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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by deniseuk190466 on October 21, 2024, at 9:58:09
Hi,
I'm looking for advice for my friend and this site is the best by far IMO and the best source of info.
My friend is male, 55 and Asian. He has has a drink problem but only drinks in the evening. His Mother has manic depression and there tends to be mental health issues on her side of the family.
My friend suffers with General Anxiety Disorder, although he does not seem to suffer with the physical symptoms of anxiety. His is mainly anticipatory, in that he worries about everything he needs to do, about going out and socialising, about the future. He is obsessively clean (well that's in my opinion ha ha) He is a lovely person but can be very moody and irritable which in my opinion is related to his condition.
To get back to the question, my friend rarely gets a good night sleep. He finds it really difficult to sleep, admittedly this is worse when he drinks but generally he struggles with sleep.
He has tried lots of meds, Pregabalin, Klonopin included to no avail. I really want him to try Zyprexa but he is loathe to as he tried Seroquel and had sleep paralysis, he is terrified of experiencing that again.
My friend has had sleep paralysis without taking meds so he does have an issue there.
I am only after opinions here, I know that we all respond differently to meds.
Does anyone know of a good medication to aid sleep but which is unlikely to cause sleep paralysis.
Does anyone have any experience of this?
Denise
Posted by Hugh on October 24, 2024, at 23:45:17
In reply to Need advice on meds for sleep, posted by deniseuk190466 on October 21, 2024, at 9:58:09
A lot of people take trazodone for sleep. It helped me sleep, but I stopped taking it because it made me feel groggy all morning and into the afternoon.
https://www.medicalnewstoday.com/articles/trazodone-for-sleep
I know someone who takes amitriptyline for sleep and likes it. He takes 25 mg at bedtime.
https://www.healthline.com/health/sleep/amitriptyline-for-sleep#off-label-prescribing
Posted by deniseuk190466 on October 27, 2024, at 15:14:32
In reply to Re: Need advice on meds for sleep, posted by Hugh on October 24, 2024, at 23:45:17
Hi Hugh,
Thanks for the advice. I will suggest Amiltriptaline to him. He has already tried Trazodone.
It doesn't help matters that he drinks most nights but I think he is drinking to self medicate as it is the only thing that helps him escape a bit.
Denise> A lot of people take trazodone for sleep. It helped me sleep, but I stopped taking it because it made me feel groggy all morning and into the afternoon.
>
> https://www.medicalnewstoday.com/articles/trazodone-for-sleep
>
> I know someone who takes amitriptyline for sleep and likes it. He takes 25 mg at bedtime.
>
> https://www.healthline.com/health/sleep/amitriptyline-for-sleep#off-label-prescribing
Posted by SLS on November 3, 2024, at 20:21:14
In reply to Re: Need advice on meds for sleep, posted by deniseuk190466 on October 27, 2024, at 15:14:32
Hi, Denise.
I ended up writing far too much to answer your question. Sorry about that.
Has your friend tried zolpidem (Ambien) or any of the other z-drugs? What drugs has he tried so far?
If his main problem is falling asleep rather than staying asleep, it could help. I have found it consistently effective, even after 4 years. It is not a benzodiazepine. I found that there are no hangovers, and that I feel refreshed the next morning. Zolpidem does not produce physiological dependence or dosage escalation. The only withdrawal symptom I had when discontinuing zolpidem was mild to moderate insomnia. After two nights, I was able to sleep without it. I am currently taking 5.0 mg, but no more than 30 minutes before going to bed. It works quick. It reminds me of triazolam (Halcion) but is not as potent. Both drugs have a short half-life. However, benzodiazepines can be incredibly hard to discontinue if they had been taken chronically.
A rather unique side effect of zolpidem is night binge-eating. The following morning, it is unlikely that you will remember doing it. This doesn't happen to everyone, and it can be managed behaviorally. I think most doctors will try 5.0 mg hs first, and go to 10 mg hs if necessary.
The other Z-drugs include zopiclone, ezopiclone, and zaleplon. Eszopiclone (Lunesta) has a significantly longer half life than zopiclone and zaleplon. It might be a better choice if staying asleep is a problem. It can produce a metallic taste as a side effect.
Among the tricyclics, amitriptyline, doxepin, and trimipramine can be effective when treating insomnia, but might not be an ideal solution if high dosages are required. Anticholinergic side effects emerge. Of the three, doxepin is the most potent H1 histamine blocker (antihistamine). This is the property that makes diphenhydramine (Benadryl) so effective at producing sedation.
As an aside, doctors have used trazodone as a sleep aid for people taking MAOIs. It is presumed that serotonin syndrome does not occur when it is given to someone taking a MAOI. From what I understand, this is usually the case and is used effectively. However, When trazodone was introduced to me while I was taking a MAOI, I experienced an episode of being unable to move my legs in order to walk. I could stand without effort, and there was no rigidity. My legs simply didn't obey my command to walk. It was weird, but I was rather unconcerned. It was more amusing than it was frightening. My doctors at the NIH felt that this episode was a sort of mild hyperserotonergic reaction.
- Scott
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