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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 43. This is the beginning of the thread.
Posted by SLS on January 21, 2012, at 15:42:40
What have you found to be an effective treatment for insomnia?
--------------------------------
In the past, I have used combinations of benzodiazepines and Z-drugs. When I suffered from total insomnia produced by Parnate, I combined Halcion and Ativan. Doctors are afraid of Halcion now, but I think it has a place in treating severe initial insomnia. Ativan is not as good for treating initial insomnia, but is good at maintaining sleep once the Halcion has done its work to put you to sleep. Now, I use a combination of Sonata and Ativan when needed. Sonata puts me to sleep and Ativan keeps me asleep.
1. Short-acting for sleep initiation: Sonata, Halcion
2. Medium-acting for sleep maintenance: Ativan, Restoril
- Scott
Posted by linkadge on January 21, 2012, at 16:15:36
In reply to Poll - How do you treat insomnia?, posted by SLS on January 21, 2012, at 15:42:40
The absolute best combination I have taken is the following (I have had severe chronic insomnia for years).
1) - Time released melatonin 3mg
2) - cyproheptadine (0.5mg)
3) - lorazepamI take the meds in that order. Most often the lorazepam becomes unnecessary. Between these 3 you are getting:
benzodiazapine agonist
mealatonin agonist
h1 blockade
5-ht2a blockade
calcium channel blockade(with very little else - all very good insomnia busting mechanisms. Cyprohepdatine is almost like an antipsychotic in nature. There is zero activation like with a TCA, but it still shares the calcium, hitamine and antiserotonin effects.
Linkadge
Posted by emmanuel98 on January 21, 2012, at 18:03:15
In reply to Poll - How do you treat insomnia?, posted by SLS on January 21, 2012, at 15:42:40
I take 100mg trazadone and 2mg ativan, but switch every so often to 25mg seroquel so as not to build tolerance. I usually have a bottle of strong beer or two glasses of wine as well. I sleep fitfully, but usually enough to feel okay in the morning. I've always slept fitfully but parnate made my sleep sooo much worse.
Posted by herpills on January 21, 2012, at 18:05:36
In reply to Poll - How do you treat insomnia?, posted by SLS on January 21, 2012, at 15:42:40
> What have you found to be an effective treatment for insomnia?
>For some reason Ambien does nothing for me. I have used trazadone, between 50-100mgs, Saphris 5mg, and diphenhydramine 25-100mgs. Currently using 75 mg of diphenhydramine.
Posted by gadchik on January 21, 2012, at 18:16:56
In reply to Poll - How do you treat insomnia?, posted by SLS on January 21, 2012, at 15:42:40
klonopin+remeron,or benadryl,if I have insomnia.Once,I let 1/2 xanax dissolve under my tongue(horrible taste)along w/my k.Worked like a charm.
Posted by sigismund on January 21, 2012, at 20:00:41
In reply to Poll - How do you treat insomnia?, posted by SLS on January 21, 2012, at 15:42:40
>What have you found to be an effective treatment for insomnia?
Mirtazepine was great except for the next day. Cypro was OK. Didn't like doxepin. Benzos at least leave me feeling OK next day, but they don't improve the quality of sleep long term. Herbs are good but I need a lot. Gabapentin deepens sleep, but makes my feet swell up. Haven't tried trimipramine yet, but it increases prolactin. Otherwise it sounds good. Serzone is interesting. At askapatient people either give it a 5 or a 1. Agomelatine was good for the first couple of months.
Posted by Raisinb on January 21, 2012, at 20:35:45
In reply to Poll - How do you treat insomnia?, posted by SLS on January 21, 2012, at 15:42:40
If I am not on an insomnia causing drug (Wellbutrin was the worst) 2 mg Xanax works like a charm. In three years I have never needed to increase it.
Ambien and Lunesta both worked for me for a few months but not long term. Remeron also works but i did not like feeling lie a zombie. Seroquel only worked for me intermittently. If a med only works some of the time I find the stress of worrying about whether it will work blows sleep out the window anyway.
Posted by Phillipa on January 21, 2012, at 21:12:25
In reply to Re: Poll - How do you treat insomnia?, posted by Raisinb on January 21, 2012, at 20:35:45
Last night first night in years did have it do to an incident increased xanax and slept. Didn't feel right today though. And the l0mg of valium. Is it true tolerance next leads to toxicity? Some thread said that? Phillipa
Posted by torrid2 on January 21, 2012, at 21:59:01
In reply to Poll - How do you treat insomnia?, posted by SLS on January 21, 2012, at 15:42:40
a really good part of good sleep is eating within 30 minutes of waking to raise blood sugar and not to eat within at least 4 hours of sleeping. I know a lot of people will eat things like cerial before bed but better quality sleep can be gained by eating in the morning and not eating at night. reducing lights and noise in the evening also part of good sleep habbits. Gonna have some frosted flakes and go to bed now goodnight.
Posted by SLS on January 22, 2012, at 4:51:48
In reply to Re: Poll - How do you treat insomnia?, posted by linkadge on January 21, 2012, at 16:15:36
Nice combination treatment. I know you had been working at it for a long time.
Has the cyproheptadine increased your appetite?
Isn't your insomnia more of a problem with sleep maintenance than it is of sleep initiation?
Are you feeling any better in the mornings now?
- Scott
> The absolute best combination I have taken is the following (I have had severe chronic insomnia for years).
>
> 1) - Time released melatonin 3mg
> 2) - cyproheptadine (0.5mg)
> 3) - lorazepam
>
> I take the meds in that order. Most often the lorazepam becomes unnecessary. Between these 3 you are getting:
>
> benzodiazapine agonist
> mealatonin agonist
> h1 blockade
> 5-ht2a blockade
> calcium channel blockade
>
> (with very little else - all very good insomnia busting mechanisms. Cyprohepdatine is almost like an antipsychotic in nature. There is zero activation like with a TCA, but it still shares the calcium, hitamine and antiserotonin effects.
>
> Linkadge
>
>
>
>
>
Posted by tensor on January 22, 2012, at 16:39:59
In reply to Poll - How do you treat insomnia?, posted by SLS on January 21, 2012, at 15:42:40
> What have you found to be an effective treatment for insomnia?
>
> --------------------------------
>
> In the past, I have used combinations of benzodiazepines and Z-drugs. When I suffered from total insomnia produced by Parnate, I combined Halcion and Ativan. Doctors are afraid of Halcion now, but I think it has a place in treating severe initial insomnia. Ativan is not as good for treating initial insomnia, but is good at maintaining sleep once the Halcion has done its work to put you to sleep. Now, I use a combination of Sonata and Ativan when needed. Sonata puts me to sleep and Ativan keeps me asleep.
>
> 1. Short-acting for sleep initiation: Sonata, Halcion
>
> 2. Medium-acting for sleep maintenance: Ativan, Restoril
>
>
> - ScottI take Abilify now for depression and it gives me terrible insomnia, most initial. I have taken 20-30mg of zolpidem + 100mg Seroquel IR and it has worked somewhat. I'm quitting Seroquel now because it carries over some sedative effects to the next day.
Funny enough, I was gonna post here now about Halcion. So here I go, is Halcion (at 0.5mg) more effective for initial insomnia than the Z-drugs?
Never tried Sonata, how does it compare to Halcion in terms of knock-out power?
Thanks.
Posted by SLS on January 22, 2012, at 17:42:16
In reply to Re: Poll - How do you treat insomnia? » SLS, posted by tensor on January 22, 2012, at 16:39:59
> Funny enough, I was gonna post here now about Halcion. So here I go, is Halcion (at 0.5mg) more effective for initial insomnia than the Z-drugs?
Halcion (triazolam) is the most potent of the benzodiazepines at producing sleep induction. I find Sonata (zaleplon) to be less helpful, but may still be worth a try. With Halcion, rebound awakenings can occur because the drug has such a short half-life. If this is not a problem for you, then you probably won't need a second hypnotic. I needed Ativan (lorazepam) with its medium half-life to keep me asleep. By itself, Ativan did not do the job. You can use Restoril instead of Ativan. Halcion can sometimes produce amnesia, in much the same way as can Ambien (zolpidem). Less frequently, behavioral disinhibition can occur.
For me, Halcion was a very clean drug. I didn't have a single side effect. I was able to discontinue it using a taper. I guess if it were necessary, you could use Ativan to help with this.
- Scott
Posted by bleauberry on January 22, 2012, at 17:58:35
In reply to Poll - How do you treat insomnia?, posted by SLS on January 21, 2012, at 15:42:40
Gosh I hate the little bit of a hangover the next day but super low dose remeron....1mg to 7.5mg....which was much more sedating than any of the higher doses. For as needed situations I've found combos of skullcap, lemon balm, valerian and passionflower to work good enough on their own for mild to moderate situations and they make a good base for serious situations. I never used benzos much but when I did I slept good. The best quality sleep I ever had was on zyprexa.
Posted by gadchik on January 22, 2012, at 18:28:52
In reply to Re: Poll - How do you treat insomnia?, posted by bleauberry on January 22, 2012, at 17:58:35
A cup of coffee,followed by 2 cups green tea,always takes away that morning hangover from remeron,for me.problem w/remeron is i get used to it if used too often.but it provides me a deep,restful sleep,at a low,low dose when i use it sparingly.
Posted by jono_in_adelaide on January 22, 2012, at 18:55:18
In reply to Poll - How do you treat insomnia?, posted by SLS on January 21, 2012, at 15:42:40
When I cant sleep, I take one of my 1mg alprazolam combined with 25mg doxylamine (Restavit in Australia, Unisom Sleeptabs in the US)
Posted by Abby Cunningham on January 22, 2012, at 19:26:39
In reply to Poll - How do you treat insomnia?, posted by SLS on January 21, 2012, at 15:42:40
I take 1mg xanax and 5mg Melatonin. And recently was prescribed 25mg. Hydroxine HCL
Posted by phidippus on January 22, 2012, at 22:46:12
In reply to Poll - How do you treat insomnia?, posted by SLS on January 21, 2012, at 15:42:40
Go to for severe insomnia: Seroquel @ 200 mg.
Got to for light insomnia: Rozerem 16 mgOther medications that have helped:
Gabitril
Ativan
ClonidineEric
Posted by SLS on January 23, 2012, at 7:26:20
In reply to Re: Poll - How do you treat insomnia? » SLS, posted by phidippus on January 22, 2012, at 22:46:12
> Go to for severe insomnia: Seroquel @ 200 mg.
Interesting that you should find 200 mg more effective than 50-100 mg. I was under the impression that higher dosages of Seroquel were less effective for treating insomnia.
I like your idea of combining clonazepam and Seroquel that you proposed in another thread.
- Scott
Posted by phidippus on January 23, 2012, at 13:16:28
In reply to Re: Poll - How do you treat insomnia? » phidippus, posted by SLS on January 23, 2012, at 7:26:20
I find Seroquel to be activating at 300 mg and above.
Ativan with Seroquel also works well.
As for staying asleep I would really recommend Gabitril, as it improves stage 4 sleep.
Eric
Posted by SLS on January 23, 2012, at 13:25:43
In reply to Re: Poll - How do you treat insomnia? » SLS, posted by phidippus on January 23, 2012, at 13:16:28
> I find Seroquel to be activating at 300 mg and above.
>
> Ativan with Seroquel also works well.
>
> As for staying asleep I would really recommend Gabitril, as it improves stage 4 sleep.
I tried Gabitril once. If anything, it disrupted my sleep. Gabitril is a weird one from what I can see. Some people experience an anxiolytic effect with it while others become agitated.
- Scott
Posted by Morgan Miller on January 23, 2012, at 13:32:07
In reply to Re: Poll - How do you treat insomnia? » linkadge, posted by SLS on January 22, 2012, at 4:51:48
Timed release melatonin-Source Naturals spray
Low dose zyprexa-i dont think I will ever need this again
Bacopa
Posted by Morgan Miller on January 23, 2012, at 13:33:16
In reply to Re: Poll - How do you treat insomnia? » linkadge, posted by SLS on January 22, 2012, at 4:51:48
Timed release melatonin-Source Naturals spray
Low dose zyprexa-i dont think I will ever need this again
Bacopa
Posted by phidippus on January 23, 2012, at 13:37:31
In reply to Re: Poll - How do you treat insomnia? » phidippus, posted by SLS on January 23, 2012, at 13:25:43
Gabitril is a gaba reuptake inhibitor and like benzodiazapines has the risk of paradoxical effects.
Eric
Posted by Peter Heuer on January 23, 2012, at 15:08:51
In reply to Poll - How do you treat insomnia?, posted by SLS on January 21, 2012, at 15:42:40
Hi,
I have tried almost every drug for sleep the last 40 years,
but now I'm on Remeron and Lyrica.This is a good combo that I can recommend.
I take 45 mg of mirtazapine and 100 mg of pregabalin.
I'm also on Wellbutrin, Buspar and Fluanxol.
Best regards,
Peter Heuer
Posted by tensor on January 23, 2012, at 15:38:18
In reply to Re: Poll - How do you treat insomnia? » tensor, posted by SLS on January 22, 2012, at 17:42:16
> Halcion (triazolam) is the most potent of the benzodiazepines at producing sleep induction. I find Sonata (zaleplon) to be less helpful, but may still be worth a try. With Halcion, rebound awakenings can occur because the drug has such a short half-life. If this is not a problem for you, then you probably won't need a second hypnotic. I needed Ativan (lorazepam) with its medium half-life to keep me asleep. By itself, Ativan did not do the job. You can use Restoril instead of Ativan. Halcion can sometimes produce amnesia, in much the same way as can Ambien (zolpidem). Less frequently, behavioral disinhibition can occur.
>
> For me, Halcion was a very clean drug. I didn't have a single side effect. I was able to discontinue it using a taper. I guess if it were necessary, you could use Ativan to help with this.
>
>
> - ScottDid you get dependent on Halcion? Thought its short halflife would prevent that.
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