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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by miss volare on December 19, 2005, at 10:54:26
I just can't get more than 1.5-2 hrs of sleep at a time--then i'm awake and restless. I've been on 10 mg/d. What alternatives might work besides the diphenhydramine i've been taking? I've tried Ambien and it did Nothing. Can't do benzos due to previous addiction. Maybe i should become an inventor and follow the Alexander G Bell sleep hygiene schedule!
Posted by med_empowered on December 19, 2005, at 17:21:47
In reply to Abilify (apriprazole) and insomnia, posted by miss volare on December 19, 2005, at 10:54:26
hi! You might want to try Abilify in the AM. Also, try reducing the dose a bit. How bad was your benzo addiction? Some docs can be understanding and work with you..something like Restoril could be very helpful in your situation. If thats not an option...higher-dose Ambien (some docs will RX 20mgs or so for hardcore insomnia), possibly add-ons like Neurontin or Trazadone, might help.
Posted by Phillipa on December 19, 2005, at 19:59:21
In reply to Re: Abilify (apriprazole) and insomnia, posted by med_empowered on December 19, 2005, at 17:21:47
I was told by the pharmacist that lunesta is considered a scheduled drug. So how can they advertise that it is nonaddictive and for longterm use? fondly, Phillipa
Posted by yxibow on December 19, 2005, at 22:38:23
In reply to Re: Abilify (apriprazole) and insomnia » med_empowered, posted by Phillipa on December 19, 2005, at 19:59:21
> I was told by the pharmacist that lunesta is considered a scheduled drug. So how can they advertise that it is nonaddictive and for longterm use? fondly, Phillipa
It is C-IV like Ambien. It has partial affinity for BZ receptors although not to the extent that other C-IV drugs such as benzodiazepines have. For its FDA intended purpose, sleep, Ambien and Lunesta are in most people, non-addictive and mostly non-habituating (I tend to need a higher dose of Ambien personally so one could say I'm slightly more habituated by cross tolerance to benzodiazepines).
For some bizarre drug spree of 10x the dose of Lunesta or Ambien offlabel and unregulated... well, that's another story. And one would get rather sick anyway at such a dose.
Its semantics too, because I would not consider benzodiazepines addictive, but habituating. C-II and C-III narcotics I would consider potentially and most likely addictive, e.g. morphine, oxycontin, etc. Not to mention nicotine.
Posted by temoigneur on December 19, 2005, at 22:53:25
In reply to Abilify (apriprazole) and insomnia, posted by miss volare on December 19, 2005, at 10:54:26
> I just can't get more than 1.5-2 hrs of sleep at a time--then i'm awake and restless. I've been on 10 mg/d. What alternatives might work besides the diphenhydramine i've been taking?
Hi, I've had really bad insomnia, where I stare at the wall till 5 AM and feel that only a lead mallet would bring sleep.. For me Remeron is extremely sedating. I had a benzo addiction as well, I'll post an article about sleep meds..
Unfortunately all the hypnotics that worked well for me when the Antidepressants were working are benzo related/based.. I'm not a chemist, so I don't know about interactions but I'd try remeron if your doctor okays it.
Important to take probably no more than fifteen milligrams, as it looses it's sedating properties as you raise the dose above that, for some. Here's the article on sleep meds.. I really want to try abilify too, so I'll be interested to see if you can sleep:)
"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."
Posted by yxibow on December 19, 2005, at 22:54:09
In reply to Abilify (apriprazole) and insomnia, posted by miss volare on December 19, 2005, at 10:54:26
> I just can't get more than 1.5-2 hrs of sleep at a time--then i'm awake and restless. I've been on 10 mg/d. What alternatives might work besides the diphenhydramine i've been taking? I've tried Ambien and it did Nothing. Can't do benzos due to previous addiction. Maybe i should become an inventor and follow the Alexander G Bell sleep hygiene schedule!
Prior addiction does not mean that future addiction is a guaranteed means of action though I sympathize with your concern. I would try to convince your doctor to take Ambien at 20mg -- many people do, including myself.. well I actually backed off to 15mg at the moment. Your prior use of benzodiazepines may have made more cross tolerance as it is not fully out of your system perhaps.
The suggestion of Abilify in the morning is also a good one -- it causes akathisia, which you may be experiencing, in which case I would add Akineton (biperiden).
There are other more off and on-label sleep aids that I would list in order of yuck
Remeron (mirtazapine), tetracyclic, weight/hunger inducing. REM sleep potential.
Sinequan (doxepin), tricyclic, groggy first few times at least, go easy on dosing
Desyrel (trazodone), unrelated antidepressant, possible dose escalation and general groggy mirth. Priapism in males.
Cloral Hydrate.. not terribly safe.
I would try to convince your doctor on the Ambien or try Lunesta. Halcion, Restoril, or Dalmane are also benzodiazepines that are more directed towards sleep than other benzodiazepines which are more anxiolytic so the question isn't necessarily addiction but abuse to life threatening potentials if you truly cannot control addiction. That is between you and your doctorHope you get some pleasant dreams
Posted by Emme on December 20, 2005, at 14:58:22
In reply to Abilify (apriprazole) and insomnia, posted by miss volare on December 19, 2005, at 10:54:26
> I just can't get more than 1.5-2 hrs of sleep at a time--then i'm awake and restless. I've been on 10 mg/d.
1) How long have you been on it? My abilify-induced insomnia has improved somewhat since I started it in August. My pdoc says the sleep situation often improves with time. In the meantime.....
2) Have you and your doc discussed seroquel? Perhaps in conjunction with a lower dose of Abilify? As far as sleeping aids, I prefer Seroquel over Ambien, Lunesta, Rozerem, and Trazodone.
Gpood luck.
Emme
Posted by miss volare on December 21, 2005, at 16:27:41
In reply to Re: Abilify (apriprazole) and insomnia » miss volare, posted by Emme on December 20, 2005, at 14:58:22
Thanks very much for all the good advice/info. I have been on just about every SSRI/SSNRI/atypical/etcetera to treat my rapidcycling bipolar. I appreciate your input, but can't see getting on ANOTHER drug to add to the four i am taking. I guess i'll just ride this one out...
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