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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by zonked on October 5, 2011, at 22:37:32
Oh, guys.
I am getting light sleep on two 10mg Ambien IR, which I alternate with 30-60 temazepam. I know they are probably cross-tolerant, plus I take between 0.5-2mg of Xanax per day, so there's probably a tolerance issue there as well.
[Side note: After 3 months, I have finally gotten Medicaid to pay for my Xanax, and retroactively. Yay! That took a lot of effort, but an extra $80 in my pocket for the fills I paid for in cash.]
I haven't filled my Ambien CR script yet, but I will ask for brand as my doc forgot to check "Dispense as Written" (I do not really trust generic ER/XR/XL medications.)
Dalmane: It sounds so appealing. I haven't taken it in years and was on Cymbalta at the time, and I don't remember much about it other than it works. Who's taken this? Hangover effect? Any other side effects? Long term tolerance? Jono, you're right about the half life. I don't want Klonopin-like hangover effects - did you personally take this? Has anyone?
Lunesta: Another Z-drug. Haven't tried this one, but the FDA has approved it for long term use. Anyone taken this?
Rozerem: The ratings are so ghastly on askapatient.com I'm almost afraid to touch this one.
Melatonin: Does this _really_ cause depression in those prone to it? Has anyone taken it here and notice their depression worsening?
If I've learned one thing the last year about psychopharmacology, it's that there seems to be no ideal hypnotic: there's either tolerance (benzos and Z-drugs) or intolerable side effects (Trazodone, rozerem, antipsychotics, antihistamines).
I know I've brought this up before, and recently. I'm doing well overall, and I do sleep but it's not refreshing. I just don't like waking up non-refreshed and having to take so much hypnotic...
I was thinking about Clonidine, but have steered clear because of reports of depressogenic side effects....
On the quest for an ideal hypnotic, Nardil-compatible...
-z
Posted by Chairman_MAO on October 5, 2011, at 23:48:24
In reply to hypnotics: Dalmane, Lunesta? any1 taken? jono/SLS?, posted by zonked on October 5, 2011, at 22:37:32
While on Nardil, I had to avoid the "z-drugs" because I'd get up in the middle of the night and, in a stupor, seek out any carbohydrates within my residence and binge on them. I'd go through whole boxes of instant oatmeal packets, peanut butter--it was ludicrous.
I used 2mg lorazepam nightly and never developed a tolerance. YMMV.
Rozarem is uselss. I use 3mg lunesta now, it is "OK". It would probably be better if I didn't have a benzo dependency.
I used clonidine while on tranylcypromine at night to help with sleep sometimes. Never had a problem with it inducing depression. I'm not sure that it's the best thing for sleep architecture, though, either.
Nothing works like GHB. Pity we live in a medico-statist nightmare.
Posted by SLS on October 6, 2011, at 5:53:23
In reply to Re: hypnotics: Dalmane, Lunesta? any1 taken? jono/SLS? » zonked, posted by Chairman_MAO on October 5, 2011, at 23:48:24
> I used 2mg lorazepam nightly and never developed a tolerance. YMMV.
I used lorazepam every night for a few years without developing tolerance to its hypnotic effects. I like lorazepam because it is clean (for me). I do not experience hangovers or any perceptible changes in cognition. I remain clear-headed. More recently, I have had success combining zaleplon (Sonata) with lorazepam (Ativan). I fall asleep faster and remain asleep through the night. There is less chance of amnesia or sleep-walking / eating with this treatment.
- Scott
Posted by zonked on October 6, 2011, at 9:59:37
In reply to Re: hypnotics: Dalmane, Lunesta? any1 taken? jono/SLS? » Chairman_MAO, posted by SLS on October 6, 2011, at 5:53:23
> > I used 2mg lorazepam nightly and never developed a tolerance. YMMV.
>
> I used lorazepam every night for a few years without developing tolerance to its hypnotic effects. I like lorazepam because it is clean (for me). I do not experience hangovers or any perceptible changes in cognition. I remain clear-headed. More recently, I have had success combining zaleplon (Sonata) with lorazepam (Ativan). I fall asleep faster and remain asleep through the night. There is less chance of amnesia or sleep-walking / eating with this treatment.
>
>
> - ScottInitiation and maintenance were both terrible last night - I felt as though I was awake the entire night! During my first (rapid-to) remission with Zoloft 10 years ago, I obtained some Sonata until I was able to see my doctor about the insomnia problem. It did not keep me asleep.
Which are you using for initiation and which maintenance? I was told by more than one doctor not to use Xanax for sleep (I never asked why); but I do wonder if combining Xanax with a Z-drug such as Lunesta or its older cousin, Sonata, would be ideal.
I almost never take my full two, 1mg Xanax during the day, so that leaves me more than enough to try this with the Ambien I have remaining.
Another night of no sleep, and I'm filling the CR. Brand. Teva Ambien doesn't even cause the weird behaviors that original brand Ambien did (which I learned to suppress, i.e. being on instant messenger, email etc)... but that could be because I am tolerant to the class of drugs.
If I get this sleep problem fix, that's one more step to tweaking this regime to about as good as it will get with Nardil and T and Xanax at the base. Able to work, able to cope, able to learn, and able to live...
BTW: Scott, how are you feeling today? I can only speak for myself but I think we're all delighted (and perhaps over-eager) to hear about your progress with Viibryd.
PS: They appear to have relaunched the consumer site. It had changed to "coming soon" after Forest bought Clinical Data; the healthcare professional site is now up as well -- on that site it appears to show Viibryd activating presynaptic and postsynaptic receptors. Correct me if I am wrong. :-)
-z
Posted by SLS on October 6, 2011, at 10:20:20
In reply to Re: hypnotics: Dalmane, Lunesta? any1 taken? jono/SLS? » SLS, posted by zonked on October 6, 2011, at 9:59:37
Hi Z.
> > > I used 2mg lorazepam nightly and never developed a tolerance. YMMV.
> > I used lorazepam every night for a few years without developing tolerance to its hypnotic effects. I like lorazepam because it is clean (for me). I do not experience hangovers or any perceptible changes in cognition. I remain clear-headed. More recently, I have had success combining zaleplon (Sonata) with lorazepam (Ativan). I fall asleep faster and remain asleep through the night. There is less chance of amnesia or sleep-walking / eating with this treatment.
> Initiation and maintenance were both terrible last night - I felt as though I was awake the entire night! During my first (rapid-to) remission with Zoloft 10 years ago, I obtained some Sonata until I was able to see my doctor about the insomnia problem. It did not keep me asleep.
>
> Which are you using for initiation and which maintenance?Sonata for initiation and Ativan for maintenance. I am impressed with results from using this combination.
> I was told by more than one doctor not to use Xanax for sleep...
I would tend to agree with this. It is better that you use something that is clean and devoid of euphoriant effects.
> BTW: Scott, how are you feeling today?
All I can say is...
:-)
> I can only speak for myself but I think we're all delighted (and perhaps over-eager) to hear about your progress with Viibryd.
I appreciate the warm fuzzies. So far, so good. Before declaring success, I would like to get past the point in which any antidepressant effects due to Nardil discontinuation dissipate. My guess is that I did not experience this phenomenon, and that my improved state is due entirely to Viibryd treatment. I am encouraged.
You are right about Viibryd binding to multiple 5-HT1a receptor populations.
- Scott
Posted by Phillipa on October 6, 2011, at 11:12:40
In reply to Re: hypnotics: Dalmane, Lunesta? any1 taken? jono/SLS? » zonked, posted by SLS on October 6, 2011, at 10:20:20
Scott I googled patient reviews on viibryd last night and it seemed most loved it and gave a l0 and also felt great. So that is good. Phillipa
Posted by floatingbridge on October 6, 2011, at 12:10:16
In reply to hypnotics: Dalmane, Lunesta? any1 taken? jono/SLS?, posted by zonked on October 5, 2011, at 22:37:32
Zonked,
Is awakening during the night a problem as well as maintaining deep sleep?
Lunesta worked for awhile, but I found it gave me the most hangover out of the z meds. However it's popular and did work for a few years for me.
I'm hoping that the CR of ambien will be your ticket. With my pdoc's supervision I have taken it with tenazepam w/o incident. Both meds do give me a hangover, but no sleep is worst of all :-)
Right now I am able to sleep on gabapentin and tenazepam as needed. The gabapentin seems to lengthen my sleep time and improve the quality (in that when I am asleep, I am not aware that I am sleeping :-/). I have no idea what it might do to sleep architecture.
Good luck getting the sleep piece in place!
Posted by jono_in_adelaide on October 6, 2011, at 19:59:38
In reply to Re: hypnotics: Dalmane, Lunesta? any1 taken? jono/SLS? » zonked, posted by floatingbridge on October 6, 2011, at 12:10:16
Dalmane will cause more hangover than temazepam, but less than its halflife might suggest, because it is redistributed to fatty tissue.
A study conduced by the BMJ in the 70's showed that nitrazepam (another benzo hypnotic commonly used in england, europe and australia) kept working for 6 months, and the authors concluded that tolorance to benzo hypnotics wasnt a problem for most patients.
Your dose is very high - it might be wise to try combining (say) 30mg of temazepam or Dalmane with (say) 25mg of doxepin.
Posted by bleauberry on October 9, 2011, at 6:14:50
In reply to hypnotics: Dalmane, Lunesta? any1 taken? jono/SLS?, posted by zonked on October 5, 2011, at 22:37:32
I think what works best is to constantly rotate whatever the sleeping med is, instead of taking the same thing every night.
Of all the sleep meds my favorite was low dose remeron. Most people don't know it but the lower the dose the more sedation. Anything as tiny as a crumb to as large as 7.5mg is quite sedating to me.
For a more natural approach consider drinking lemon balm tea, passionflower, skull cap...all good calming herbs that provide numerous other benefits, Tea, tincture, or pill. Tinctures are most potent for me but I sip the teas too.
Other things you need to try:
Magnesium glycinate or malate. If not possible, then the more common magnesium citrate.
GABARhodiola Rosea. It's actually a mild stimulant for some people yet is almost always calming at the same time, as well as antidepressant, anti aging, pro energy. A the right dose it is excellent on sleep and anxiety while at the same time providing energy and mood during the day. Dosing is tricky because rhodiola takes on different characteristics and behaviors depending on whether a low dose or high dose, and every one is different so it takes some experimenting and patience.
Any of the above, or a combination, can be combined with what you already take.
Posted by jono_in_adelaide on October 10, 2011, at 0:36:38
In reply to Re: hypnotics: Dalmane, Lunesta? any1 taken? jono/SLS?, posted by bleauberry on October 9, 2011, at 6:14:50
I agree, rotating a benzo type med (Temazepam, Ambien) with an antihistamine/seretonin type med (Seroquel or Doxepin), two nights on one med, 2 nights on the other.
Having said that, there was a major study conducted in the BMJ in the mid 70's that showed nitrazepam kept its hypnotic activity for atleast 6 months, and the authors concluded that if people werent tolorant after 6 months, they were unlikely to become tolorant at all, so, a long term benzo type med would likely remain effective long term, though you might well become dependent
Posted by zonked on October 10, 2011, at 1:17:32
In reply to Re: hypnotics: Dalmane, Lunesta? any1 taken? jono/SLS? » zonked, posted by Chairman_MAO on October 5, 2011, at 23:48:24
> Nothing works like GHB. Pity we live in a medico-statist nightmare.You sure you don't have cataplexy? Only kidding.
No, GHB is good for a great many things. I knew several people (before it was made illegal, and I think before "Xyrem" debuted) who became highly dependent on it, but is that any different than a lot of things we take? I will say that SWIM has, when he was younger, taken "recreational" doses of what is now known as "Xyrem", and it produces an experience very much like MDMA only with much enhanced sexuality. I can see why the DEA/FDA had their eyes on it.
I have no idea how doses of Xyrem for cataplexy compare with typical recreational GHB doses; but you're right--it's a potential miracle medicine for many things. It's too bad this culture has such a black and white view on anything with abuse potential, leaving people sick who would otherwise be healed.
-z
Posted by Chairman_MAO on October 11, 2011, at 13:41:39
In reply to Re: hypnotics: Dalmane, Lunesta? any1 taken? jono/SLS?, posted by zonked on October 10, 2011, at 1:17:32
The combined death toll and public health cost of alcohol and tobacco eclipses that of all "drugs of abuse" combined many times over.
Anyone can "abuse" anything. I've met people that preferred Seroquel over typical "drugs of abuse".
The DEA should be defunded and remembered as a rhelic of a troubled time.
The third-leading cause of death in the United States is physician-induced death. The first two are heart disease and cancer, but they'll never prohibit Marlboros nor McDonalds.
Posted by jono_in_adelaide on October 21, 2011, at 1:18:44
In reply to Re: hypnotics: Dalmane, Lunesta? any1 taken? jono/SLS? » zonked, posted by Chairman_MAO on October 11, 2011, at 13:41:39
Um, where did that come from?
I wasnt advocating any sort of a war on drugs, just saying that rotating sleep meds with different modes of action can help keep them fresh and give you good sleep every night for a long time.
Sadly, the current drug laws were put in place to stop the 1% of people who abuse drugs, and the 99% who use them sensibly have to suffer. (For example, in Australia until 1988 you could buy 5 nights worth of chloral hydrate without prescription, if you provided the pharmacist with ID and signed the poison register..... it was re scheduled to prescription only because a few people used to go around to 10 different pharmacies buying bottles of it, and use it to get high)
The many now suffer for the mis deeds of a few.
I'm just glad we can still get ibuprofen OTC
Posted by Phillipa on October 21, 2011, at 19:13:38
In reply to Re: hypnotics: Dalmane, Lunesta? any1 taken? jono/SLS?, posted by jono_in_adelaide on October 21, 2011, at 1:18:44
Jono when my Father was alive ibuphrophen was script also and he had osteoarthritis. Then later over the counter med. Now all the warning of danger of this med and tylenol. Phillipa
Posted by jono_in_adelaide on October 23, 2011, at 2:29:35
In reply to Re: hypnotics: Dalmane, Lunesta? any1 taken? jono/SLS? » jono_in_adelaide, posted by Phillipa on October 21, 2011, at 19:13:38
Yes, its all relative..... its easier to seriously hear your self with Tylenol than most prescription drugs.
In England they have made it that you can only buy 16 tablets without prescription, to cut down accidental and deliberate overdoses..... and it seems to have worked.
Not very convenient, but it seems to be working
Posted by islandangel on October 31, 2011, at 2:29:07
In reply to Re: hypnotics: Dalmane, Lunesta? any1 taken? jono/SLS?, posted by jono_in_adelaide on October 23, 2011, at 2:29:35
Dear Zonked,
I've had many years of experience as an insomniac, fibro and chronic back pain which I now know is Spondylitis. Melatonin didn't do much for me but make my emotions rage. What an awful feeling. Elavil was next, that was before Ambien came on the market. Elavil gave me hangovers but was helpful for pain. Ambien made me a walking, talking, cooking, eating zombie. My husband shared the sleep walking stories with me. It was horrible! Now I know why so many actors have gotten into trouble with Ambien. I finally landed on Lunesta. I take 3 mg and often take 6mg on a bad night. I do take a small 5mg or 10mg Flexeril *early (like 6pm) if I have pain that will keep me awake. If you dont take it early you will likely have a hangover. Flexeril is a cousin to Elavil.I try to take a break from Lunesta on the weekends or at least Saturday night. This seems to help during the week. On my Lunesta free night I usually take 1,200 mg of Valerian extract with 400mg lemonbalm (more lemonbalm will make you agitated). It probably helps that I take Neurontin.
By the way, I've tried Rozerem. It did nothing for me.
Best of luck and sweet dreams!
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