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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Sadaiyappan on August 15, 2005, at 11:15:16
Hey people... Been having problems sleeping... I take remeron...
Can someone give me a list of all the sleeping drugs available ? And I want drugs that are as strong [in terms of getting you to sleep] as remeron / trazadome... Ambien / Lunesta don't do much for me...
Posted by rjlockhart98 on August 15, 2005, at 11:44:31
In reply to Sleeping Meds, posted by Sadaiyappan on August 15, 2005, at 11:15:16
I take Restoril (Temazepam) 30mg nightly.
Restoril (Temazepam)
Klonopin (Clonazepam)
Sonata
Doral (quazlepam)
Xanax (Alprazolam)
Valium (diazpeam)Rarely Used:
Nembutal (pentobarbital)
Amytal (amobarbital)
Seconal (secobarbital)
Tuinal (secobarbital/amobaribtal)These are reallyt not even chosen anymore, they are for SEVERE insomnia when nothing else works.
Xanax is not really a choice by doctors anymore.
Posted by anneL on August 15, 2005, at 15:40:41
In reply to Re: Sleeping Meds, posted by rjlockhart98 on August 15, 2005, at 11:44:31
Hi Matt,
Does Restoril help you sleep well and do you wake up with any "hangover"? Do you take it nightly?
It has been several years since I have tried it. I take clonazepam now, but it is not sedating enough anymore (after 5 years). :) Laurie
Posted by Mike081078 on August 15, 2005, at 16:32:23
In reply to Sleeping Meds, posted by Sadaiyappan on August 15, 2005, at 11:15:16
I used to suffer from horrible insomnia. If I fell asleep I would jerk back awake in like 30-45 minutes and most nights I wouldn't even fall asleep... just kind of hover over the threshold to sleep for the whole night if I didn't lose patience and just got up
For the past 4-5 years I've been taking 1MG of Clonazepam every night. I'd have to say that it works better now then it did when I first started taking it and probably won't have to increase it anytime soon. It takes about an hour for it to kick in after which I usually drift right off to sleep and sleep like a baby for 7-8 hours.
There is also no morning pill hangover that I'm aware of or that I've experienced. Just make sure you take it 8 hours before you have to be up.
Posted by med_empowered on August 15, 2005, at 18:45:38
In reply to Re: Sleeping Meds, posted by Mike081078 on August 15, 2005, at 16:32:23
hey! Ambien doesn't cut it for a lot of people...for me, its OK short-term, but after a weeks, it just kind of stops doing anything. Restoril was helpful for me, although it didn't always cut it (add-on Vistaril or Tranxene was sometimes needed). The newer meds, like Lunesta, are more adjustable in terms of dosage than Ambien (usually Ambien is 10mgs,unless you have liver problems, in which case it 5mgs). Remeron is good for some people, but you might get weight gain/day time sedation, and there's the usual risk of (hypo)mania and other drug-induced craziness that you get from antidepressants. Hydroxyzine (Vistaril, Atarax) is an old-school antihistamine that helps with sleep...I liked it at first, but long term it seemed to flatten my mood, so I quit taking it. There's also the antipsychotics...Seroquel and Zyprexa are both used as sleep-aids. I don't like antipsychotics in general, but...if I had to choose, I'd say low-dose seroquel (25-100mgs) would be preferable to Zyprexa. If all else fails, you might want to try a barbiturate. It seems that Phenobarbital is the drug of choice in this category; it works, but it takes forever to kick in, lasts forever, and generally makes you feel icky. Nembutal, Seconal, and Tuinal (Amytal+Seconal mix) are the traditional top picks of the barbs for sleep; Alurate (aprobarbital) is another option that might be worth considering if your situation gets to that point...its a schedule III substance so you'll actually be able to get refills (Nembutal, Seconal, and Tuinal are schedule II, so no refills; Phenobarbital is schedule IV). There are also older non-barbiturate sedatives that still get RX'd now and then...Doriden, Placydil, those things. They're not all that safe, and they're not popular, but they're still an option for the chronically sleep-deprived. Neurontin is useful too...I hated it for anxiety (didn't work), but 600-1200mgs at bedtime was awesome for sleep. But..tolerance develops quickly, so the dose always has to be adjusted, and I usually had something of a morning hangover. If you're interested in doing the alternative health thing, there's 5-HTP, which apparently converts into serotonin after you ingest it. 100mgs, give or take, helped me sleep alot, but it can cause nausea, so watch out for that. Valerian, especially when combined with Passionflower, also helped me a lot, although when I took as much as I needed I did get a bit of a hangover (nothing crazy though). Melatonin is still popular, but if you have depression or have depressive tendencies, you might want to avoid it; it can apparently make depression worse (and presumably induce depression in those prone to it). Kava Kava was awesome for anxiety and sleep, but it killed some people so now its hard to find...avoid at all costs if your liver is anything but extremely healthy. Oh...lest I forget...chloral hydrate is another option. Its old (1800s old) its rough (tends to cause nausea) and the sedation is kind of heavy (kind of barbiturate-like...it was used in "knockout drops" to sedate people back in the day) but it does work, and hardcore insomniacs still sing its praises. If you do take chloral hydrate, you might wanna call a couple pharmacies and see if they have the capsules; those are much, much gentler on the stomach than the liquid form, which is incredibly rough. Good luck!
Posted by Phillipa on August 15, 2005, at 20:43:20
In reply to Re: Sleeping Meds, posted by med_empowered on August 15, 2005, at 18:45:38
Hey med! I was going to suggest the chloral hydrate. It worked at 5cc for me for a year. then I had to up the dose. I took it along with xanax. So you see I have increcible sleep problems. Fondly, Phillipa
Posted by Sadaiyappan on August 17, 2005, at 9:28:56
In reply to Re: Sleeping Meds » med_empowered, posted by Phillipa on August 15, 2005, at 20:43:20
Yeah, I've heard of Kava Kava and Laverian... Is Laverian also bad for the liver ? Also does your body build up a tolerance to laverian, or can i take the same dose forever ?
Another question I have is about Melatonin... I've read about people taking it for sleep, and i know it is a "natural hormone" but how strong is it ? Will I be able to replace my remeron with melatonin alone ?
Posted by med_empowered on August 17, 2005, at 16:52:20
hi! Yeah, Kava kava has a bad rep w/ regards to liver issues, but it seems that most of the problems were limited to "high risk" people. Valerian is more sedating but not as good for anxiety; dosing really has to be individualized, so I'd recommend you go out and get a bottle or two of the standardized extract and starting taking it 1-2 hours before your target bedtime...when I used it, I started at a little less than the dosage recommended on the bottle, and moved up by 1 capsule until I fell asleep. I think I ended up using 3 caps instead of the 2 the directions recommended, but the sleep was awesome. From what I understand, there aren't any *known* problems with the liver or any other organ system, but if you want to take it longer than 3months, you might want to take a break after a couple months, maybe switch over to a conventional med or a different alternative treatment for a bit, and then re-start it. There's no evidence that Valerian is harmful, but taking a break now and then will definitely help reduce any potential harm and help it keep working for you. Melatonin is a natural hormone--your brain produces it, and it is partly responsible for sleep. Recommendations on dosing range from less than 1mg at nite to 3mgs+ at nite...again, this is something that may require a bit of experimentation with dosing. As for replacing Remeron...I would think you could replace Remeron with something else, conventional or alternative, but its best to taper off most meds, so keep that in mind. A friend of mine uses Melatonin along with Trazodone for sleep--apparently, the combo gives her high quality sleep, and it helps keep the doses of trazodone and melatonin at a minimum, which probably reduces side-effects considerably.
Posted by Sadaiyappan on August 17, 2005, at 17:35:36
In reply to Re: Sleeping Meds, posted by Sadaiyappan on August 17, 2005, at 9:28:56
Hi people, I've heard of Kava Kava and was told that Laverian is a "step up" from Kava Kava...
So i guess i can take that for sleep, but i want to know if my body will build up a tolerance too it or if i can take the same dose forever...
Also same thing about melatonin... will my body build up a tolerance or no ? And is melatonin strong enough to replace my Remeron ?
Posted by mattw84 on August 18, 2005, at 0:41:38
In reply to Sleeping Meds, posted by Sadaiyappan on August 15, 2005, at 11:15:16
As Phillipa mentioned, chloral hydrate is a *very* effective sleep induction agent -- but it is not a drug easily aquired and most doctors have never heard of it. General dosing is 500mg 15 minutes before you want to sleep, it is very potent but tends to lose its efficacy rather quickly and is also very toxic at higher doses so if by some chance you do get ahold of it do not be tempted to increase the dose. The trade name is Somnote and it is made by breckenridge pharmacueticals, good luck!
Matt
Posted by Phillipa on August 18, 2005, at 16:46:01
In reply to Re: Sleeping Meds, posted by mattw84 on August 18, 2005, at 0:41:38
Matt! You're back. And I see your Babblemail is now lit up! How's school or rather Residency. Fondly, Phillipa
Posted by Declan on August 18, 2005, at 18:39:27
In reply to Re: Sleeping Meds, posted by Sadaiyappan on August 17, 2005, at 9:28:56
If you are prone to depression the best herbs for sedation are the trophorestoratives which include Avene officinalis (oatstraw), St John's Wort, Scuttelaria laterifolia (skullcap), Turnera Aphrodisica (Damiana), Verbena officialanus (vervain), Withania somniferum (ashwaganda), and Zizyphus spinosa. The idea is that valerian etc, like benzos may worsen depression. I like Withania and Zizyphus myself, also Lycium Barbarum (Goji). Naturally their effect is very mild.
Declan
Posted by Sadaiyappan on August 18, 2005, at 19:44:37
In reply to Re: Sleeping Meds, posted by Declan on August 18, 2005, at 18:39:27
Ok... but no one is telling me wether your body builds up a tolerance to these drugs....
Posted by Declan on August 19, 2005, at 17:38:24
In reply to Re: Sleeping Meds, posted by Sadaiyappan on August 18, 2005, at 19:44:37
No, you shouldn't build up a tolerance to them, if only because they are very mild (too ineffective). I put them up because some depressed epople look for sedative herbs and I was just quoting from a good book I've got..
"Principles and Practice of Phytotherapy, Mills,S and Bone,K. Churchill Livingstone, 2000."
Declan
I wonder if the double double quotes thing will work.
Posted by Declan on August 19, 2005, at 17:45:17
In reply to Re: Sleeping Meds » Sadaiyappan, posted by Declan on August 19, 2005, at 17:38:24
One of the double quotes went away but I didn't get a direct link to Amazon. Maybe they just don't have it?
Declan
Posted by Dr. Bob on August 20, 2005, at 11:41:27
In reply to Re: Sleeping Meds » Sadaiyappan, posted by Declan on August 19, 2005, at 17:38:24
> "Principles and Practice of Phytotherapy"
I think it was a case of too much information. :-)
Bob
Posted by Declan on August 20, 2005, at 13:31:20
In reply to Re: direct link to Amazon, posted by Dr. Bob on August 20, 2005, at 11:41:27
I'll just try the title next time. Thanks
Declan
This is the end of the thread.
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