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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by floatingbridge on August 25, 2011, at 6:20:01
It's 3:30 a.m.
So, lunesta w/ ambien w/ risperdone are not a sleep option for me. That is what I was prescribed yesterday and told to call if it does not work..
These were mentioned as options:
Tenazapam (sp?)
Halcyon (scared me)
(Ativan is agitating. Librium, too)
I said I didn't want to up my benzo intake.Then zyprexa
Then off on AP ideas like saphris which he admitted was less sedating. Guess he likes AP's.
Seroquel (bad reaction once)
I said I wasn't keen on going further into AP's.I asked for amitriptyline. No-go with the Emsam. I would need 14 days to clear Emsam according to new guidelines (had computer there.). I could withdraw from Emsam, try ami, but we both balked at that wholesale change at this point.
Tradzadone (I forget why that was ruled out....)
There are no diet restrictions at 9mg Emsam, but other than that, he's treating it like a full on maoi.
Sleep on a maoi....anything not mentioned? Anything mentioned that short term would do least harm?
Posted by floatingbridge on August 25, 2011, at 7:50:49
In reply to Sleep on maoi ideas... today?, posted by floatingbridge on August 25, 2011, at 6:20:01
Tenazapam or tradzadone after reading a bit?
Does Tenazapam extend sleep in real world experience?
Zyprexa would not really keep me asleep, would it?
Risperdone does not.
Posted by Phillipa on August 25, 2011, at 11:29:17
In reply to Tenazapam, tradzadone, zyprexa? » floatingbridge, posted by floatingbridge on August 25, 2011, at 7:50:49
Tenazapam is restoril I think and hear good things about it on here. I never took it benzo based think. So that would be my choice. Love Phillipa
Posted by Christ_empowered on August 25, 2011, at 11:49:26
In reply to Tenazapam, tradzadone, zyprexa? » floatingbridge, posted by floatingbridge on August 25, 2011, at 7:50:49
hey, fb. I took 30mgs Temazepam (Restoril) while I was hospitalized. It worked nicely. Probably not a long-term solution (I've read the benzo sleeping pills stop working sooner than ambien and the newer drugs. That could be BS though), but it is very effective and it should work as long as the dose is high enough (it comes in 7.5, 15, 22.5, and 30. The 15 and 30 are generic).
Good luck.
Posted by floatingbridge on August 25, 2011, at 11:55:10
In reply to Re: Tenazapam, tradzadone, zyprexa? » floatingbridge, posted by Phillipa on August 25, 2011, at 11:29:17
Hi Phillipa,
Yeah, it's a benzo. Supposed to be longer acting, but not like Valium. I guess I could cut back on Xanax and work the timing, etc, etc. I don't think taking ambien and lunesta together is an improvement. I feel very dumb on top of sleep deprived.
My new pdoc perks up a bit discussing AAP's. :-/
Says I will probably need something on board prophelactically
because of my thought tendencies. I said well, that's where therapy comes in, and he gets that abstracted look I read as sad resolve. But who knows? He's one guy in an office full of pharmaceauticals. (No disrespect; he's o.k.). Still, up at 3:00 a.m. and suddenly goggling prodromal symptoms :-/
Very silly.
Posted by floatingbridge on August 25, 2011, at 12:11:44
In reply to Re: Tenazapam, tradzadone, zyprexa?, posted by Christ_empowered on August 25, 2011, at 11:49:26
> hey, fb. I took 30mgs Temazepam (Restoril) while I was hospitalized. It worked nicely. Probably not a long-term solution (I've read the benzo sleeping pills stop working sooner than ambien and the newer drugs. That could be BS though), but it is very effective and it should work as long as the dose is high enough (it comes in 7.5, 15, 22.5, and 30. The 15 and 30 are generic).
>
> Good luck.Thanks, CE.
Ongoing good luck to you, too.
Posted by sigismund on August 25, 2011, at 14:34:59
In reply to Tenazapam, tradzadone, zyprexa? » floatingbridge, posted by floatingbridge on August 25, 2011, at 7:50:49
>Does Tenazapam extend sleep in real world experience?
Trazadone has pretty dreadful reviews on askapatient. It's not available here and I decided it wasn't worth ordering it. A little priapism was nevertheless inviting.
Temazepam is not great for sleep maintenance. One option is to take it when you wake in the middle of the night. Since you do not want to increase your benzo load, you are in a bind.
I would actually prefer to sleep badly than to take some of the things that might help (Remeron certainly, havn't tried Seroquel or Zyprexa).
Posted by mellow on August 25, 2011, at 15:48:16
In reply to Sleep on maoi ideas... today?, posted by floatingbridge on August 25, 2011, at 6:20:01
How do you do with benadryl? Tylenol PM is basically 50mg of benadryl or you can get it without the Tylenol trade name Unisom right over the counter. That and risperdal knocks me out on days I can afford to have a little hangover which is the least of my problems compared to agitated sleep.
What is your full cocktail at this point? Lunesta plus Ambien with an AP seems like too much almost like throwing a handgranade at your body. I hope and pray you find some relief. Once sleep goes my whole system shuts down. I know where you are at right now and it's no fun.
mellow
Posted by floatingbridge on August 25, 2011, at 17:56:54
In reply to Re: Sleep on maoi ideas... today?, posted by mellow on August 25, 2011, at 15:48:16
Well crud. I don't hold out tons of hope for the benzo alternative, either. There is no magic sleep pill.
I do know last week's big tanking of mood was preceded by 6 days of very little sleep. It was ugly.
The rock and the hard place. And today is o.k., but yeah, it does not feel great with both lunesta and ambien running round. Now that felt doped.
I cut back a little on my xanax by .5mg, in case.... What ridiculous arithmetic.
I would not make a good spy. All the interogation *team* would need to do is say 'sleep deprivation' and all state secrets would be divulged :-/
Posted by JONO_IN_ADELAIDE on August 25, 2011, at 19:48:39
In reply to Sleep on maoi ideas... today?, posted by floatingbridge on August 25, 2011, at 6:20:01
Might be worth trying chloral hydrate, though with continual nightly use tolorance can develop quite fast - this doesnt tend to happen so much with benzos. Temazepam 15-30mg at an hour before bedtime would be a good option if you're willing to try a benzo.
You can boost the effect of Ambien or temazepam by taking 50mg of Benadryl at the same time.
Doxepin would aslo be worth a look, say 25-50mg an hour before bedtime
Posted by Phillipa on August 25, 2011, at 19:59:57
In reply to Re: Sleep on maoi ideas... today?, posted by JONO_IN_ADELAIDE on August 25, 2011, at 19:48:39
Jono was on chloral hydrate for quite a few years with benzos slept great first year when I went off it was at 20mg. So I canned it had to titrate down. Phillipa
Posted by floatingbridge on August 25, 2011, at 20:31:54
In reply to Re: Sleep on maoi ideas... today? » JONO_IN_ADELAIDE, posted by Phillipa on August 25, 2011, at 19:59:57
Jono, don't know chloral hydrate.... Doc didn't mention. Has an old fashioned sounding name.
I have an odd reaction to antihistamines. They make me feel weird and awake and restless. Wish they worked. I have tried them a number of times :-/ They help you sleep?
Thanks.
Posted by jono_in_adelaide on August 25, 2011, at 22:10:02
In reply to Re: Sleep on maoi ideas... today?, posted by floatingbridge on August 25, 2011, at 20:31:54
That reaction to antihistamnes isnt uncommon actualy.
Chloral hydrate is an old drug (invented in the 1880's I think) but still effective for that.
Its an alternative to benzos, though I honestly think a benzo or a "z drug" would be your best bet.
A study published in the BMJ in the 70's showed that a benzodiazepine sleeping pill produced imrpovement in sleep that was sustained through atleast six months of nightly use, and the authors concluded that if tolorance hadnt set in after 6 months, it wasnt going to.
Temazepam is probably the best drug in the group for sleep (long acting enough to not cause rebound insomnia in the early hours like Halcion, short acting enough not to produce a hangover)
Usual dose 15-30mg an hour before bedtime.
Posted by Phillipa on August 25, 2011, at 23:49:09
In reply to Re: Sleep on maoi ideas... today?, posted by jono_in_adelaide on August 25, 2011, at 22:10:02
Jono yes very old med similar to alchohol isn't it? Phillipa
Posted by floatingbridge on August 26, 2011, at 0:51:54
In reply to Re: Sleep on maoi ideas... today?, posted by jono_in_adelaide on August 25, 2011, at 22:10:02
Thanks again, Jono. I pick up some temazapam tomorrow. Maybe I will have a favorable response. If I can sleep a bit more, life will be more doable.
I might even be able to show up for a sleep study.
I nixed halcion. Too many odd stories circulating, though probably works fine for some. And I didn't do anything odd on 'z' drugs. Except finally not sleep.
I think our ex-president George Bush Sr. took halcion. (It came out later came out, but I could have this mangled.) He did some strange things that memory and history have seemed to forget, like fall forward onto his supper plate while seated at a Japanese diplomatic event.
Posted by jono_in_adelaide on August 27, 2011, at 5:28:58
In reply to Re: Sleep on maoi ideas... today? » jono_in_adelaide, posted by floatingbridge on August 26, 2011, at 0:51:54
Temazepam is more slowly adsorbed than some other benzos, so you'll need to take it an hour before bedtime.
Hope it works for you, best of luck!
Posted by floatingbridge on August 27, 2011, at 7:27:26
In reply to Re: Sleep on maoi ideas... today?, posted by jono_in_adelaide on August 27, 2011, at 5:28:58
I must have adjusted (what's the real term) to benzodiazepine's effect. I was awake since the almost usual 3:00 a.m. It was 15mg capsule. Tomorrow I will split the capsule and see about taking half when I wake during the night.
Though feeling 'drugged'. Maybe Emsam is disrupting my already fragile sleep.
How many times can I call the psychiatrist :-/ ?
Thanks, Jono.
Posted by floatingbridge on August 27, 2011, at 7:29:15
In reply to Re: Sleep on maoi ideas... today?, posted by jono_in_adelaide on August 27, 2011, at 5:28:58
Have you been able to start tapering your Xanax yet?
Posted by creepy on August 30, 2011, at 0:18:51
In reply to Sleep on maoi ideas... today?, posted by floatingbridge on August 25, 2011, at 6:20:01
Depending on your dose of emsam you could probably take the TCA as well.
HAve you tried seroquel or short-acting antihistamines like hydroxyzine? Or (not sure if this is wise with an MAOI, never seen it covered in a psychopharm textbook but it sounds scary) alpha / beta blockers?
Posted by floatingbridge on August 30, 2011, at 2:14:00
In reply to Re: Sleep on maoi ideas... today?, posted by creepy on August 30, 2011, at 0:18:51
Creepy, I thought of prazosin, an alpha blocker (I think), but I might just fold on the Emsam. I took 45mg of Tenazapam two hours ago, and am back awake, typing away. This is too much.
You asked in another thread about stimulation. I think it's slowly picking up. Today was more energetic. I loathe to give it up now with my fatigue level, but insomnia has reached an insane proportion.
Antihistamines and I do not get along.
This is crummy.
I really do appreciate yours and other's suggestions.
Other than a big fat AP to knock me out. Or an elephant dart.
Posted by Phillipa on August 30, 2011, at 23:35:13
In reply to Re: Sleep on maoi ideas... today? » creepy, posted by floatingbridge on August 30, 2011, at 2:14:00
Sorry this stinks big time:( Phillipa
Posted by floatingbridge on August 31, 2011, at 3:20:40
In reply to Re: Sleep on maoi ideas... today? » floatingbridge, posted by Phillipa on August 30, 2011, at 23:35:13
> Sorry this stinks big time:( Phillipa
Phillipa, yes, it is stinking. :P
So is news about your pdoc retiring in December!
Posted by Phillipa on August 31, 2011, at 19:49:37
In reply to Re: Sleep on maoi ideas... today? » Phillipa, posted by floatingbridge on August 31, 2011, at 3:20:40
FB if she doesn't find replacements for her patients it's abandonment and the records destroying then would also be I think. I'm thinking of reporting her now to the state medical board. Already stopped at luvox doc it's a no go no medicaire. Greg tried. Love Phillipa
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