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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by skills on February 22, 2002, at 7:28:30
i have a real problem sleeping. I have tried many BZDs and choral hydate and trazodone with some succes. I have not found anything that is suitable for long term use. I am now on lofepramine to try and help sleep. Is this useful? Any other sujestions would be very much appreciated. Thanks....skills
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
Posted by johnj on February 22, 2002, at 16:51:32
In reply to sleep advice needed, posted by skills on February 22, 2002, at 7:28:30
Remeron is the best thing I have found for insomnia/depression/anxiety. The sedation is rought at first and I would suggest starting at 30 mgs, that is what I did. Start it on a Friday night would be better too, I almost didn't make it to work the first day I took it. It has been the best for me, far better that the TCA(pamelor) I took.
Posted by TenelKa on February 22, 2002, at 17:36:54
In reply to Re: sleep advice needed » skills, posted by Elizabeth on February 22, 2002, at 14:29:45
Isn't it odd how someone else describes the exact problem you might have but didn't know how to phrase? (I feel your pain skills!) Elizabeth, I read your post about:
"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?" ... what happens if it's all three?
Posted by Kat26 on February 22, 2002, at 19:48:49
In reply to sleep advice needed, posted by skills on February 22, 2002, at 7:28:30
Please don't laugh, but praying for sleep really has helped me every single time.
Kat26
Posted by Ritch on February 23, 2002, at 9:18:55
In reply to Re: sleep advice needed, posted by Kat26 on February 22, 2002, at 19:48:49
> Please don't laugh, but praying for sleep really has helped me every single time.
>
> Kat26Hi Kat,
I don't think that is funny at all. I think a big source of insomnia is GAD-related intrusive worrying that you can't shut off so you can get to sleep. I have had a lot of workplace stressors over the last two weeks and I just can't stop thinking about them and my sleep has been the worst its been in three months. Prayer probably is an interesting form of "CBT" that people haven't really thought about. It shifts your attention away from the cyclic-thoughts keeping you awake. So should meditation. My clonazepam doesn't work for sleep anymore (not well, anyway), and I don't like feeling groggy from medication when I get up.
Mitch
Posted by skills on February 23, 2002, at 12:56:09
In reply to Re: sleep advice needed » Kat26, posted by Ritch on February 23, 2002, at 9:18:55
Thanks for all the advice. My sleeping problem means that i sleep between the hours of 10pm-12am and then wake up. I am then awake for the rest of the night. I feel tried all day but cannot sleep and this makes me feel awful. BZDs do not work, apart from rohypnol but this is unsuitable as a treatment. My doctor has run out of ideas but i will suggest Remeron. thanks......skills
Posted by Ritch on February 23, 2002, at 14:21:03
In reply to Re: sleep advice needed, posted by skills on February 23, 2002, at 12:56:09
> Thanks for all the advice. My sleeping problem means that i sleep between the hours of 10pm-12am and then wake up. I am then awake for the rest of the night. I feel tried all day but cannot sleep and this makes me feel awful. BZDs do not work, apart from rohypnol but this is unsuitable as a treatment. My doctor has run out of ideas but i will suggest Remeron. thanks......skills
Hi,
Interesting. That is the exact type of insomnia I get. I rarely ever have trouble getting to sleep from the get go. I usually will sleep a little longer before I get up though. I am an evening worker and I normally get to sleep about midnite-1am and then if I have an early morning awakening it usually is about 4-5am (3-4 hrs later). Then it is impossible to get back to sleep until just before I have to get up! Then I will really start to drift off and sleep about 7am or so. Very frustrating. If that is your primary problem Remeron should do ya! I have never seen any other med in my life cause so much sleepiness. You may have trouble with grogginess the next day. Some people it doesn't bother.Mitch
Posted by Gracie2 on February 23, 2002, at 23:21:11
In reply to Re: sleep advice needed » skills, posted by Ritch on February 23, 2002, at 14:21:03
I've had trouble with insomnia since my early teens. Anyone who has not suffered from severe
long-term insomnia cannot imagine the total emotional chaos that results and the debilitating long-term effects.
I am being treated for manic depression and the ensuing bouts of sleepnessness during the manic cycle. This drug nearly forces you to sleep at night and get up in the morning. Before your body adapts to the drug, you will have to power through a couple of weeks of great lethargy and fatigue, which is frustrating. After 2-3 weeks,
you will find yourself adapting to the medication, so don't give up on it. Energy sloooowly returns, and you must concentrate on the small steps you are taking towards improvement instead of dwelling on the things you are not able to do during the transition, because those abilities will eventually return.
Many people - including myself - were put off by the fact that Seroquel is an anti-psychotic. I have never been psychotic, and I didn't want to be labeled as such. Apparently Seroquel has other uses. I am now ready for sleep (usually)by 10:00 pm and sleep soundly until morning. This is an absolute,almost miraculous change in my routine, and has put me more in touch with the "real world". I would discuss the use of Seroquel with your doctor.
Good luck- Gracie
Posted by Maisy on February 24, 2002, at 20:38:38
In reply to sleep advice needed, posted by skills on February 22, 2002, at 7:28:30
Here is an article you might find useful.
http://www.pslgroup.com/dg/12EA62.htm
Posted by sugarbush_inthenorth on March 26, 2003, at 9:53:30
In reply to Advice from the insomnia Queen, posted by Gracie2 on February 23, 2002, at 23:21:11
Im so glad to hear that your getting sleep...
:)
I had a car accident in 96 sustained head injury. Since then, I have always had sleep disturbances.My Dr. placed me on Seroquel and I started thinking...
Does my doctor think im Shzoid? I didnt want to get labeled either. Going to the pharmacy and getting that extra glance, annoys me.In the past My neurophysc. tried Selegeline to keep me awake. But then an assault happened in 2001 in Florida, I couldnt sleep:(((
Man! did I yo yo...sleep deprived for two weeks, Totally time, sleep would have been a few days. I actually started dreaming while I was awake. Past memories overlapped reality...whew...
Anyway Im glad to know that there is someone else out there using Seroquel to sleep.
Sleep deprivation is exhausting, emotionally, mentally, physically.
Posted by jay beck on July 4, 2003, at 17:19:03
In reply to Re: Advice from the insomnia Queen, posted by sugarbush_inthenorth on March 26, 2003, at 9:53:30
i had insomnia myself i wanted prescription meds but my prevous drug history prevented my p-doc from prescibing them (actually glad he didnt now). i use the herb valerian and the suppliment melatonin an hour before i want to try to sleep. it gave me a big improvement. I also cut my 2nd cup of coffee out of my life. now im sleeping adiquatly. my general rule is if you can avoid more medication its for the better. Im also really against using anti-psychotics for sleep, they really do muck with your brain and can zombie someone out.
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