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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by twinch42085 on June 18, 2008, at 1:15:58
Hello All,
Over the past couple of years I have had insomnia to the point that I just don't try to sleep. No, but really it seems that way. I have tried several medications.
Ambien 10mg; Seroquel 25mg-100mg; Halcion .125mg-.50mg; Restoril 30mg; Rozerem 8mg; Lunesta 3mg and several different benzodiazepines.Nothing works for me and I am wanting suggestions on insomnia medications I can suggest to my pdoc on Tuesday. Any suggestions?
Thanks You :)
Twinch
Posted by Phillipa on June 18, 2008, at 10:46:47
In reply to Help! Suggestions! Insomnia out the WaZoo!, posted by twinch42085 on June 18, 2008, at 1:15:58
You've been on a lot. Those are the ones that worked for me in combos of benzos and lunesta. Now I can't wake-up so the opposite is happening. Trazadone they say works???? Love Phillipa
Posted by twinch42085 on June 18, 2008, at 12:12:40
In reply to Re: Help! Suggestions! Insomnia out the WaZoo! » twinch42085, posted by Phillipa on June 18, 2008, at 10:46:47
I know someone who takes trazodone, but is it not a antidepressant? I have heard of this stuff called Xyrem that is marketed here. It is a schedule II drug. I think it resembles the drug GHB.
What about Chloral Hydrate or Sonata?
Thanks : )
Twinch
Posted by blueboy on June 18, 2008, at 14:31:53
In reply to Help! Suggestions! Insomnia out the WaZoo!, posted by twinch42085 on June 18, 2008, at 1:15:58
> Hello All,
>
> Over the past couple of years I have had insomnia to the point that I just don't try to sleep. No, but really it seems that way. I have tried several medications.
>
>
> Ambien 10mg; Seroquel 25mg-100mg; Halcion .125mg-.50mg; Restoril 30mg; Rozerem 8mg; Lunesta 3mg and several different benzodiazepines.
>
> Nothing works for me and I am wanting suggestions on insomnia medications I can suggest to my pdoc on Tuesday. Any suggestions?
>Ambien works for me but I take 25-30 mg. My pdoc freaked a bit when I told him, but one night I took 10mg and waited an hour, then another 10mg and waited an hour, then 5 or 10 more (it was a long time ago). Now I don't mess around, I take 20-30mg to start, depending on how wired up I feel.
Same with my benzo (Klonopin) and Lunesta-- I take 2.5 to 3 times the suggested dosage. But I try not to take Klonopin more than twice a week. Well, I don't try, I plain don't take it more than that, as I have an addictive personality.
Speaking of which, 30mg of Ambien can actually get you a bit high, LOL. Don't tell anyone. If the gov't finds out it is pleasant, they'll ban it. They don't like you to take drugs that make you feel better.
Posted by Phillipa on June 18, 2008, at 19:29:50
In reply to Re: Help! Suggestions! Insomnia out the WaZoo! » Phillipa, posted by twinch42085 on June 18, 2008, at 12:12:40
Took chloral hydrate for a few years worked great. Didn't know you had access to this med. Phillipa
Posted by twinch42085 on June 18, 2008, at 20:23:07
In reply to Re: Help! Suggestions! Insomnia out the WaZoo!, posted by blueboy on June 18, 2008, at 14:31:53
I have tried 20mg of Ambien before. It causes a great deal of amnesia and the high feeling only makes me want to take more and more until I pass out. I quit taking it because of this.
Thanks : )
Twinch
Posted by twinch42085 on June 18, 2008, at 20:28:55
In reply to Re: Help! Suggestions! Insomnia out the WaZoo! » twinch42085, posted by Phillipa on June 18, 2008, at 19:29:50
Yes, according to Wikipedia it is a schedule IV drug in the United States. My insurance company offers name brand which is SOMNOTE or the generic. The generic is $9.
Thanks : )
Twinch
Posted by bleauberry on June 18, 2008, at 20:47:03
In reply to Help! Suggestions! Insomnia out the WaZoo!, posted by twinch42085 on June 18, 2008, at 1:15:58
Might be time now to look at things that are not usually thought of as sleep meds. Things that affect different circuits than you have been doing so far. Obviously the whole GABA thing aint it. If you wanted to still try the GABA approach, then try taking higher doses of drugs you've already tried. Sometimes 2 to 3 times the normal dose is needed.
Not sure why, but the dopamine agonist idea popped into my head. I mean, heavy sedation is side effect that causes some people to stop taking them. And it is a totally different circuit that has not yet been touched by your previous trials. I just say if the logical doesn't work, then logic says look where you haven't looked, and don't keep looking in the same arena you've been looking in.
Who knows, something weird like lithium or magnesium might fix the whole thing. Wouldn't be the first time it happened. Of course, how silly to think something as simple as a mineral you buy at the store could do that. But it has happened. All I know is, the GABA circuitry does not seem to be a player in your case, so it is something else.
Posted by Timx2 on June 22, 2008, at 1:54:25
In reply to Help! Suggestions! Insomnia out the WaZoo!, posted by twinch42085 on June 18, 2008, at 1:15:58
I could only suggest trying other low-dose anti-psychotics...maybe a tricyclic anti-depressant or higher doses of some of the hypnotics and benzodiazepines you have tried (in which case addiction will most likely be brought up....)
Tim
Posted by cactus on June 24, 2008, at 6:21:26
In reply to Re: Help! Suggestions! Insomnia out the WaZoo!, posted by Timx2 on June 22, 2008, at 1:54:25
Mogadon (nitrazepam) but if you are in the US it's not available. It's one of the best sleep aids I have ever used.
Rivotril (clonazepam) works well for me too and Valium used to work great. If you haven't tried it, maybe that might be another option.
Halcion and temazepam wear off too quickly and stilnox/ambien gave me a very bad reaction.
Posted by Molybdenum on June 24, 2008, at 8:57:29
In reply to Help! Suggestions! Insomnia out the WaZoo!, posted by twinch42085 on June 18, 2008, at 1:15:58
Hi,
Mirtazapine (Remeron) is a great soporific. And it's a quick onset anti-depressant too. Generics have been out for ages so it's also cheap.
Give it a try - the knock-out aspect is felt within an hour and the best thing is that it actually improves your sleep quality a bit, as opposed to the benzos that reduce quality.
Some sedation can initially persist into the next day but from my experience, that went away in a week or so. Highly recommended.
:)
Posted by BPPsychFellow on June 29, 2008, at 12:44:41
In reply to Re: Help! Suggestions! Insomnia out the WaZoo! » twinch42085, posted by Molybdenum on June 24, 2008, at 8:57:29
Hi twinch,
Sorry to hear about your trouble sleeping. I've seen patients with similar problems. A few questions: What is your current primary diagnosis? Do you have trouble falling asleep, staying asleep, or waking too early?
Difficulty sleeping could be related to depression, hypomania/mania, or even anxiety I suppose. Let me know and I'll try to make some suggestions.
-Regards, BPPsychFellow
Posted by yxibow on June 30, 2008, at 1:58:06
In reply to Help! Suggestions! Insomnia out the WaZoo!, posted by twinch42085 on June 18, 2008, at 1:15:58
> Hello All,
>
> Over the past couple of years I have had insomnia to the point that I just don't try to sleep. No, but really it seems that way. I have tried several medications.
>
>
> Ambien 10mg; Seroquel 25mg-100mg; Halcion .125mg-.50mg; Restoril 30mg; Rozerem 8mg; Lunesta 3mg and several different benzodiazepines.
>
> Nothing works for me and I am wanting suggestions on insomnia medications I can suggest to my pdoc on Tuesday. Any suggestions?
>
> Thanks You :)
>
> Twinch
It sounds like a (obvious) serious sleep disorder.
Lunesta can be dosed beyond 3mg though few health insurance companies will pay for that, but the real issue is, there's something else going on and while at the moment, a "quick fix" so you can get some sleep may be something from a pill, there are other avenues that should be explored if you have the resources.
For one, a sleep study (you go, stay overnight at an outpatient clinic and they monitor your breathing and an EEG, etc.). If not that, a holter (worn) EEG for 24 hours. Your GP would know more about that, although I'm surprised your psychiatrist has not suggested such diagnostics.What medications do you currently take ? If you take or have taken or have habituated to any benzodiazepines recently, the whole GABA sleep aid system may be completely ineffective.
Besides the Remeron mentioned (7.5mg or possibly even half a tablet of that -- weight gain is more than not dose related as well as gradual hunger increase which should be monitored.), there is (and I don't know what else you take so this may be contraindicated) amitriptyline (Elavil), and doxepin (Sinequan).
Doxepin tends to wear off faster as a sleep aid although the initial dose can be a whopper if you've never had any anticholinergics or related medications. But it does allow you to go back to sleep if you wake up, for some.
Amitriptyline can be effective at as little as 10mg, and that is usually the typical dose for off-label purposes which include beyond the sleep-disorder spectrum. I happen to currently use it because the Seroquel I take isn't completely effective for that on its own.
OTC antihistamines such as Benadryl (the ones intended for antihistamine purposes are cheaper than the sleep aids and contain the same ingredient -- diphenhydramine) or Unisom or generic [the ones that do contain doxylamine] (doxylamine succinate) may work for a little while but can cause depression and extreme grogginess, not to mention dry mouth (which tricyclics can also do). Both are probably not harmful up to 75mg.
There's also augmentation to medication with 5-HTP, usually extracted from Griffonia seeds, available at most health stores.
A similar and related augmentation, reintroduced to the market is l-tryptophan because of a theoretically contaminated batch which produced some dire consequences around 1989 I believe, which I personally have only found at GNC as far as in stores although it may be available at other chains as well. It usually is found around 500-1000mg.
However, the most important thing is to remember not to stack many sleep aids together -- first of all the mixture could be toxic with each other, but mainly because of respiratory depression.
This is the end of the thread.
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