![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 7 to 31 of 31. Go back in thread:
Posted by jlbl2l on August 21, 2004, at 6:09:04
In reply to Re: Sleeping drugs » jms600, posted by chemist on August 20, 2004, at 19:19:47
chemist,
I see you have gotten used to some of my terms heh "z-drugs" etc.
Anyways, my input on the subject is don't use any benzos because they disrupt the sleep stages. they stick you in stage 2 sleep for much longer than normal which disrupts normal body processes tht occur in stage 3/4 espececially (deep sleep, slow wave) growth hormone secretion etc..
Halicon would be ok or very short acting ones since they just intiate sleep tho.What about benadryl or antihistamines?
jlbl2l
Posted by Larry Hoover on August 21, 2004, at 9:29:44
In reply to Re: Sleeping drugs, posted by jlbl2l on August 21, 2004, at 6:09:04
> Anyways, my input on the subject is don't use any benzos because they disrupt the sleep stages. they stick you in stage 2 sleep for much longer than normal which disrupts normal body processes tht occur in stage 3/4 espececially (deep sleep, slow wave) growth hormone secretion etc..
I'm sorry, but that is quite false. In "normal" people, benzos block deep sleep, but in those with primary insomnia, quite the opposite occurs.
As a "victim" of such generalizations by doctors, I have had to fight hard, and educate my caregivers all by myself, to get the care I need. Temazepam treatment marked the first time in years that I obtained restorative sleep, and is the pivotal turning point in my own recovery. Moreover, long-term treatment (years-long) may be necessary, to maintain the benefit.
Lar
Clin Pharmacol Ther. 2000 Aug;68(2):175-88.
A pharmacodynamic Markov mixed-effects model for the effect of temazepam on sleep.Karlsson MO, Schoemaker RC, Kemp B, Cohen AF, van Gerven JM, Tuk B, Peck CC, Danhof M.
Department of Pharmacy, Uppsala University, Sweden. mats.karlsson@biof.uu.se
BACKGROUND: A hypnogram shows how sleep travels through its various stages in the course of a night. The sleep stage changes can be quantified to study sedative drug effects. METHODS: Hypnograms from 21 patients with primary insomnia were collected during a randomized, placebo-controlled crossover study of 20 mg temazepam. A separate daytime session was performed to determine the pharmacokinetics of 20 mg temazepam and its effect on saccadic eye movement and electroencephalogram. A first-order Markov model was developed to describe the probability of sleep stage changes as a function of time after drug intake and time after last sleep stage change. The influence of temazepam concentration on the probability to change sleep stage was incorporated into the model. RESULTS: Transitions between sleep stages were profoundly influenced by the time of the night and by the time since the last change of sleep stage. Temazepam reduced the time spent awake. This effect could be attributed to four mechanisms: (1) transition to "deeper" sleep was facilitated, (2) transition to "lighter" sleep was inhibited, (3) regardless of sleep stage, the transition to wake state was inhibited, and (4) return to sleep was facilitated. Daytime sensitivities to temazepam, measured with the surrogate markers saccadic peak velocity and electroencephalogram beta activity, each correlated with one of the transition probabilities influenced by temazepam. CONCLUSIONS: By the development of a Markov model for these non-ordered six categorical data, the effect of temazepam on the sleep-wake status could be interpreted in terms of known mechanisms for sleep generation and benzodiazepine pharmacology.
Posted by chemist on August 21, 2004, at 10:10:46
In reply to Re: Sleeping drugs, posted by jlbl2l on August 21, 2004, at 6:09:04
hi again, jason....i am aware of the benzo/benzo-derivative reduced time spent in stage 4, although i thought that (at least) for zolpidem (ambien in the u.s.) that this was not a problem....i use a bit of diphenhydramine on occasion, to be sure, and it is just my personal bias towards benzos/ambien, really. if there is a better, cleaner solution, i'm all for it! best, chemist
> chemist,
>
> I see you have gotten used to some of my terms heh "z-drugs" etc.
>
> Anyways, my input on the subject is don't use any benzos because they disrupt the sleep stages. they stick you in stage 2 sleep for much longer than normal which disrupts normal body processes tht occur in stage 3/4 espececially (deep sleep, slow wave) growth hormone secretion etc..
> Halicon would be ok or very short acting ones since they just intiate sleep tho.
>
> What about benadryl or antihistamines?
>
> jlbl2l
Posted by jlbl2l on August 21, 2004, at 11:36:31
In reply to Re: Sleeping drugs » jlbl2l, posted by Larry Hoover on August 21, 2004, at 9:29:44
Larry,
I don't mean to be like those mean doctors if you need a benzo by all means take it, but i do disagree. That is one single study which wasn't all that in depth in EEG activity or sleep spindles during sleep anyways. There are countless more showing the opposite for insomnia or for other conditions or for benzos in general.
If i were a doctor, i would find a medication that is the least disruptive to the sleep stages first using my best effort. (All for the care of my patient). If i failed, then I would use something like a benzo, but id rather not. Then again, I would be a very good doctor and maybe even order and EEG or sleep study if nothing was working. A good smart doc would do that before dispensing meds left and right...
jlbl2l
Posted by jlbl2l on August 21, 2004, at 11:41:29
In reply to Re: Sleeping drugs » jlbl2l, posted by chemist on August 21, 2004, at 10:10:46
hi chemist,
actually the strange thing is that the "z-meds" don't disrupt the sleep stages/spindle. I always thought that was odd. (At least Ambien doesnt..) It just maintains a normal sleep cycle. It is just benzos that disrupt slow wave sleep 3/4.
Neurontin and Xyrem (and Lyrica/pregabalin) are the only drugs i know that actually increase slow wave sleep at the moment.Not a bad option option actually, if one can get Xyrem for sleep.
Posted by Larry Hoover on August 21, 2004, at 12:40:19
In reply to Re: Sleeping drugs » Larry Hoover, posted by jlbl2l on August 21, 2004, at 11:36:31
> Larry,
>
> I don't mean to be like those mean doctors if you need a benzo by all means take it, but i do disagree. That is one single study which wasn't all that in depth in EEG activity or sleep spindles during sleep anyways. There are countless more showing the opposite for insomnia or for other conditions or for benzos in general.I hope you're not looking for an essay. Specific benzos, the ones that are hypnotics, most certainly do increase slow wave activity. I gave a single example, as modest proof of the alternative to your generalizations.
J Psychiatr Res. 2000 Nov-Dec;34(6):423-38.
Effects of hypnotics on the sleep EEG of healthy young adults: new data and psychopharmacologic implications.Feinberg I, Maloney T, Campbell IG.
Department of Psychiatry, University of California, CA, Davis, USA. ifeinberg@ucdavis.edu
Benzodiazepine hypnotics increase NREM sleep and alter its EEG by reducing delta (0.3-3 Hz) and increasing sigma (12-15 Hz) and beta (15-23 Hz) activity. We tested whether the nonbenzodiazepine hypnotic, zolpidem (10 mg), produced the same pattern of sleep and EEG changes as two "classical" benzodiazepines, triazolam (0.25 mg) and temazepam (30 mg). Sleep EEG of 16 subjects was analyzed with period amplitude analysis for 3 nights during drug administration or placebo. The effects of zolpidem were in the same direction but generally of smaller magnitude than those of the classical benzodiazepines. These differences are more likely the result of non-equivalent dosages than different pharmacologic actions. Period amplitude analysis showed that the decreased delta activity resulted mainly from a decrease in wave amplitude. In contrast, the increased sigma and beta activity were produced by increased wave incidence. Delta suppression increased with repeated drug administration but sigma and beta stimulation did not. While these findings have little relevance for the clinical choice of hypnotics they may hold important implications for the brain mechanisms involved in hypnotic tolerance and withdrawal delirium.
Posted by zeugma on August 21, 2004, at 16:10:59
In reply to Re: Sleeping drugs » jlbl2l, posted by Larry Hoover on August 21, 2004, at 12:40:19
Just to add my input on this question (purely anecdotal): even .25 mg clonazepam worsened my narcoleptic symptoms (hypnagogic and hypnopompic hallucinations, sleep onset REM periods and sleep disruption); apparently the mechanism, as far as I can figure out, is that the benzo suppressed slow-wave sleep to some degree, collapsing me back into premature REM. Since only clonazepam has been effective, of all the meds I've tried, in abating my severe social and generalized anxiety,I've had to be very careful to avoid naps during the day (hard, as I have a very low level of energy and take various stims [megadoses of caffeine, plus a little Ritalin]) including some caffeine during the times I am most tempted to nap, from 4 to 6 p.m. I also try to reduce the temptation to nap after clonazepam ingestion by taking my afternoon dose far from any bed. Clonazepam, at least, has a detrimental effect on my sleep disorder and I am sure it has to do with SWS supression.
Posted by zeugma on August 21, 2004, at 16:43:46
In reply to Clonazepam, posted by zeugma on August 21, 2004, at 16:10:59
I am sure clonazepam's role in precipitating narcoleptic symptoms and even cataplexy has a lot to do with the fact that clonazepam is one of the most potent benzos in supressing convulsions as well as anxiety. My (primitive) understanding of epilepsy is that it is an intrusion of NREM sleep into waking, while narcolepsy presents the opposite symtomology: an intrusion of REM (including atonia) into waking. It strikes me as interesting that AED's are also potent anti-manics (at least some of them such as Depakote are), while conversely, drugs like Tofranil and Norpramin have long been mainstays of narcolepsy treatment for preventing the cataplectic attacks characteristic of that disorder. What is it about clonazepam that might make it a more powerful AED than other benzos? Does alprazolam, which appears to have antidepressant activity, also potently block seizures? I am curious because Lamictal is that only AED that I have heard that might have AD activity; any thoughts on these or related topics? Sorry for the incoherence of this post, I am drinking my half-caffeinatyed pot of coffee and trying desperately to stay awake long enough for me to get through this late-afternoon lull, without stimulating myself to the point of insomnia. I exist on a very delicate balance of stimulants and sedatives.
Thanks,z
Posted by chemist on August 21, 2004, at 17:29:24
In reply to Q for Larry, chemist on K and AED's, posted by zeugma on August 21, 2004, at 16:43:46
hi z, chemist here...i think larry or some of the other folks more enlightened than i will be of help...the comment that comes to my equally-caffeinated mind is that klonopin appears to be classified - for what that is worth - as an anti-convulsant, as opposed to an anti-epileptic or anti-seizure med. this might be a matter of semantics, but i think there is likely some science here, too: i know of some folks who have been shot-up with lorazepam or diazepam upon, shall we say, arriving at the facility in a very agitated state, and thorazine or haldol was not deemed appropriate (this is my way of trying to state that there is a fine line between being an agressive, angry non-compliant patient and a psychotic patient, as far as what will cool their heels the quickest). i am a long-time xanax user, and i would not call is sedating or activating, yet this is after years of being on it or the related benzos, so i am long past the point of noticing the good/bad/ugly and my rose-colored glasses are firmly in place. okay, enough. i will be interested to see what the rest of the gang contributes, as your points - and personal experience - are food for thought, and i do not want to hazard a guess.....thanks much for the mental stimulation, looking forward to some closure! best, chemist
> I am sure clonazepam's role in precipitating narcoleptic symptoms and even cataplexy has a lot to do with the fact that clonazepam is one of the most potent benzos in supressing convulsions as well as anxiety. My (primitive) understanding of epilepsy is that it is an intrusion of NREM sleep into waking, while narcolepsy presents the opposite symtomology: an intrusion of REM (including atonia) into waking. It strikes me as interesting that AED's are also potent anti-manics (at least some of them such as Depakote are), while conversely, drugs like Tofranil and Norpramin have long been mainstays of narcolepsy treatment for preventing the cataplectic attacks characteristic of that disorder. What is it about clonazepam that might make it a more powerful AED than other benzos? Does alprazolam, which appears to have antidepressant activity, also potently block seizures? I am curious because Lamictal is that only AED that I have heard that might have AD activity; any thoughts on these or related topics? Sorry for the incoherence of this post, I am drinking my half-caffeinatyed pot of coffee and trying desperately to stay awake long enough for me to get through this late-afternoon lull, without stimulating myself to the point of insomnia. I exist on a very delicate balance of stimulants and sedatives.
>
> Thanks,z
Posted by zeugma on August 21, 2004, at 18:41:14
In reply to Re: Q for Larry, chemist on K and AED's » zeugma, posted by chemist on August 21, 2004, at 17:29:24
i know of some folks who have been shot-up with lorazepam or diazepam upon, shall we say, arriving at the facility in a very agitated state, and thorazine or haldol was not deemed appropriate >
hi chemist, i appreciate your tact in describing the fine line between being a little upset at arriving at the 'facility' and not being a candidate for more aggressive (for want of a better word) pharmacotherapy. i guess that i too might not be in the best of moods upon arrival. this was my first smile of the day :)
-z
Posted by chemist on August 21, 2004, at 19:00:31
In reply to Re: Q for Larry, chemist on K and AED's » chemist, posted by zeugma on August 21, 2004, at 18:41:14
> i know of some folks who have been shot-up with lorazepam or diazepam upon, shall we say, arriving at the facility in a very agitated state, and thorazine or haldol was not deemed appropriate >
>
> hi chemist, i appreciate your tact in describing the fine line between being a little upset at arriving at the 'facility' and not being a candidate for more aggressive (for want of a better word) pharmacotherapy. i guess that i too might not be in the best of moods upon arrival. this was my first smile of the day :)
>
> -zwell, glad to make *somebody* happy! be well, stay cool, and all that......perhaps we'll have coffee one of these days, who knows? best, chemist
Posted by alesta on August 21, 2004, at 19:39:06
In reply to Re: Q for Larry, chemist on K and AED's » zeugma, posted by chemist on August 21, 2004, at 19:00:31
chemist,
we all love you! by the way, check your messages.:)
amy :)
Posted by chemist on August 21, 2004, at 19:40:45
In reply to Re: Q for Larry, chemist on K and AED's--chemist, posted by alesta on August 21, 2004, at 19:39:06
> chemist,
>
> we all love you! by the way, check your messages.:)
>
> amy :)
>
>
>
messages? please advise, i am lost (seriously) on this one.....all the best, chemist
Posted by alesta on August 21, 2004, at 19:42:28
In reply to Re: Q for Larry, chemist on K and AED's--chemist » alesta, posted by chemist on August 21, 2004, at 19:40:45
sorry, i meant your email......:)
amy:)
Posted by chemist on August 21, 2004, at 19:47:08
In reply to Re: Q for Larry, chemist on K and AED's--chemist, posted by alesta on August 21, 2004, at 19:42:28
> sorry, i meant your email......:)
>
> amy:)um, nothing.....might i ask you to send via babblemail, also did you send to an account with a .edu or .com extension????? best, chemist
Posted by alesta on August 21, 2004, at 19:54:12
In reply to Re: Q for Larry, chemist on K and AED's--chemist » alesta, posted by chemist on August 21, 2004, at 19:47:08
i used the babblemail feature.
maybe you don't have the babblemail feature turned on? i had to turn mine on....(via updating registration)
amy:)
Posted by chemist on August 21, 2004, at 19:58:09
In reply to Re: Q for Larry, chemist on K and AED's--chemist, posted by alesta on August 21, 2004, at 19:54:12
> i used the babblemail feature.
>
> maybe you don't have the babblemail feature turned on? i had to turn mine on....(via updating registration)
>
> amy:)it's on, i have babblemailed back and forth with 2 others today.....haven't got anything yet. i'll try you, if that doesn't work, i'll give you an alternate.....c
Posted by chemist on August 21, 2004, at 20:06:27
In reply to Re: Q for Larry, chemist on K and AED's--chemist, posted by alesta on August 21, 2004, at 19:54:12
amy, babblemail sent (allegedly successfully) to alesta, minutes ago.....let me know if you got it......c
Posted by alesta on August 21, 2004, at 20:08:19
In reply to Re: Q for Larry, chemist on K and AED's--chemist » alesta, posted by chemist on August 21, 2004, at 19:58:09
did you get it? got yours...
Posted by chemist on August 21, 2004, at 20:09:47
In reply to Re: Q for Larry, chemist on K and AED's--chemist, posted by alesta on August 21, 2004, at 20:08:19
> did you get it? got yours...
yes, let's knock this off before we put everybody to sleep....i believe you have one of my other email contacts by now......yours, chemist
Posted by jlbl2l on August 21, 2004, at 20:23:30
In reply to Re: Sleeping drugs » jlbl2l, posted by Larry Hoover on August 21, 2004, at 12:40:19
Larry,
This study just verifies what i am saying. benzos decrease delta wave activity (slow wave sleep 3/4) and increase beta wave activity (stage 2).
the non-benzodizepine hypnotics "z drugs" generally keep the sleep spindle in place, at least in the case with zolpidem - and it basically says zolpidem was less disruptive in this study - and i can bring up many studies that say ambien (zoldipem) maintains the sleep spindle without majorly disrupting the sleep stages.
I have no idea how you conclude this study says there isn't supression of slow wave sleep by the benzodizepines.
"decreased delta activity resulted mainly from a decrease in wave amplitude"
"Delta suppression increased with repeated drug administration "
"increased sigma and beta activity were produced by increased wave incidence"
What more is there to say, do I not understand your post correctly? benzodizepines suppress slow wave activity (delta waves..) and increase stage 2 sleep (beta) that is what these studies say.
If you want to talk about the non-benzodizepine hypnotic ambien, let me know, as that is a different class and we can pull up numerous studies on it if you like.
all the best,
jlbl2l
Posted by Larry Hoover on August 21, 2004, at 21:03:11
In reply to Re: Sleeping drugs » Larry Hoover, posted by jlbl2l on August 21, 2004, at 20:23:30
> What more is there to say, do I not understand your post correctly? benzodizepines suppress slow wave activity (delta waves..) and increase stage 2 sleep (beta) that is what these studies say.
I apologize for posting in such a fragmented way. My mind was elsewhere, and I guess I assumed you could read my mind?
Quick synopsis...
In my first post to this thread, I said:
"I'm sorry, but that is quite false. In "normal" people, benzos block deep sleep, but in those with primary insomnia, quite the opposite occurs."I backed that up with a study of primary insomniacs, excerpted here:
"Transitions between sleep stages were profoundly influenced by the time of the night and by the time since the last change of sleep stage. Temazepam reduced the time spent awake. This effect could be attributed to four mechanisms: (1) transition to "deeper" sleep was facilitated, (2) transition to "lighter" sleep was inhibited, (3) regardless of sleep stage, the transition to wake state was inhibited, and (4) return to sleep was facilitated."Which I intended to contrast with this other study in healthy people, which found:
"Benzodiazepine hypnotics increase NREM sleep and alter its EEG by reducing delta (0.3-3 Hz) and increasing sigma (12-15 Hz) and beta (15-23 Hz) activity. "I forgot to include that one in the first post. Then, I just added the following, which was incomplete. I've added the words I left out, which was due to my rushed response:
"I hope you're not looking for an essay. Specific benzos, the ones that are hypnotics, most certainly do increase slow wave activity *in primary insomnics*. I gave a single example, as modest proof of the alternative to your generalizations."All I meant to say all along is that there is a population in which the hypnotic benzos have a predictable but paradoxical response.
Sorry for making a mess of things....trying to do too many things at one time.
Lar
Posted by jlbl2l on August 21, 2004, at 21:36:50
In reply to Re: Sleeping drugs » jlbl2l, posted by Larry Hoover on August 21, 2004, at 21:03:11
Larry,
No problem. I understand, basically what your saying is some people react the opposite to those benzos like yourself. one persons nightmare is another person's magic. i get it. most drugs have some people who have the opposite reaction. i just wasnt understanding. i do believe the majority of people aren't like this though. as long as it works for you tho.
all the best,
jason
Posted by Larry Hoover on August 22, 2004, at 9:06:29
In reply to Re: Sleeping drugs, posted by jlbl2l on August 21, 2004, at 21:36:50
> Larry,
>
> No problem. I understand, basically what your saying is some people react the opposite to those benzos like yourself. one persons nightmare is another person's magic. i get it. most drugs have some people who have the opposite reaction. i just wasnt understanding.That was, like, totally my fault, dude. I was so hectified yesterday, I was totally distractulated. I am humbly grateful for your patience and tolerance.
> i do believe the majority of people aren't like this though. as long as it works for you tho.
>
> all the best,
> jasonI'd go with the majority opinion. ;-)
However, like I said, I was victimized by doctors who wouldn't accept that there even was another case to consider.
There's another aspect to this whole thing, about tolerance. Unlike lorazepam, long-term use (up to 20 years) of temazepam does not seem to (necessarily) create tolerance. Even long-term users had similar responses to temazepam-naive controls.
Lar
Br J Clin Pharmacol. 1997 Sep;44(3):267-75.
A study of the effects of long-term use on individual sensitivity to temazepam and lorazepam in a clinical population.
van Steveninck AL, Wallnofer AE, Schoemaker RC, Pieters MS, Danhof M, van Gerven JM, Cohen AF.
Centre for Human Drug Research, Leiden University Hospital, The Netherlands.
AIMS: The central effects of benzodiazepines may be attenuated after chronic use by changes in pharmacokinetics, pharmacodynamics or both. This attenuation may be influenced by the dosing pattern and the characteristics of the user population. The objectives of this study were to evaluate drug sensitivity in long-term users of temazepam and lorazepam in a clinical population. METHODS: The sensitivity to benzodiazepine effects in chronic users (1-20 years) of lorazepam (n = 14) or temazepam (n = 13) was evaluated in comparison with age and sex matched controls. Drug sensitivity was evaluated by plasma concentration in relation to saccadic eye movement parameters, postural stability and visual analogue scales. RESULTS: Pharmacokinetics of lorazepam and temazepam did not differ between patients and control subjects. Chronic users of lorazepam showed clear evidence of reduced sensitivity, indicated by lack of any pharmacodynamic difference between patients and controls at baseline, when drug concentrations were similar to the peak values attained in the control subjects after administration of 1-2.5 mg of lorazepam. In addition, there was a two- to four fold reduction in the slopes of concentration-effect plots for measures of saccadic eye movements and body sway (all; P < or = 0.01). By contrast, sensitivity in chronic users of temazepam was not different from controls. The difference between the temazepam and the lorazepam group appears to be associated with a more continuous drug exposure in the latter, due to the longer half-life and a more frequent intake of lorazepam. This pattern of use may be partly related to the more anxious personality traits that were observed in the chronic users of lorazepam. CONCLUSIONS: Chronic users of lorazepam show evidence of tolerance to sedative effects in comparison with healthy controls. Tolerance does not occur in chronic users of temazepam. The difference may be related to pharmacological properties, in addition to different patterns of use, associated with psychological factors.
Posted by flutterby1 on August 22, 2004, at 18:31:56
In reply to Sleeping drugs, posted by jms600 on August 20, 2004, at 16:44:55
Ambien 10 mg is magic for me.Adding Remron 7.5-10mg eliminated tolerance problem. Its a good idea to clear your system for 3 days (using benadryl) every few months.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.