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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by temoigneur on December 18, 2005, at 22:54:30
Ed wrote;
How is dexedrine affecting your sleep?
The first night I was on Dexedrine I stared at the wall till 5AM, despite taking 5mg zyprexa, 15mg Remeron, 1mg clonazepam and about thirty mg of Nozenan! I gained extremely rapid tolerance to the 20mg dexedrine spanule, and the next day I felt neither the manic effect or the insomnia.
So I have two problems in the immediate; tolerance to stim. and insomnia when they do work.
I'm taking the stimulants in the first place because I'm so drugged from 5mg zyprexa 325 valproac acid, and 2mg clonazepam, that I can hardly stay awake for even part of the day without a stimulant. I don't reduce these medications right now because I'm stabilized on them.. I'm hoping maybe the combination of these and a stimulant will give me something more than coming off everything, but as I'm typing it here it doesn't make sense, too many medications.
At any rate, when the antidepressants and or the stimulants are working, I have really bad insomnia.. so I wanted to address the sleep issue.
I understand that many insomnia pills work via benzodiazepine receptors. When I initially took SSRI's I slept well with Immovane for 4 months, then gained tolerance to it, and things fell apart.
The article I'll post below talks about switching between 'benzo' sleeping agents and other types, taking the other types more than fifty percent of the time. When the antidepressants or stimulants are working though, the strongest non benzo sleeping aid I've found; remeron, isn't strong enough to put me to sleep. I was wondering if anyone had knowledge of a very sedating, short acting antipsychotic that I might combine with say Remeron on the non benzo' nights.. Hopefully an AP that wouldn't strong affect functioning during waking hours. I could then switch between that and chloral hydrate, - a benzo like sleep aid. Here's the article;
"All the typically used sleep meds such as Lunesta, Ambien, Ambien CR, Sonata, Hacion, Klonopin, Restoril are all variants on the benzodiazepine mechanism. They all attach to one or more of the Benzodiazepine sites on the GABA receptors in the sleep areas of your brain. Because they vary somewhat in which site subtypes they attach to and where those type are located in the brain, there are variations on how they effect anxiety, sleep, seizures etc... That being said, the adaption process by which you become tolerant and they cease to work without increasing the dose is the same. That means they are "cross tolerant" in that tolerance to one creates some tolerance to every other depending on the differences mentioned earlier. That means rotating will slow the process by some percentage, maybe 20-70% depending on which and how you do it. You will still develop tolerance, you will slowly become physicallly addicted and when you quit you will experinece quite nasty withdrawal if you do this for a 6 months or more, give or take.
Rotation will work if you rotate away from the benzodiazepine sleep meds more than 50% of the time. The more the better. That gives your brain the time to adapt back to normal during the no benzo nights. They call that the drug holiday approach and it does work if followed properly. Some of the meds you can try during the no-benzo nights might be melatonin, Rozerem, Unisom, Benadryll, Remeron, Seroquel , Trazadone, Aluna, Valerian, 5HTP, nothing, etc...
Xyrem, Alcohol, Phenobarbital and Chloral Hydrate also work via the GABA mechanism so will have cross-tolerance also."
Thank you Ed, Med Emp, others
Posted by ed_uk on December 19, 2005, at 13:05:34
In reply to Sleeping well consistently Ed_UK Med Emp others;, posted by temoigneur on December 18, 2005, at 22:54:30
Hi
>So I have two problems in the immediate; tolerance to stim. and insomnia when they do work.
How do you know that? You never tried a lower dose of Dexedrine :-) 20mg was too much to start with.
>antipsychotic
Have you ever tried Seroquel for sleep?
>I could then switch between that and chloral hydrate...
Why chloral hydrate?
Regards
Ed
>
Posted by temoigneur on December 20, 2005, at 22:05:56
In reply to Re: Sleeping well consistently Ed_UK Med Emp others; » temoigneur, posted by ed_uk on December 19, 2005, at 13:05:34
> Hi
>
> >So I have two problems in the immediate; tolerance to stim. and insomnia when they do work.
>
> How do you know that? You never tried a lower dose of Dexedrine :-) 20mg was too much to start with.I think I wanted to be in perpetual mania;) I've gained some tolerance to the stim and no longer have sleep trouble at 20mg; >
> >antipsychotic
>
> Have you ever tried Seroquel for sleep?
>
Seroquel made me horribly psychotic...:(
> >I could then switch between that and chloral hydrate...
>
> Why chloral hydrate?
>
For some reason I thought Chloral Hydrate was strong ... and might be one of the only hypnotics I would respond too, right now I'm focussing on abilify for my schizo affective... (alleged)thanks
> Regards
>
> Ed
>
> >
Posted by ed_uk on December 21, 2005, at 14:24:00
In reply to Re: Sleeping well consistently Ed_UK Med Emp others; » ed_uk, posted by temoigneur on December 20, 2005, at 22:05:56
Hi
>I think I wanted to be in perpetual mania;)
What goes up must come down :-( ......a good reason to be cautious with the dose.
Ed
This is the end of the thread.
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