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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 4 to 28 of 28. Go back in thread:
Posted by notfred on October 27, 2006, at 22:21:43
In reply to Re: Lunesta » johnnyj, posted by yxibow on October 27, 2006, at 3:50:16
> May challenge Lunesta again at 4(+)mg to see what it does.
I have been on 6 mgs ~7 months. Lunesta is weakish
as a hynoptic, it takes a higher dose to be effective for some people.
Posted by yxibow on October 28, 2006, at 1:15:12
In reply to Re: Lunesta, posted by notfred on October 27, 2006, at 22:21:43
> > May challenge Lunesta again at 4(+)mg to see what it does.
>
>
> I have been on 6 mgs ~7 months. Lunesta is weakish
> as a hynoptic, it takes a higher dose to be effective for some people.
>
>6.. wow... I don't think my psychiatrist would start out at that :). That's like 30mg of Ambien or something. I did once take 25mg of Ambien, not much difference.
-- tidingsJay
Posted by notfred on October 28, 2006, at 10:35:01
In reply to Re: Lunesta » notfred, posted by yxibow on October 28, 2006, at 1:15:12
> 6.. wow... I don't think my psychiatrist would start out at that :). That's like 30mg of Ambien or something. I did once take 25mg of Ambien, not much difference.
>I see a top psycopharmacologist, he is the first doc to have recognized I am a fast metabolizer.
It is nice to not be limited the standard PDR dose or at least being able to quickly move to the higher ranges indicated
by the monograph. I burn up normal doses too fast for them to often be effective, for some drugs.My pdoc is/or did do research w/Lunesta. He was telling me about a conference he went to, there may be a change in the dosage indications for this drug.
I would not compare it to Ambien, the half lives are very different. The indications are different,
It does not seem Ambien CR is really more effective in stopping early waking.Of course I did not start at 6. Lunesta did not work for me till I went to 6 mg, I started at 3. I don't have any real sig. hangover, I just woke up from 8 hrs sleep and am typing on the laptop w/i 10 mins of waking.
I just checked, I have been on lunesta for 10 months now (I have been saying 7, which was a guess). In the past I have avoided true hypnotics for sleep for several reasons.
1) They all cause speech problems. I have a background in speech pathology so I am very sensitive to fluency and articulation problems,
most people might call this slurring ones words.
I always have it, usually after waking, on hypnotics. It tends to happen a bit during the day
and although very minor, I do not suspect people notice, but it drives me crazy.
2) memory problems
3) Interaction with PRN Ativan, increasing common benzo side effects.Lunesta is not causing any of this yet, & at 10 months it is getting quite likely it is not going to happen. Ambien most likely would not either; it is just too short acting to work for me.
Posted by Phillipa on October 28, 2006, at 19:25:07
In reply to Re: Lunesta, posted by notfred on October 28, 2006, at 10:35:01
Notfred this I have wondered about so many times but how do you know if you're a fast metabolizer as I must be as I never no matter the combo sleep more than four hours at a time and then a repeat is necessary. Thanks Love Phillipa
Posted by yxibow on October 28, 2006, at 21:03:16
In reply to Re: Lunesta, posted by notfred on October 28, 2006, at 10:35:01
> > 6.. wow... I don't think my psychiatrist would start out at that :). That's like 30mg of Ambien or something. I did once take 25mg of Ambien, not much difference.
> >
>
> I see a top psycopharmacologist, he is the first doc to have recognized I am a fast metabolizer.As I do too if we're not trading me toos and silly mine is better... :)
> It is nice to not be limited the standard PDR dose or at least being able to quickly move to the higher ranges indicated
> by the monograph. I burn up normal doses too fast for them to often be effective, for some drugs.I do also. It's called practice out of standard psychiatric care but both of us know that there is a level of certain medications that will burn through me too.
>
> My pdoc is/or did do research w/Lunesta. He was telling me about a conference he went to, there may be a change in the dosage indications for this drug.That would be good to bring it into "mainstream". I know its already regularly challenged at 4 from what I can see on here.
> I would not compare it to Ambien, the half lives are very different. The indications are different,
> It does not seem Ambien CR is really more effective in stopping early waking.Correct, I was just lumping it into the category of pseudobenzodiazepines. Lunesta, which is the only useful/active metabolite of the generic zopiclone sold around the world is a cyclopyrrone while Ambien is a imidazopyridine.
>
> Of course I did not start at 6. Lunesta did not work for me till I went to 6 mg, I started at 3. I don't have any real sig. hangover, I just woke up from 8 hrs sleep and am typing on the laptop w/i 10 mins of waking.Pretty good. I wouldn't have any "hangovers" if it weren't for the Seroquel too, probably.
> I just checked, I have been on lunesta for 10 months now (I have been saying 7, which was a guess). In the past I have avoided true hypnotics for sleep for several reasons.
>
> 1) They all cause speech problems. I have a background in speech pathology so I am very sensitive to fluency and articulation problems,
> most people might call this slurring ones words.
> I always have it, usually after waking, on hypnotics. It tends to happen a bit during the day
> and although very minor, I do not suspect people notice, but it drives me crazy.Other medications that modulate GABA also have speech problems: Neurontin, especially at the beginning can cause major amounts of it as it tapers as one is used to it. The patient (at least in my opinion) is rarely aware.
> 2) memory problems
That is a problem with a number of things that modulate GABA as well.
> 3) Interaction with PRN Ativan, increasing common benzo side effects.
The Ativan actually means you're not benzodiazepine naive and therefore there is crospollination which besides high metabolizing may necessitate a higher dose of a pseudobenzodiazepine (e.g. Lunesta.)
>
> Lunesta is not causing any of this yet, & at 10 months it is getting quite likely it is not going to happen. Ambien most likely would not either; it is just too short acting to work for me.Sounds great -- I assume you get your liver levels checked at a physical, etc.
Posted by notfred on October 28, 2006, at 23:06:45
In reply to Re: Lunesta » notfred, posted by Phillipa on October 28, 2006, at 19:25:07
> but how do you know if you're a fast metabolizer
Testing for levels of products of metabolism. In some meds we know what is average & tests exist.
Genetics controls a lot of metabolism but all of the processes and genes used for each drug are not fully known.For me with AD's I get few side effects at normal
doses but also few effects in general. I can take doses that would leave others comatose. 300 mgs of doxepin and I am just fine. Most would never wake up.
Posted by Phillipa on October 28, 2006, at 23:32:06
In reply to Re: Lunesta, posted by notfred on October 28, 2006, at 23:06:45
Is that why I can take 20mg of valium,.5 or lmg of xanax and even add in seroquel at about l6mg as I bite the 25mg and still not sleep or wake up in four hours? And is that why Ad'd don't work for me? I really dont understand all the technical stuff. They don't teach that in nursing. I probably should have e-mailed you. oh well Love Phillipa
Posted by ed_uk on October 29, 2006, at 10:31:53
In reply to Re: Lunesta » notfred, posted by yxibow on October 28, 2006, at 21:03:16
The standard dose of zopiclone is 7.5mg, which would have the same effect as 3.75mg Lunesta. Although 7.5mg is the maximum approved dose of zopiclone, I occasionally see prescriptions for 15mg or 22.5mg. Elderly people are sometimes prescribed the 3.75mg tablet.
Ed
Posted by notfred on October 29, 2006, at 15:25:12
In reply to Re: Lunesta » notfred, posted by yxibow on October 28, 2006, at 21:03:16
>
> As I do too if we're not trading me toos and silly mine is better... :)
>Good for you. I always advocate that people see the best pdoc they can, on this board. Once you start doing just 15 min med checks it really is not that expensive to see someone good.
Yes, I have good primary health care.
Posted by johnnyj on October 29, 2006, at 16:15:30
In reply to Re: Lunesta » johnnyj, posted by yxibow on October 27, 2006, at 3:50:16
It took me a few weeks to get used to lunesta (3 mg) It does cause a lot of dreams and I remember them more too. I am on nothing else right now. It seemed to make me sleep (knocks me out at some point)but initially it seemed to make me feel kind of depressed. This seems to come and go and I feel it is kind of drug induced (hard to explain that though). I do have some anxiety issues but I am starting to wonder if some things are lunesta side effects. I was on tranzene for over 10 years and felt so much better when I went off. I can't believe I was on it for so long. Small doses were the worst withdrawal as I am med sensitive.
Oh yeah, one big thing I have is a startle if I wake early and try to go back to sleep. My body jerks me awake as sleep is too light. This is so annoying.
I am also off lithium now because my pdoc does not know why I was ever put on it. I am unipolar with anixety/ocd (pure O) as my main symptoms. Anxiety seems to cause me to become depressed more than the other way around. I had lithium withdrawal for about 3 weeks and then things improved. Head tension is the worst side effect for me right now and that is what gets me down.
I also finally found out that I have a lot of allergies and take claritin now with moderate relief.
So, I am thinking of stopping Lunesta and see if I can sleep. With a back up plan if things go bad. My pdoc wants me on luvox and klonopin, but I am wary of benzo's since tranzene was terrible for me. If I sleep things are good and I know when I wake up how the day is going to go. If my head is heavy it is a rough day.
Any suggetions or comments anyone?
johnnyj
Posted by johnnyj on October 29, 2006, at 16:30:11
In reply to Re: Lunesta, posted by notfred on October 27, 2006, at 22:21:43
Did you have any withdrawal when you stopped it. I don't know if I should stop completely or taper? The doc says to stop is ok, but I am not sure??
I can take a few days of not sleeping but tapering doesn't seem like it would help in the case of lunesta. I think SLS talked something about kindling?
Any comments?
Posted by notfred on October 29, 2006, at 17:02:50
In reply to Re: Lunesta » notfred, posted by Phillipa on October 28, 2006, at 23:32:06
> Is that why I can take 20mg of valium,.5 or lmg >of xanax and even add in seroquel at about l6mg >as I bite the 25mg and still not sleep or wake up >in four hours? And is that why Ad'd don't work >for me?
I wish I could answer that but only a doc can.
I do think metabolism is one of the many things that needs to be checked when there is consistent med failure.That might be a good question for your doc, is there a way to tell if I am a fast metabolizer ?
There are tests for this for only a handful of psyco meds.I remember you were getting some things accessed concerning lymes, how is that going ?
Posted by notfred on October 29, 2006, at 17:38:14
In reply to Re: Lunesta » notfred, posted by johnnyj on October 29, 2006, at 16:30:11
> Did you have any withdrawal when you stopped it. I don't know if I should stop completely or taper? The doc says to stop is ok, but I am not sure??
>I would use some klon at bedtime but in general
if you take klon it should cover you for any withdrawal effects from Lunesta. Except for getting to sleep. Either take some klon or
slowly step down the Lunesta dose/klon dose you take at night.> I can take a few days of not sleeping but tapering doesn't seem like it would help in the case of lunesta. I think SLS talked something about kindling?
Kicking the legs out from under something is not effective here. Withdrawal is a sign you are stressing your nervous system. This may set you
up for more protracted problems or initiate additional cycles now or later. This is easy to avoid with a taper or substution.
Posted by Phillipa on October 29, 2006, at 19:07:37
In reply to Re: Lunesta, posted by notfred on October 29, 2006, at 17:02:50
Western blot still positive but it always will be as I had active lymes so the Western blot the most accurate test will remain positive. But since there was none in my cerebral spinal fluid the rheumatologist said I'd gotten enough antibiotics. I was on them for over three years. But who knows what organs were attacked it's a sneaky disease. And the spirochettes hide in you body tissues and can come out at any time. For all I know it's responsible for the thyroid being hyper now. But lyme's right now has a lot of controversy surrounding the proper treatment. Love Phillipa
Posted by yxibow on October 30, 2006, at 7:31:28
In reply to Re: Lunesta » notfred, posted by Phillipa on October 29, 2006, at 19:07:37
> Western blot still positive but it always will be as I had active lymes so the Western blot the most accurate test will remain positive. But since there was none in my cerebral spinal fluid the rheumatologist said I'd gotten enough antibiotics. I was on them for over three years. But who knows what organs were attacked it's a sneaky disease. And the spirochettes hide in you body tissues and can come out at any time. For all I know it's responsible for the thyroid being hyper now. But lyme's right now has a lot of controversy surrounding the proper treatment. Love Phillipa
The Western Blot is only the most accurate -after- one gets the IgG and IgM (if I recall the correct spelling) titers.
Posted by johnnyj on October 30, 2006, at 8:57:32
In reply to Re: Lunesta, posted by notfred on October 29, 2006, at 17:38:14
Wouldn't I just be substituing one drug for another with Klonopin? How would I do that and not get dependent on the klo? Any suggestions on dosage?
I woke up this morning feeling dizzy and spacey, and my ears very sensitive. It seems like I feel worse in the morning. I don't know if this is because on the lunesta? I woke up after about 6 hours, had a light one hour and then wide awake at 5:30. The funny thing is I don't have terrible anxiety right now.
I have a terrible tension headache. I do have bruxism so this is part of the problem.
I tried to do progressive muscle relaxation last night and kept jerking awake. This was before taking lunesta.
From some reading I wonder if my tension stuff is anxiety/depression and maybe an ssri needs to be tried. However, this can cause possible more bruxism. I also read that neurotin has helped this. All I know is I am getting more tired as time goes by.
Any suggestions anyone?
johnnyj
Posted by Phillipa on October 30, 2006, at 17:48:25
In reply to Re: Lunesta » Phillipa, posted by yxibow on October 30, 2006, at 7:31:28
Had an infection control specialist they tested all of those too. I have a copy of the medical records here. When we moved here I was sent to a rheumatologist who worked at Yale New Haven and is very familiar with lymes. He checked all the bloodwork and tests that were done. He said I'd had the max of antiobiotics and did one more Westen Blot that the health dept called me to say it was positive. Called the doc's office the Nurse said to send all the paperwork to them from the health dept as all was well. Love Phillipa
Posted by Phillipa on October 30, 2006, at 17:57:19
In reply to Re: Lunesta » notfred, posted by johnnyj on October 30, 2006, at 8:57:32
Johnny yes you would be. But sleep is important. A TCA pamelar knocked me out at l0mg so hard I couldn't get out of bed untill 2pm. And that is a very low dose. Love Phillipa sorry your thread was hyjacked for a while
Posted by yxibow on October 31, 2006, at 13:04:03
In reply to Re: Lunesta, posted by notfred on October 28, 2006, at 10:35:01
I'm now trying it at 4mg. The first time I fell asleep at the computer. I believe 4 and beyond are more effective than Ambien, but who knows -- its again, all the individual. Curiously enough this time the taste really wasnt some favourite metal or even transmetal [humour].
-- Jay
Posted by johnnyj on November 1, 2006, at 8:18:22
In reply to Re: Lunesta » notfred, posted by yxibow on October 31, 2006, at 13:04:03
the last 4 or 5 days I have been waking up feeling really wierd. I am on 3 mg. I have dizziness and spaciness, and my ears are really sensitive. My head is heavy too and feel more depressed. The dizziness is the worst and I am having a hard time focusing. Things seem to improve throughout the day which makes me wonder if these are side effects?
johnnyj
Posted by yxibow on November 1, 2006, at 13:34:06
In reply to Re: Lunesta » yxibow, posted by johnnyj on November 1, 2006, at 8:18:22
> the last 4 or 5 days I have been waking up feeling really wierd. I am on 3 mg. I have dizziness and spaciness, and my ears are really sensitive. My head is heavy too and feel more depressed. The dizziness is the worst and I am having a hard time focusing. Things seem to improve throughout the day which makes me wonder if these are side effects?
>
> johnnyjThey could be, I don't know what other medications you are on which could synergistically react.
A number of sleep medications can cause hangover effects though those intended purely for sleep usually have much less than offlabel medications.
Posted by johnnyj on November 1, 2006, at 14:00:33
In reply to Re: Lunesta » johnnyj, posted by yxibow on November 1, 2006, at 13:34:06
I am not on any other meds right now. I may try ambien or trazadone to see if the current side effects diminish. I have found a lot of other people that have had the same problem after being on lunesta for a few months. It is either the lunesta or anxiety/depression coming back on it's own.
Posted by yxibow on November 3, 2006, at 2:00:54
In reply to Re: Lunesta » yxibow, posted by johnnyj on November 1, 2006, at 14:00:33
> I am not on any other meds right now. I may try ambien or trazadone to see if the current side effects diminish. I have found a lot of other people that have had the same problem after being on lunesta for a few months. It is either the lunesta or anxiety/depression coming back on it's own.
It could cause depression in those susceptible to benzodiazepine depression, I surmise. Still, personally I would rather be on Lunesta or Ambien than Trazodone. The sleep on Trazodone is just revolting, it can cause priapisms (unwanted erections), idiosyncratic heart palpitations, the dose can escalate, and it also contains a metabolite mCPP which can exacerbate preexisting psychosis (not saying you have that.) But some doctors are mortified of going near anything that resembles a benzodiazepine and offlabel prescribe it anyhow. But that's just my view of it. Plus one time I thought I emptied my system of alcohol, but apparently not -- woke up on the bathroom floor after apparently trying to use the loo, only time I ever blacked out, on Trazodone.
Anyhow, good luck with the Ambien if you want to try that. There's also Sonata but that is even weaker than Lunesta.
Posted by johnnyj on November 3, 2006, at 20:29:18
In reply to Re: Lunesta » johnnyj, posted by yxibow on November 3, 2006, at 2:00:54
I would like to try getting off the lunesta and see how things go but how to do that without insomnia seems impossible. I don't really want a benzo but what to do??
I have this hope that if I could go a few days without lunesta maybe I would just finally crash and sleep. Only one way to know but I need a back up plan and with my pdoc firing me I can't get one devised with confidence.
Lunesta is causing some difficulties especially waking up so abrupt and feeling I had "fake" sleep. Very odd. I am sensing that maybe a ssri is the only way to go for me. It would be nice not to be on anything but that is quickly appearing to be impossible.
I may give the ambien a shot tonight and then try to wean over Thanksgiving, if I can make it. I get the feeling I will know in a few days of quitting if it will work. It would just be nice to have something besides a benzo to help me over the hump(if there is a hump to get over that is)
Weaning the lunesta just seems to not be the ticket. I feel it will cause some negative effect side effect wise until I am totally off and then my head may feel relieved. Just don't know until I try I guess. I just hope ambien doesn't make me feel worse....
Thanks for the suggestions.
johnnyj
Posted by notfred on November 4, 2006, at 0:19:02
In reply to Re: Lunesta » notfred, posted by johnnyj on October 30, 2006, at 8:57:32
> I tried to do progressive muscle relaxation last night and kept jerking awake. This was before taking lunesta.
>
This jerking awake could be a hypnagogic jerk. I think they are quite common.
This is the end of the thread.
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