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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Jadde on February 21, 2020, at 2:43:18
Tonight will be the third night in as many weeks that I will be up ALL night. It is 3:30am. My meds:
-Nardil 60mg (down from 75mg)
-5mg zyprexa (bedtime)
-5mg melatonin (bedtime)This was working at some point but even the nights I do sleep now are broken up every 1-2 hours. Im thinking this could be a reason my Nardil isnt effective this time around. Maybe not.
I know the archives are probably full of examples of successful sleep strategies, but Im wondering if there is a current consensus in regard to the most effective sleep meds/aids.
I see my Pdoc next week, would be awesome if I had some ideas to take in with me. I had to ask to be put on Nardil, might be the same with sleep meds.
Btw- trazodone got me to sleep but had to ditch it because of morning hangover. At this point Id probably try anything.
Thanks, Jade
Posted by undopaminergic on February 21, 2020, at 3:33:18
In reply to Help please. Cant sleep, posted by Jadde on February 21, 2020, at 2:43:18
>
> -Nardil 60mg (down from 75mg)
> -5mg zyprexa (bedtime)
> -5mg melatonin (bedtime)
[...]
> I know the archives are probably full of examples of successful sleep strategies, but Im wondering if there is a current consensus in regard to the most effective sleep meds/aids.
>Well, you are already taking melatonin and olanzapine (Zyprexa), and that should help at least somewhat. However, unless you need the olanzapine, I would switch to another antihistamine called cyproheptadine (Periactin), because it can improve sleep quality. Trimipramine (Surmontil) is an antidepressant with strong antihistamine action, and it has been shown to enhance REM-sleep and to normalise the circadian cortisol curve. You could add a benzodiazapine, but in my view, these are bad for sleep quality. The Z-drugs are better, ie. zolpidem, zaleplon, zopiclone, or eszopiclone.
-undopaminergic
Posted by Lamdage22 on February 21, 2020, at 4:17:55
In reply to Re: Help please. Cant sleep, posted by undopaminergic on February 21, 2020, at 3:33:18
I thin that Seroquel is more immediately sedating than Zyprexa. At least for me.
Posted by undopaminergic on February 21, 2020, at 4:59:42
In reply to Re: Help please. Cant sleep, posted by Lamdage22 on February 21, 2020, at 4:17:55
> I thin that Seroquel is more immediately sedating than Zyprexa. At least for me.
>I've tried both, but I can't tell. I did find Seroquel a stronger appetite stimulant, however.
-undopaminergic
Posted by linkadge on February 21, 2020, at 7:07:15
In reply to Re: Help please. Cant sleep, posted by undopaminergic on February 21, 2020, at 4:59:42
The MAOIs are notorious for causing sleep problems.
You could try lowering the dose by 15mg.
Linkadge
Posted by PeterMartin on February 21, 2020, at 8:08:00
In reply to Re: Help please. Cant sleep, posted by linkadge on February 21, 2020, at 7:07:15
I've been dealing w sleep issues also but to RLS "zaps" that I think came from switching off Nardil w.o. tapering.
I agree w the suggestion of Seroquel though. I have taken only a tiny piece of a 100mg pill (~25mg) for the past 10+ yrs and it has never failed to get me to sleep. Almost always through the night (unless in the very rare times I get RLS physical issues waking).
Iirc Seroquel acts primarily on histamine at low dosages (~100 and less).
Posted by Lamdage22 on February 21, 2020, at 8:48:30
In reply to Re: Help please. Cant sleep, posted by undopaminergic on February 21, 2020, at 4:59:42
For me the opposite is true. That's the sad thing: You don't know how it affects you unless you try.
> I've tried both, but I can't tell. I did find Seroquel a stronger appetite stimulant, however.
>
> -undopaminergic
>
Posted by Jadde on February 21, 2020, at 16:03:26
In reply to Re: Help please. Cant sleep, posted by undopaminergic on February 21, 2020, at 3:33:18
> >
> > -Nardil 60mg (down from 75mg)
> > -5mg zyprexa (bedtime)
> > -5mg melatonin (bedtime)
> [...]
> > I know the archives are probably full of examples of successful sleep strategies, but Im wondering if there is a current consensus in regard to the most effective sleep meds/aids.
> >
>
> Well, you are already taking melatonin and olanzapine (Zyprexa), and that should help at least somewhat. However, unless you need the olanzapine, I would switch to another antihistamine called cyproheptadine (Periactin), because it can improve sleep quality. Trimipramine (Surmontil) is an antidepressant with strong antihistamine action, and it has been shown to enhance REM-sleep and to normalise the circadian cortisol curve. You could add a benzodiazapine, but in my view, these are bad for sleep quality. The Z-drugs are better, ie. zolpidem, zaleplon, zopiclone, or eszopiclone.
>
> -undopaminergic
>I used to take olanzapine for depression and I was actually surprised it worked for a while AND I would fall right to sleep. I think my dr prescribed it again for my current sleep issues because I had taken it before with no problems (other than weight gain). It certainly isnt working for me now. The question of wether or not I need it is unclear. I definitely should have been on an AP while on Parnate, maybe my dr will tell me I need it for more than just sleep. Not sure.
Thank you for the suggestions, I will definitely be taking this list to my next appt (Wednesday).
Jade
Posted by Jadde on February 21, 2020, at 16:14:11
In reply to Re: Help please. Cant sleep, posted by Lamdage22 on February 21, 2020, at 4:17:55
> I thin that Seroquel is more immediately sedating than Zyprexa. At least for me.
I have to agree. My son is BP and as a teen he was on Seroquel. One morning I accidentally scooped up his Seroquel with my vitamins. I barely made it to the steps and slept hard all day. Maybe a poor example but there it is.
Btw- he has epilepsy and his depakote controls the BP tendencies now. Its all he takes luckily.
Posted by Jadde on February 21, 2020, at 16:17:46
In reply to Re: Help please. Cant sleep, posted by linkadge on February 21, 2020, at 7:07:15
> The MAOIs are notorious for causing sleep problems.
>
> You could try lowering the dose by 15mg.
>
> LinkadgeYes, I recently dropped from 75mg down to 60mg. No med has ever caused me this much trouble, even Nardil the last time I was on it. Strange.
Posted by Jadde on February 21, 2020, at 16:22:31
In reply to Re: Help please. Cant sleep, posted by PeterMartin on February 21, 2020, at 8:08:00
> I've been dealing w sleep issues also but to RLS "zaps" that I think came from switching off Nardil w.o. tapering.
>
> I agree w the suggestion of Seroquel though. I have taken only a tiny piece of a 100mg pill (~25mg) for the past 10+ yrs and it has never failed to get me to sleep. Almost always through the night (unless in the very rare times I get RLS physical issues waking).
>
> Iirc Seroquel acts primarily on histamine at low dosages (~100 and less).Ugh, RLS is the worst. I had it while taking Abilify.
Its looking like Seroquel May top the list when I see my doc next week. Thank you.
Posted by Lamdage22 on February 22, 2020, at 5:28:46
In reply to Re: Help please. Cant sleep, posted by Jadde on February 21, 2020, at 16:14:11
Id vote for Seroquel then.
Posted by bleauberry on March 6, 2020, at 19:02:40
In reply to Help please. Cant sleep, posted by Jadde on February 21, 2020, at 2:43:18
I can name a half dozen herbs that would be very helpful. But I have not studied any of them in relation to an MAOI. I don't know how safe or unsafe they would be. They would definitely lower blood pressure. In terms of serotonin syndrome I highly doubt it, but have not looked into.
Maybe go with a prescription sleep med - try a couple different ones - and use them once every other day, once every 3 days, to try to get to a point where your system learns how to sleep with Nardil. Don't want to get dependent on the sleep meds, which is why to not use them every night.
But then again, sleep is so important for everything - immune system, hormone function, mood chemical function, digestive function, everything. Without good sleep, at least several times a week, it's gonna be a rough road that takes longer to reach the goal.
This is the end of the thread.
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