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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by jms600 on August 20, 2004, at 16:44:55
Hi,
Being on Prozac I occasionally have difficulty getting to sleep at night. My doctor has prescribed me 10mg of Temazepam for occasional use, but unfortunately it takes around one and a half hours to kick in. So if I am having a bad night its nearly light before I'm asleep!
Does anyone know of a much faster acting sleeping drug I can take to induce a good nights sleep? Would liquid versions of the benzodiazepines work quicker?
Whatever I take it has to be safe to take with both Prozac and Sodium Valproate.
Thanks!
Posted by crazychickuk on August 20, 2004, at 17:29:01
In reply to Sleeping drugs, posted by jms600 on August 20, 2004, at 16:44:55
Leave the benzo's alone. . try something like 7.5mg (1/4 of a pill) of mirtazipine (zispin/remeron)
Posted by Waki on August 20, 2004, at 18:21:28
In reply to Sleeping drugs, posted by jms600 on August 20, 2004, at 16:44:55
10 mg Ambien worked quicker for me but it also had made me tired half the day.
Temazepam was the first thing I ever took that knocked me out and allowed me to wake up with the alarm clock.
Posted by chemist on August 20, 2004, at 19:19:47
In reply to Sleeping drugs, posted by jms600 on August 20, 2004, at 16:44:55
hello there, chemist here....first off, do have a look further up the board concerning Restoril (temazepam), with input from many of PB's prolific and knowledgeable denizens. second, halcion is a faster-acting benzo derivative that might be your solution. i would suggest looking into ambien as well. given your resistance to the rather powerful temazepam, it is of my opinion that a non-benzo solution is unlikely to be of use. finally, none of the benzos/derivatives/``z-drugs'' (such as ambien, and i would avoid sonata, by the way) interact unfavorably with your other meds. all the best, chemist
> Hi,
>
> Being on Prozac I occasionally have difficulty getting to sleep at night. My doctor has prescribed me 10mg of Temazepam for occasional use, but unfortunately it takes around one and a half hours to kick in. So if I am having a bad night its nearly light before I'm asleep!
>
> Does anyone know of a much faster acting sleeping drug I can take to induce a good nights sleep? Would liquid versions of the benzodiazepines work quicker?
>
> Whatever I take it has to be safe to take with both Prozac and Sodium Valproate.
>
> Thanks!
Posted by King Vultan on August 20, 2004, at 19:23:41
In reply to Sleeping drugs, posted by jms600 on August 20, 2004, at 16:44:55
> Hi,
>
> Being on Prozac I occasionally have difficulty getting to sleep at night. My doctor has prescribed me 10mg of Temazepam for occasional use, but unfortunately it takes around one and a half hours to kick in. So if I am having a bad night its nearly light before I'm asleep!
>
> Does anyone know of a much faster acting sleeping drug I can take to induce a good nights sleep? Would liquid versions of the benzodiazepines work quicker?
>
> Whatever I take it has to be safe to take with both Prozac and Sodium Valproate.
>
> Thanks!
Triazolam (Halcion) is the one that's more useful for people who have trouble falling asleep. Temazepam (Restoril) is an excellent sleep med but has a longer time of onset and is more useful for maintaining sleep. As mentioned, Ambien could also be a good choice, as might Sonata, which has an even faster time of onset, but it has such a short half life that it may not be the best choice for people who also have trouble waking up in the middle of the night. In general, that is also true for both Halcion and Ambien, but probably to a lesser extent than Sonata.I am not familiar with sodium valproate, but if temazepam is okay, than triazolam is probably safe also; although, this drug does have some idiosyncracies, particularly for elderly patients. Ambien and Sonata, in general, are regarded as very safe meds, but they can be much more expensive than these older benzodiazepines, depending on your insurance company.
Todd
Posted by chemist on August 20, 2004, at 19:27:02
In reply to Re: Sleeping drugs, posted by King Vultan on August 20, 2004, at 19:23:41
> > Hi,
> >
> > Being on Prozac I occasionally have difficulty getting to sleep at night. My doctor has prescribed me 10mg of Temazepam for occasional use, but unfortunately it takes around one and a half hours to kick in. So if I am having a bad night its nearly light before I'm asleep!
> >
> > Does anyone know of a much faster acting sleeping drug I can take to induce a good nights sleep? Would liquid versions of the benzodiazepines work quicker?
> >
> > Whatever I take it has to be safe to take with both Prozac and Sodium Valproate.
> >
> > Thanks!
>
>
> Triazolam (Halcion) is the one that's more useful for people who have trouble falling asleep. Temazepam (Restoril) is an excellent sleep med but has a longer time of onset and is more useful for maintaining sleep. As mentioned, Ambien could also be a good choice, as might Sonata, which has an even faster time of onset, but it has such a short half life that it may not be the best choice for people who also have trouble waking up in the middle of the night. In general, that is also true for both Halcion and Ambien, but probably to a lesser extent than Sonata.
>
> I am not familiar with sodium valproate, but if temazepam is okay, than triazolam is probably safe also; although, this drug does have some idiosyncracies, particularly for elderly patients. Ambien and Sonata, in general, are regarded as very safe meds, but they can be much more expensive than these older benzodiazepines, depending on your insurance company.
>
> Toddhello there, KV....serendipity shines, as apparently you and i were penning identical responses....i'll take your endorsement that i'm on the right track :) ....all the best, chemist
Posted by jlbl2l on August 21, 2004, at 6:09:04
In reply to Re: Sleeping drugs » jms600, posted by chemist on August 20, 2004, at 19:19:47
chemist,
I see you have gotten used to some of my terms heh "z-drugs" etc.
Anyways, my input on the subject is don't use any benzos because they disrupt the sleep stages. they stick you in stage 2 sleep for much longer than normal which disrupts normal body processes tht occur in stage 3/4 espececially (deep sleep, slow wave) growth hormone secretion etc..
Halicon would be ok or very short acting ones since they just intiate sleep tho.What about benadryl or antihistamines?
jlbl2l
Posted by Larry Hoover on August 21, 2004, at 9:29:44
In reply to Re: Sleeping drugs, posted by jlbl2l on August 21, 2004, at 6:09:04
> Anyways, my input on the subject is don't use any benzos because they disrupt the sleep stages. they stick you in stage 2 sleep for much longer than normal which disrupts normal body processes tht occur in stage 3/4 espececially (deep sleep, slow wave) growth hormone secretion etc..
I'm sorry, but that is quite false. In "normal" people, benzos block deep sleep, but in those with primary insomnia, quite the opposite occurs.
As a "victim" of such generalizations by doctors, I have had to fight hard, and educate my caregivers all by myself, to get the care I need. Temazepam treatment marked the first time in years that I obtained restorative sleep, and is the pivotal turning point in my own recovery. Moreover, long-term treatment (years-long) may be necessary, to maintain the benefit.
Lar
Clin Pharmacol Ther. 2000 Aug;68(2):175-88.
A pharmacodynamic Markov mixed-effects model for the effect of temazepam on sleep.Karlsson MO, Schoemaker RC, Kemp B, Cohen AF, van Gerven JM, Tuk B, Peck CC, Danhof M.
Department of Pharmacy, Uppsala University, Sweden. mats.karlsson@biof.uu.se
BACKGROUND: A hypnogram shows how sleep travels through its various stages in the course of a night. The sleep stage changes can be quantified to study sedative drug effects. METHODS: Hypnograms from 21 patients with primary insomnia were collected during a randomized, placebo-controlled crossover study of 20 mg temazepam. A separate daytime session was performed to determine the pharmacokinetics of 20 mg temazepam and its effect on saccadic eye movement and electroencephalogram. A first-order Markov model was developed to describe the probability of sleep stage changes as a function of time after drug intake and time after last sleep stage change. The influence of temazepam concentration on the probability to change sleep stage was incorporated into the model. RESULTS: Transitions between sleep stages were profoundly influenced by the time of the night and by the time since the last change of sleep stage. Temazepam reduced the time spent awake. This effect could be attributed to four mechanisms: (1) transition to "deeper" sleep was facilitated, (2) transition to "lighter" sleep was inhibited, (3) regardless of sleep stage, the transition to wake state was inhibited, and (4) return to sleep was facilitated. Daytime sensitivities to temazepam, measured with the surrogate markers saccadic peak velocity and electroencephalogram beta activity, each correlated with one of the transition probabilities influenced by temazepam. CONCLUSIONS: By the development of a Markov model for these non-ordered six categorical data, the effect of temazepam on the sleep-wake status could be interpreted in terms of known mechanisms for sleep generation and benzodiazepine pharmacology.
Posted by chemist on August 21, 2004, at 10:10:46
In reply to Re: Sleeping drugs, posted by jlbl2l on August 21, 2004, at 6:09:04
hi again, jason....i am aware of the benzo/benzo-derivative reduced time spent in stage 4, although i thought that (at least) for zolpidem (ambien in the u.s.) that this was not a problem....i use a bit of diphenhydramine on occasion, to be sure, and it is just my personal bias towards benzos/ambien, really. if there is a better, cleaner solution, i'm all for it! best, chemist
> chemist,
>
> I see you have gotten used to some of my terms heh "z-drugs" etc.
>
> Anyways, my input on the subject is don't use any benzos because they disrupt the sleep stages. they stick you in stage 2 sleep for much longer than normal which disrupts normal body processes tht occur in stage 3/4 espececially (deep sleep, slow wave) growth hormone secretion etc..
> Halicon would be ok or very short acting ones since they just intiate sleep tho.
>
> What about benadryl or antihistamines?
>
> jlbl2l
Posted by jlbl2l on August 21, 2004, at 11:36:31
In reply to Re: Sleeping drugs » jlbl2l, posted by Larry Hoover on August 21, 2004, at 9:29:44
Larry,
I don't mean to be like those mean doctors if you need a benzo by all means take it, but i do disagree. That is one single study which wasn't all that in depth in EEG activity or sleep spindles during sleep anyways. There are countless more showing the opposite for insomnia or for other conditions or for benzos in general.
If i were a doctor, i would find a medication that is the least disruptive to the sleep stages first using my best effort. (All for the care of my patient). If i failed, then I would use something like a benzo, but id rather not. Then again, I would be a very good doctor and maybe even order and EEG or sleep study if nothing was working. A good smart doc would do that before dispensing meds left and right...
jlbl2l
Posted by jlbl2l on August 21, 2004, at 11:41:29
In reply to Re: Sleeping drugs » jlbl2l, posted by chemist on August 21, 2004, at 10:10:46
hi chemist,
actually the strange thing is that the "z-meds" don't disrupt the sleep stages/spindle. I always thought that was odd. (At least Ambien doesnt..) It just maintains a normal sleep cycle. It is just benzos that disrupt slow wave sleep 3/4.
Neurontin and Xyrem (and Lyrica/pregabalin) are the only drugs i know that actually increase slow wave sleep at the moment.Not a bad option option actually, if one can get Xyrem for sleep.
Posted by Larry Hoover on August 21, 2004, at 12:40:19
In reply to Re: Sleeping drugs » Larry Hoover, posted by jlbl2l on August 21, 2004, at 11:36:31
> Larry,
>
> I don't mean to be like those mean doctors if you need a benzo by all means take it, but i do disagree. That is one single study which wasn't all that in depth in EEG activity or sleep spindles during sleep anyways. There are countless more showing the opposite for insomnia or for other conditions or for benzos in general.I hope you're not looking for an essay. Specific benzos, the ones that are hypnotics, most certainly do increase slow wave activity. I gave a single example, as modest proof of the alternative to your generalizations.
J Psychiatr Res. 2000 Nov-Dec;34(6):423-38.
Effects of hypnotics on the sleep EEG of healthy young adults: new data and psychopharmacologic implications.Feinberg I, Maloney T, Campbell IG.
Department of Psychiatry, University of California, CA, Davis, USA. ifeinberg@ucdavis.edu
Benzodiazepine hypnotics increase NREM sleep and alter its EEG by reducing delta (0.3-3 Hz) and increasing sigma (12-15 Hz) and beta (15-23 Hz) activity. We tested whether the nonbenzodiazepine hypnotic, zolpidem (10 mg), produced the same pattern of sleep and EEG changes as two "classical" benzodiazepines, triazolam (0.25 mg) and temazepam (30 mg). Sleep EEG of 16 subjects was analyzed with period amplitude analysis for 3 nights during drug administration or placebo. The effects of zolpidem were in the same direction but generally of smaller magnitude than those of the classical benzodiazepines. These differences are more likely the result of non-equivalent dosages than different pharmacologic actions. Period amplitude analysis showed that the decreased delta activity resulted mainly from a decrease in wave amplitude. In contrast, the increased sigma and beta activity were produced by increased wave incidence. Delta suppression increased with repeated drug administration but sigma and beta stimulation did not. While these findings have little relevance for the clinical choice of hypnotics they may hold important implications for the brain mechanisms involved in hypnotic tolerance and withdrawal delirium.
Posted by zeugma on August 21, 2004, at 16:10:59
In reply to Re: Sleeping drugs » jlbl2l, posted by Larry Hoover on August 21, 2004, at 12:40:19
Just to add my input on this question (purely anecdotal): even .25 mg clonazepam worsened my narcoleptic symptoms (hypnagogic and hypnopompic hallucinations, sleep onset REM periods and sleep disruption); apparently the mechanism, as far as I can figure out, is that the benzo suppressed slow-wave sleep to some degree, collapsing me back into premature REM. Since only clonazepam has been effective, of all the meds I've tried, in abating my severe social and generalized anxiety,I've had to be very careful to avoid naps during the day (hard, as I have a very low level of energy and take various stims [megadoses of caffeine, plus a little Ritalin]) including some caffeine during the times I am most tempted to nap, from 4 to 6 p.m. I also try to reduce the temptation to nap after clonazepam ingestion by taking my afternoon dose far from any bed. Clonazepam, at least, has a detrimental effect on my sleep disorder and I am sure it has to do with SWS supression.
Posted by zeugma on August 21, 2004, at 16:43:46
In reply to Clonazepam, posted by zeugma on August 21, 2004, at 16:10:59
I am sure clonazepam's role in precipitating narcoleptic symptoms and even cataplexy has a lot to do with the fact that clonazepam is one of the most potent benzos in supressing convulsions as well as anxiety. My (primitive) understanding of epilepsy is that it is an intrusion of NREM sleep into waking, while narcolepsy presents the opposite symtomology: an intrusion of REM (including atonia) into waking. It strikes me as interesting that AED's are also potent anti-manics (at least some of them such as Depakote are), while conversely, drugs like Tofranil and Norpramin have long been mainstays of narcolepsy treatment for preventing the cataplectic attacks characteristic of that disorder. What is it about clonazepam that might make it a more powerful AED than other benzos? Does alprazolam, which appears to have antidepressant activity, also potently block seizures? I am curious because Lamictal is that only AED that I have heard that might have AD activity; any thoughts on these or related topics? Sorry for the incoherence of this post, I am drinking my half-caffeinatyed pot of coffee and trying desperately to stay awake long enough for me to get through this late-afternoon lull, without stimulating myself to the point of insomnia. I exist on a very delicate balance of stimulants and sedatives.
Thanks,z
Posted by chemist on August 21, 2004, at 17:29:24
In reply to Q for Larry, chemist on K and AED's, posted by zeugma on August 21, 2004, at 16:43:46
hi z, chemist here...i think larry or some of the other folks more enlightened than i will be of help...the comment that comes to my equally-caffeinated mind is that klonopin appears to be classified - for what that is worth - as an anti-convulsant, as opposed to an anti-epileptic or anti-seizure med. this might be a matter of semantics, but i think there is likely some science here, too: i know of some folks who have been shot-up with lorazepam or diazepam upon, shall we say, arriving at the facility in a very agitated state, and thorazine or haldol was not deemed appropriate (this is my way of trying to state that there is a fine line between being an agressive, angry non-compliant patient and a psychotic patient, as far as what will cool their heels the quickest). i am a long-time xanax user, and i would not call is sedating or activating, yet this is after years of being on it or the related benzos, so i am long past the point of noticing the good/bad/ugly and my rose-colored glasses are firmly in place. okay, enough. i will be interested to see what the rest of the gang contributes, as your points - and personal experience - are food for thought, and i do not want to hazard a guess.....thanks much for the mental stimulation, looking forward to some closure! best, chemist
> I am sure clonazepam's role in precipitating narcoleptic symptoms and even cataplexy has a lot to do with the fact that clonazepam is one of the most potent benzos in supressing convulsions as well as anxiety. My (primitive) understanding of epilepsy is that it is an intrusion of NREM sleep into waking, while narcolepsy presents the opposite symtomology: an intrusion of REM (including atonia) into waking. It strikes me as interesting that AED's are also potent anti-manics (at least some of them such as Depakote are), while conversely, drugs like Tofranil and Norpramin have long been mainstays of narcolepsy treatment for preventing the cataplectic attacks characteristic of that disorder. What is it about clonazepam that might make it a more powerful AED than other benzos? Does alprazolam, which appears to have antidepressant activity, also potently block seizures? I am curious because Lamictal is that only AED that I have heard that might have AD activity; any thoughts on these or related topics? Sorry for the incoherence of this post, I am drinking my half-caffeinatyed pot of coffee and trying desperately to stay awake long enough for me to get through this late-afternoon lull, without stimulating myself to the point of insomnia. I exist on a very delicate balance of stimulants and sedatives.
>
> Thanks,z
Posted by zeugma on August 21, 2004, at 18:41:14
In reply to Re: Q for Larry, chemist on K and AED's » zeugma, posted by chemist on August 21, 2004, at 17:29:24
i know of some folks who have been shot-up with lorazepam or diazepam upon, shall we say, arriving at the facility in a very agitated state, and thorazine or haldol was not deemed appropriate >
hi chemist, i appreciate your tact in describing the fine line between being a little upset at arriving at the 'facility' and not being a candidate for more aggressive (for want of a better word) pharmacotherapy. i guess that i too might not be in the best of moods upon arrival. this was my first smile of the day :)
-z
Posted by chemist on August 21, 2004, at 19:00:31
In reply to Re: Q for Larry, chemist on K and AED's » chemist, posted by zeugma on August 21, 2004, at 18:41:14
> i know of some folks who have been shot-up with lorazepam or diazepam upon, shall we say, arriving at the facility in a very agitated state, and thorazine or haldol was not deemed appropriate >
>
> hi chemist, i appreciate your tact in describing the fine line between being a little upset at arriving at the 'facility' and not being a candidate for more aggressive (for want of a better word) pharmacotherapy. i guess that i too might not be in the best of moods upon arrival. this was my first smile of the day :)
>
> -zwell, glad to make *somebody* happy! be well, stay cool, and all that......perhaps we'll have coffee one of these days, who knows? best, chemist
Posted by alesta on August 21, 2004, at 19:39:06
In reply to Re: Q for Larry, chemist on K and AED's » zeugma, posted by chemist on August 21, 2004, at 19:00:31
chemist,
we all love you! by the way, check your messages.:)
amy :)
Posted by chemist on August 21, 2004, at 19:40:45
In reply to Re: Q for Larry, chemist on K and AED's--chemist, posted by alesta on August 21, 2004, at 19:39:06
> chemist,
>
> we all love you! by the way, check your messages.:)
>
> amy :)
>
>
>
messages? please advise, i am lost (seriously) on this one.....all the best, chemist
Posted by alesta on August 21, 2004, at 19:42:28
In reply to Re: Q for Larry, chemist on K and AED's--chemist » alesta, posted by chemist on August 21, 2004, at 19:40:45
sorry, i meant your email......:)
amy:)
Posted by chemist on August 21, 2004, at 19:47:08
In reply to Re: Q for Larry, chemist on K and AED's--chemist, posted by alesta on August 21, 2004, at 19:42:28
> sorry, i meant your email......:)
>
> amy:)um, nothing.....might i ask you to send via babblemail, also did you send to an account with a .edu or .com extension????? best, chemist
Posted by alesta on August 21, 2004, at 19:54:12
In reply to Re: Q for Larry, chemist on K and AED's--chemist » alesta, posted by chemist on August 21, 2004, at 19:47:08
i used the babblemail feature.
maybe you don't have the babblemail feature turned on? i had to turn mine on....(via updating registration)
amy:)
Posted by chemist on August 21, 2004, at 19:58:09
In reply to Re: Q for Larry, chemist on K and AED's--chemist, posted by alesta on August 21, 2004, at 19:54:12
> i used the babblemail feature.
>
> maybe you don't have the babblemail feature turned on? i had to turn mine on....(via updating registration)
>
> amy:)it's on, i have babblemailed back and forth with 2 others today.....haven't got anything yet. i'll try you, if that doesn't work, i'll give you an alternate.....c
Posted by chemist on August 21, 2004, at 20:06:27
In reply to Re: Q for Larry, chemist on K and AED's--chemist, posted by alesta on August 21, 2004, at 19:54:12
amy, babblemail sent (allegedly successfully) to alesta, minutes ago.....let me know if you got it......c
Posted by alesta on August 21, 2004, at 20:08:19
In reply to Re: Q for Larry, chemist on K and AED's--chemist » alesta, posted by chemist on August 21, 2004, at 19:58:09
did you get it? got yours...
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