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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by wyatthaslakefever on December 27, 2005, at 0:17:52
hey babblers,
urg, i have SUCH a problem sleeping these days. so much worry, the kind of obsessional cycling worry i've been plauged with for years now. i'm medicated, 40mgs prozac, but it doesn't seem to be helping as much as it used to. i know i need a re-eval, but what to do in the meantime? it's getting to be such a problem. i end up taking antihystamines to try and help but they often leave me groggy. anybody with the same problem(s)--PTSD, Obsessional Thought, Hystrionic Personality--have any suggestions?
thanks, you lot!
Posted by med_empowered on December 27, 2005, at 1:37:55
In reply to Problems with SLEEP, posted by wyatthaslakefever on December 27, 2005, at 0:17:52
You could try..Ambien/Ambien CR, Sonata, Resotril, Ativan, xanax (not my 1st pick), Neurontin/Lyrica, nite-time Klonopin, Vistaril....if its really bad, a barbiturate could be used short-term.
Posted by yxibow on December 27, 2005, at 1:59:52
In reply to Re: Problems with SLEEP, posted by med_empowered on December 27, 2005, at 1:37:55
> You could try..Ambien/Ambien CR, Sonata, Resotril, Ativan, xanax (not my 1st pick), Neurontin/Lyrica, nite-time Klonopin, Vistaril....if its really bad, a barbiturate could be used short-term.
>
>I would definately leave out the barbiturates.
But Ambien and its patent extender Ambien CR both can be used long term irregardless of what might be said about them. Tolerance might build slightly but I dont think it nearly as significant as certain benzodiazepines such as xanax. Sonata is a fairly weak agent of the new pure sleep agents. Lunesta is a little weaker but about the same as Ambien especially at its highest dosage -- the only thing is that metallic taste, which for most wears off in minutes to hours, although some claim it lasts into the next day.
I think that for sleep, the first line should be sleep agents, and not crude antihistamine receptor agents. They promote REM sleep better. I suppose the exception might be Remeron, there is some evidence I think that it does promote better sleep hygiene, at the cost of being very vigilant about one's diet -- it can cause noticeable weight gain.
tidings and good sleep
Posted by med_empowered on December 27, 2005, at 3:29:35
In reply to Re: Problems with SLEEP, posted by yxibow on December 27, 2005, at 1:59:52
Hi! the other poster brought up some other options. Remeron helps alot of people, but it can cause noticeable weight gain very, very quickly..if you go this route, going for 30mgs+ instead of the usual 15 might help.
Personally, I'd avoid Seroquel--some people swear by it, but it really shouldn't be first line for insomnia, unless you can't sleep b/c you're psychotic.
Barbiturates aren't used very often, but they can be very helpful if all else fails (even then, though, you're only going to want to take them for 2 weeks tops).
Some people love this new Rozerem stuff. I haven't used it, but its non-controlled (unlimited refills, no abuse potential), so thats a definite plus. Lunesta and and the other new ones usually dont cause too many problems w/ withdrawal, but they are schedule IV, so there could be refill issues.
Vistaril is an antihistamine, and I dont like it very much, but it is good stuff sometimes for hardcore insomnia. 200mgs seems to be pretty standard for nite time sedation.
Prozac sometimes makes sleep problems more pronounced--in the original Prozac studies, a lot of the patients were also on anxiolytics (Valium, Ativan, etc.) and/or sedatives. You could try switching to another AD in the same class, or trying something new like Effexor or Cymbalta. If you tend to be super-anxious all the time, and your doc won't go for a benzo, adding BuSpar might help--you could adjust the dosing so most of it is at nite, which will help you sleep for a little while. BuSpar also sometimes makes antidepressants work better, although this doesn't happen for everyone.
Herbal supplements could help...if you're interested, valerian, kava kava, and the like sometimes help people get to sleep. So does melatonin, although people with depression should probably avoid melatonin.
Posted by summerflowers on December 27, 2005, at 4:59:14
In reply to Re: Problems with SLEEP, posted by med_empowered on December 27, 2005, at 3:29:35
This is natural,but these pills I got here in NZ sleep ezy containing:valerian,hops,chamomile,passion flower,calcium hydrogen phosphate,magnesium phosphate, worked better than any drug and gave my husband the best nights sleep in years.(as observed by me).Hes not on any medications yet though so I dont know how it would mix.Goodluck with getting a good night sleep.(arina)
Posted by James K on December 27, 2005, at 12:03:52
In reply to Problems with SLEEP, posted by wyatthaslakefever on December 27, 2005, at 0:17:52
Ambien helped me for years, especially when I was on ssri's. You have to be very carefull to go right to bed, because if you stay up weirdness can begin. Especially if you drink.
Unfortunately, all the med changes in the last two years messed it up for me. Don't screw around with seroquel, it will knock you out, but since when should we be prescribed powerful anti-psychotics for their side-effects? I wish I'd never touched it. Unfortunately, when you go into hospital you have to just swallow what they hand you.
Lunesta did nothing for me sleepwise, and I woke up really nasty mouth. I haven't been able to find anything about how it works, but I woke up with a seroquel feeling.
Hope some of this is useful. I'm on nothing now (sleepwise) and don't sleep worth a flip and I hate it.
Posted by greenhornet on December 27, 2005, at 12:59:53
In reply to Re: Problems with SLEEP, posted by James K on December 27, 2005, at 12:03:52
This may sound rather rather pedestrian, but have you tried warm milk? I did the whole range of sleepers (nasty nightmares from Ambian) and after coming off Seroquel turned to prayer and warm milk. It usually works if I can't sleep.
Posted by yxibow on December 27, 2005, at 13:59:55
In reply to Re: Problems with SLEEP, posted by med_empowered on December 27, 2005, at 3:29:35
> Hi! the other poster brought up some other options. Remeron helps alot of people, but it can cause noticeable weight gain very, very quickly..if you go this route, going for 30mgs+ instead of the usual 15 might help.
Some say that the higher dosage improves weight gain -- I definately didn't observe that; it helped my main problem alot but the weight gain became more pronounced and I think that speaks for a number of people, but a smaller portion of the population may have a counteracting of weight at super high doses of Remeron.
>
> Personally, I'd avoid Seroquel--some people swear by it, but it really shouldn't be first line for insomnia, unless you can't sleep b/c you're psychotic.That I would agree with, although 25mg of Seroquel is so low that it is barely detectable psychiatrically, i.e. EPS, TD, etc.
>
> Barbiturates aren't used very often, but they can be very helpful if all else fails (even then, though, you're only going to want to take them for 2 weeks tops).Barbiturates are on my last resort list, they were shelved by benzodiazepines for a good reason -- the LD50 is on the order of at least 5 of not 10 times the LD50 of benzodiazepines and not very far off from the ED50 (effective). If you want to talk about scheduling, most of them are in C-II and C-III.
>
> Some people love this new Rozerem stuff. I haven't used it, but its non-controlled (unlimited refills, no abuse potential), so thats a definite plus.And its still a hormone like melatonin and one has to be careful with depression
Lunesta and and the other new ones usually dont cause too many problems w/ withdrawal, but they are schedule IV, so there could be refill issues.
>That depends on your doctor and state -- I've never had problem with Ambien refills. At least here in California as of oh, when was it, July 1? I dunno, C-IV and C-III is now not quite exactly but sort of like C-II with triplicates and all that, its just a special scrip form that has additional information of your name and address on it (and maybe DOB, I forget). It really isnt much different from before and most C-IV drugs are routinely refilled up to 6 times. This of course doesn't apply to your doctor if you've routinely abused Xanax by popping half a jar or something or if you have some anal retentive pharmacy.
> Vistaril is an antihistamine, and I dont like it very much, but it is good stuff sometimes for hardcore insomnia. 200mgs seems to be pretty standard for nite time sedation.Antihistamines tend to leave you very dry in the morning and a general nasty headache feeling. Yes, they are a relatively safe, but not the most pleasant form of sleep aid.
>Herbal supplements could help...if you're interested, valerian, kava kava, and the like sometimes help people get to sleep.>So does melatonin, although people with depression should probably avoid melatonin.
Yes. Was told that several times by doctors.
Valerian is very weak and gives me nausea the day after -- however some who are not cross tolerant to other GABA agents might benefit a little.
Kava should be used sparingly because of liver issues but for the Kava-naive patient it may give a 1 or 2 beer feeling.
Neither of those two wear off completely clean, but are okay OTC ideas for a very temporary time.
Posted by summerflowers on December 27, 2005, at 18:11:56
In reply to Re: Problems with SLEEP, posted by yxibow on December 27, 2005, at 13:59:55
I heard kava kalm can cause hallucinations in some people.Seroquel can cause sleep state problems(nightmares,flashbacks)in some people,as an adverse effect.I witnessed this too.Insomnia is such a difficult thing because its the worrying about NOT SLEEPING which makes it harder to sleep knowing time is ticking on,and knowing how much we suffer for lack of it the next day(s).Hope your having some luck(sleep).(arina)
Posted by blueberry on December 27, 2005, at 18:54:10
In reply to Problems with SLEEP, posted by wyatthaslakefever on December 27, 2005, at 0:17:52
Since you are on prozac, zyprexa goes well with it. A mere 2.5mg gave me the best sleep of my life for about 5 years until it finally lost its punch.
Seroquel 25mg...try cutting it in half first.
Remeron 7.5mg.
Lunesta 1mg to 3mg.
Ultra low dose elavil or doxepin. (either one in the 2mg to 5mg range)
Anything at the health food store that has a mixture of gaba, glycine, and taurine...but keep the dose low at first to around 100mg (they are usually in the 500mg range and can actually have the opposite effect sometimes at that dose).
There are herbs, but mixing with prozac is kind of iffy.
It's all trial and error. You might even ask your doc to give you a prescription for 3 pills of this, 3 pills of that, 3 pills of such and such, and just sample them all looking for one you can live with that works.
Posted by Phillipa on December 27, 2005, at 20:59:29
In reply to Re: Problems with SLEEP, posted by James K on December 27, 2005, at 12:03:52
Had to add that you don't have to take a med they give you in the hospital. Unless you are very paranoid, dangerous, etc. And even giving meds for schizophenia a court order must be issued. Fondly, Phillipa
Posted by James K on December 28, 2005, at 13:13:18
In reply to Re: Problems with SLEEP » James K, posted by Phillipa on December 27, 2005, at 20:59:29
> Had to add that you don't have to take a med they give you in the hospital. Unless you are very paranoid, dangerous, etc. And even giving meds for schizophenia a court order must be issued. Fondly, Phillipa
Yes I agree. I think I was talking in short-hand. What happens is after a while arguing with meds nurse, psychiatrist, techs., getting your head straight etc., I just start doing whatever they say just so I can go home. Thats about the only thing wrong with having good insurance coverage, instead of kicking you out when you're still in crisis, they look for reasons to hang on to you.
I need to work on staying either passive or aggressive and become assertive. Especially when it comes to working as a partner with my Psychiatrist on meds. Thanks for pointing that out, I wouldn't want to scare or misinform someone thinking they may need to go in.
Posted by linkadge on December 28, 2005, at 17:45:22
In reply to Re: Problems with SLEEP » Phillipa, posted by James K on December 28, 2005, at 13:13:18
SSRI's can cause sleep problems as mentioned above. Prozac can oftentimes be the worst on sleep.
The insomnia that SSRI's can cause can sometimes get worse over time instead of better.My depression got worse and worse on SSRI's as my sleep got worse and worse.
I would think about reducing the prozac, and perhaps adding a more sleep promoting AD such as trazedone, remeron, doxapine, amitryptaline etc.Don't let insomnia persist. Attack it as strongly as you would attack the depression. Poor sleep will affect every aspect of your life.
Good luck
Linkadge
Posted by Declan on December 29, 2005, at 2:38:48
In reply to Re: Problems with SLEEP, posted by linkadge on December 28, 2005, at 17:45:22
Hey Link, if sleep deprivation is (sometimes?) good for depression, how does that sit with attacking insomnia, if you get my drift?
Declan
Posted by linkadge on December 29, 2005, at 10:54:31
In reply to Re: Problems with SLEEP » linkadge, posted by Declan on December 29, 2005, at 2:38:48
I see what you are saying.
Just in my own experience, the sweet smell of euthemia after one SD night, can turn nasty after more SD nights. Consistantly disturbed sleep often makes me physically sick.
Some doctors think that its not so much lack of sleep that produces an AD effect as much as it is an alteration in certain sleep parameters.
An effective antidepressant *may* be able to alter those parameters without disturbing sleep time.
I've taken effective antidepressants that havn't subjectivly disturbed sleep. These are the ones that had kept me well the longest.
Sleep may be depressogenic for many, so it may not be right for me to generalize. But I do think that chronic sleep problems can make a lot of people depressed.
Linkadge
Posted by summerflowers on December 29, 2005, at 16:31:28
In reply to Re: Problems with SLEEP, posted by linkadge on December 29, 2005, at 10:54:31
one of my children can stay awake all night and still be wide awake and happy.Another 2 are grumpy and really strange if they even go to bed an hour late.People are all so different.(arina),
This is the end of the thread.
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