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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by pauladd on March 21, 2004, at 12:32:27
Diagnosed with ADD, trying stattera, has potential, but:
I'm finding strattera wakes me up in the middle of the night, or makes it hard for me to fall asleep. Then I am a zombie all day long. Groggy.
Any guidance on the best time of day to take it? I've tried morning, dinner time and bedtime.
Do these sleep disturbances go away after a while?
Perhaps there is something that would help me sleep? I've tried it with Adderall to wake me up during the day, no luck.
Don't really have access to my pdoc right now, getting the strattera from a GP that is somewhat clueless.
Posted by zeugma on March 21, 2004, at 15:24:41
In reply to Sleep disturbances with Strattera..., posted by pauladd on March 21, 2004, at 12:32:27
Are you taking divided doses or all at once? If you try all at once in the morning, that might help woth the insomnia.
Posted by pauladd on March 21, 2004, at 19:49:05
In reply to Re: Sleep disturbances with Strattera..., posted by zeugma on March 21, 2004, at 15:24:41
> Are you taking divided doses or all at once? If you try all at once in the morning, that might help woth the insomnia.
I tried a morning dose. Made me a zombie during the day. I tried that for about 2 or 3 weeks.
I also tried adding adderall during the day, but that didn't perk me up. Maybe provigil?
Posted by zeugma on March 21, 2004, at 22:19:43
In reply to Re: Sleep disturbances with Strattera..., posted by pauladd on March 21, 2004, at 19:49:05
The Provigil-Strattera combination is supposed to be a good one- I'm going to ask my pdoc if he's heard anything about this at my next appt. It might help.
Posted by King Vultan on March 22, 2004, at 8:04:34
In reply to Sleep disturbances with Strattera..., posted by pauladd on March 21, 2004, at 12:32:27
> Diagnosed with ADD, trying stattera, has potential, but:
>
> I'm finding strattera wakes me up in the middle of the night, or makes it hard for me to fall asleep. Then I am a zombie all day long. Groggy.
>
> Any guidance on the best time of day to take it? I've tried morning, dinner time and bedtime.
>
> Do these sleep disturbances go away after a while?
>
> Perhaps there is something that would help me sleep? I've tried it with Adderall to wake me up during the day, no luck.
>
> Don't really have access to my pdoc right now, getting the strattera from a GP that is somewhat clueless.
You might want to consider switching to the tricyclic desipramine, which has nearly identical therapeutic effects to Strattera, is much cheaper, and in my experience on the two drugs, caused less insomnia with no daytime sleepiness. I got so fed up with the insomnia and grogginess after a week on Stattera that I dumped it and switched back to desipramine, which I had taken some months before.Todd
Posted by Sad Panda on March 22, 2004, at 10:58:43
In reply to Re: Sleep disturbances with Strattera... » pauladd, posted by King Vultan on March 22, 2004, at 8:04:34
> > Diagnosed with ADD, trying stattera, has potential, but:
> >
> > I'm finding strattera wakes me up in the middle of the night, or makes it hard for me to fall asleep. Then I am a zombie all day long. Groggy.
> >
> > Any guidance on the best time of day to take it? I've tried morning, dinner time and bedtime.
> >
> > Do these sleep disturbances go away after a while?
> >
> > Perhaps there is something that would help me sleep? I've tried it with Adderall to wake me up during the day, no luck.
> >
> > Don't really have access to my pdoc right now, getting the strattera from a GP that is somewhat clueless.
>
>
> You might want to consider switching to the tricyclic desipramine, which has nearly identical therapeutic effects to Strattera, is much cheaper, and in my experience on the two drugs, caused less insomnia with no daytime sleepiness. I got so fed up with the insomnia and grogginess after a week on Stattera that I dumped it and switched back to desipramine, which I had taken some months before.
>
> Todd
>It's interesting, disapointing & disturbing that the older drugs are proving to be better than the newer drugs that are far more expensive.
Cheers,
Panda.
Posted by pauladd on March 22, 2004, at 11:09:16
In reply to Re: Sleep disturbances with Strattera... » pauladd, posted by King Vultan on March 22, 2004, at 8:04:34
>
> You might want to consider switching to the tricyclic desipramine, which has nearly identical therapeutic effects to Strattera, is much cheaper, and in my experience on the two drugs, caused less insomnia with no daytime sleepiness. I got so fed up with the insomnia and grogginess after a week on Stattera that I dumped it and switched back to desipramine, which I had taken some months before.
>
> Todd
>Thanks. I've tried desipramine several times. I'm very anxious on it and it makes me very angry at the most miniscule of things. Chest pain too.
I've tried just about everything under the sun - adderall, ritalin, wellbutrin, effexor, etc etc etc.
They either don't work or if they do work have some horrible side-effect.
Strattera seems the most benign so far...
Thanks
Posted by zeugma on March 22, 2004, at 22:47:09
In reply to Re: Sleep disturbances with Strattera... » King Vultan, posted by Sad Panda on March 22, 2004, at 10:58:43
> > > Diagnosed with ADD, trying stattera, has potential, but:
> > >
> > > I'm finding strattera wakes me up in the middle of the night, or makes it hard for me to fall asleep. Then I am a zombie all day long. Groggy.
> > >
> > > Any guidance on the best time of day to take it? I've tried morning, dinner time and bedtime.
> > >
> > > Do these sleep disturbances go away after a while?
> > >
> > > Perhaps there is something that would help me sleep? I've tried it with Adderall to wake me up during the day, no luck.
> > >
> > > Don't really have access to my pdoc right now, getting the strattera from a GP that is somewhat clueless.
> >
> >
> > You might want to consider switching to the tricyclic desipramine, which has nearly identical therapeutic effects to Strattera, is much cheaper, and in my experience on the two drugs, caused less insomnia with no daytime sleepiness. I got so fed up with the insomnia and grogginess after a week on Stattera that I dumped it and switched back to desipramine, which I had taken some months before.
> >
> > Todd
> >
>
> It's interesting, disapointing & disturbing that the older drugs are proving to be better than the newer drugs that are far more expensive.
>
> Cheers,
> Panda.
>
The newer drugs are new in the sense of being molecules that have fresh patents on them, but they are not new at all when it comes to how they work. Strattera was marketed as an ADD med when it was noticed that the almost pharmacologically identical desipramine was getting robust results treating ADD in children, but had the cardiotoxic 'TCA' label attached (and four children dropped dead for unknown reasons during the early '90's while taking desipramine. That opened up a market for Lilly to offer a 'safer alternative). I don't believe that we are going to get better drugs for depression or related conditions during our lifetimes. It may be that the TCA's and MAOI's define a limit for AD efficacy- since we have had them for over half a century and have not worked out in detail how THEY work, it is no wonder that nothing has come along since that has been any better.For certain purposes, however, Strattera is an improvement on desipramine. It is safer to combine with nortriptyline, for instance.
>
>
Posted by utopizen on March 24, 2004, at 23:10:57
In reply to Re: Sleep disturbances with Strattera... » Sad Panda, posted by zeugma on March 22, 2004, at 22:47:09
You may want to lower your dose of Straterra, and take it in divided doses at that lowered dose. Talk to your doctor about this... often patients find it difficult to tolerate 40mg as a starting dose, and require a lower one until side effects subside. Using a stimulant to take care of your immediate inattentive issues may help, but talk to your doc first-- they both target NE, and it's unknown if this can become an issue (although it is not uncommon to combine an amphetamine these days with Straterra).
A more rational (healthy) approach is to first, lower your dose, since you clearly are with your Adderall for any immediate issues if you need help with concentration while you adjust.
Second, talk to your doctor about combining Provigil with the Straterra. It's novel, but my Boston doc is a sleep doc who's at a big research hospital and has good experiences with patients combining the two when they have sleepiness+ADD.
Third, consider a sleeping pill (Ambien has the fewest interactions, and alternatives have very many)
If all else fails, if you think waiting it out for a couple of weeks with just a nightly dose will help you. A sleeping pill plus a lot of exercise, or exercise alone, should help you the most. If you begin a solid exercise regimen each day, it will actually change your sleep waves and make them more efficient. You will have deeper, more restorative sleep, and feel more refreshed afterwards. If you are not exercising, they may very well account for your sensitivity to this side effect. If you don't notice a difference after an exercise regimen, it is generally an indication you should try a more prolonged (and daily) one.
(e.g., if you walk/run an hour each day and still wake up at night, the chances of you walking/running two hours each day and falling asleep very well is quite good).
Many may rationalize that they don't have "time" for exercise, but if you considered the hours you lose through your sleep distrubances, you'd realize it's actually more productive to spend even up to 2-3 hours/day if you choose to than have poor sleep at night that wastes far more time out of your day.
It's unlikely you'll continue to receive sleep distrubances for a prolonged period, as your body generally is quite resillent with adjusting its sleeping rythms to med changes after awhile.
Again, talk with your doctor, and keep hope up. If you happen to have depression, note that my therapist told me what psychologists tell depressed patients is to "activate" themselves through regular meals each day, regular exercise, and socialization with people they like to be around.
If you have difficulty falling asleep, try going to sleep later at night, as doing otherwise will simply condition yourself to not associating your bed with sleep. Try a self-hypnosis tape as well. And wake up reasonably early in the A.M. every day of the week, at the same time everyday, despite how many hours you may have not slept the night prior. This sort of conditioning will take two weeks, in combination with regular exercise, regular meal times, and if necessary, CBT.
take care!
This is the end of the thread.
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