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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by fachad on February 28, 2002, at 14:58:20
I have been taking Ambien for sleep for about a year. It is very expensive, and my insomnia is SSRI (Prozac) induced early morning awakenings, so Ambien, being short acting, is not really very effective.
So today I asked my pdoc if it would be OK to take a regular, cheap, generic benzo. He agreed and asked me if I had a preference for which one.
I've never taken any before, so I did not know what to say. He started to give me lorazepam, but I asked if I could have temazapem instead. I had heard that lorezepam was more addicting. He gave me 15mg/day of temezapam.
Anyway, next month he'll either refill the temazapam or give me something different.
Are there any qualitative differences between benzos like there are between SSRIs or are they all pretty much the same? (I know about the half life and active metabolites considerations).
Is temezapam the best choice, given that my insomnia is more a problem with staying asleep than falling asleep?
What are other good benzos to consider for insomnia?
Posted by jay on March 1, 2002, at 0:50:33
In reply to Best Benzo for Sleep / Qualitative Differences?, posted by fachad on February 28, 2002, at 14:58:20
> I have been taking Ambien for sleep for about a year. It is very expensive, and my insomnia is SSRI (Prozac) induced early morning awakenings, so Ambien, being short acting, is not really very effective.
>
> So today I asked my pdoc if it would be OK to take a regular, cheap, generic benzo. He agreed and asked me if I had a preference for which one.
>
> I've never taken any before, so I did not know what to say. He started to give me lorazepam, but I asked if I could have temazapem instead. I had heard that lorezepam was more addicting. He gave me 15mg/day of temezapam.
>
> Anyway, next month he'll either refill the temazapam or give me something different.
>
> Are there any qualitative differences between benzos like there are between SSRIs or are they all pretty much the same? (I know about the half life and active metabolites considerations).
>
> Is temezapam the best choice, given that my insomnia is more a problem with staying asleep than falling asleep?
>
> What are other good benzos to consider for insomnia?I would go with temazepam, but if you can, go up to 30 mg's if needed. I don't know if your pdoc will go along with it, but I have found it better than *any* benzo for sleep out there. You could even combine say 15mg's of temazepam, and the ativan.
Good luck...
Jay
Posted by Rakken on March 1, 2002, at 15:24:18
In reply to Re: Best Benzo for Sleep / Qualitative Differences? » fachad, posted by jay on March 1, 2002, at 0:50:33
I know that klonopin and prozac complement eachother. It prolongs the klonopin and since klonopin is a longer acting benzo it could help you get through the night well. That is if you often wake up or what not. But klonopin is more for anxiety than sleep I think. Yet, at a higher dose it might just work quite well. Klonopin can give you a morning after "blah" feeling though. That's just my input. And there are plenty of generic forms of klonopin. Just another option if the temazepam doesn't work out. The klonopin would definitely work better than lorazepam at least (in my opinion).
Posted by Joy on March 1, 2002, at 17:17:54
In reply to Best Benzo for Sleep / Qualitative Differences?, posted by fachad on February 28, 2002, at 14:58:20
I agree, Ambien is not great for sleeping. I also have been on Prozac a year [just coming off it] and it does cause insomnia. I take alazoprom [generic Zanax] with a small dose of Trazodone [generic Desyrel] and sleep through the night. It's a very inexpensive combo. My psych is fine with it. I don't worry about addiction; I don't have that personality. I take alazopram occasionally for anxiety [as needed, very seldom]but it helps alot at night with Trazodone for sleeping. It's just a matter of preference though my pdoc was not for me taking Klonopin as he feels it has depressive side effects where Xanax does not [according to him].
Joy> I have been taking Ambien for sleep for about a year. It is very expensive, and my insomnia is SSRI (Prozac) induced early morning awakenings, so Ambien, being short acting, is not really very effective.
>
> So today I asked my pdoc if it would be OK to take a regular, cheap, generic benzo. He agreed and asked me if I had a preference for which one.
>
> I've never taken any before, so I did not know what to say. He started to give me lorazepam, but I asked if I could have temazapem instead. I had heard that lorezepam was more addicting. He gave me 15mg/day of temezapam.
>
> Anyway, next month he'll either refill the temazapam or give me something different.
>
> Are there any qualitative differences between benzos like there are between SSRIs or are they all pretty much the same? (I know about the half life and active metabolites considerations).
>
> Is temezapam the best choice, given that my insomnia is more a problem with staying asleep than falling asleep?
>
> What are other good benzos to consider for insomnia?
Posted by Mark H. on March 1, 2002, at 20:38:32
In reply to Best Benzo for Sleep / Qualitative Differences?, posted by fachad on February 28, 2002, at 14:58:20
Clonazepam (generic Klonopin) has the advantage of being the least addictive of the benzodiazepines, and it is often used even to help people get off of the more powerful and addictive types.
It is prescribed in fairly large quantities for anxiety, but in small quantities for sleep disorders, such as Restless Leg Movement Syndrome and Periodic Limb Movement Disorder.
Personally, I find that 0.25mg (HALF of a 0.5mg pill) per night is PLENTY to insure restful sleep and still allows me to get up in the morning without feeling like I have been drugged.
At that low dosage, don't expect it to knock you out. You still have to do your part to fall asleep and stay asleep. But it certainly improves the quality of sleep for me (I take Effexor).
Best wishes,
Mark H.
Posted by fachad on March 1, 2002, at 21:09:24
In reply to Best Benzo for Sleep / Qualitative Differences?, posted by fachad on February 28, 2002, at 14:58:20
Last night I took the temazepam (15mg) at about 8:30, planning to go to bed at 9:30. At 10:30 I was still not even a little drowsy, but I went to bed anyway. At midnight, still wide awake, I broke down and took 1/2 of an Ambien.
I figured that at least the temazepam would keep me asleep for a while.
When I woke up at 4:00 AM, and was not able to go back to sleep, I was really suprised and disappointed.
Monday I'm going to phone my pdoc and ask if I should take 30mg of temazepam or if I should try a different benzo.
I hate it when things don't work like you expect.
Posted by Elizabeth on March 4, 2002, at 1:32:48
In reply to Temazepam Did NOT Work At All, posted by fachad on March 1, 2002, at 21:09:24
This post caught my eye.
Temazepam (Restoril) is the standard benzo doctors give for insomnia. Once, a doctor gave it to me. After taking the prescribed dose of 30 mg, I slept as poorly as ever.
Temazepam *sucks*.
Have you considered taking Ambien twice -- once at bedtime, once when you wake up in the middle of the night? Or combining Ambien with Sonata in the same way?
Klonopin is a nice long-acting benzo for sleep.
-elizabeth
Posted by fachad on March 4, 2002, at 8:43:02
In reply to Re: Temazepam DOES NOT Work At All » fachad, posted by Elizabeth on March 4, 2002, at 1:32:48
My pdoc was going to give me lorazepam, but I asked for temazepam. Mabye that was a dumb move on my part.
My main motivation for getting away from Ambien is cost - even with my health insurance, Ambien costs $40/month. A month's worth of temazepam was about $3, self-paid.
My insurance will not pay for more than 1 Ambien tablet per day (same for Concerta), so I would have to split a 10mg tablet to take some in the night.
If I took Ambien at bedtime and Sonata upon awakening, I would have to pay $80/month ($40 for the Ambien + $40 for the Sonata). That's just a few bucks shy of $1,000/year. One Thousand Dollars, yikes.
Not that I wouldn't pay it if it was the only way for me to get good sleep, but with so many conventional benzos out there as generics, I just can't see paying the big bucks for the proprietary pills when they don't even give me a whole night of uninterrupted sleep.
I think I saw somewhere that you had taken estazolam. How was that?
I eliminated the long acting meds because I don't want buildup and mental dulling. It seems like my generic choices are:
-temazepam (doesn't work)
-lorazepam (is it too addicting?)
-estazolam (anyone? anyone?)
-clonazepam (will it make me depressed, or groggy, or mentally less sharp?)
-oxazepam (does'nt look like a very good hypnotic)
Did I miss anything? Am I overestimating the risk of addiction with lorazepam, or the risk of depression/dulling wiht clonazepam?
**************************************************
BTW, I have been thru all the non-benzo sleepers.- TCAs - weight gain, even with tiny doses. Literally dreamt of jelly doughnuts and chocolate cake, ice cream, hot fudge, etc.
- trazodone/nefazodone - wake up after few hrs w/headache
- hydroxyzine - way too groggy the next day. I did not know you could fall asleep while on a brisk walk on a cold morning.
- OTC antihistamines - don't last thru the night.
> This post caught my eye.
>
> Temazepam (Restoril) is the standard benzo doctors give for insomnia. Once, a doctor gave it to me. After taking the prescribed dose of 30 mg, I slept as poorly as ever.
>
> Temazepam *sucks*.
>
> Have you considered taking Ambien twice -- once at bedtime, once when you wake up in the middle of the night? Or combining Ambien with Sonata in the same way?
>
> Klonopin is a nice long-acting benzo for sleep.
>
> -elizabeth
Posted by sleepingbeauty on March 6, 2002, at 18:37:53
In reply to Re: Temazepam DOES NOT Work At All » Elizabeth, posted by fachad on March 4, 2002, at 8:43:02
Ditto to the Temazepam not working!!!
I must be treatment resistant because Ambien and Sonata are like taking a placebo for me, does nada...anytime, any amount!
I finally just had to bite the bullet and take .50-1.00 mg of Xanax every night PLUS take 50 mg of Vistaril. Now at least I sleep a decent amount!
~hence the name I chose for posting here....I only WISH I could sleep like her (sigh)~
Posted by fachad on March 6, 2002, at 22:09:25
In reply to Re: Temazepam DOES NOT Work At All, posted by sleepingbeauty on March 6, 2002, at 18:37:53
A little more info helped me make sense of the total lack of result from temazepam.
After talking to my pdoc on Monday, he increased my temazepam to 30mg. It still did nothing.
Then I realized that I had been taking Ambien every night for about 8 months, and my body was just refusing to sleep without it, period.
So now I'm taking 5mg Ambien with the temazepam, and sleeping fairly well. In a few days, I'll try taking 2.5mg (quartering those tiny Ambien tablets is not easy), and then, if all goes well, no Ambien, just temazepam.
Less than 10mg of Ambien never put me to sleep before, and I'm sleeping OK on 5mg now, so I know the temazepam is doing something.
For your severe insomnia, have you tried doxepin or Remeron? They work so well for me but I am very sensitive to the weight gain from these meds.
But if you can tolerate them, they work extremely well. Better than Ambien, better than temazepam (so far anyway)and they last longer so they help with waking up too early. Also, people do not seem to develop tolerance to them like they do to BZ hypnotics.
I think the typical hypnotic dose of Remeron is 7.5 to 30mg, sometimes a higher dose having less hypnotic effect. The hypnotic dose of doxepin for me is 10mg but some people take up to 300mg.
Also, doxepin gives me sweet dreams - literally. I dream of eating jelly dougnuts and chocolate cake and ice cream with hot fudge...
> Ditto to the Temazepam not working!!!
>
> I must be treatment resistant because Ambien and Sonata are like taking a placebo for me, does nada...anytime, any amount!
>
> I finally just had to bite the bullet and take .50-1.00 mg of Xanax every night PLUS take 50 mg of Vistaril. Now at least I sleep a decent amount!
>
> ~hence the name I chose for posting here....I only WISH I could sleep like her (sigh)~
Posted by Daveman on March 6, 2002, at 22:57:44
In reply to Re: Temazepam DOES NOT Work At All » sleepingbeauty, posted by fachad on March 6, 2002, at 22:09:25
Hi:
I read your message about the difficulty in "quartering" Ambien 10 mg. tabs to get to 2.5 mg. My suggestion would be to go to the 5 mg. tabs, which you would only cut in half. (Myself, I take 15 mg. Remeron, which is very helpful but yes I have gained weight- worth the trade for my money).
Dave
Posted by Elizabeth on March 9, 2002, at 2:06:48
In reply to Re: Temazepam DOES NOT Work At All, posted by sleepingbeauty on March 6, 2002, at 18:37:53
> I must be treatment resistant because Ambien and Sonata are like taking a placebo for me, does nada...anytime, any amount!
I was there at one point (very bad depression). I still am not convinced that Sonata has any active ingredients, but now Ambien seems to be working as well as it ever did for me. (Convincing my pdoc to prescribe the 20mg dose that I need -- well, that'll be another matter.) How much Ambien and Sonata have you tried taking, out of curiosity?
> I finally just had to bite the bullet and take .50-1.00 mg of Xanax every night PLUS take 50 mg of Vistaril. Now at least I sleep a decent amount!
I find that I develop tolerance to antihistamine sedation (including from ADs like TCAs, trazodone, Remeron) within a few days. And that's not so much Xanax; I have to take 2 mg if I'm going to be sedated (or just to stop a panic attack). Not tolerance; just natural resistance to the stuff. (I think that Goodman & Gilman's calls it "intrinsic tolerance.")
> ~hence the name I chose for posting here....I only WISH I could sleep like her (sigh)~
Hey: even if you can't sleep, that doesn't mean you're not beautiful!
-elizabeth
This is the end of the thread.
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