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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by Sigismund on January 19, 2008, at 17:24:04
Seroquel may be good for sleep but may not provide good sleep quality.
Remeron is OK for me until the next day when I would definately rather have not taken it.
So I'm wondering about the lowest effective dose of Zyprexa?
I think the 5HT2 antagonism (or whatever it is) might agree with me. And if I kept the dose really low perhaps the whole appetite, weight gain, prolactin thing would be handleable.
My problem is sleep maintenance. I get to sleep easily because I'm so tired, but wake up after four hours. Even if I take something then, sleep tends to be very very light.
I wouldn't be thinking of something like Zyprexa if I hadn't eliminated all the causes I can think of.
So what's the very minimum effective dose?
And does it feel really awful?
(I hate antihistamines and anticholinergics.)
Posted by linkadge on January 19, 2008, at 18:34:02
In reply to Insomnia, posted by Sigismund on January 19, 2008, at 17:24:04
I wouldn't recomend zyprexa as a sleep aid. To me, it felt like remeron with an even worse feeling of "I wish I hadn't taken this" the next day.
It has a longer half life than seroquel so that can suck.
You might try some time released melatonin alone or in conjunction with a 5-ht2 blocker of some sort.
Linkadge
Posted by Phoenix1 on January 19, 2008, at 19:10:09
In reply to Insomnia, posted by Sigismund on January 19, 2008, at 17:24:04
> Seroquel may be good for sleep but may not provide good sleep quality.
Have you tried Seroquel for sleep, and experienced poor quality sleep? I have found it to provide decent sleep quality at around the 50mg mark. Lots of people get by with half or a quarter of that much. Not sure how much different Zyprexa would bexcept it has a reputation for being less sedating than Seroquel.
Phoenix1
Posted by bleauberry on January 19, 2008, at 19:17:28
In reply to Insomnia, posted by Sigismund on January 19, 2008, at 17:24:04
I would like to expand on what Linkadge said.
First, instead of putting all the focus on hard drugs, maybe try some things that are harmonious with natural biochemistry. Melatonin for example. Low dose 5htp possible (10mg-25mg). Magnesium with glycine or gaba or all three together. One of these normal bodily things could be at fault in the first place, and any drug will only attempt to mask it but not fix a thing.
I'm sure everyone has a different experience on zyprexa. For me it was always a reliable sleep aid throughout 8 years without next day grogginess. I found it had far less next day sedation than remeron. Remeron to me was tons more powerful in that regard. Both had a similar waking grogginess stuffiness kind of feeling, but with zyprexa it was gone after the first coffee. That's just my experience though. Sleep was good and constant. I did sometimes have vivid evil dreams which I didn't like. I also tried seroquel and found it left me in a total daze like I was seriously drugged all the next day. Zyprexa never did that to me. So my experience was different than Linkadge in that regard.
Posted by Phillipa on January 19, 2008, at 21:17:03
In reply to Re: Insomnia » Sigismund, posted by bleauberry on January 19, 2008, at 19:17:28
Sigi if for bathroom try something light like sonata. Phillipa I have done this for about 20 years. Broken sleep. PJ
Posted by cumulative on January 19, 2008, at 22:30:32
In reply to Insomnia, posted by Sigismund on January 19, 2008, at 17:24:04
I assume your circadian rhythms are disrupted.
I would consider:
1) Time-released melatonin
2) No computer/tv/bright light/blue light within 2 (preferably 4) hours of bedtime.
3) Light box upon awakening.
Posted by Sigismund on January 20, 2008, at 1:23:24
In reply to Re: Insomnia, posted by cumulative on January 19, 2008, at 22:30:32
I've tried lots of things.
I take melatonin timed release, and Seroctin can help.
Herbs like zizyphus, skullcap and lemon balm are good but tend to be expensive.Then there's the usual glycine, maybe taurine, GABA, and tryptophan.
My circadian rhythms may well suck, melatonin notwithstanding.
I keep thinking it's the blueberries/goji berries/grape seed extract/resveretrol/vitamin B/boswellia/fish oil/ whatever else I took in the morning that does it, but no matter how I cycle it the result is the same. Hey, I forgot the big two.....green tea and alcohol. I try to be sensible about it.
Thanks for responding, my friends.
Certainly good sleep is everything.
Posted by X-ray on January 20, 2008, at 7:07:00
In reply to Insomnia, posted by Sigismund on January 19, 2008, at 17:24:04
Hello Sigismund,
I have been on Elavil for 35 years.
This drug has bad side effects, but I shall have to live with that.I have tested Remeron for six months, but now I have returned to Elavil.
Here's how I perceived the difference between Elavil and Remeron.
Remeron is a modern medicine, while Elavil is a "dirty drug" from 1958.
The big problem with Remeron is that most people put on weight.
However, I could handle that.But I slept better on Elavil.
This drug improves the quality of my sleep.Elavil also has good sedative effects.
I am able to work efficient when I have had a good night's sleep.I have tried almost everything, but I think that Elavil is one of the best medicines for depressed and anxious people.
My current combo is Elavil (50 mg in the evening) and Buspar (20 mg + 20 mg in the daytime).
Best of Luck,
X-ray
Posted by johnj on January 20, 2008, at 13:41:16
In reply to Re: Insomnia, posted by X-ray on January 20, 2008, at 7:07:00
What is your dx? Is it anxiety related sleep issues? Have you tried any other tca's? Thank you.
johnj
Posted by CareBear04 on January 20, 2008, at 15:29:19
In reply to Insomnia, posted by Sigismund on January 19, 2008, at 17:24:04
hi-- i have the same problem with sleep, not having much trouble falling asleep but finding it really hard to stay asleep. this is despite combining substantial doses of lots of meds, any one of which would probably know a normal person out. i usually take 100-150mg of seroquel, 12.5 of ambien cr, 2mg of prosom, and 1mg of klonopin before bed. and i still wake up around 3-4am and can't get back to sleep. sonata is good for that since it's out of your system within 3-4 hours. i need 20mg, but i think the usual dose is 10. unfortunately, my insurance won't cover it, so i'm having to make do without.
for me, sleep problems are definitely depression and anxiety-related. i tend to think it's caused more by anxiety since my thoughts keep racing, making any sleep very surface-y and not restful. but my pdoc seems to view it as more related to depression since early-morning wakening is a classic symptom. what are your symptoms and/or diagnosis? if you have issues with mood, an AD would probably even out your sleep more effectively in the long-term than an AP like seroquel or zyprexa.
as for comparisons among the meds you mentioned, i would relate them in this order from most sedating to least: zyprexa > seroquel > remeron. i've been trying out remeron recently and 7.5 or 15mg doesn't put me to sleep. seroquel used to work really well after i used to the next-day sluggishness, but i think i've become too tolerant to its effects since i need increasingly higher doses to help me sleep. zyprexa had a huge effect on me in lots of areas, but this was about four years ago before i seem to have developed some weird sort of med resistance. at 2.5mg, it knocked me out completely so that i never even had dreams. and it definitely caused the most next-day lethargy of any of the meds. and even at this lowest dose, i gained about 3-4 lbs per week. i was able to avoid the weight gain effect, though, when i stopped taking it regularly and used it only as a prn when i wanted to be completely out of it. despite the side effects, zyprexa was good for anxiety, and it kept my mood stable during the weeks it took for zoloft to kick in. i guess it's an individual matter of balancing costs and benefits.
good luck,
cb
Posted by X-ray on January 21, 2008, at 13:39:29
In reply to Re: Insomnia » X-ray, posted by johnj on January 20, 2008, at 13:41:16
Hello johnj,
I have been diagnosed with a schizoid personality disorder.
The big problem is that I sleep very badly without medicine.I have been on Prozac and a few others of the SSRI's.
I took Prozac in the morning and Elavil in the evening.That combo didn't agree with me, and I fired my psychiatrist.
My G.P. has provided me with prescriptions ever since.I am not at all happy with Elavil as a sleeping aid, but I guess that I need the drug.
I challenge all members of this forum for suggestions.
Best of Luck,
X-ray
Posted by clipper40 on January 21, 2008, at 21:30:23
In reply to Insomnia, posted by Sigismund on January 19, 2008, at 17:24:04
Sigismund,
Have you ever tried low dose trimipramine? Very different side effect profile than the other tricyclics and it's supposed to be great for sleep.
Clipper
Posted by yxibow on January 22, 2008, at 0:19:01
In reply to Insomnia, posted by Sigismund on January 19, 2008, at 17:24:04
> Seroquel may be good for sleep but may not provide good sleep quality.
>
> Remeron is OK for me until the next day when I would definately rather have not taken it.
>
> So I'm wondering about the lowest effective dose of Zyprexa?
>
> I think the 5HT2 antagonism (or whatever it is) might agree with me. And if I kept the dose really low perhaps the whole appetite, weight gain, prolactin thing would be handleable.
>
> My problem is sleep maintenance. I get to sleep easily because I'm so tired, but wake up after four hours. Even if I take something then, sleep tends to be very very light.
>
> I wouldn't be thinking of something like Zyprexa if I hadn't eliminated all the causes I can think of.
>
> So what's the very minimum effective dose?
> And does it feel really awful?
> (I hate antihistamines and anticholinergics.)
>
Have you tried Trazodone (50-150 mg) ?Even that with the Seroquel I'm already on for other reasons sometimes wakes me up in the night so I chose between l-tryptamine and 5HTP (the metabolite) to continue sleep.
Excercise (mea culpa) helps improve the body's sleep cycle as well, like bundling up and taking a walk in the evening, not too soon before bed and not be too stimulated (caffeine, computer games, etc) before bed (again something I could do more myself).
I do sympathize, I haven't had a good nights sleep in 15 years.
Posted by Phillipa on January 22, 2008, at 19:25:30
In reply to Re: Insomnia » Sigismund, posted by yxibow on January 22, 2008, at 0:19:01
Jay we're twins as it doesn't matter how much or how many meds I take up in four hours like clock work. Love Phillipa
Posted by Sigismund on January 23, 2008, at 4:26:33
In reply to Re: Insomnia - have you tried this? » Sigismund, posted by clipper40 on January 21, 2008, at 21:30:23
I have tried Ealvil/amitrip and it lasted too long the next day.
I tried dothep, I think it is, an old fasioned TCA in a very low dose, and I don't want to repeat that.
But not trimiprimine.
Posted by clipper40 on January 23, 2008, at 11:26:57
In reply to Other things I've tried, posted by Sigismund on January 23, 2008, at 4:26:33
I believe trimipramine has very little anticholinergic effect - unlike the other TCAs. Might be worth looking into. If you don't know much about it, there's more info on it here at Babble. I know Larry takes it for sleep (or at least he used to).
Posted by linkadge on January 23, 2008, at 22:07:49
In reply to Re: Other things I've tried » Sigismund, posted by clipper40 on January 23, 2008, at 11:26:57
I think that trimipramine is still pretty strongly anticholinergic, it has strong m1 antagonism and 5-ht2a antagonism.
It can improve sleep achetecure apparently though.
I thought it was pretty good, although it did have a strong hangover effect. I don't know how it works (no monoamine uptake inhibition), but it really is an antidepressant (at least thats what I found).Linkadge
Posted by yxibow on January 23, 2008, at 22:32:07
In reply to Re: Other things I've tried, posted by linkadge on January 23, 2008, at 22:07:49
Doxepin, which is usually given at 10mg for insomnia is now being remarketed for approval as Silenor 3 and 6mg.
The claim is that effects at 10mg are lessened at that dose but as much as 7 hours of sleep are seen. I dunno -- I fit that "chronic insomnia" and doxepin does work at 10mg for about 4 days and then I become accustomed to it. It does possess an ability to go back to sleep though. I got a bit cold though taking doxepin off and on -- I suppose due to its regulation of ACh.
Posted by Tony P on January 24, 2008, at 11:50:23
In reply to Re: Other things I've tried, posted by linkadge on January 23, 2008, at 22:07:49
> I think that trimipramine is still pretty strongly anticholinergic, it has strong m1 antagonism and 5-ht2a antagonism.
>
> It can improve sleep achetecure apparently though.
> I thought it was pretty good, although it did have a strong hangover effect. I don't know how it works (no monoamine uptake inhibition), but it really is an antidepressant (at least thats what I found).
>
> LinkadgeAgreed. Wikipedia states "Trimipramine is the only effective drug against insomnia known so far that does not alter the normal sleep architecture. In particular, it does not suppress REM-sleep...." It's been my mainstay the last year or so. As you say the hangover is bad (the half-life may be as long as 36 hours), so I find some combination of _two_alarms, a light box &/or a pot of coffee on automatic essential if I have to be anywhere.
It _is_ an A/D and can react with others (esp. MAOI's) as I just learned last night to my cost, but it is about the mildest and safest of the TCAs that way; my pdoc said when they used to use it as an antidepressant it was so ineffective they gave people 600 mg and up, whereas I take 100-200 mg for sleep.
I've also found melatonin to be moderately effective so long as I'm not agitated.
Seroquel I think is horrible; poor quaity toss-and-turn-sleep, 50 mg doesn't last long enough but I still feel hungover the next AM. The only good thing I have to say about it is if I'm having a hypomanic episode and it looks like I'm going to stay up all night doing things, Seroquel stops me dead in my tracks.
Posted by X-ray on January 24, 2008, at 12:39:50
In reply to Re: Other things I've tried, posted by Tony P on January 24, 2008, at 11:50:23
Hello Tony P,
I have been on Elavil for many years, but I would like to have another drug as a sleep aid.
Have you ever been on Elavil?
I would be like to know how these two drugs compare to one another.Best of Luck,
X-ray
Posted by linkadge on January 24, 2008, at 17:49:51
In reply to Re: Other things I've tried, posted by Tony P on January 24, 2008, at 11:50:23
You seem to react similar to me. I find melatonin helps if I can sleep (but not stressed). If I'm really stressed out or agitated melatonin doesn't help.
I also find seroquel is not worth it. The sleep is marginal, and my daytime productivity is poor.
In some cases, the only thing that works is a benzo. If I can't sleep before a test, or presentation melatonin, seroquel or other usually don't do anything, but a benzo seems to hit the spot.
Linkadge
Posted by Sigismund on January 26, 2008, at 0:32:53
In reply to Re: Insomnia, posted by linkadge on January 19, 2008, at 18:34:02
Link, is feverfew a 5HT2 blocker?
Posted by Dr. Bob on January 26, 2008, at 8:29:37
In reply to 5HT2 +raquo; linkadge, posted by Sigismund on January 26, 2008, at 0:32:53
> Link, is feverfew a 5HT2 blocker?
Sorry to interrupt, but I'd like to redirect follow-ups regarding feverfew to Psycho-Babble Alternative. Here's a link:
http://www.dr-bob.org/babble/alter/20080110/msgs/808975.html
Thanks,
Bob
Posted by 4WD on January 29, 2008, at 20:19:50
In reply to Insomnia, posted by Sigismund on January 19, 2008, at 17:24:04
Hi,
Have you tried Trazadone? I take it and like you, I don't have trouble falling asleep, just waking up too early. Since I have been on Trazadone I get at least an extra hour or two of sleep than before.
I am on a small dose 100mg. I take right before I lie down to go to sleep because I don't want to get in the habit of needing something to put me to sleep. I am generally asleep before the Trazadone has a chance to kick in.Marsha
> Seroquel may be good for sleep but may not provide good sleep quality.
>
> Remeron is OK for me until the next day when I would definately rather have not taken it.
>
> So I'm wondering about the lowest effective dose of Zyprexa?
>
> I think the 5HT2 antagonism (or whatever it is) might agree with me. And if I kept the dose really low perhaps the whole appetite, weight gain, prolactin thing would be handleable.
>
> My problem is sleep maintenance. I get to sleep easily because I'm so tired, but wake up after four hours. Even if I take something then, sleep tends to be very very light.
>
> I wouldn't be thinking of something like Zyprexa if I hadn't eliminated all the causes I can think of.
>
> So what's the very minimum effective dose?
> And does it feel really awful?
> (I hate antihistamines and anticholinergics.)
>
Posted by starfox on February 2, 2008, at 8:17:18
In reply to Re: Insomnia » Sigismund, posted by 4WD on January 29, 2008, at 20:19:50
Nightly dose of Doxepin 150mg or 250mg when im really stressed out!. Helps to stop the weird dreams and provides a long, deep sleep also it keeps me happy and content with life. Please start at a very small dose and work your way up 25mg to 50mg a week then when you find an ideal dosage keep it there. I am prescribed this drug by my GP but Pfizer have now discontinued Sinequan (Doxepin Hydrochloride) in the UK. I continue to use Doxepin as generic, sold as Spectra by Solus which is a division of Ranbaxxy India, I have to purchase it online(Very cheap!!)and it is just as good as the brand version (Sinequan). I hope this info will help you or indeed others in your quest for sleep :-) God bless
Starfox UK
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