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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Phillipa on February 3, 2005, at 17:43:33
How come everybody can fall asleep on ambien, seroquel{low dose}, klonopin, etc,. How come the pdoc puts me on a "cocktail of meds" and still I'm awake after 4 hours for more benzos? Is it because I've taken them for so many years {30), and have a tolerence to them? What can I do about it? Could it be because I have so many worries right now, and stresses? I know you have answered my other Posts on sleep, but I am getting desperate. Changing pdocs etc, and even putting myself in the hospital. Thanks Phillipa
Posted by Minnie-Haha on February 3, 2005, at 18:31:23
In reply to I Don't Understand?, posted by Phillipa on February 3, 2005, at 17:43:33
> How come everybody can fall asleep on ambien, seroquel{low dose}, klonopin, etc,. How come the pdoc puts me on a "cocktail of meds" and still I'm awake after 4 hours for more benzos? Is it because I've taken them for so many years {30), and have a tolerence to them? What can I do about it? Could it be because I have so many worries right now, and stresses? I know you have answered my other Posts on sleep, but I am getting desperate. Changing pdocs etc, and even putting myself in the hospital. Thanks Phillipa
I went through 15 months of what you've described. I would go to sleep, but ALWAYS wake up 3-4 hours later and not be able to get back to sleep. I would awaken with high anxiety (a few times even close to a panic attack). ***I tried Ativan, Ambien, Flexerall, Elavil, Sonata and Klonopin*** They all might help me get to sleep (which usually wasn't the problem anyway), but I would always wake up 3-4 hours later. I went to my FP, a gastroenterologist (there was also nausea involved) and finally an endocrinologist. I also had a sleep study done. All I did was confirm that I have GERD (reflux), discover that I have thyroid nodules (but they don't appear to be cancerous or causing any trouble -- I guess a lot of people have nodules) and lastly, that I had high urinary cortisol. I wondered if I might have Cushing's disease, even though I don't have most of the typical Cushing's symptoms. Then I heard about pseudo-Cushing's, which is often related to untreated anxiety and depression. I finally reached a point where I couldn't stand the always being fatigued, anxious, crying, so I let my pdoc RX Cymbalta. I am sleeping MUCH better now, so I think the pseudo-Cushing's is a likely culprit.
I know you've had bad luck finding the right meds for you, but I think when you do, you're likely to start sleeping better. (My personal opinion is that the benzos help with sleep at first, but eventually interfere with it. They also seemed to contribute to my depression, so I'd try to get off those if I were you. I'd also suggest -- if you haven't already done so -- seeing some specialists and ruling out some medical conditions, like I tried to do.)
FWIW: The sleep study indicated *possible* PLMD (periodic limb movement disorder), but that hasn't really panned out. I could've tried levadopa, but I was leery about doing that.)
Don't give up hope. Be kind and patient with yourself. Get counseling/psychotherpy to see you through, and try to get a little exercise and sunshine everyday until you find the answers.
Good luck!
Posted by Minnie-Haha on February 3, 2005, at 18:35:39
In reply to Re: I Don't Understand? » Phillipa, posted by Minnie-Haha on February 3, 2005, at 18:31:23
When I was weaning myself off the benzos, I used a lot of natural alternatives like chamomile tea, calcium & magnesium supplements, warm baths with 2-3 drops of lavendar essential oil... that kind of stuff. Didn't help a lot, but took the edge off a bit.
Maybe the new Lunesta stuff will help you when it comes out!
Posted by Phillipa on February 3, 2005, at 18:48:11
In reply to Re: I Don't Understand? » Phillipa, posted by Minnie-Haha on February 3, 2005, at 18:31:23
I try to go to the beach every day and walk 5 miles but it's raining. I went back to the Gym on Monday and lifted wts at my usual amt, and I feel like an old woman, with painful legs, arms, back, etc., still. I have been to an infection control MD, for the chronic Lymes Disease, which is in remission, he sent me to a neurologist, who did a spinal tap, and an endocrinologist. Still no answer except that I've have Hashimotos Thyroiditis, since the worst of this and the beginning of AD's. That was 8 years ago. Who else do I need to see we're losing our insurance. Fondly, Phillipa
Posted by Phillipa on February 3, 2005, at 18:50:12
In reply to Re: I Don't Understand?, posted by Minnie-Haha on February 3, 2005, at 18:35:39
So you were using benzos too? May I ask what drugs , doseages, and how many years, and the total amt of each a day. Thanks, Phillipa
Posted by Minnie-Haha on February 3, 2005, at 18:59:23
In reply to Re: I Don't Understand? » Minnie-Haha, posted by Phillipa on February 3, 2005, at 18:48:11
> I try to go to the beach every day and walk 5 miles but it's raining. I went back to the Gym on Monday and lifted wts at my usual amt, and I feel like an old woman, with painful legs, arms, back, etc., still. I have been to an infection control MD, for the chronic Lymes Disease, which is in remission, he sent me to a neurologist, who did a spinal tap, and an endocrinologist. Still no answer except that I've have Hashimotos Thyroiditis, since the worst of this and the beginning of AD's. That was 8 years ago. Who else do I need to see we're losing our insurance. Fondly, Phillipa
It sounds like you're doing what you can for the exercise part. Do you live somewhere rainy? Do you think you might benefit from light therapy? (I live in Arizona, so that's not a problem here. Sometimes I get sick of the sun!)
You've seen an endo, so I don't know what to tell you there. What's your TSH like? The only thing I can think to suggest is a sleep study. They're expensive, so try to get one before your insurance expires.
Hang in there. I feel for you.
Posted by Minnie-Haha on February 3, 2005, at 19:03:09
In reply to Re: I Don't Understand? » Minnie-Haha, posted by Phillipa on February 3, 2005, at 18:50:12
> So you were using benzos too? May I ask what drugs , doseages, and how many years, and the total amt of each a day. Thanks, Phillipa
I didn't get too far down that road before I decided it was causing more problems than it was curing. I took .25 to 1.0 mg Ativan for about 8 months I guess. The Klonopin I took .5 to 1.0 mg for only a few weeks. I now might take one or the other very infrequently... maybe once a month.
Posted by Phillipa on February 3, 2005, at 19:31:51
In reply to Re: I Don't Understand?, posted by Minnie-Haha on February 3, 2005, at 18:59:23
East Coast, near Emerald Isle, NC. I really don't want the sleep study, cause it's hard enough to fall asleep. Everything has to be "just right". You are probably a lot younger than I am and other options were available to you that weren't for me. I started with panic attacks. Tried a TCA one night, and ended up walking around the block all night crying. So valium, meprobamate, and on and on. Phillipa
Posted by Mark H. on February 3, 2005, at 19:40:42
In reply to I Don't Understand?, posted by Phillipa on February 3, 2005, at 17:43:33
Phillipa,
I don't know if it would work for you or not, but even a small dose of Zyprexa (2.5 mg) gives me the deepest, most wonderful sleep I've ever experienced, night after night. I don't know if your condition would warrant trying it, but for me it has been a miracle.
I hope you find something that works as well for you.
Mark H.
Posted by Phillipa on February 3, 2005, at 20:07:22
In reply to Re: I Don't Understand?, posted by Mark H. on February 3, 2005, at 19:40:42
Do you know how that equivent would compare let's say to 50mg of seroquel? Fondly, Phillipa
Posted by Colleen D. on February 3, 2005, at 20:20:20
In reply to I Don't Understand?, posted by Phillipa on February 3, 2005, at 17:43:33
nortriptyline. Both are TCAs and both have been recommended by my doc. Tolerance is not an issue with these. They also help with anxiety. Clonazepam is not sedating enough for me to use as a sleep aid.
Good luck!
Colleen
60mg Cymbalta
1.25mg clonazepam
and 25mg doxepin at bedtime
Posted by Colleen D. on February 3, 2005, at 20:23:05
In reply to May I also suggest a low dose of doxepin or.... » Phillipa, posted by Colleen D. on February 3, 2005, at 20:20:20
30 capsules and nortriptyline is more expensive.
Colleen
Posted by Ritch on February 4, 2005, at 0:19:20
In reply to I Don't Understand?, posted by Phillipa on February 3, 2005, at 17:43:33
> How come everybody can fall asleep on ambien, seroquel{low dose}, klonopin, etc,. How come the pdoc puts me on a "cocktail of meds" and still I'm awake after 4 hours for more benzos? Is it because I've taken them for so many years {30), and have a tolerence to them? What can I do about it? Could it be because I have so many worries right now, and stresses? I know you have answered my other Posts on sleep, but I am getting desperate. Changing pdocs etc, and even putting myself in the hospital. Thanks Phillipa
>I would go to sleep, but ALWAYS wake up 3-4 hours later and not be able to get back to sleep. I would awaken with high anxiety (a few times even close to a panic attack). ***I tried Ativan, Ambien, Flexerall, Elavil, Sonata and Klonopin*** They all might help me get to sleep (which usually wasn't the problem anyway), but I would always wake up 3-4 hours later. I went to my FP, a gastroenterologist (there was also nausea involved) and finally an endocrinologist. I also had a sleep study done. All I did was confirm that I have GERD (reflux), discover that I have thyroid nodules (but they don't appear to be cancerous or causing any trouble -- I guess a lot of people have nodules) and lastly, that I had high urinary cortisol.
Sleep maintenance problems. That's what I've been fighting for three or four years now. I was on a little gabapentin at night with my Depakote, clonazepam and it was working rather well and my pdoc wanted me off the gabapentin. So, I suggested using Trileptal (low-dose) to help me sleep instead. Well.... that *did* work for the sleep, but I'm having problems tolerating the Trileptal (nausea yet again!). Anyhow, I'm thinking about asking for 250mg of Keppra at bedtime for sleep. Have either of you tried that for sleep? I've tried it in the past and it also worked, but it seemed to make me grouchy.
Posted by lars1 on February 4, 2005, at 8:49:53
In reply to I Don't Understand?, posted by Phillipa on February 3, 2005, at 17:43:33
> How come everybody can fall asleep on ambien, seroquel{low dose}, klonopin, etc,. How come the pdoc puts me on a "cocktail of meds" and still I'm awake after 4 hours for more benzos? Is it because I've taken them for so many years {30), and have a tolerence to them?Hi Phillipa,
After 30 years, it's to be expected that you may have built up a tolerance and need higher doses. That is not necessarily a problem, since you will also have built up a tolerance to the side effects.
I seem to recall that in another post you mentioned that you recently started taking Ambien and that it helped you get to sleep, but that you still woke up in the middle of the night. Ambien has a short half-life (1.4 to 4.5 hours), which is bad (you may wake up in the middle of the night), but also good (if you do wake up, you can take another dose and still not have much hangover in the morning). It's too bad they don't make an extended-release version. I wonder if you might have luck taking half your dose before bed, and the other half if/when you wake in the middle of the night? If that doesn't work, maybe you could ask your doctor about taking a full 10 mg dose at both times? I have had good results getting to sleep if I take Ambien "prophylactically" about an hour before bed, if I expect that I might have trouble falling asleep. I seem to be able to get by with a lower dose that way than if I wait until I've already been tossing and turning and trying to sleep.
I think that the Ambien may end up helping you a lot. As you know, benzos have many effects -- hypnotic, anti-anxiety, anti-seizure, etc. Once you've used them for a while, you may start feeling rebound effects as the drug is wearing off (that is, when the drug concentration is below the "average" that you've become used to). These effects are the reverse of the drug's normal effects: insomnia, increased anxiety, reduced seizure threshold, etc. As a result, if you use benzos during the day, you may start to have rebound insomnia at night. If you then use benzos to sleep you may have rebound anxiety in the day, leading to higher daytime doses to quell the anxiety, leading to higher nighttime doses, leading to... well, you get the picture. The 24/7 use promotes tolerance and can make the drug less effective for you.
Anyway, Ambien has a more specific effect than benzos, targeting sleep but not having much anti-anxiety effect. That means that it also doesn't have much daytime pro-anxiety rebound effect, only (theoretically) a daytime insomnia effect, which wouldn't be a problem for most people. So, I think that Ambien shouldn't lead to the same dose escalation cycle that benzos can. If you use Ambien instead of benzos to sleep, using a higher dose of Ambien if that's what it takes to get by without benzos, then over time you may find the benzos more effective during the day, and you might eventually be able to reduce the dose. That would reduce the tendency toward nighttime rebound effects from the benzos, so you might eventually be able to reduce the Ambien, too.
Finally, if you haven't already done so, you might read up on "sleep hygiene" and see if there are any non-medical things you may have overlooked to help you sleep well. (If I've already mentioned this to you, I apologize. I don't mean to repeat myself.)
Best wishes,
Lars
Posted by ed_uk on February 4, 2005, at 9:43:50
In reply to Re: I Don't Understand? » Phillipa, posted by lars1 on February 4, 2005, at 8:49:53
Hi L!
>It's too bad they don't make an extended-release version.
As far as I know, Ambien CR is in development.
Hi Phillipa!Since Xanax has a short half-life, it tends to wear off in the middle of the night. Perhaps your insomnia would improve if you took slow release Xanax instead. Also, Lunesta (eszopiclone) might be effective in keeping you asleep for longer than Ambien- which has a very short duration of action.
Ed xxx
Posted by lars1 on February 4, 2005, at 10:30:50
In reply to Re: I Don't Understand? » lars1, posted by ed_uk on February 4, 2005, at 9:43:50
>Lunesta (eszopiclone) might be effective in keeping you asleep for longer than Ambien- which has a very short duration of action.
Hi Ed!
Good point. The label gives a half-life of about six hours, and it has a selective action for sleep, like Ambien, so it should have the same benefits in not causing rebound anxiety.
Lars
Posted by banga on February 4, 2005, at 10:40:32
In reply to Insomnia » ed_uk, posted by lars1 on February 4, 2005, at 10:30:50
People who take small dose seroquel for sleep--how does it work for you? at what dosage? Does it help with anxiety throughout the day?
Posted by Mark H. on February 4, 2005, at 14:20:04
In reply to Re: I Don't Understand? » Mark H., posted by Phillipa on February 3, 2005, at 20:07:22
> Do you know how that equivent would compare let's say to 50mg of seroquel? Fondly, Phillipa
Hi Phillipa,
Unfortunately I don't. I looked up Seroquel on the manufacturer's site, and it seems they recommend dosages ranging from 25mg to 800mg a day, so I can't even guess how Zyprexa would compare.
You might want to ask your doctor if Zyprexa is something that you could try, either instead of Seroquel or in addition to it. I suspect you'd know right away whether it was helpful or not. I took 5 mg a night for a few months, but I noticed that I felt a bit too foggy during the day, so with my doctor's approval, I cut back to 2.5mg a night and that dosage has been perfect for me.
Each person's chemistry is unique, however, and what works for me may or may not work for someone else. But getting a good night's sleep is so important to my mental and emotional health, and Zyprexa really helps me.
With kind regards,
Mark H.
Posted by Phillipa on February 4, 2005, at 16:30:12
In reply to Re: I Don't Understand?, posted by Mark H. on February 4, 2005, at 14:20:04
I appreciate all of your respones. I have mentioned Lunesta to my pdoc, and she doesn't know anything about it except that it's a new drug. I told her I wanted to try it. She said the drug reps aren't even talking about it yet, and she's affiliated with a large teaching Hospital. I have also questioned myself if I am "trained" to wake-up in a few hours. I used to live in a house that had a train go by at about 2am each night. Fondly, Phillipa
Posted by Maxime on February 4, 2005, at 22:37:24
In reply to I Don't Understand?, posted by Phillipa on February 3, 2005, at 17:43:33
I am a chronic insomniac. The ONLY thing that will break the cycle for is Thorazine. 25 mg for a couple of days and then I am fine. Plus it helps with the BP.
Maxime
Posted by Maxime on February 4, 2005, at 22:40:02
In reply to I Don't Understand?, posted by Phillipa on February 3, 2005, at 17:43:33
Phillipa - Hasn't your new PDOC taken you off many of the benzos? YOu mentioned twitching etc. It is no wonder you can't sleep. You are going through a withdrawal.
Maxime
This is the end of the thread.
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