Posted by Elizabeth on April 11, 2002, at 10:10:03
In reply to Re: ALAN - Long Term BZDs OK for Anxiety not Sleep? » fachad, posted by alan on April 10, 2002, at 12:21:41
> 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.
I don't think the disruption will necessarily cause serious problems. (Antidepressants disrupt sleep architecture a lot too, after all, and nobody's saying we shouldn't be using those long-term.)
> But many times sleep disorders are a symptom of something else too - depression, apnea, etc.
That's something you have to watch out for. Benzos can actually be dangerous for people with sleep apneas. It's usually okay to use benzos for insomnia associated with depression, as long as you treat the depression too.
> 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.
It's hard to separate the sedative and anxiolytic effects of benzos. I think that, as a rule, you shouldn't expect a sedative-hypnotic drug to "knock you out" -- you need to lie down and turn the lights off and do your best to relax, too! I think this may be why many people report rapid tolerance to sedative-hypnotics. Of course, benzos do lose their sedating effects with time (this is an advantage when they're used to treat daytime anxiety). The short-acting benzos tend to cause tolerance more/faster than the long-acting ones.
> As far as receptor subtypes are concerned, your theory sounds plausable and is probably accurate. I know of no credible studies about this though.
It's not just fachad's theory. Ambien binds selectively to a particular subtype of benzodiazepine receptor, and it lacks many of the effects of benzos (muscle relaxant, anticonvulsant, etc.).
> 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.
I had tolerance problems with both of these, having to raise the dose every couple of days in order to maintain the sedative-hypnotic effects. (I got up to 400 mg of trazodone before giving up on it; in a pinch I even used it in the daytime once as an antihistamine.) I also know of a few other people who also found that they stopped working after a little while. Also, TCAs and trazodone can both cause withdrawal symptoms -- not as bad as benzo withdrawal, of course, but TCA withdrawal in particular can be very unpleasant.
Trazodone tends to increase the time spent in sleep stages III and IV and decrease state II sleep. Interestingly, it can increase the time spent in REM sleep. It doesn't increase REM density as the SSRIs do. TCAs have various effects on sleep architecture. In particular, they decrease the amount and percentage of time spent in REM sleep. They also tend to increase slow-wave sleep. Benzodiazepines decrease the percentage of time spent in slow-wave sleep and REM sleep, increase the percentage in stage II sleep, and increase REM latency. There is also an increase in the number of REM cycles, although they are shortened. So anyway, it's hardly accurate to say that TCAs and trazodone cause no "significant change in sleep architecture."
-elizabeth
poster:Elizabeth
thread:102248
URL: http://www.dr-bob.org/babble/20020408/msgs/102745.html