Posted by JLM on October 1, 2002, at 21:48:41
In reply to Re: Tapering off of Ativan for sleep..........., posted by JLM on October 1, 2002, at 0:26:22
> > Generally bzd's like ativan shouldn't be used for sleep because the sedative effect wears off. Of course if an anxiety disorder is what's keeping you awake, bzd monotherapy is completely appropriate to help with sleep.
> >
> > You could either:
> >
> > 1) Taper by 1/4 mg every week or few days, not going any faster than your body tells you to.
> >
> > or
> >
> > 2) Ask your doc for some klonopin (longer acting) to start or overlap with the ativan and then decrease the ativan slowly. The increase in anxiety from the ativan leaving your system will be taken over by the klonopin leaving your system at a much slower rate. This is a very common method and valium can be used instead of klon. Of course the trick is taking the right amount of Klon (perhaps .5mg at nite) while decreasing the ativan. Or more klon may be needed to start - in two equally divided doses daily since you'll feel the withdrawal throughout your waking hours.
> >
> > Any stratagies with you doc as to how to address the sleep issue once you're off? Just wondering...
> >
> >
> > Best,
> >
> > Alan
>
> Alan, thanks. Yes, we are going to do a sleep study in a sleep lab it sounds like. My HMO actually has one believe it not.
>
> I think a lot of it is poor sleep hygeine, and the fact that my internal body clock is way out of whack. Its called Delayed Sleep Phase Syndrome. In simple terms, instead of going to bed at a 'normal' time I am going to bed at 4 or 5 in the morning. For about 12 years I worked 2nd shift, and that is generally how it starts. Apparently people with DSPS don't really respond all that well to bz's for sleep, and I seem to be one of those people. The only thing that somewhat works is the ativan, and I don't think it works well enough to justify long term use. I simply don't want to take bz's for any reason, for any length of time.
>
> Usually DSPS is addressed by rolling forward your bedtime by 3 hours a day, until you get back all the way around the clock to an evening bedtime. Its my understanding that most people with DSPS, even thou they sleep, don't get refreshing sleep, and now for me its gotten to the point where I am even having a hard time initiating sleep, which is certainly anxiety producing. It tends to become a viscious cycle, because you lay there thinking 'I really need to fall asleep' and the more your worry about NOT sleeping, the less your able to sleep. Loads of fun ;)
>
> J
>
>
>
>Does this seem like a reasonable strategy to you?
http://www.benzo.org.uk/ashvtaper.htm
REASONS FOR A DIAZEPAM (VALIUM) TAPER
Professor C Heather Ashton DM, FRCP
April 2001School of Neurosciences
Division of Psychiatry
The Royal Victoria Infirmary
Queen Victoria Road
Newcastle upon Tyne NE1 4LPProfessor Ashton's Main Page
Diazepam [Valium] is one of the most slowly eliminated benzodiazepines. It has a half-life of up to 200 hours, which means that the blood level for each dose falls by only one half in about 8.3 days. The only other benzodiazepines with similar half lives are chlordiazepoxide [Librium], flunitrazepam [Rohypnol] and flurazepam [Dalmane] all of which are converted to a diazepam metabolite in the body. The slow elimination of diazepam allows a smooth, gradual fall in blood level, allowing your body to adjust slowly to a decreasing concentration of the benzodiazepine. With more rapidly eliminated benzodiazepine e.g. lorazepam, (Ativan) (which has a half-life of 10-20 hours) the blood concentration drops rapidly and withdrawal symptoms can occur between doses, because your body has little time to adjust to low concentrations.
Diazepam comes in the smallest dosage levels of all benzodiazepines – 2mg tablets which can be halved to give 1mg doses. This means you can reduce in stages of 1mg every 1-4 weeks or more. It is difficult to obtain such low doses of other benzodiazepines. For example the lowest dose of lorazepam in the UK is 1mg, equivalent to 10mg of diazepam. (In the US 0.5mg lorazepam are available, but these are equivalent to 5mg diazepam).
Many other benzodiazepines are more potent than diazepam. For example lorazepam (Ativan) is 10 times stronger and it is difficult to reduce from this gradually. Temazepam [Restoril], though less potent than diazepam, has a shorter half-life and the smallest tablet is 10 mg (equivalent to 5mg diazepam).
Because of the slow elimination and small available dosage strengths of diazepam, it is often advisable to switch to diazepam when withdrawing from other stronger or more rapidly eliminated benzodiazepines. This switch allows you to tail off your benzodiazepine dosage smoothly and gradually and minimises withdrawal symptoms.
When making the switch it is important to do it gradually, replacing one dose at a time and at approximately weekly intervals and making allowance for the difference in potency. For example, if you are taking lorazepam 1mg three times daily, first change the night dose to 10mg diazepam. (This can be done in two stages if necessary e.g. lorazepam 0.5mg (half a 1mg tablet) plus diazepam 5mg; then drop the lorazepam and go on to diazepam 10mg). A week or two later change one of the day-time doses, and two weeks later change the other day-time dose.
poster:JLM
thread:121630
URL: http://www.dr-bob.org/babble/20020930/msgs/121888.html