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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 29. This is the beginning of the thread.
Posted by halcyondaze on January 19, 2007, at 23:00:55
Okay, here's a little brief history: I have chronic insomnia. I've had it since I was a newborn and can remember it from the age of five. For a while, I took Benadryl every night and that worked but eventually I had to keep upping the dose I was taking for it to work. I was put on a tricyclic antidepressant and then eventually replaced the Benadryl with Seroquel at 25 mg. This used to knock me out beautifully and I slept like I never had before, falling asleep quickly and waking up rested.
Then I went on Parnate and my whole world collapsed. Seroquel was like a placebo. I raised it to 100 mg but I still had trouble falling asleep and staying asleep. My doctor added Ambien (10 mg) and Ambien CR (6.25 mg), and reduced the Seroquel back down to 25 mg. It worked but I had some weird side effects like blacking out and binge eating. So we tried Temazepam (Restoril), which didn't do anything in terms of helping me fall asleep but caused me to pass out for 12 hours after I finally did get to sleep at 4 a.m. I also tried Rozerem, which did absolutely nothing. And then I went off of Parnate for a while.
Since having been back on it for three months, I've had to increase the Seroquel back to 100 mg. I've also been on Lunesta, which didn't help me fall asleep and Ambien, but I had to take 20 mg to fall asleep and my doctor was not comfortable with that dosage. So now I am on Sonata, which doesn't really help me sleep and definitely doesn't help me stay asleep, as I am waking up four hours later, and my doctor doesn't want me taking it in the middle of the night in addition to before I go to sleep.
ANYONE have any ideas of other sleeping meds I can try? I cannot take the newer benzos because of my past Xanax addiction but I was thinking maybe Halcion? It's abuse potential is comparable to Ambien, from what I've read in the literature. At this point I will try anything that helps me fall asleep and stay asleep.
Oh, yeah, and if anyone has any advice about what to do about the terrible acne induced by Parnate (which has recently taken over my back, shoulders, and chest as well - ugh! - and doesn't seem to be responding to Differin and Duac), that would be great.
Posted by Phillipa on January 19, 2007, at 23:36:02
In reply to INSOMNIA - PLEASE HELP!!! FRUSTRATED!!!, posted by halcyondaze on January 19, 2007, at 23:00:55
Can you take valium? I take l5mg now and lunesta 3mg with 50mg of luvox. But I still wake up in four hours and then take 5mg of valium to get back to sleep. Like you they have tried everything and multiple combos that's just me. Oh the very best is chloral hydrate from the l800. It at 5cc let me sleep all night. But the best was beer. Sorry but it worked the best and woke up feeling great 4-6 at night after work. Love Phillipa
Posted by Quintal on January 20, 2007, at 0:25:49
In reply to INSOMNIA - PLEASE HELP!!! FRUSTRATED!!!, posted by halcyondaze on January 19, 2007, at 23:00:55
Hmmm...... with that posting name I assumed you might have tried Halcion already. I took Halcion (triazolam) for a while but I ordered it from an online pharmacy - it's no longer prescribed in the UK and rarely used elsewhere either because it soon gained a reputation for producing seizures and homicidal behaviour in users. It was also thought to be highly addictive due to its short half-life so I can't imagine any pdoc prescribing it for you. I found it no more effective than Ambien.
Q
Posted by UgottaHaveHope on January 20, 2007, at 2:49:57
In reply to INSOMNIA - PLEASE HELP!!! FRUSTRATED!!!, posted by halcyondaze on January 19, 2007, at 23:00:55
Seorquel is usually extremely effective unless you (1) are taking a medication which may weaken or even reverse its effect or (2) are too worked up emotionally about losing sleep that nothing will calm you down at this point.
If Parnate is anything like Emsam, and activating, then that may be the challenge. Emsam has affected my sleep. Have you considered trying Nardil, which is supposed to be more sedating or calming than Parnate. Ive never taken but perhaps someone on this board can give you their experience with sleep on Nardil.
My heart goes out to you. Not getting my sleep does not start my day well at all.
Posted by Declan on January 20, 2007, at 3:23:27
In reply to INSOMNIA - PLEASE HELP!!! FRUSTRATED!!!, posted by halcyondaze on January 19, 2007, at 23:00:55
I guess you must have some good reason to be on Parnate, but as you know, it is bad for sleep and you have always had problems with that.
And you get acne from it as well.Is there any other AD you could substitute for Parnate?
There's nothing particularly wonderful about Halcion, and I have read that it can be implicated in depression.
Posted by kelv on January 20, 2007, at 5:58:06
In reply to INSOMNIA - PLEASE HELP!!! FRUSTRATED!!!, posted by halcyondaze on January 19, 2007, at 23:00:55
Ask you Doc for Seconal-that should help.
Posted by mindevolution on January 20, 2007, at 6:28:53
In reply to INSOMNIA - PLEASE HELP!!! FRUSTRATED!!!, posted by halcyondaze on January 19, 2007, at 23:00:55
i get a good nights sleep with restoril and it usually works unless there is something really wrong. if you are willing to use seroquel then you may want to try mirtazapine (remeron) which i think blocks the histamine receptor.
if you are really bad then maybe you could even ask for barbituates, as i think i remeber reading that some are used as general anesthetics. depends on how well you get on with your doc though.
Posted by blueberry1 on January 20, 2007, at 8:09:46
In reply to INSOMNIA - PLEASE HELP!!! FRUSTRATED!!!, posted by halcyondaze on January 19, 2007, at 23:00:55
Don't quote me on this, but I believe low dose Remeron is safe with parnate. Low dose is also the most sedating dose. Can you try 7.5mg to 15mg of remeron? While mileage varies, I can say from personal experience that 7.5mg or 15mg is powerfully sedating, giving excellent long sleep for me, with a morning grogginess that goes away in about an hour. And I've tried everything else...ambien, lunesta, melatonin, herbs, xanax, klonopin, diazepam, seroquel, zyprexa, and I'm sure I forgot some. Remeron is/was the queen of them all for sleep. At least for me.
Posted by laima on January 20, 2007, at 8:10:13
In reply to Re: INSOMNIA - PLEASE HELP!!! FRUSTRATED!!! » halcyondaze, posted by Quintal on January 20, 2007, at 0:25:49
I could have sworn I read somewhere that Halcion can induce very severe and persistent depressions after a period of use?
And I tried restoril before, it did knock me out, but it felt almost "sinister", in that I think it was tipping me towards worsening depression. Wasn't "soft" at all- pulled me under without allowing me to savor any pre-bedtime relaxation. Maybe I didn't like it because I was comparing it to other sleep meds. I also think it's part benzo actually.
I've been surprised before by how well melatonin puts me to sleep- have you thought to try it, or perhaps since your insomnia is severe, rozerem? That one REALLY put me to sleep.
Posted by laima on January 20, 2007, at 8:11:43
In reply to INSOMNIA - PLEASE HELP!!! FRUSTRATED!!!, posted by halcyondaze on January 19, 2007, at 23:00:55
Ooops, sorry. I see you have tried rozerem.
Posted by laima on January 20, 2007, at 8:13:21
In reply to INSOMNIA - PLEASE HELP!!! FRUSTRATED!!!, posted by halcyondaze on January 19, 2007, at 23:00:55
Parnate causes acne? That's not very uplifting.
Posted by kelv on January 20, 2007, at 8:14:18
In reply to Re: INSOMNIA - PLEASE HELP!!! FRUSTRATED!!!, posted by mindevolution on January 20, 2007, at 6:28:53
> if you are really bad then maybe you could even ask for barbituates, depends on how well you get on with your doc though.
You sound like you have pretty hard out insomnia, having tried all you mentioned in the usual hypnotical class.
Seconal, secobarbital sodium-comes in a red 200mg bullet shaped cap-was called "the gift of sleep"
Tuinal, may be more successful, it combines 100mgs Seconal and 100mgs Amytal, and is a half blue/red capsule, known as 'rainbows'
Ask you Doc.
Posted by halcyondaze on January 20, 2007, at 10:54:42
In reply to INSOMNIA - PLEASE HELP!!! FRUSTRATED!!!, posted by halcyondaze on January 19, 2007, at 23:00:55
Thanks for all the responses. But due to my history of addiction, my doc will never Rx a drug that is potentially addictive.
We just recently discussed Cogentin (b/c I also have mild restless leg) - do you think this might help w/ sleep?
Posted by halcyondaze on January 20, 2007, at 12:05:52
In reply to Re: INSOMNIA - PLEASE HELP!!! FRUSTRATED!!!, posted by halcyondaze on January 20, 2007, at 10:54:42
I've been examining abuse liability of various drugs in the literature and have come up with a list of possibilities w/ a lower or similar abuse liability as Ambien. Any experiences with the following for sleep initiation and maintenance?
1) Triazolam (Halcion)
2) Flurazepam (Dalmane)
3) Estazolam (ProSom)
4) Oxazepam (Serax)
5) Zopiclone (Imovane - is this available in the US? It's the precursor to the isomer of Lunesta)
6) Quazepam (Doral)
OR ... I was thinking of switching from Parnate to Nardil. How long do I have to wash out before I can go from one MAOI to another?
THANK YOU ALL.
P.S. As far as the name, "halcyon" (not in the drug sense) is one of my favorite words, and "halcyon daze" is a play on "halcyon days".
Posted by Quintal on January 20, 2007, at 12:18:06
In reply to Specific drugs - any experiences?, posted by halcyondaze on January 20, 2007, at 12:05:52
>3) Estazolam (ProSom)
Yes, I tried it and liked it very much. I read it allegedly has less abuse potential than most other benzodiazepines.
>5) Zopiclone (Imovane - is this available in the US? It's the precursor to the isomer of Lunesta)
Zopiclone is very widely prescribed in the UK and I've taken it many times. It is effective but I can't compare it to Lunesta because it isn't available here.
Q
Posted by halcyondaze on January 20, 2007, at 12:38:37
In reply to Re: Specific drugs - any experiences? » halcyondaze, posted by Quintal on January 20, 2007, at 12:18:06
> >3) Estazolam (ProSom)
>
> Yes, I tried it and liked it very much. I read it allegedly has less abuse potential than most other benzodiazepines.
>
> >5) Zopiclone (Imovane - is this available in the US? It's the precursor to the isomer of Lunesta)
>
> Zopiclone is very widely prescribed in the UK and I've taken it many times. It is effective but I can't compare it to Lunesta because it isn't available here.
>
> QWhy isn't Zopiclone available in the US? I'm surprised they approved Lunesta so quickly while its precursor is not available.
That's what I've been looking at (abuse liability) since I have a history of substance dependence (including Xanax) but was able to take meds with a lower potential for abuse like Ambien and Temazepam without abusing them.
There's this terrific paper I've been using: << neuroscience.jhu.edu/griffiths papers/v66s0906.pdf >> (full text available here) with the half-lives, peak times, animal self-administration, human/liking, actual abuse, withdrawal, memory impairment, lethality, and overall abuse liability of essentially every hypnotic imaginable. Scroll to page 37 and you'll find the chart.
Posted by halcyondaze on January 20, 2007, at 12:40:05
In reply to Re: Specific drugs - any experiences?, posted by halcyondaze on January 20, 2007, at 12:38:37
I think I copied the link wrong, here it is:
<< http://neuroscience.jhu.edu/griffiths%20papers/v66s0906.pdf >>
page 37 has the chart. GREAT paper. shockingly available in full text without requiring an academic database.
Posted by Declan on January 20, 2007, at 14:17:28
In reply to Re: INSOMNIA - PLEASE HELP!!! FRUSTRATED!!!, posted by laima on January 20, 2007, at 8:10:13
William Styron in "Darkness Visible" attributed his major depressive episode to Halcion.
Mirtazepine is great for sleep, but with me the awful feeling stayed around till after lunch.
Mirtazepine increased the depth of sleep.
Posted by Declan on January 20, 2007, at 14:19:48
In reply to Specific drugs - any experiences?, posted by halcyondaze on January 20, 2007, at 12:05:52
I'd give oxazepam a miss.
Dalmane is better, even with the metallic taste.
Posted by Quintal on January 20, 2007, at 14:27:27
In reply to Re: Specific drugs - any experiences?, posted by Declan on January 20, 2007, at 14:19:48
Dalmane has a metallic taste? I wonder why? I thought that was unique to zopiclone and eszopiclone?
Q
Posted by Declan on January 20, 2007, at 14:41:25
In reply to Re: Specific drugs - any experiences? » Declan, posted by Quintal on January 20, 2007, at 14:27:27
It gave me a metallic taste.
It was 30 years ago now, can you believe it?
Posted by mindevolution on January 20, 2007, at 16:36:27
In reply to Re: INSOMNIA - PLEASE HELP!!! FRUSTRATED!!!, posted by halcyondaze on January 20, 2007, at 10:54:42
> We just recently discussed Cogentin (b/c I also have mild restless leg) - do you think this might help w/ sleep?are you kidding? if you wanted a drug to make you mentally ill you found a beauty, it can even creates a toxic psychosis: look at the side effects and don't underestimate their potential: http://en.wikipedia.org/wiki/Anticholinergic
http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=895its the treatment they used to give people with parkinson's before they developed levodopa and dopamine agonists and is generally thought to accelerate a patients mental decline in return for a minor improvement in muscle control. "Acetylcholine is also involved with attention, the sleep-wake cycle, and other aspects of cognitive functioning."
http://www.medscape.com/viewarticle/408593_5ME
Posted by halcyondaze on January 20, 2007, at 17:19:57
In reply to Re: INSOMNIA - PLEASE HELP!!! FRUSTRATED!!!, posted by mindevolution on January 20, 2007, at 16:36:27
>
> > We just recently discussed Cogentin (b/c I also have mild restless leg) - do you think this might help w/ sleep?
>
> are you kidding? if you wanted a drug to make you mentally ill you found a beauty, it can even creates a toxic psychosis: look at the side effects and don't underestimate their potential: http://en.wikipedia.org/wiki/Anticholinergic
> http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=895
>
> its the treatment they used to give people with parkinson's before they developed levodopa and dopamine agonists and is generally thought to accelerate a patients mental decline in return for a minor improvement in muscle control. "Acetylcholine is also involved with attention, the sleep-wake cycle, and other aspects of cognitive functioning."
> http://www.medscape.com/viewarticle/408593_5
>
> MEI've taken anticholinergics for bladder problems without incident.
Posted by yxibow on January 21, 2007, at 3:43:11
In reply to Re: INSOMNIA - PLEASE HELP!!! FRUSTRATED!!!, posted by mindevolution on January 20, 2007, at 16:36:27
>
> > We just recently discussed Cogentin (b/c I also have mild restless leg) - do you think this might help w/ sleep?
>
> are you kidding? if you wanted a drug to make you mentally ill you found a beauty, it can even creates a toxic psychosis: look at the side effects and don't underestimate their potential: http://en.wikipedia.org/wiki/Anticholinergic
> http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=895
>
> its the treatment they used to give people with parkinson's before they developed levodopa and dopamine agonists and is generally thought to accelerate a patients mental decline in return for a minor improvement in muscle control. "Acetylcholine is also involved with attention, the sleep-wake cycle, and other aspects of cognitive functioning."
> http://www.medscape.com/viewarticle/408593_5
>
> ME
I've taken 3 of the 4 major anticholinergics on the US market and I have yet to become more mentally ill than the burden on me.They serve a valuable purpose and are still used in Parkinsons and neuroleptic EPS managment as well as treatments for things like idiopathic or drug induced sialorrhea.
Par, a subunit of Abbott discontinued Akineton in the US (leaving 3 - Artane, Cogentin, and rarely procyclidine, if it is still available), which was an anticholinergic with the least side effects I've encountered, I touched on this before.
Nonetheless, anticholinergics should be taken in incremental doses slowly as yes, they are related to atropine and can cause atropine toxicity which can include a type of psychosis in large doses; more frequently temperature regulation (chills) or fever and other nasty things can happen if one takes more than their body can handle, which, is unpredictable from person to person, and one usually works up to a dose level if they are using it consistently instead of PRN.
As for insomnia, I would not use the partial antihistamine/anticholinergic Cogentin for that purpose -- an antihistamine like Atarax or even better OTC doxylamine succinate (Unisom) would be viable candidates.
Posted by yxibow on January 21, 2007, at 4:00:42
In reply to Specific drugs - any experiences?, posted by halcyondaze on January 20, 2007, at 12:05:52
> I've been examining abuse liability of various drugs in the literature and have come up with a list of possibilities w/ a lower or similar abuse liability as Ambien. Any experiences with the following for sleep initiation and maintenance?
> 1) Triazolam (Halcion)Not taken it personally, but the hype that led to discontinuation in many countries other than the US was limited in nature and not conclusive. Nonetheless it wouldn't be my first choice due to the past inconclusive hype.
>
> 2) Flurazepam (Dalmane)Dalmane, if you haven't taken it before will floor you. It is scarily (personal opinion) soporific and creates a sensation of feeling like one has been drugged. Continued use probably lessens this probably, but one can become habituated, of course.
>
> 3) Estazolam (ProSom)Have not tried.
>
> 4) Oxazepam (Serax)Serax is one of the few benzodiazepines that doesn't go through the liver particularly. It is a fairly weak agent.
>
> 5) Zopiclone (Imovane - is this available in the US? It's the precursor to the isomer of Lunesta)It is available in Canada and is a generic drug worldwide. The makers of Lunesta managed to patent a generic drug in its markets the active stereoisomer of zopiclone, which is Lunesta.
> 6) Quazepam (Doral)
Do not have any information on this.
All of the above have greater "abuse liability" than Ambien/Ambien CR with the exception of Zopiclone. Abuse is the intentional misuse of prescribed or otherwise obtained medications at levels at or exceeding medically typical doses. Habituation potential is what one would more apply to benzodiazepines and pseudobenzodiazepines.Ambien, Lunesta, and Sonata are pseudobenzodiazepines and while they touch on GABA-BZ, they are not benzodiazepines themselves. Ambien can be taken longer than previously thought, although at some point habituation probably will set in. Lunesta was created to be a more long term agent.
Lunesta is weaker than Ambien and probably requires greater than 3mg doses for the fairly insomniac, which includes myself. I did try it at 4mg, which made it slightly better.
I use Rozerem currently to taper from Ambien but I may return to Ambien. Rozerem is far more powerful than melatonin -- I took the maximum typically found OTC 5mg of melatonin and woke up with night terrors; definately weaker than Rozerem.
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