit anyway.
Up to this point, you've only been focusing on the sedatives, and they haven't worked. That is already a dead-end road. Pure logic. It is a different mechanism, real simple. It aint benzo, it aint histamine, and it aint dopamine.
No joke. Put those two meds at the top of your list before thinking of anything else.
Posted by Sigismund on April 22, 2009, at 3:27:00
In reply to Re: Severe insomnia, considering Percocet, posted by Neal on April 19, 2009, at 21:03:54
>Sigi . . . you feeling all right?
No
However
I am
Used to
It
Posted by G-man885858 on April 23, 2009, at 16:57:33
In reply to Re: Severe insomnia, considering Percocet » G-man885858, posted by bleauberry on April 21, 2009, at 17:27:50
Bleauberry,
I have some good news... My doc just prescribed me Desipramin. I guess I will test out your norepinephrine theory.
Desipramin has the least side effects of all the TCA's right?
Posted by desolationrower on April 24, 2009, at 14:26:56
In reply to Bleauberry » bleauberry, posted by G-man885858 on April 23, 2009, at 16:57:33
ACK. While i think NA might be important, i'm not sure a reuptake is what you need. And desip is only a NRI, nothing else. IMO just reducing NA or especially Alpha1 activation is a good idea for sleep, so clonidine would be my reccomendation. Amytr. like bb said i also think would help, it has alpha1 blocking, and is an antihistamine, and the antimuscarinic might help too. Additionally, hte meds that cause you problems all increase 5ht. Blocking 5ht2 receptors would be a good idea; it improves deep sleep. amytr. does this, but desipramine doesn't. the biggest side effect of those nasty TCAs is somnelence. get rid of the other sides, get rid of the sleep aid. desip might help you not feel so tired during the day though, or possibly normalize alpha1 activity or something.
Basically, i'd go: cyproheptadine maybe up to 20mg or mirtazapine 15mg-30mg probably (h1/5ht2 blocking), add clonidine (alpha1 blocking, alpha2 agonist to decrease na), then a benzo/z-drug. also gabapentin might help too. i'd also use melatonin and magnesium. if you haven't, learn some meditation. it helped me fall asleep faster because i learned to clear my mind when i went to bed.
-d/r
Posted by G-man885858 on April 29, 2009, at 22:30:48
In reply to Re: Severe insomnia, considering Percocet » G-man885858, posted by bleauberry on April 21, 2009, at 17:27:50
Bleauberry,
What kind of doc prescribes you Hydrocortisone?
My GP doesn't recognize the salivary cortisol panel as "legitimate", so I need to find another MD who recognizes it, and will give me HC. Where should I look?Thanks!
This is the end of the thread.
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