Posted by Elizabeth on February 22, 2002, at 14:29:45
In reply to sleep advice needed, posted by skills on February 22, 2002, at 7:28:30
Hi. What sort of insomnia do you have: do you have a hard time getting to sleep? Do you wake up frequently in the middle of the night? Or do you wake up early in the morning without getting enough sleep to feel rested?
Lofepramine is a tricyclic antidepressant. These can be helpful for insomnia, and I think it's worth giving it a try. Other tricyclic antidepressants such as amitriptyline, doxepin, and trimipramine may be more sedating, if you find lofepramine inadequate. Many people use these drugs to help them sleep.
Zolpidem (not sure what the brand name would be where you are; in the U.S. it's Ambien, and in some other places it's Stilnoct) is a good sedative that usually doesn't cause tolerance. Zopiclone, which is somewhat similar to zolpidem, may be available where you are (brand names include Imovane and Rhovane). Mirtazapine is another sedating antidepressant which tends to have fewer side effects than the tricyclics.
Some people find antihistamines like hydroxyzine and diphenhydramine useful.
Other options include anticonvulsants such as gabapentin and valproate, alpha-adrenergic agonists (clonidine, guanfacine), atypical antipsychotics (olanzapine, risperidone, quetiapine, etc.), and certain amino acids or related supplements {tryptophan, melatonin).
Are you being treated for anything else, besides the insomnia? Sometimes that helps in making a choice of medication: for example, if someone has depression and insomnia, one might choose a sedating antidepressant; for epilepsy or bipolar disorder with insomnia, a sedating anticonvulsant; etc. (Clonidine is commonly used in the treatment of children with ADHD; it helps them sleep and also has a calming effect in the daytime and may relieve anxiety.) So if you're being treated for another condition, that might aid in selection of a sedative drug.
For the most part, the ones you've tried are the ones that tend to cause tolerance. (Trazodone supposedly doesn't do this, but when I tried it I kept having to increase the dose every few days, so you're not alone.) There are many other options -- I've just listed the ones I could think of off the top of my head.
-elizabeth
poster:Elizabeth
thread:95084
URL: http://www.dr-bob.org/babble/20020222/msgs/95122.html