Psycho-Babble Medication Thread 66282

Shown: posts 1 to 11 of 11. This is the beginning of the thread.

 

Sleep problems

Posted by Maisy on June 13, 2001, at 6:23:34

This is my second time around with Effexor. Started it
last year for PPD. Relapsed and am now back on 150mg.
This time around however I find my sleep is still very
disturbed. I have been at 150mg for about six weeks
now and thought this would diminish. I have trouble
falling asleep and have difficulty staying asleep.
I was taking xanax 0.25mg, two at night to help or a
15mg restoril. I stopped these four nights ago and am
back to the same problem. Any advice for me??

 

Re: Sleep problems » Maisy

Posted by Cam W. on June 13, 2001, at 8:22:39

In reply to Sleep problems, posted by Maisy on June 13, 2001, at 6:23:34

Maisy - Are you having trouble falling asleep or staying asleep (or both). I am taking 300mg of Effexor in the morning and have trouble initiating sleep. I tried Imovane™ (zopiclone - only in Canada, pity) but the taste perversion lasts all day and it sure is disgusting. I also tried Starnoc™ (zapelon - Sonata U.S.) but found I had to take two to get to sleep. Now I am using Restoril™ (temazepam) 15mg or 30mg, but I find it too sedating and I don't like sleeping that deep.

Herbal sleeping aids may also be appropriate. Valerian or chamomille teas may work, but ask your doc if it is right for you.

I see my doc tomorrow and will ask about the Starnoc/Sonata, again. It has a very short half-life and it can be taken a second time, in the middle of the night, if need be. This seems a good choice for me, as I have trouble falling asleep. If 2 capsules do the trick, then I am all for it.

There are the usual nonpharmaceutical things to try first, though. Avoid caffeine at least 4 hours prior to sleep (even in some chocolate). If you are taking the Effexor XR (which I recommend over the regular), take the entire daily dose in the morning (although some people do have to split the dose). No stenuous exercise up to 2 hours prior to bed; it gets the heart pumping to much. Go to bed earlier and read (I found Faulkner, Vonnegut, or any of the existentialist philosophers - Heidegger, Hegel, Sartre, etc. - use to put me right to sleep; now I like them - damn).

I hope that this is of some help. - Cam

 

Re: Sleep problems » Maisy

Posted by SalArmy4me on June 13, 2001, at 8:24:11

In reply to Sleep problems, posted by Maisy on June 13, 2001, at 6:23:34

You may have to use the benzos for as long as you are on the Effexor. What you could do is take mirtazapine (this would help you sleep) along with the Effexor, creating that "big-gun" therapy mentioned by Stahl in "Psychopharmacology of Depression and Bipolar Disorder": http://www.dr-bob.org/tips/split/Mixing-antidepressants.html

 

Re: Sleep problems

Posted by Cam W. on June 13, 2001, at 9:19:31

In reply to Re: Sleep problems » Maisy, posted by SalArmy4me on June 13, 2001, at 8:24:11

Maisy - I don't think that adding mirtazepine would do much but cause more side effects, in the long run; which can be much worse than the sleep disturbance itself. I have not had much clinical experience with mirtazepine, but I do not believe in using augmentation strategies unless clearly warranted. If you are having doubts about the above, ask your doc for his/her opinion.

What I need to add to my personal experience with Effexor is that the sleep problems seem to be lessening with time. You and I may not need a sleeping agent in a month or two. - Cam


> You may have to use the benzos for as long as you are on the Effexor. What you could do is take mirtazapine (this would help you sleep) along with the Effexor, creating that "big-gun" therapy mentioned by Stahl in "Psychopharmacology of Depression and Bipolar Disorder": http://www.dr-bob.org/tips/split/Mixing-antidepressants.html

 

Re: Sleep problems » Cam W. » Maisy

Posted by Nance on June 14, 2001, at 19:12:47

In reply to Re: Sleep problems » Maisy, posted by Cam W. on June 13, 2001, at 8:22:39

I had the same reaction to Imovane (zopiclone) that you did, Cam - a horrible bitter taste in my mouth that lasted almost 48 hours. Drinking water made it even worse - try avoiding water for 2 days! I much prefer Starnoc/Sonata (zaleplon), although I too have to take 2 capsules (20mg). Product monographs indicate that 20mg is the accepted maximum dose (only if the standard 10mg dose doesn't work), but it's only effective for initiating sleep, not maintaining it (half-life of one hour, lasts about four hours), as you pointed out. I especially like the fact that I'm not foggy when I wake up in the morning, and that there seems to be little risk of tolerance developing for as long a year.

Reference: Zaleplon Safe And Tolerable For Long-Term Treatment Of Insomnia
http://www.pslgroup.com/dg/12EA62.htm

I would include one caution, though. Taking it after you've eaten a high fat meal can reduce its effectiveness, but make sure you've eaten _something_ for dinner. I took it one night when I had eaten very little during the day, and found that my stippled bedroom ceiling had turned into an amazing white skyscape of small, fluffy, pulsating 3D clouds with stipple raindrops! I rather enjoyed this hallucination (but then I'm an aging ex-hippie, and I've been there before!), and I couldn't really see it when I took off my glasses, but I'm sure a lot of people might find this effect very distressing. I want to make it clear that I am most certainly NOT recommending that anyone try this intentionally - it's just an advisory for people with depression- and/or medication-induced anorexia.

For complete zaleplon info, including possible drug interactions, see http://cp.gsm.com/ - select monographs. This is my favourite drug info site, and I can't recall if I've seen it referred to here. The Drug Interaction reports are terrific - you enter all your meds, click "Generate Report" and voila! - all possible interactions are listed and explained. The downside of this site is the registration requirement (I registered as an educator, which I am, but not in anything remotely connected to medicine), and the fact that it may become a pay site on Aug. 1 ($500 for info that is currently free - sob, sob). They were originally going subscription only in April, but didn't, so maybe they'll wait a while longer until they have a sufficiently large paid subscriber base.

Hope this has been helpful. - Nance

 

Re: Sleep problems

Posted by Daveman on June 15, 2001, at 1:10:12

In reply to Re: Sleep problems » Cam W. » Maisy, posted by Nance on June 14, 2001, at 19:12:47

Hey Cam and Nance:

I used Sonata occasionally over a two-year period for occasional insomnia and found it to be an exceptionally effective medication. Then, one day, I found myself spiralling into a panic attack and even two Sonata capsules (10 mg. each) were ineffective. I went a whole week sleeping less than 8 hours total, until Xanax broke the cycle- wherepon I fell into a deep depression which lasted two months and was finally counteracted by my current Celexa/Remeron cocktail.

I still have about half a bottle of Sonata left but haven't tried it since my "adventure". I wonder if I just built up a tolerance to it, and if so, after not taking any for 8 months, will it work again? The brain is such a tricky thing (as if you didn't know that already:))

Dave

 

Re: Sleep problems » Daveman

Posted by Nance on June 15, 2001, at 15:29:20

In reply to Re: Sleep problems, posted by Daveman on June 15, 2001, at 1:10:12

WOW! How awful for you -

I knew that depression is one of the possible side effects of Starnoc/Sonata, but I've never heard of it being associated with panic attacks and insomnia that severe. I guess it just goes to show that you can never tell how something will affect you, especially when it hasn't been on the market long enough to have an established history. Tolerance isn't _supposed_ to be problem with it, but there are too many reports on this board of drug reactions that aren't _supposed_ to happen for me to discount any possibility!

I can't determine from your message if you think the Starnoc/Sonata caused this reaction, or if you are saying that it didn't help with the panic attack. It doesn't really sound to me like tolerance is the issue here, so it may still work for your insomnia; I realize I'm making an assumption that you were taking it to help you get to sleep. I don't think that zaleplon has been indicated for treatment of panic attacks, but I could be wrong. Maybe Cam, or someone else, can advise. If you don't mind me asking, do have a history of panic attacks, or did this hit you out of the blue? It would be interesting to know whether this drug may be triggering a pre-existing condition, or whether it may be causing a new one. My anxiety manifests itself as paralytic immobility - I wonder if panic attack would be a risk factor for the more 'vegetative' insomniac?

I'm definitely on the alert for increased depression - I'm having a big enough problem already trying to find an effective antidepressant regimen. I'm glad to hear the Celexa/Remeron combo is working for you. Have you had any side effects that you would attribute to the Remeron? I'm currently on Celexa/WellbutrinSR and it's not really working. I'm also tapering off Dexedrine Spansule - it had an extreme paradoxical effect on me - dropped me even deeper into the Black Hole, and welded me to the couch. I have the opportunity to be involved in a clinical trial comparing sertraline and mirtazapine (Remeron isn't approved in Canada yet), but I'd have to give up the Wellbutrin, and sertraline (or placebo) wouldn't be near the top of my 'next-to-try' list. I've not really been seriously considering Remeron because of the high incidence of weight gain and sedation, neither of which I need. I'm plenty anergic enough already! Maybe I _should_ consider it (when it becomes available) - based on your experience, what do you think?

Something I've started to look into is moclobemide (it's available here). Based on a limited trial with a 'natural herbal product' ;-) while on vacation last year, I suspect I may have dopaminergic issues that are not being addressed. Think I'll go and do a search in the archives.

Again, glad you're feeling better - let us know what happens if you try the zaleplon again.

 

Re: Sleep problems-Nance

Posted by Daveman on June 15, 2001, at 20:29:56

In reply to Re: Sleep problems » Daveman, posted by Nance on June 15, 2001, at 15:29:20

Nance:

I should clarify. I was taking Sonata for insomnia, not panic attacks. I'd had panic attacks on and off for several years but had never taken any meds for them. I do not blame Sonata at all for the panic spiral, it was just ineffective at breaking that cycle, and its' ineffectiveness increased the spiral. Xanax is what broke the cycle. My question was more, now that I'm sort of stable, would the Sonata work for me as it did before the panic/depression hit? I guess the only way to find out is to take it some night when I'm struggling for sleep and see.

Dave


> WOW! How awful for you -
>
> I knew that depression is one of the possible side effects of Starnoc/Sonata, but I've never heard of it being associated with panic attacks and insomnia that severe. I guess it just goes to show that you can never tell how something will affect you, especially when it hasn't been on the market long enough to have an established history. Tolerance isn't _supposed_ to be problem with it, but there are too many reports on this board of drug reactions that aren't _supposed_ to happen for me to discount any possibility!
>
> I can't determine from your message if you think the Starnoc/Sonata caused this reaction, or if you are saying that it didn't help with the panic attack. It doesn't really sound to me like tolerance is the issue here, so it may still work for your insomnia; I realize I'm making an assumption that you were taking it to help you get to sleep. I don't think that zaleplon has been indicated for treatment of panic attacks, but I could be wrong. Maybe Cam, or someone else, can advise. If you don't mind me asking, do have a history of panic attacks, or did this hit you out of the blue? It would be interesting to know whether this drug may be triggering a pre-existing condition, or whether it may be causing a new one. My anxiety manifests itself as paralytic immobility - I wonder if panic attack would be a risk factor for the more 'vegetative' insomniac?
>
> I'm definitely on the alert for increased depression - I'm having a big enough problem already trying to find an effective antidepressant regimen. I'm glad to hear the Celexa/Remeron combo is working for you. Have you had any side effects that you would attribute to the Remeron? I'm currently on Celexa/WellbutrinSR and it's not really working. I'm also tapering off Dexedrine Spansule - it had an extreme paradoxical effect on me - dropped me even deeper into the Black Hole, and welded me to the couch. I have the opportunity to be involved in a clinical trial comparing sertraline and mirtazapine (Remeron isn't approved in Canada yet), but I'd have to give up the Wellbutrin, and sertraline (or placebo) wouldn't be near the top of my 'next-to-try' list. I've not really been seriously considering Remeron because of the high incidence of weight gain and sedation, neither of which I need. I'm plenty anergic enough already! Maybe I _should_ consider it (when it becomes available) - based on your experience, what do you think?
>
> Something I've started to look into is moclobemide (it's available here). Based on a limited trial with a 'natural herbal product' ;-) while on vacation last year, I suspect I may have dopaminergic issues that are not being addressed. Think I'll go and do a search in the archives.
>
> Again, glad you're feeling better - let us know what happens if you try the zaleplon again.

 

Re: Sleep problems » Daveman

Posted by Nance on June 15, 2001, at 23:29:23

In reply to Re: Sleep problems-Nance, posted by Daveman on June 15, 2001, at 20:29:56

Thanks for the clarification. I don't see any reason why zaleplon shouldn't work for you again - apparently, it's been used regularly for as long as a year with no development of tolerance, and it doesn't sound like you were using it all that regularly.

*Zaleplon Safe And Tolerable For Long-Term Treatment Of Insomnia*
http://www.pslgroup.com/dg/12EA62.htm

Sweet dreams!

 

Re: Sleep problems » Nance

Posted by Daveman on June 16, 2001, at 0:12:34

In reply to Re: Sleep problems » Daveman, posted by Nance on June 15, 2001, at 23:29:23

Thanks for the link! Very intersting article. Think I'll print it out and discuss it with my pdoc.

Thanks again.

Dave


> Thanks for the clarification. I don't see any reason why zaleplon shouldn't work for you again - apparently, it's been used regularly for as long as a year with no development of tolerance, and it doesn't sound like you were using it all that regularly.
>
> *Zaleplon Safe And Tolerable For Long-Term Treatment Of Insomnia*
> http://www.pslgroup.com/dg/12EA62.htm
>
> Sweet dreams!

 

Re: Sleep problems

Posted by Glenn Fagelson on June 17, 2001, at 0:41:58

In reply to Sleep problems, posted by Maisy on June 13, 2001, at 6:23:34

> This is my second time around with Effexor. Started it
> last year for PPD. Relapsed and am now back on 150mg.
> This time around however I find my sleep is still very
> disturbed. I have been at 150mg for about six weeks
> now and thought this would diminish. I have trouble
> falling asleep and have difficulty staying asleep.
> I was taking xanax 0.25mg, two at night to help or a
> 15mg restoril. I stopped these four nights ago and am
> back to the same problem. Any advice for me??

For Maisy and all the others who have
sleep problems,

I am taking magnesium in a powder form
that has quite a calming effect on me.
It is called Natural Calm. Caution:
It can cause diarrhea. Also, one needs
to supplement this with calcium. I'll
give you their site: www.NaturalCalm.net
and also, www.VitaminsThat Work.com

Good Luck, Glenn


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