![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 44. This is the beginning of the thread.
Posted by KaraS on September 9, 2004, at 20:16:18
I don't know what to do about it. I'm either in a cycle where I can't do anything but sleep or else I can't sleep at all. (Actually I can sleep in the afternoon without a problem. It's at nighttime that I can't sleep at all. Is that cortisol related?) There's a bit of anxiety and some RLS involved.
I have some Ambien and Sonata samples here but I'm afraid to try them. I don't want to become dependent as I once was on Ativan. After reading the Ambien abuse thread below, I'm even more scared. How is it that some people can take Ambien, Restoril or another benzo indefinitely without a problem and someone else ends up with a 90 pill a day habit?
I've tried trazadone and Neurontin and they both made me feel quite sick. I still have the neurontin and may try it again in smaller dosage. I tried Benadryl again last night and it makes my heart race while making the rest of me groggy. It was a very strange and scary experience.
5-htp made me groggy the next day. Melatonin gets me to sleep but doesn't keep me there for long. I haven't tried Valerian yet. I've read different things about whether or not people develop tolerance to it as well.
Lastly, there's the sedating tricyclics. Doxepin works well but I'm also quite groggy the next day. Maprotiline worked well with less grogginess but still some. On top of that they both made me fat. All I wanted to do was eat when I took them. I'm finally thin again and I want to stay that way, da-- it! Do I have to choose between being thin and exhausted or fat and sleeping at night??????
Any suggestions would be greatly appreciated.
Kara
Posted by fires on September 9, 2004, at 20:31:59
In reply to Trouble sleeping - please help, posted by KaraS on September 9, 2004, at 20:16:18
> I don't know what to do about it. I'm either in a cycle where I can't do anything but sleep or else I can't sleep at all. (Actually I can sleep in the afternoon without a problem. It's at nighttime that I can't sleep at all. Is that cortisol related?) There's a bit of anxiety and some RLS involved.
>
> I have some Ambien and Sonata samples here but I'm afraid to try them. I don't want to become dependent as I once was on Ativan. After reading the Ambien abuse thread below, I'm even more scared. How is it that some people can take Ambien, Restoril or another benzo indefinitely without a problem and someone else ends up with a 90 pill a day habit?
>
> I've tried trazadone and Neurontin and they both made me feel quite sick. I still have the neurontin and may try it again in smaller dosage. I tried Benadryl again last night and it makes my heart race while making the rest of me groggy. It was a very strange and scary experience.
>
> 5-htp made me groggy the next day. Melatonin gets me to sleep but doesn't keep me there for long. I haven't tried Valerian yet. I've read different things about whether or not people develop tolerance to it as well.
>
> Lastly, there's the sedating tricyclics. Doxepin works well but I'm also quite groggy the next day. Maprotiline worked well with less grogginess but still some. On top of that they both made me fat. All I wanted to do was eat when I took them. I'm finally thin again and I want to stay that way, da-- it! Do I have to choose between being thin and exhausted or fat and sleeping at night??????
>
> Any suggestions would be greatly appreciated.
>
> Kara
>
>
Suggestions:Talk with your MD about:
1)AM light exposure.
2) Low dose Remeron
3) Clonazepam
4) Sleep polysomnography
Good luck
Posted by KaraS on September 9, 2004, at 22:39:36
In reply to Re: Trouble sleeping - please help, posted by fires on September 9, 2004, at 20:31:59
> Suggestions:
>
> Talk with your MD about:
>
> 1)AM light exposure.
>
> 2) Low dose Remeron
>
> 3) Clonazepam
>
> 4) Sleep polysomnography
>
> Good luck
>
>Thanks for your response.
1) I do need to get consistent AM light exposure. I have a light box I should start using again.
2) Low dose Remeron might lead to too much weight gain
3) Wouldn't I develop a tolerance/dependence problem with clomazepam?
4) Sleep polysomnography - I would love to get tested for sleep problems (I'm assuming that's what this is) as soon as I can afford it.
-K
Posted by Sad Panda on September 9, 2004, at 23:00:43
In reply to Trouble sleeping - please help, posted by KaraS on September 9, 2004, at 20:16:18
> I don't know what to do about it. I'm either in a cycle where I can't do anything but sleep or else I can't sleep at all. (Actually I can sleep in the afternoon without a problem. It's at nighttime that I can't sleep at all. Is that cortisol related?) There's a bit of anxiety and some RLS involved.
>
> I have some Ambien and Sonata samples here but I'm afraid to try them. I don't want to become dependent as I once was on Ativan. After reading the Ambien abuse thread below, I'm even more scared. How is it that some people can take Ambien, Restoril or another benzo indefinitely without a problem and someone else ends up with a 90 pill a day habit?
>
> I've tried trazadone and Neurontin and they both made me feel quite sick. I still have the neurontin and may try it again in smaller dosage. I tried Benadryl again last night and it makes my heart race while making the rest of me groggy. It was a very strange and scary experience.
>
> 5-htp made me groggy the next day. Melatonin gets me to sleep but doesn't keep me there for long. I haven't tried Valerian yet. I've read different things about whether or not people develop tolerance to it as well.
>
> Lastly, there's the sedating tricyclics. Doxepin works well but I'm also quite groggy the next day. Maprotiline worked well with less grogginess but still some. On top of that they both made me fat. All I wanted to do was eat when I took them. I'm finally thin again and I want to stay that way, da-- it! Do I have to choose between being thin and exhausted or fat and sleeping at night??????
>
> Any suggestions would be greatly appreciated.
>
> Kara
>
>
Hi Kara,A TCA with less antihistamine activity might be enough, I would try Nortriptyline. Trazodone might be worth trying again at lower doseages. The AP Risperdal taken at low doseage might also be worth a shot.
Cheers,
Paul.
Posted by sb417 on September 10, 2004, at 1:37:13
In reply to Trouble sleeping - please help, posted by KaraS on September 9, 2004, at 20:16:18
Hi Kara,
Do you have trouble falling asleep? Or are you able to fall asleep easily but you can't stay asleep? Also, you mentioned that you got sick from Trazodone and Neurontin. Can you elaborate? In what way were you sick on those meds?
I also have a lot of sleep difficulties. I don't have trouble falling asleep, but I have a phase shift (delayed sleep phase syndrome), and lately I have some trouble staying asleep (probably hormonal). I have definitely not overcome my sleep problems, but the following things seem to help:
1) Getting regular exercise fairly early in the day. It doesn't have to be first thing in the morning, but I think it helps to exercise before noon or 2 p.m. I've read that exercise suppresses melatonin for about 12 hours or so, so if you exercise too late, it might keep you up. Of course, I know many people who exercise after work and have no trouble falling asleep, so that is highly variable. For me, however, I find it's best to exercise between 30-40 minutes per day, no later than about 12-2 pm.
2) Use the bright lights early in the morning.
3) Eat higher protein meals earlier in the day, and higher carbohydrate meals later in the day. I try to have a bedtime snack with carbohydrate and either milk or yogurt. I take my magnesium glycinate or magnesium citrate right before bed, too. If I'm feeling really "wired," I try to make sure I have a high carbohydrate dinner like pasta or pizza. That turns me into a slug, and I tend to sleep better when I'm a carbohydrate-laden slug. When I'm premenstrual, I allow myself some extra sweets, and the sweets seem to help me sleep better also.
4) Take B vitamins during the day, but not too close to bedtime. I imagine a lot of people will disagree with me on this point, but I find that B vitamins too close to bedtime tend to wake me up, although a tiny chip of Vitamin B6 along with the magnesium can relax me.
5) This next point is probably the most difficult. You have to be compulsive and rigid about bedtime and awake time. You have to set a schedule and be very strict. I think the idea is that if you're on a regular schedule and you force yourself to go to bed at the same time and get up at the same time, eventually you'll get tired enough to go to bed at the right time. I gather that you're still not on a regular routine as far as school or a job, so this can be difficult to put into practice, but it's worth a try.
6)Is it possible that some of the supplements you're taking might be causing you to have difficulty sleeping?
7) Unfortunately, I have found that both late-night TV and late-night computer use (which I'm doing now) tend to be too stimulating. I think the lights from the TV and the computer can further suppress melatonin and wreak more havoc with the circadian rhythms. When I'm away from home and without my computer, I tend to go to bed much earlier.
There are some other things I'll probably think of later, but I think item #5 is probably the most important one and the most difficult one to put into practice. I put up a lot of resistance to being rigid about bedtime and morning alarm time, but when I am strict about it, it really does seem to work. By the way, I posted on PB Books to you about two biographies that might interest you. These two are in addition to the Kitty Kelly book.
Posted by King Vultan on September 10, 2004, at 9:38:12
In reply to Trouble sleeping - please help, posted by KaraS on September 9, 2004, at 20:16:18
One thing you can do that took me years to figure out is to alternate sleep aids. I was also wary of stuff like Ambien and even made a 30 pill prescription last over five years, as I was so worried about becoming dependent on it that I rarely ever used it. Obviously, I got very little benefit from it also, and my antidepressant induced insomnia went largely untreated.
Now that I am on an MAOI, the insomnia is so bad I really have no choice and have had to come up with some kind of scheme to combat the sleeplessness. I just increased the Halcion/triazolam that I take every other night to a whole 0.25 mg pill. Half a pill was sufficient for me on Nardil, but it isn't enough on Parnate. The 2 x 25 mg of Benadryl that worked to some extent on Nardil seems to be woefully inadequate on Parnate, so I am going to have to figure out something else. I was planning on talking to my doctor about trying trazodone again, or maybe doxepin, Surmontil/trimipramine, hydroxyzine, or maybe something even more unconventional.
Your heart racing on the Benadryl is likely due to that drug's anticholinergic properties; Benadryl is strong enough that way to have some efficacy in treating Parkinson's Disease, but I think more for people with milder symptoms. There is another OTC sleep aid very similar to the molecule used in Benadryl/diphenhydramine, which is the doxylamine succinate that is in the Unisom tablets (there is also another Unisom product that contains 50 mg diphenhydramine, just to be confusing). I don't know how anticholinergic the doxylamine really is compared to diphenhydramine, as neither of them have the effect on me you describe, but I do doubt if the doxylamine is any worse--and it might be better.
One of the drugs I mentioned, trimipramine/Surmontil came up once when I was talking to my pdoc. I believe he said he uses it particularly for people with stomach problems, so it may have a tendency to make you less sick than the trazodone, but this is another super powerful tricyclic antihistamine, nearly as strong as doxepin. I would expect it to have some of the same chubbiness inducing properties, but I have heard that it is supposed to be unusually good for sleep, though.
Todd
Posted by Sad Panda on September 10, 2004, at 10:58:44
In reply to Re: Trouble sleeping - please help » KaraS, posted by sb417 on September 10, 2004, at 1:37:13
> Hi Kara,
>
> Do you have trouble falling asleep? Or are you able to fall asleep easily but you can't stay asleep? Also, you mentioned that you got sick from Trazodone and Neurontin. Can you elaborate? In what way were you sick on those meds?
>
> I also have a lot of sleep difficulties. I don't have trouble falling asleep, but I have a phase shift (delayed sleep phase syndrome), and lately I have some trouble staying asleep (probably hormonal). I have definitely not overcome my sleep problems, but the following things seem to help:
>
> 1) Getting regular exercise fairly early in the day. It doesn't have to be first thing in the morning, but I think it helps to exercise before noon or 2 p.m. I've read that exercise suppresses melatonin for about 12 hours or so, so if you exercise too late, it might keep you up. Of course, I know many people who exercise after work and have no trouble falling asleep, so that is highly variable. For me, however, I find it's best to exercise between 30-40 minutes per day, no later than about 12-2 pm.
>
> 2) Use the bright lights early in the morning.
>
> 3) Eat higher protein meals earlier in the day, and higher carbohydrate meals later in the day. I try to have a bedtime snack with carbohydrate and either milk or yogurt. I take my magnesium glycinate or magnesium citrate right before bed, too. If I'm feeling really "wired," I try to make sure I have a high carbohydrate dinner like pasta or pizza. That turns me into a slug, and I tend to sleep better when I'm a carbohydrate-laden slug. When I'm premenstrual, I allow myself some extra sweets, and the sweets seem to help me sleep better also.
>
> 4) Take B vitamins during the day, but not too close to bedtime. I imagine a lot of people will disagree with me on this point, but I find that B vitamins too close to bedtime tend to wake me up, although a tiny chip of Vitamin B6 along with the magnesium can relax me.
>
> 5) This next point is probably the most difficult. You have to be compulsive and rigid about bedtime and awake time. You have to set a schedule and be very strict. I think the idea is that if you're on a regular schedule and you force yourself to go to bed at the same time and get up at the same time, eventually you'll get tired enough to go to bed at the right time. I gather that you're still not on a regular routine as far as school or a job, so this can be difficult to put into practice, but it's worth a try.
>
> 6)Is it possible that some of the supplements you're taking might be causing you to have difficulty sleeping?
>
> 7) Unfortunately, I have found that both late-night TV and late-night computer use (which I'm doing now) tend to be too stimulating. I think the lights from the TV and the computer can further suppress melatonin and wreak more havoc with the circadian rhythms. When I'm away from home and without my computer, I tend to go to bed much earlier.
>
> There are some other things I'll probably think of later, but I think item #5 is probably the most important one and the most difficult one to put into practice. I put up a lot of resistance to being rigid about bedtime and morning alarm time, but when I am strict about it, it really does seem to work. By the way, I posted on PB Books to you about two biographies that might interest you. These two are in addition to the Kitty Kelly book.
>
>Can we keep this kind of advice on the alternative board please? Here is a link to that board: http://www.dr-bob.org/babble/alter/
Posted by KaraS on September 10, 2004, at 16:49:32
In reply to Re: Trouble sleeping - please help » KaraS, posted by Sad Panda on September 9, 2004, at 23:00:43
> > I don't know what to do about it. I'm either in a cycle where I can't do anything but sleep or else I can't sleep at all. (Actually I can sleep in the afternoon without a problem. It's at nighttime that I can't sleep at all. Is that cortisol related?) There's a bit of anxiety and some RLS involved.
> >
> > I have some Ambien and Sonata samples here but I'm afraid to try them. I don't want to become dependent as I once was on Ativan. After reading the Ambien abuse thread below, I'm even more scared. How is it that some people can take Ambien, Restoril or another benzo indefinitely without a problem and someone else ends up with a 90 pill a day habit?
> >
> > I've tried trazadone and Neurontin and they both made me feel quite sick. I still have the neurontin and may try it again in smaller dosage. I tried Benadryl again last night and it makes my heart race while making the rest of me groggy. It was a very strange and scary experience.
> >
> > 5-htp made me groggy the next day. Melatonin gets me to sleep but doesn't keep me there for long. I haven't tried Valerian yet. I've read different things about whether or not people develop tolerance to it as well.
> >
> > Lastly, there's the sedating tricyclics. Doxepin works well but I'm also quite groggy the next day. Maprotiline worked well with less grogginess but still some. On top of that they both made me fat. All I wanted to do was eat when I took them. I'm finally thin again and I want to stay that way, da-- it! Do I have to choose between being thin and exhausted or fat and sleeping at night??????
> >
> > Any suggestions would be greatly appreciated.
> >
> > Kara
> >
> >
>
>
> Hi Kara,
>
> A TCA with less antihistamine activity might be enough, I would try Nortriptyline. Trazodone might be worth trying again at lower doseages. The AP Risperdal taken at low doseage might also be worth a shot.
>
> Cheers,
> Paul.
>Hi Panda, (can't call you Paul yet - I'm just not used to it yet)
Nort. was one of the most stimulating meds I've ever taken. I know most people can take it for sleep - but definitely not me. I don't remember how much trazadone I took but it might be worth trying again. Risperdal sounds intriguing - something I hadn't considered yet. Is it one of the newer APs? I'll have to read up on it more. Thanks!
BTW, How are you doing? Last I heard you had hit a bit of a rough spot yourself. Are you feeling better now?
-K
Posted by KaraS on September 10, 2004, at 17:06:11
In reply to Re: Trouble sleeping - please help » KaraS, posted by sb417 on September 10, 2004, at 1:37:13
Hi sb,
> Do you have trouble falling asleep? Or are you able to fall asleep easily but you can't stay asleep? Also, you mentioned that you got sick from Trazodone and Neurontin. Can you elaborate? In what way were you sick on those meds?
Both trouble falling asleep and staying asleep. Trazodone made me feel nauseous and it didn't go away even after a couple of months. Neurontin I only took once or twice and I just remember that I felt awful the next day. Maybe it's worth trying a smaller dosage. I wish I remembered how much of each I had taken but it was a long time ago.
> I also have a lot of sleep difficulties. I don't have trouble falling asleep, but I have a phase shift (delayed sleep phase syndrome), and lately I have some trouble staying asleep (probably hormonal). I have definitely not overcome my sleep problems, but the following things seem to help:Delayed sleep phase syndrome - is that when you keep going to bed later and later because your natural clock is much longer than the normal 24 hours? What is diurnal variation and how does that fit into sleep issues? I like to stay up really late. It's the only time when I feel semi alive and have any energy and motivation so I always end up going to bed later and later. I wonder if that is actually what you're calling delayed shift?
> 1) Getting regular exercise fairly early in the day. It doesn't have to be first thing in the morning, but I think it helps to exercise before noon or 2 p.m. I've read that exercise suppresses melatonin for about 12 hours or so, so if you exercise too late, it might keep you up. Of course, I know many people who exercise after work and have no trouble falling asleep, so that is highly variable. For me, however, I find it's best to exercise between 30-40 minutes per day, no later than about 12-2 pm.These days I'm so exhausted and out of it until later in the day. There's no way I can make myself move in the morning. I know it would be great for me so maybe once I start to feel better... I can do it.
> 2) Use the bright lights early in the morning.I just got out the light box again and am going to get the light every morning.
> 3) Eat higher protein meals earlier in the day, and higher carbohydrate meals later in the day. I try to have a bedtime snack with carbohydrate and either milk or yogurt. I take my magnesium glycinate or magnesium citrate right before bed, too. If I'm feeling really "wired," I try to make sure I have a high carbohydrate dinner like pasta or pizza. That turns me into a slug, and I tend to sleep better when I'm a carbohydrate-laden slug. When I'm premenstrual, I allow myself some extra sweets, and the sweets seem to help me sleep better also.
I've been taking a high carb snack before bed but think it's probably good advice to have my dinner be high carbs as well. (Sugar gives me blood sugar problems so tends to disrupt my sleep.)
> 4) Take B vitamins during the day, but not too close to bedtime. I imagine a lot of people will disagree with me on this point, but I find that B vitamins too close to bedtime tend to wake me up, although a tiny chip of Vitamin B6 along with the magnesium can relax me.Yeah, the Bs have to come earlier in the day. I find the same holds for the Multi. If I take the multi in the evening I can really feel the difference.
> 5) This next point is probably the most difficult. You have to be compulsive and rigid about bedtime and awake time. You have to set a schedule and be very strict. I think the idea is that if you're on a regular schedule and you force yourself to go to bed at the same time and get up at the same time, eventually you'll get tired enough to go to bed at the right time. I gather that you're still not on a regular routine as far as school or a job, so this can be difficult to put into practice, but it's worth a try.I know. I've read this often enough but haven't been able to discipline myself. I think now that I'm so miserable and exhausted that I just might have what it takes to make that effort, though.
> 6)Is it possible that some of the supplements you're taking might be causing you to have difficulty sleeping?I'm not really taking that much now and I pretty much know what's stimulating and what isn't so I don't think that's an issue.
> 7) Unfortunately, I have found that both late-night TV and late-night computer use (which I'm doing now) tend to be too stimulating. I think the lights from the TV and the computer can further suppress melatonin and wreak more havoc with the circadian rhythms. When I'm away from home and without my computer, I tend to go to bed much earlier.Late night computer could be keeping me up as well. I'll try a cutoff time. In fact, for experiment's sake, I'll try not logging on or turning the tv on for a few nights.
> There are some other things I'll probably think of later, but I think item #5 is probably the most important one and the most difficult one to put into practice. I put up a lot of resistance to being rigid about bedtime and morning alarm time, but when I am strict about it, it really does seem to work. By the way, I posted on PB Books to you about two biographies that might interest you. These two are in addition to the Kitty Kelly book.Thanks for your input. I'll check out the books.
Kara
Posted by KaraS on September 10, 2004, at 17:21:55
In reply to Re: Trouble sleeping - please help » KaraS, posted by King Vultan on September 10, 2004, at 9:38:12
Hi Todd,
>One thing you can do that took me years to figure out is to alternate sleep aids.
That was my intent - to vary meds and alternative sleep aids so that my system didn't get dependent on any one or two things. However, I'm having trouble even finding those one or two things that will work for me and not have a lot of side effects.
>I was also wary of stuff like Ambien and even made a 30 pill prescription last over five years, as I was so worried about becoming dependent on it that I rarely ever used it. Obviously, I got very little benefit from it also, and my antidepressant induced insomnia went largely untreated.
Sounds just like me.
> Now that I am on an MAOI, the insomnia is so bad I really have no choice and have had to come up with some kind of scheme to combat the sleeplessness. I just increased the Halcion/triazolam that I take every other night to a whole 0.25 mg pill. Half a pill was sufficient for me on Nardil, but it isn't enough on Parnate. The 2 x 25 mg of Benadryl that worked to some extent on Nardil seems to be woefully inadequate on Parnate, so I am going to have to figure out something else. I was planning on talking to my doctor about trying trazodone again, or maybe doxepin, Surmontil/trimipramine, hydroxyzine, or maybe something even more unconventional.Why are you not worried about Halcion and yet you were worried about Ambien? Halcion seems scarier to me than Ambien but that might just be because of the bad press it got a few years back. Was the hype unwarranted?
What was your experience on trazadone the first time? That would seem to be ideal to me if you could tolerate it. I don't know hydroxyzine at all. I'll have to check into that one more.
>
> Your heart racing on the Benadryl is likely due to that drug's anticholinergic properties; Benadryl is strong enough that way to have some efficacy in treating Parkinson's Disease, but I think more for people with milder symptoms. There is another OTC sleep aid very similar to the molecule used in Benadryl/diphenhydramine, which is the doxylamine succinate that is in the Unisom tablets (there is also another Unisom product that contains 50 mg diphenhydramine, just to be confusing). I don't know how anticholinergic the doxylamine really is compared to diphenhydramine, as neither of them have the effect on me you describe, but I do doubt if the doxylamine is any worse--and it might be better.I have heard of doxylamine succinate. I had such a bad time with the benadryl that I'm afraid of trying it. Maybe I should just bite the bullet. It would be worth it if it worked for me.
> One of the drugs I mentioned, trimipramine/Surmontil came up once when I was talking to my pdoc. I believe he said he uses it particularly for people with stomach problems, so it may have a tendency to make you less sick than the trazodone, but this is another super powerful tricyclic antihistamine, nearly as strong as doxepin. I would expect it to have some of the same chubbiness inducing properties, but I have heard that it is supposed to be unusually good for sleep, though.So Surmontil is between doxepin and maprotiline in terms of strength? If I'm going to risk the chubbiness and the grogginess, then I might as well go with maprotiline if it still works for me.
Thanks Todd! Please let me know how you decide to handle your own sleep issue.
-K
Posted by zeugma on September 10, 2004, at 19:48:53
In reply to Re: Trouble sleeping - please help » King Vultan, posted by KaraS on September 10, 2004, at 17:21:55
hi kara,
i appreciated the help you gave me from the earler thread, so i will write this although i'm in the evening fog :) I think noradrenergic meds are the way to go for long-term reregulation of the sleep cycle. Many report they have less need of sleep, without a concomitant increase in fatigue, on an NE reuptake inhibitor other than the notorious Strattera. Both the noradrenergic locus coeruleus and the serotnergetic raphe are intimately involved in the sleep/wake cycle; however, while both serotonergetic and noradrenergic AD's promote waking, noradrenergic meds seem to do so in a way that takes less of a toll on sleep itself. I remember that I never slept better than when I was on nortriptyline and Strattera at the same time. OTOH MAOI's cause intense insomnia regardless of how 'stimulating' or 'sedating' the med is considered to be; hence Nardil causes intractable insomnia as often as Parnate, so I think these terms are somewhat misleading when considered in terms of their effect on sleep. Maprotiline, if it worked for you, is definitely better long-term than a benzo (sorry for the categorical tone of that, I'm tired enough to be less careful than usual with my phrasing :))
-z
Posted by KaraS on September 10, 2004, at 21:00:56
In reply to Re: Trouble sleeping - please help » KaraS, posted by zeugma on September 10, 2004, at 19:48:53
> hi kara,
>
> i appreciated the help you gave me from the earler thread, so i will write this although i'm in the evening fog :) I think noradrenergic meds are the way to go for long-term reregulation of the sleep cycle. Many report they have less need of sleep, without a concomitant increase in fatigue, on an NE reuptake inhibitor other than the notorious Strattera. Both the noradrenergic locus coeruleus and the serotnergetic raphe are intimately involved in the sleep/wake cycle; however, while both serotonergetic and noradrenergic AD's promote waking, noradrenergic meds seem to do so in a way that takes less of a toll on sleep itself. I remember that I never slept better than when I was on nortriptyline and Strattera at the same time. OTOH MAOI's cause intense insomnia regardless of how 'stimulating' or 'sedating' the med is considered to be; hence Nardil causes intractable insomnia as often as Parnate, so I think these terms are somewhat misleading when considered in terms of their effect on sleep. Maprotiline, if it worked for you, is definitely better long-term than a benzo (sorry for the categorical tone of that, I'm tired enough to be less careful than usual with my phrasing :))
>
> -z
>Hi z,
I think it should work out that if you manage to find something(s) to fix the depression, then it should also take care of the sleep problems. If the the neurons finally have what they need, then the system should be in balance and you should be able to sleep well at night... and I should win the next big lottery jackpot because I deserve it!
But, back to the real world... noradrenergics:
Good to know about their effect on sleep. I just wonder if I'm a candidate for any of them. Nortriptyline made me so wired I couldn't sleep at all. I haven't tried Strattera. Desipramine was also way too stimulating. Reboxetine is probably quite similar. I haven't heard of anyone's sleep being helped by Wellbutrin - though they may require less sleep as you say. I think my only realistic option in this category is Strattera (unless I'm forgetting something?).I didn't know that all of the MAOIs disrupted sleep. As you could probably tell, I was assuming that the more sedating Nardil might help with sleep. Thanks for the clarification.
I'm going to check out a few options that people have recommended but somehow I fear I'll go back on Maprotiline and get fat again.
BTW, I thought of you yesterday at my new job as I struggled to get beyond the fatigue and brain fog to understand what they were trying to teach me.
Hope you're adjusting well to the start of school.
Thanks again for all your help.
Kara
Posted by Jaynee on September 10, 2004, at 21:55:46
In reply to Re: Trouble sleeping - please help » zeugma, posted by KaraS on September 10, 2004, at 21:00:56
Can you get ahold of zopiclone? If not, you are probably in the US, and will have to wait for Estorra, the new and improved zopiclone.
I have been on zopiclone for a year, and it works pretty good.
Posted by KaraS on September 10, 2004, at 23:01:40
In reply to Re: Trouble sleeping - please help, posted by Jaynee on September 10, 2004, at 21:55:46
> Can you get ahold of zopiclone? If not, you are probably in the US, and will have to wait for Estorra, the new and improved zopiclone.
>
> I have been on zopiclone for a year, and it works pretty good.What kind of medications are those and what country are you in? I've never heard of either of them.
Posted by KaraS on September 10, 2004, at 23:06:18
In reply to Re: Trouble sleeping - please help, posted by Jaynee on September 10, 2004, at 21:55:46
I reacted paradoxically to it. When I tried 5 mg. of generic methylphenidate it put me to sleep. It wears off so I wouldn't be groggy in the morning. I wonder if this would work on a regular basis? Would there be a tolerance kind of issue in that it would stop putting me to sleep? Anyone have any thoughts on this?
Posted by sb417 on September 11, 2004, at 0:11:12
In reply to Re: Trouble sleeping - please help » sb417, posted by KaraS on September 10, 2004, at 17:06:11
> > Both trouble falling asleep and staying asleep. Trazodone made me feel nauseous and it didn't go away even after a couple of months. Neurontin I only took once or twice and I just remember that I felt awful the next day. Maybe it's worth trying a smaller dosage. I wish I remembered how much of each I had taken but it was a long time ago.>
Hi Kara,
You and I have similar reactions to some medications. I felt awful after trying Neurontin also. In fact, I felt awful for several days after taking it. I had a paradoxical reaction to Trazadone.
> > Delayed sleep phase syndrome - is that when you keep going to bed later and later because your natural clock is much longer than the normal 24 hours?>In the delayed sleep phase syndrome, I want to go to bed later and get up later each day. If left to my own devices, I would probably do just that. I do remember reading about some studies done a few years ago in which the subjects were in a cave, deprived of all external cues that would indicate the time of day. There was no sunlight, no clocks, etc. If I remember correctly, I believe the subjects ended up on a 25 hour cycle, or perhaps it was even a bit longer.
>
> > > These days I'm so exhausted and out of it until later in the day. There's no way I can make myself move in the morning. I know it would be great for me so maybe once I start to feel better... I can do it.>I feel like that in the morning until I exercise. It takes nearly superhuman effort to get myself to the pool, but once I've done my exercise, I really do feel better. I've come to believe that one reason I hate to go to bed at night is that it takes so much effort to get to a point where I feel good and productive that I don't want to let go of it by going to sleep because the next morning I have to start all over again.
> I've been taking a high carb snack before bed but think it's probably good advice to have my dinner be high carbs as well. (Sugar gives me blood sugar problems so tends to disrupt my sleep.) >Yes, you're absolutely right about the sugar. I shouldn't have mentioned that except that when I have PMS, I find a bit of sugar seems to help. Too much makes it worse.
Oh, another thing that seems to help at night before you go to bed is to have very few lights on, and use very low wattage light bulbs. This helps me wind down. If I use any bulb above 60 watts, that keeps me up later. Even 60 is too much. Also, if you wake up in the middle of the night to go to the bathroom, try to use only a flashlight or a nightlight. Turning on the lights for even a moment can wreak havoc with melatonin.
Posted by KaraS on September 11, 2004, at 2:58:49
In reply to Re: Trouble sleeping - please help » KaraS, posted by sb417 on September 11, 2004, at 0:11:12
> > > Both trouble falling asleep and staying asleep. Trazodone made me feel nauseous and it didn't go away even after a couple of months. Neurontin I only took once or twice and I just remember that I felt awful the next day. Maybe it's worth trying a smaller dosage. I wish I remembered how much of each I had taken but it was a long time ago.>
>
>
> Hi Kara,
> You and I have similar reactions to some medications. I felt awful after trying Neurontin also. In fact, I felt awful for several days after taking it. I had a paradoxical reaction to Trazadone.
>
>
> > > Delayed sleep phase syndrome - is that when you keep going to bed later and later because your natural clock is much longer than the normal 24 hours?>That's what I thought it meant.
>
> In the delayed sleep phase syndrome, I want to go to bed later and get up later each day. If left to my own devices, I would probably do just that.That's exactly my problem and since I haven't been working, I have been doing just that. Then I'll get some temporary work and have to try to get on a normal schedule for a few days. It's absolutely hell on my body.
I do remember reading about some studies done a few years ago in which the subjects were in a cave, deprived of all external cues that would indicate the time of day. There was no sunlight, no clocks, etc. If I remember correctly, I believe the subjects ended up on a 25 hour cycle, or perhaps it was even a bit longer.
I had also heard of that study but I wonder why others don't have the same problems that we do if everyone is on a 25 hour clock. (One of nature's nasty little jokes, wouldn't you say?)> >
> > > > These days I'm so exhausted and out of it until later in the day. There's no way I can make myself move in the morning. I know it would be great for me so maybe once I start to feel better... I can do it.>
>
> I feel like that in the morning until I exercise. It takes nearly superhuman effort to get myself to the pool, but once I've done my exercise, I really do feel better. I've come to believe that one reason I hate to go to bed at night is that it takes so much effort to get to a point where I feel good and productive that I don't want to let go of it by going to sleep because the next morning I have to start all over again.EXACTLY!! I'm finally getting some motivation and feeling like I have some energy at that point. Is this just the depression and if that's ever under control, we won't experience this anymore?
> > I've been taking a high carb snack before bed but think it's probably good advice to have my dinner be high carbs as well. (Sugar gives me blood sugar problems so tends to disrupt my sleep.) >
>
> Yes, you're absolutely right about the sugar. I shouldn't have mentioned that except that when I have PMS, I find a bit of sugar seems to help. Too much makes it worse.
>
> Oh, another thing that seems to help at night before you go to bed is to have very few lights on, and use very low wattage light bulbs. This helps me wind down. If I use any bulb above 60 watts, that keeps me up later. Even 60 is too much. Also, if you wake up in the middle of the night to go to the bathroom, try to use only a flashlight or a nightlight. Turning on the lights for even a moment can wreak havoc with melatonin.No kidding, that little bit of light can wreak that much havoc? Have you ever taken melatonin? I'm wondering if you're supersensitive to its effects or if we all are that sensitive to it?
Do you take anything to help you sleep or are these lifestyle changes enough? Also, would you mind telling me what other meds you take? If you have already done that in the past, I apologize for asking again. My memory is not terribly good right now.
Posted by King Vultan on September 11, 2004, at 10:07:28
In reply to Re: Trouble sleeping - please help » King Vultan, posted by KaraS on September 10, 2004, at 17:21:55
>
>
> Why are you not worried about Halcion and yet you were worried about Ambien? Halcion seems scarier to me than Ambien but that might just be because of the bad press it got a few years back. Was the hype unwarranted?
>
> What was your experience on trazadone the first time? That would seem to be ideal to me if you could tolerate it. I don't know hydroxyzine at all. I'll have to check into that one more.
>
> >
I'm not actually worried about either Ambien or Halcion anymore, as I decided the hang up I used to have about these types of meds was silly. Why the change? Probably from starting to read message boards like this one. I use Halcion rather than Ambien because Halcion is available as a generic and costs me only $10 for 30 pills, compared to Ambien at $50 for 30 pills. I believe Halcion is also more powerful.I only used trazodone for three days while on Nardil, as it made me more and more depressed each day I used it. I now believe this may have something to do with the same issue that caused me to get very sleepy on Provigil--the hypothesis that this may be a result of having hypersensitive dopamine autoreceptors. Since my thought was that the extra dopamine being made available by Provigil was shutting down my dopamine neurons via this mechanism, trazodone could quite possibly do the same thing because one of its major effects is to blockade serotonin 2A receptors, which also releases dopamine. This is also one of the mechanisms by which atypical antipsychotics work--they release dopamine to counteract negative psychotic symptoms by blockading serotonin 2A receptors.
I found an Australian site yesterday listing the dosage of doxylamine succinate, the stuff in the OTC Unisom tablets, as 25-50 mg for sleep. I believe the maximum recommended in the US is only 25 mg, but I have been having so much trouble sleeping, I did decide to go with 2 x 25. I did sleep drastically better than I did on the 2 x 25 mg Benadryl I had used a couple nights before, but I was a little zonked this morning. I think I will try one Unisom pill next time and see if I can get away with that.
Todd
Posted by Sad Panda on September 11, 2004, at 12:29:16
In reply to Re: Trouble sleeping - please help » Sad Panda, posted by KaraS on September 10, 2004, at 16:49:32
> > > I don't know what to do about it. I'm either in a cycle where I can't do anything but sleep or else I can't sleep at all. (Actually I can sleep in the afternoon without a problem. It's at nighttime that I can't sleep at all. Is that cortisol related?) There's a bit of anxiety and some RLS involved.
> > >
> > > I have some Ambien and Sonata samples here but I'm afraid to try them. I don't want to become dependent as I once was on Ativan. After reading the Ambien abuse thread below, I'm even more scared. How is it that some people can take Ambien, Restoril or another benzo indefinitely without a problem and someone else ends up with a 90 pill a day habit?
> > >
> > > I've tried trazadone and Neurontin and they both made me feel quite sick. I still have the neurontin and may try it again in smaller dosage. I tried Benadryl again last night and it makes my heart race while making the rest of me groggy. It was a very strange and scary experience.
> > >
> > > 5-htp made me groggy the next day. Melatonin gets me to sleep but doesn't keep me there for long. I haven't tried Valerian yet. I've read different things about whether or not people develop tolerance to it as well.
> > >
> > > Lastly, there's the sedating tricyclics. Doxepin works well but I'm also quite groggy the next day. Maprotiline worked well with less grogginess but still some. On top of that they both made me fat. All I wanted to do was eat when I took them. I'm finally thin again and I want to stay that way, da-- it! Do I have to choose between being thin and exhausted or fat and sleeping at night??????
> > >
> > > Any suggestions would be greatly appreciated.
> > >
> > > Kara
> > >
> > >
> >
> >
> > Hi Kara,
> >
> > A TCA with less antihistamine activity might be enough, I would try Nortriptyline. Trazodone might be worth trying again at lower doseages. The AP Risperdal taken at low doseage might also be worth a shot.
> >
> > Cheers,
> > Paul.
> >
>
> Hi Panda, (can't call you Paul yet - I'm just not used to it yet)
>
> Nort. was one of the most stimulating meds I've ever taken. I know most people can take it for sleep - but definitely not me. I don't remember how much trazadone I took but it might be worth trying again. Risperdal sounds intriguing - something I hadn't considered yet. Is it one of the newer APs? I'll have to read up on it more. Thanks!
>
> BTW, How are you doing? Last I heard you had hit a bit of a rough spot yourself. Are you feeling better now?
>
> -K
>
>Hi Kara,
I am fine now, thanks for asking. :)
A little Amitriptyline might be worth trying, it falls half way between Nortriptyline & Doxepin as far as sedation & appetite is concerned.
Trazodone & Serzone are interesting because they are 5-HT2A antagonists which gives high quality sleep & they are 5-HT2C agonists which is believed to supress appetite. Most 5-HT2A antagonists tend to be 5-HT2C antagonists too. The drugs that are equipotent 5-HT2A & C antagonist as well as being H1 antagonists, such as Remeron & Zyprexa, tend to cause the most weight gain.
Cheers,
Paul.
Posted by Jaynee on September 11, 2004, at 14:34:39
In reply to Re: Trouble sleeping - please help » Jaynee, posted by KaraS on September 10, 2004, at 23:01:40
I am in Canada. We have zopiclone here, but it is not available in the US. Estorra should be available in the US sometime this year or early 2005.
"They" say that Estorra can be taken long term.
Look it up on google, lots of info.
Good luck.
ps, don't give up until you find something that works for you, sleep is too important.
Posted by KaraS on September 11, 2004, at 15:47:51
In reply to Re: Trouble sleeping - please help » KaraS, posted by King Vultan on September 11, 2004, at 10:07:28
> I'm not actually worried about either Ambien or Halcion anymore, as I decided the hang up I used to have about these types of meds was silly. Why the change? Probably from starting to read message boards like this one. I use Halcion rather than Ambien because Halcion is available as a generic and costs me only $10 for 30 pills, compared to Ambien at $50 for 30 pills. I believe Halcion is also more powerful.
So how have you prevented tolerance to Halcion? Are you only taking it once or twice a week?
Can you tell me more about hydroxyzine and it's use for sleep?
> I only used trazodone for three days while on Nardil, as it made me more and more depressed each day I used it. I now believe this may have something to do with the same issue that caused me to get very sleepy on Provigil--the hypothesis that this may be a result of having hypersensitive dopamine autoreceptors. Since my thought was that the extra dopamine being made available by Provigil was shutting down my dopamine neurons via this mechanism, trazodone could quite possibly do the same thing because one of its major effects is to blockade serotonin 2A receptors, which also releases dopamine. This is also one of the mechanisms by which atypical antipsychotics work--they release dopamine to counteract negative psychotic symptoms by blockading serotonin 2A receptors.
Does the fact that I respond paradoxically to dopaminergics mean that I also have presynaptic hypersensitive dopamine autoreceptors or are there other possible explanations? (BTW, Provigil didn't make me sleepy or alert - just produced that leaden limbs feeling. I may not have tried enough to get more of a reaction though.)
> I found an Australian site yesterday listing the dosage of doxylamine succinate, the stuff in the OTC Unisom tablets, as 25-50 mg for sleep. I believe the maximum recommended in the US is only 25 mg, but I have been having so much trouble sleeping, I did decide to go with 2 x 25. I did sleep drastically better than I did on the 2 x 25 mg Benadryl I had used a couple nights before, but I was a little zonked this morning. I think I will try one Unisom pill next time and see if I can get away with that.
>
> ToddI should try the Unisom because it would be a cheap and easy fix but I'm so afraid to. The Benadryl was so awful. I was so exhausted and drugged feeling yet my heart was racing (as I said earlier). It's a horrible state to be in because you can't sleep yet you can't do anything else because you're so drugged feeling. Each minute was like an hour. Wish I could know the result without having to do the experiment.
Kara
Posted by KaraS on September 11, 2004, at 15:55:45
In reply to Re: Trouble sleeping - please help » KaraS, posted by Sad Panda on September 11, 2004, at 12:29:16
> > > > I don't know what to do about it. I'm either in a cycle where I can't do anything but sleep or else I can't sleep at all. (Actually I can sleep in the afternoon without a problem. It's at nighttime that I can't sleep at all. Is that cortisol related?) There's a bit of anxiety and some RLS involved.
> > > >
> > > > I have some Ambien and Sonata samples here but I'm afraid to try them. I don't want to become dependent as I once was on Ativan. After reading the Ambien abuse thread below, I'm even more scared. How is it that some people can take Ambien, Restoril or another benzo indefinitely without a problem and someone else ends up with a 90 pill a day habit?
> > > >
> > > > I've tried trazadone and Neurontin and they both made me feel quite sick. I still have the neurontin and may try it again in smaller dosage. I tried Benadryl again last night and it makes my heart race while making the rest of me groggy. It was a very strange and scary experience.
> > > >
> > > > 5-htp made me groggy the next day. Melatonin gets me to sleep but doesn't keep me there for long. I haven't tried Valerian yet. I've read different things about whether or not people develop tolerance to it as well.
> > > >
> > > > Lastly, there's the sedating tricyclics. Doxepin works well but I'm also quite groggy the next day. Maprotiline worked well with less grogginess but still some. On top of that they both made me fat. All I wanted to do was eat when I took them. I'm finally thin again and I want to stay that way, da-- it! Do I have to choose between being thin and exhausted or fat and sleeping at night??????
> > > >
> > > > Any suggestions would be greatly appreciated.
> > > >
> > > > Kara
> > > >
> > > >
> > >
> > >
> > > Hi Kara,
> > >
> > > A TCA with less antihistamine activity might be enough, I would try Nortriptyline. Trazodone might be worth trying again at lower doseages. The AP Risperdal taken at low doseage might also be worth a shot.
> > >
> > > Cheers,
> > > Paul.
> > >
> >
> > Hi Panda, (can't call you Paul yet - I'm just not used to it yet)
> >
> > Nort. was one of the most stimulating meds I've ever taken. I know most people can take it for sleep - but definitely not me. I don't remember how much trazadone I took but it might be worth trying again. Risperdal sounds intriguing - something I hadn't considered yet. Is it one of the newer APs? I'll have to read up on it more. Thanks!
> >
> > BTW, How are you doing? Last I heard you had hit a bit of a rough spot yourself. Are you feeling better now?
> >
> > -K
> >
> >
>
> Hi Kara,
>
> I am fine now, thanks for asking. :)
>
> A little Amitriptyline might be worth trying, it falls half way between Nortriptyline & Doxepin as far as sedation & appetite is concerned.
>
> Trazodone & Serzone are interesting because they are 5-HT2A antagonists which gives high quality sleep & they are 5-HT2C agonists which is believed to supress appetite. Most 5-HT2A antagonists tend to be 5-HT2C antagonists too. The drugs that are equipotent 5-HT2A & C antagonist as well as being H1 antagonists, such as Remeron & Zyprexa, tend to cause the most weight gain.
>
> Cheers,
> Paul.
>
>Panda,
I've tried Amitriptyline and it really knocked me out - more so than doxepin. It's strange how unique our systems are sometimes.I tried Serzone and it was wonderful for sleep and it didn't increase my appetite. Too good to be true you say? Of course it was. It also made me really itchy all the time esp. when I exercised. Didn't they take this off of the market recently in the U.S.? Do you stil have it in Australia?
Glad to hear you're doing well now!
Kara
Posted by KaraS on September 11, 2004, at 15:59:25
In reply to Kara, posted by Jaynee on September 11, 2004, at 14:34:39
> I am in Canada. We have zopiclone here, but it is not available in the US. Estorra should be available in the US sometime this year or early 2005.
>
> "They" say that Estorra can be taken long term.
>
> Look it up on google, lots of info.
>
> Good luck.
>
> ps, don't give up until you find something that works for you, sleep is too important.
>
>Didn't they say that Ambien could be taken long-term when it first came out? It reminds me of how the drug companies always say that their new antidepressants get results within a week but that never seems to be the case.
Anyway, I sure hope that it's the truth. I'll keep my fingers crossed for all of us insomniacs.
I won't give up. I have to function - and soon.
Thanks.
-K
Posted by invisiblemanpa on September 11, 2004, at 17:10:17
In reply to Re: Kara » Jaynee, posted by KaraS on September 11, 2004, at 15:59:25
I started on Remeron in addition Effexor Xr last month. The Remeron has really helped with my sleep and initially with my depression...I started at 30mg and am now going to start 45mg which I think is the max dosage as my depression has been creeping back in. My Psy doc has also given me a prescreption for Restoril, which is a benzo prescribed for sleep but I rarely use it now as the Remeron does the trick.
Posted by KaraS on September 11, 2004, at 20:43:09
In reply to Sleep Help, posted by invisiblemanpa on September 11, 2004, at 17:10:17
> I started on Remeron in addition Effexor Xr last month. The Remeron has really helped with my sleep and initially with my depression...I started at 30mg and am now going to start 45mg which I think is the max dosage as my depression has been creeping back in. My Psy doc has also given me a prescreption for Restoril, which is a benzo prescribed for sleep but I rarely use it now as the Remeron does the trick.
Remeron can really increase your appetite a lot though. Have you found this to be the case yet?
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