Posted by alan on April 10, 2002, at 12:21:41
In reply to ALAN - Long Term BZDs OK for Anxiety not Sleep? » Alan, posted by fachad on April 7, 2002, at 21:00:51
> ALAN wrote: BZDs aren't really designed for sleep disturbance problems long term. If you don't have an anxiety disorder, then it's best not to use BZDs for this purpose as the same dosage over time will become less effective.
>
> fachad replies: Huh? Is this the same Alan that vociferously defends the safety, efficacy, and appropriateness of long term BZDs for anxiety?
>
> Alan, your post genuinely intrigues me. If you have the time and the inclination, please review the stuff below for correctness and answer a few questions for me.
>
> Please make comments on any errors of fact or interpretation; I'm genuinely open-minded and would like to know what a seasoned BZD expert thinks.
>
> Just so you know, I have a "gut feeling" that you are correct, but I'm trying to determine if that feeling is rational and based on evidence, or if it is residual guilt secondary to indoctrination by the anti-benzo community.
>
> (1) "BZDs aren't really designed for sleep disturbance problems long term."
>
> Maybe it's just a semantic nuance, but I don't think BZDs were designed for any particular indication at all. They were just discovered and then marketed for all sorts of things, including insomnia and anxiety.
>
> Years after the BZDs were discovered, natural BZD receptors were identified in the brain. Later specific subtypes of the BZD receptors were identified. Different subtypes mediate the BZD influence on anxiety, sleep, muscle relaxation, etc.
>
> (2) "If you don't have an anxiety disorder, then it's best not to use BZDs for this purpose as the same dosage over time will become less effective"
>
> This appears to me to be a variant of the classic anti-benzo "you'll develop tolerance" argument. The argument generally runs that tolerance will develop and dose will have to be escalated and dependence will develop and you will be in a worse mess for having started BZDs, so you should never start them in the first place.
>
> But in this case, are you saying that the BZD receptor subtype that mediates the hypnotic effect will develop tolerance, but the BZD receptor subtype that meditates the anxiolytic effect does not develop tolerance?
>
> That premise seems odd, but not impossible. Again, I am just trying to figure out if that conclusion is based on empirical data, clinical experience, anecdotal evidence, or anti-benzo bias.
>
> Based on the considertions outlined above, do you still maintain that it's appropriate to use BZDs long term for management of anxiety disorders but not for sleep disorders?
>
> -fachad
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Excellent questions and I can see how what I said could have been misinterpreted.If you have underlying anxiety that is causing the sleepnesses then yes it is appropriate - although they disrupt sleep archetechture enough that they may end up causing huge sleep deficits.
But many times sleep disorders are a symptom of something else too - depression, apnea, etc. And bzd's lose their "start up" sedating effects after a week or two so many mistake that for the anxiolytic effect wearing off and unnecessarily up their dose.
As far as receptor subtypes are concerned, your theory sounds plausable and is probably accurate. I know of no credible studies about this though.
That's why I recommended TCA's in small dose and trazadone (anywhere between 50 - 200mg) since there is no tapering needed or significant change in sleep archetechture.
But I still believe that sleep disorders can be the result of something other than that of an anxiety (primary) disorder and those cases are best dealt with with the meds that I mention since there is usually a long tapering process with bzd's for sleep that will include along with it probable relapses back into insomnia.
Alan
poster:alan
thread:102248
URL: http://www.dr-bob.org/babble/20020408/msgs/102629.html