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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by jerrympls on March 24, 2005, at 19:52:28
I suppose it's because of tolerance over the years - but I don't ever feel sedated from benzodiazapines. I'm having a horrific time with insomnia - and have for many years. I've been on 50-150mg of Seroquel for the past few years for sleep. The problem is that it works too well - I sleep through my alarms and sometimes sleep away the weekend. Ambien used to work beautifully too- but I guess I've grown tolerant to it too over the years.
The problem now is that I'm in danger of losing my job because of my problems getting to work on time and because I miss many days because I'm so hung over from the Seroquel. Yes, I've tried lower dosages - taken earlier in the evening, etc. The problem is that it's really hard to GET to sleep.
Anyway, so I saw my doc today and said "Listen, I'm in danger of being fired and I want to be off of the Seroquel." He didn't seem too concerned and said "Well, I don't know what to try." I've been on Trazadone - but it compares to Seroquel for me.
Long story short - he said - "Well, if this is an emergency then I can give you a 2 week Rx for 2-3mg of Ativan to take at bedtime." I finally just said OK. It's weird because he knows benzos don't put me to sleep and he knows I've had 13 years of chronic insomnia.
I guess I'm off topic with all of this - but am I doomed because I'm tolerant to benzos? I have a friend who falls asleep with 1mg of Xanax. I really DO NOT want to be dependant on meds to get to sleep - but I've tried everything.
I'm so frustrated.....
Jerry
Posted by Phillipa on March 24, 2005, at 20:47:58
In reply to Why don't benzos help me get to sleep?, posted by jerrympls on March 24, 2005, at 19:52:28
They said on PBabble that you can now get Lunesta. It's supposed to be a new sleep med with antidepressant effects that can be taken long term. Fondly, Phillipa
Posted by jerrympls on March 24, 2005, at 20:56:02
In reply to Re: Why don't benzos help me get to sleep? » jerrympls, posted by Phillipa on March 24, 2005, at 20:47:58
> They said on PBabble that you can now get Lunesta. It's supposed to be a new sleep med with antidepressant effects that can be taken long term. Fondly, Phillipa
I checked today at the pharmacy and they said it wasn't out yet.:-(
Posted by Phillipa on March 24, 2005, at 21:04:37
In reply to Re: Why don't benzos help me get to sleep? » Phillipa, posted by jerrympls on March 24, 2005, at 20:56:02
Really? But they said Friday! Today is only Wednesday. I'll start a Thread to clarify it. Fondly, Phillipa
Posted by rainbowbrite on March 24, 2005, at 21:10:56
In reply to Why don't benzos help me get to sleep?, posted by jerrympls on March 24, 2005, at 19:52:28
What about chlorohydrate or Sonata?? have you tried either of those, maybe they arent for long term use though.
Posted by Phillipa on March 24, 2005, at 22:37:18
In reply to Re: Why don't benzos help me get to sleep?, posted by rainbowbrite on March 24, 2005, at 21:10:56
I guarantee chloral hydrate will put you to sleep. I was put on 5cc 8yrs ago. I'm now down to lcc. It works well and you don't wake up during the night. It's safe also they use it in the elderly, babies, and as a twilight sleep for simple surgical proceedures. Only problem at least for me, is that you'll like it so much you won't want to give it up. And never drink on it. It becomes a "Mickey Finn". Fondly, Phillipa
Posted by med_empowered on March 24, 2005, at 23:26:41
In reply to Re: Why don't benzos help me get to sleep? » rainbowbrite, posted by Phillipa on March 24, 2005, at 22:37:18
Hey! Insomnia sucks--no doubt about it. There are lots of reasons you may be having sleep med "issues". Obviously, there's tolerance. On the other hand, a lot of shrinks under-utilize benzos/sleep aids...you gave an example of Ativan; when I had my all-purpose ativan RX, it was 2mgs for a panic attack, 4-5mgs for night time use..I think your shrink may be under-prescribing in an effort to "err on the side of safety". Of course, there are non-benzo alternatives. You've done the Ambien thing already (Ambien, BTW, is very benzo-ish; that's why it+sonata are schedule IV drugs, just like benzos)...like the others mentioned, there's chloral hydrate, a schedule III old-school drug that's still used by many shrinks...as Phillipa said, please be careful about alcohol (or any sedatives) w/ chloral hydrate...in addition to the "mickey finn" effect, this was one of the sedatives that killed Marilyn Monroe. Seroquel is overkill for me, too; personally, I found the solution was to rotate meds. So...I tried to go med-free, if I couldn't, I'd first try 5-10mgs Ambien OR 1-2 Sonata capsules. If that failed, it was time for 600-900 mgs Neurontin (Neur. works, but has a noticeable hangover effect). I personally HATE trazadone, but lots of people swear by Remeron (watch out for the weight problem and drug-drug interactions). For a while, mood-stabilizers (in my case, Trileptal) helped with my insomnia a good bit...if you're bipolar or have a more "complicated" depressive disorder, this might be worth trying. For non-drug alternatives, there's always exercise (helped me a lot), meditation, and good "sleep hygiene". Alternative remedies are plentiful...I personally have found that 5-HTP, 50-100mgs right before bed, helps out a whole lot, though there may be some stomach issues. Lots of people swear by melatonin, and valerian root is popular as well...supposedly, it works in a benzo-ish manner, but no one seems TOTALLY sure about that. The usual meds of last resort are the barbiturates...some shrinks are more free with them than others, some don't use them at all, and sometimes they're inappropriate for a given patient, no matter how severe the insomnia. Nonetheless, its a possibility...it seems that the most popular one still used is Phenobarbital; its a less scary barbiturate, and its a schedule IV just like benzos. But..there are lots of problems with it. It has lots of drug-drug interaction problems, it lasts FOREVER, and there are cognitive side-effects. And of course, it still leads to those mysterious "accident or suicide?" deaths, like Muriel Hemingway, so its got some lethal-potential. Less popular, but still available are Seconal (the *OFFICIAL* suicide sedative), Tuinal (amytal+seconal), Alurate, and Amytal.
Posted by Phillipa on March 25, 2005, at 0:09:28
In reply to **INSOMNIA FROM HELL**, posted by med_empowered on March 24, 2005, at 23:26:41
Med_empowered. What do you mean by the remeron drug -drug interraction? Fondly, Phillipa
Posted by med_empowered on March 25, 2005, at 1:16:09
In reply to Re: **INSOMNIA FROM HELL** » med_empowered, posted by Phillipa on March 25, 2005, at 0:09:28
hi! about the remeron thing...I just mean that, like any other anti-depressant, Remeron can cause problems when introduced into a cocktail of psychotropic drugs, especially if the cocktail already has an anti-depressant or two in it. Other than the usual AD problems and the weight gain, remeron is a very safe med.
Posted by celticmom on March 25, 2005, at 10:15:25
In reply to Why don't benzos help me get to sleep?, posted by jerrympls on March 24, 2005, at 19:52:28
Hey Jerry, have you tried any OTC antihistimines? Chlorpheniramine maleate knocks me out. It's in some allergy meds. I don't know how long it lasts for long term use, but if you are having really bad insomnia it's worth a shot.
Oh, also, my son is on clonodine to help with sleep, and it really does knock him out, but I think it has a short half life - 4 hours maybe. Then again, it could work for you.
Good luck, I hope you get some sleep!
Posted by Minnie-Haha on March 25, 2005, at 11:43:45
In reply to Why don't benzos help me get to sleep?, posted by jerrympls on March 24, 2005, at 19:52:28
> I suppose it's because of tolerance over the years - but I don't ever feel sedated from benzodiazapines. I'm having a horrific time with insomnia - and have for many years. I've been on 50-150mg of Seroquel for the past few years for sleep. The problem is that it works too well - I sleep through my alarms and sometimes sleep away the weekend. Ambien used to work beautifully too- but I guess I've grown tolerant to it too over the years.
>
> The problem now is that I'm in danger of losing my job because of my problems getting to work on time and because I miss many days because I'm so hung over from the Seroquel. Yes, I've tried lower dosages - taken earlier in the evening, etc. The problem is that it's really hard to GET to sleep.
>
> Anyway, so I saw my doc today and said "Listen, I'm in danger of being fired and I want to be off of the Seroquel." He didn't seem too concerned and said "Well, I don't know what to try." I've been on Trazadone - but it compares to Seroquel for me.
>
> Long story short - he said - "Well, if this is an emergency then I can give you a 2 week Rx for 2-3mg of Ativan to take at bedtime." I finally just said OK. It's weird because he knows benzos don't put me to sleep and he knows I've had 13 years of chronic insomnia.
>
> I guess I'm off topic with all of this - but am I doomed because I'm tolerant to benzos? I have a friend who falls asleep with 1mg of Xanax. I really DO NOT want to be dependant on meds to get to sleep - but I've tried everything.
>
> I'm so frustrated.....
>
> Jerry
>I had severe insomnia for 15 months. Could fall asleep OK, but woke up every night between 1 and 4 a.m. and then could not get back to sleep. Benzos did very little to help. I found out my cortisol was high and figured out I must have pseudo-Cushing's, which can result from un- or under-treated depression. Started on an antidepressant (in my case, Cymbalta) and was sleeping well within 2-3 weeks.
Are you taking an antidepressant?
Posted by Minnie-Haha on March 25, 2005, at 12:18:27
In reply to Re: Why don't benzos help me get to sleep? » jerrympls, posted by Minnie-Haha on March 25, 2005, at 11:43:45
> I had severe insomnia for 15 months. Could fall asleep OK, but woke up every night between 1 and 4 a.m. and then could not get back to sleep. Benzos did very little to help. I found out my cortisol was high and figured out I must have pseudo-Cushing's, which can result from un- or under-treated depression. Started on an antidepressant (in my case, Cymbalta) and was sleeping well within 2-3 weeks.
>
> Are you taking an antidepressant?
I should've added that I also tried Ambien and Sonata. And Benadryl. And chamomile tea. And warm milk. And valerian. And aromatherapy. And meditation/visualization CDs. And calcium and magnesium supplements at bedtime. And strenuous exercise in the morning. (These last two -- the calcium/magnesium supplementation and the exercise -- were the only things that helped a *tiny* bit). I tried a tiny dose of Zyprexa one night -- knocked me out, turned off all the anxious chatter in my head -- but I felt like a zombie the next day. No bueno. I even tried Elavil/Amitriptyline in a low dose at bedtime. The doc thought that since I have some neck and back pain, that might help. Nada. It wasn't until I got onto the Cymbalta that I got some relief.I feel for you man. Insomnia is awful! I was a wreck and felt like no-one in my circle of family and friends really understood.
Posted by jerrympls on March 25, 2005, at 18:46:21
In reply to Re: Why don't benzos help me get to sleep? » rainbowbrite, posted by Phillipa on March 24, 2005, at 22:37:18
> I guarantee chloral hydrate will put you to sleep. I was put on 5cc 8yrs ago. I'm now down to lcc. It works well and you don't wake up during the night. It's safe also they use it in the elderly, babies, and as a twilight sleep for simple surgical proceedures. Only problem at least for me, is that you'll like it so much you won't want to give it up. And never drink on it. It becomes a "Mickey Finn". Fondly, Phillipa
I've tried many nights on Chloral Hydrate - 1000mg and nothing.
Posted by jerrympls on March 25, 2005, at 18:53:40
In reply to **INSOMNIA FROM HELL**, posted by med_empowered on March 24, 2005, at 23:26:41
> Hey! Insomnia sucks--no doubt about it. There are lots of reasons you may be having sleep med "issues". Obviously, there's tolerance. On the other hand, a lot of shrinks under-utilize benzos/sleep aids...you gave an example of Ativan; when I had my all-purpose ativan RX, it was 2mgs for a panic attack, 4-5mgs for night time use..I think your shrink may be under-prescribing in an effort to "err on the side of safety". Of course, there are non-benzo alternatives. You've done the Ambien thing already (Ambien, BTW, is very benzo-ish; that's why it+sonata are schedule IV drugs, just like benzos)...like the others mentioned, there's chloral hydrate, a schedule III old-school drug that's still used by many shrinks...as Phillipa said, please be careful about alcohol (or any sedatives) w/ chloral hydrate...in addition to the "mickey finn" effect, this was one of the sedatives that killed Marilyn Monroe. Seroquel is overkill for me, too; personally, I found the solution was to rotate meds. So...I tried to go med-free, if I couldn't, I'd first try 5-10mgs Ambien OR 1-2 Sonata capsules. If that failed, it was time for 600-900 mgs Neurontin (Neur. works, but has a noticeable hangover effect). I personally HATE trazadone, but lots of people swear by Remeron (watch out for the weight problem and drug-drug interactions). For a while, mood-stabilizers (in my case, Trileptal) helped with my insomnia a good bit...if you're bipolar or have a more "complicated" depressive disorder, this might be worth trying. For non-drug alternatives, there's always exercise (helped me a lot), meditation, and good "sleep hygiene". Alternative remedies are plentiful...I personally have found that 5-HTP, 50-100mgs right before bed, helps out a whole lot, though there may be some stomach issues. Lots of people swear by melatonin, and valerian root is popular as well...supposedly, it works in a benzo-ish manner, but no one seems TOTALLY sure about that. The usual meds of last resort are the barbiturates...some shrinks are more free with them than others, some don't use them at all, and sometimes they're inappropriate for a given patient, no matter how severe the insomnia. Nonetheless, its a possibility...it seems that the most popular one still used is Phenobarbital; its a less scary barbiturate, and its a schedule IV just like benzos. But..there are lots of problems with it. It has lots of drug-drug interaction problems, it lasts FOREVER, and there are cognitive side-effects. And of course, it still leads to those mysterious "accident or suicide?" deaths, like Muriel Hemingway, so its got some lethal-potential. Less popular, but still available are Seconal (the *OFFICIAL* suicide sedative), Tuinal (amytal+seconal), Alurate, and Amytal.
Hey there-
Thanks for your post. I have to be honest and say I've tried all of the drugs and NON-drug remedies you listed above. Ambien was a miracle drug for me for many years. Sonata doesn't do a thing for me. I HATE trazadone. My previous family doc. finally put me on Nembutal (a barbituate) years ago. It was THEE BEST sleep I have EVER gotten. I felt more energized during the day I slept very well - no hangover. However, it was only for 2 months that he wanted me on it - so afterwards we went back to Ambien. Nov. 2004 my doctor (my pdoc) agreed to try Nembutal - and gave me a script for it. I was so relieved....except only to find out that they've stopped making it as of Nov. 1 2004!!!
So I can understand my pdoc's frustration - but I'm frustrated with him for not being more aggressive with my insomnia.
Anyway, thanks for your reply
Jerry
Posted by jerrympls on March 25, 2005, at 18:55:22
In reply to Re: Why don't benzos help me get to sleep? » jerrympls, posted by Minnie-Haha on March 25, 2005, at 11:43:45
> > I suppose it's because of tolerance over the years - but I don't ever feel sedated from benzodiazapines. I'm having a horrific time with insomnia - and have for many years. I've been on 50-150mg of Seroquel for the past few years for sleep. The problem is that it works too well - I sleep through my alarms and sometimes sleep away the weekend. Ambien used to work beautifully too- but I guess I've grown tolerant to it too over the years.
> >
> > The problem now is that I'm in danger of losing my job because of my problems getting to work on time and because I miss many days because I'm so hung over from the Seroquel. Yes, I've tried lower dosages - taken earlier in the evening, etc. The problem is that it's really hard to GET to sleep.
> >
> > Anyway, so I saw my doc today and said "Listen, I'm in danger of being fired and I want to be off of the Seroquel." He didn't seem too concerned and said "Well, I don't know what to try." I've been on Trazadone - but it compares to Seroquel for me.
> >
> > Long story short - he said - "Well, if this is an emergency then I can give you a 2 week Rx for 2-3mg of Ativan to take at bedtime." I finally just said OK. It's weird because he knows benzos don't put me to sleep and he knows I've had 13 years of chronic insomnia.
> >
> > I guess I'm off topic with all of this - but am I doomed because I'm tolerant to benzos? I have a friend who falls asleep with 1mg of Xanax. I really DO NOT want to be dependant on meds to get to sleep - but I've tried everything.
> >
> > I'm so frustrated.....
> >
> > Jerry
> >
>
> I had severe insomnia for 15 months. Could fall asleep OK, but woke up every night between 1 and 4 a.m. and then could not get back to sleep. Benzos did very little to help. I found out my cortisol was high and figured out I must have pseudo-Cushing's, which can result from un- or under-treated depression. Started on an antidepressant (in my case, Cymbalta) and was sleeping well within 2-3 weeks.
>
> Are you taking an antidepressant?
>Hi!
Yeah I'm taking Lexapro. I had my cortisol levels checked and they were LOW if you can believe that!
Posted by Phillipa on March 25, 2005, at 19:07:24
In reply to Re: Why don't benzos help me get to sleep? » Phillipa, posted by jerrympls on March 25, 2005, at 18:46:21
Wow! Chloral Hydrate didn't work? And I thought I had bad insomnia. I really feel for you. Fondly, Phillipa
Posted by ed_uk on March 26, 2005, at 9:14:59
In reply to Re: Why don't benzos help me get to sleep?, posted by Phillipa on March 25, 2005, at 19:07:24
Hi Jerry :-)
>I was so relieved....except only to find out that they've stopped making it (Nembutal) as of Nov. 1 2004!!!
Don't worry, secobarbital (Seconal) is very similar. Your doctor might give you a short course of Seconal provided that you're not too depressed at the moment.
Kind regards,
Ed.
Posted by ed_uk on March 26, 2005, at 9:15:30
In reply to Re: Why don't benzos help me get to sleep?, posted by Phillipa on March 25, 2005, at 19:07:24
Posted by jerrympls on March 28, 2005, at 18:06:04
In reply to Re: Why don't benzos help me get to sleep? Jerry » Phillipa, posted by ed_uk on March 26, 2005, at 9:14:59
> Hi Jerry :-)
>
> >I was so relieved....except only to find out that they've stopped making it (Nembutal) as of Nov. 1 2004!!!
>
> Don't worry, secobarbital (Seconal) is very similar. Your doctor might give you a short course of Seconal provided that you're not too depressed at the moment.
>
> Kind regards,
> Ed.
>HI Ed-
Yeah I brought that up and he wasn't for it.
I sure hope Lunesta is released soon.
thanks
Jerry
This is the end of the thread.
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