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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 35. This is the beginning of the thread.
Posted by Guy on October 6, 2006, at 18:10:07
I have severe GAD, panic and insomnia. When I take clonazepam, I sleep though the night, but I awaken feeling anxious and unrested. I also experience chronic pain, perhaps due to fibromyalgia. Could all this be because the benzo is preventing stage 3/4 (deep, restorative) sleep? I have recently been on Zyprexa, but it made me feel very ill, almost as if I had been poisoned (large bags under my eyes and terrible flu-like symptoms). I'm feeling really desperate and suicidal as more and more doors slam shut in my face. Do I go back on the clonazepam (shallow sleep) or continue with Zyprexa (flu)? I'm lost in the land of meds. Peace to all my fellow-sufferers...may the sweet rains of autumn wash your tears away.
Posted by Phillipa on October 6, 2006, at 21:50:56
In reply to Benzo Sleep, posted by Guy on October 6, 2006, at 18:10:07
Personally I like valium. I find even the real klonopin depressing. Love Phillipa
Posted by rjlockhart on October 7, 2006, at 0:40:11
In reply to Re: Benzo Sleep » Guy, posted by Phillipa on October 6, 2006, at 21:50:56
Xanax and Restoril are the best sleep aids. I was on Ativan i would wake up and couldnt sleep.
Xanax is hard to get from a doctor, but im taking it right now mainly for panic attacks.
Ask about Restoril or temazepam.
Matt
Posted by notfred on October 7, 2006, at 1:12:26
In reply to Benzo Sleep, posted by Guy on October 6, 2006, at 18:10:07
http://www.tranx.org.au/benzodiaz.html :
Studies have shown that long term use of the benzodiazepines for sleep increases the number of times a person wakes in the night and decreases the amount of time spent in deep sleep.
/endquote
Benzos cause one to stay in the lighter stages of sleep longer and not get as much restful sleep, stage III and IV.
Posted by laima on October 7, 2006, at 9:54:47
In reply to Re: Benzo Sleep, posted by notfred on October 7, 2006, at 1:12:26
Yes, I have heard and experienced the same thing. Whenever I've tapered away from klonopin, the quality of my sleep developes into something that feels more genuine and restful after a couple of weeks. But anxiety often brings the klonopin back, and the yo-yo goes on. There's a lot of info out there, indeed, about how benzos interfere with the deepest stages of sleep, which are the crucial "restorative" stages. I heard a psychiatrist say once, half in jest, "If you want to make someone insane, all you need to do is deprive them of Stage 4 long term.."
Interestingly, I went to a sleep lab before, and they were very, very enthused to bring on the stimulants rather than the sleep meds. Ie, if I took them in the AM, they would be largely cleared out by bedtime...is how I understood. Also interestingly, I was using klonopin and lamictal during that study, and the doctors were pretty ruffled to see that I had almost no Stage 4 and very, very little Stage 3 at the time. I also woke 39 times! I had no idea of any of it- I just thought I slept alright, thanks to klonopin. And guess what- I was a miserable, moody mess those days. They would like me to take another study now, but I had the 24 hour version, and am kind of dodging it. (Brutal.)Maybe we should be careful. I'm using some klonopin nowadays again, but I am wary to keep that up long term. (Sometimes imperfect sleep is better than no sleep or evenings of anxiety.)
Oh- and there is something interesting in Time recently about current speculations about imperfect sleep, mostly the sort associated with FREQUENT AWAKENINGS due to breathing problems, possibly CAUSING depression. How about that? (Oct 2, 2006, p87)
And as for ambien, etc- I read a Consumer Reports article recently (over the summer if anyone wants to go hunting) which claimed that they too keep a person almost exclusively in light stages of sleep- and in fact, work in part by causing the sleeper to forget their frequent awakenings. In other words, they don't remember waking up- and believe they don't, so are more satisfied. That class of drugs is famous for amnesia, of course. Now I have no idea if this is all actually true- but distressing if it is. "Not for long-term use" indeed. Sorry-threw the article away because mom gave it to me, complete with several colors of highlighters highlighting her favorite parts!
This stuff isn't easy. In an almost sickly humourous way, it kind of reminds me of those environmental interventions gone awry- ie- bring in a wild weed because it's a good crop or feeds catttle- whatever- then bring in rabbits to eat the weed when it goes out of control, then bring in something to eat the rampant rabbits, etc. Stories like that.
> http://www.tranx.org.au/benzodiaz.html :
>
> Studies have shown that long term use of the benzodiazepines for sleep increases the number of times a person wakes in the night and decreases the amount of time spent in deep sleep.
>
> /endquote
>
> Benzos cause one to stay in the lighter stages of sleep longer and not get as much restful sleep, stage III and IV.
>
Posted by laima on October 7, 2006, at 10:08:23
In reply to Benzo Sleep, posted by Guy on October 6, 2006, at 18:10:07
Re-reading your post, I hope I haven't been insensitive to your plight. I apologize. A crisis time isn't the time to debate the long-term pros and cons of medications which can help you through.
I've tried zyprexa before too, with disasterous results- it didn't agree with me. If the clonazapam, the longest acting benzo, is still making you wake up anxious, perhaps there are other options? I know some people are using seroquel, for example.
I am pretty sure other people are using lyrica, also.I tried rozerem- which I would give mixed reviews- it didn't feel as potent as a benzo-hypnotic- but it sure didn't cause any early wakening, either. Perhaps it might work for you? It's supposed to be utterly different than other sleep medicines, and the doctor offices seem full of samples due to the advertising blitz going on. Not a benzo or hypnotic, I hear.
As for that early AM panic you describe, I've experienced that, too- waking up early with a flash of urgent panic- both when using shorter acting benzos to sleep, and if I use klonopin long enough to develope a good tolerance. My doctor explained that's the point where the drug wears off. His suggestion was to take it later in the evening to stave off that flash of wakening.
Yes, the more I read and hear about sleep, the more absolutely clear it is that Stage 3/4 is critical for mental well being. The experts seem to agree about that just about unanimously. We hear so much about dreams...but they are nothing compared to that deep sleep. No wonder so many sleep meds always have that "not for long term use" disclaimer.
Good luck to you- and watch out on those sleep meds- if you are anything like me, you may find yourself then waking up at 4-5am in a panic.
> I have severe GAD, panic and insomnia. When I take clonazepam, I sleep though the night, but I awaken feeling anxious and unrested. I also experience chronic pain, perhaps due to fibromyalgia. Could all this be because the benzo is preventing stage 3/4 (deep, restorative) sleep? I have recently been on Zyprexa, but it made me feel very ill, almost as if I had been poisoned (large bags under my eyes and terrible flu-like symptoms). I'm feeling really desperate and suicidal as more and more doors slam shut in my face. Do I go back on the clonazepam (shallow sleep) or continue with Zyprexa (flu)? I'm lost in the land of meds. Peace to all my fellow-sufferers...may the sweet rains of autumn wash your tears away.
Posted by laima on October 7, 2006, at 10:32:22
In reply to Benzo Sleep, posted by Guy on October 6, 2006, at 18:10:07
A couple other non benzo, non hypnotic sleep options I've been offered, but lack experience with, include antidepressents like trazadone (?), and siniquan.
Posted by Guy on October 7, 2006, at 10:57:24
In reply to Benzo Sleep, posted by Guy on October 6, 2006, at 18:10:07
Thanks, Laima, for your suggestions. Unfortunatly Seroquel has an even worse flu effect on me than Zyprexa. I'm currently taking 125 mg Doxepin (a sedating tricyclic). I still have anxiety, and I know the sedation will soon wear off, leaving me scrambling for something else to help me make it through the night. Yes, Stages 3 and 4 sleep are essential for mental health...I firmly believe millions of people are trapped in a vicious cycle of suffering because the medical establishment has been unable to grasp this simple fact. Drop me a babble-mail if you have time and I'll tell you a bit more about my dilemma.
Posted by notfred on October 7, 2006, at 11:08:58
In reply to Stages 3 and 4 sleep, posted by Guy on October 7, 2006, at 10:57:24
I find Lunesta, 6 mg, gives very good restorative
sleep and I wake refreshed. I have been on it 7 months and it works as well today as it did when I started.
Posted by laima on October 7, 2006, at 11:38:45
In reply to Re: Stages 3 and 4 sleep, posted by notfred on October 7, 2006, at 11:08:58
Really? That's good to hear.
> I find Lunesta, 6 mg, gives very good restorative
> sleep and I wake refreshed. I have been on it 7 months and it works as well today as it did when I started.
Posted by notfred on October 7, 2006, at 16:12:08
In reply to Re: Stages 3 and 4 sleep » notfred, posted by laima on October 7, 2006, at 11:38:45
However, I cannot find any studies that indicate
if/how Lunesta effects Stages 3 and 4. The monograph
says it improves sleep latency, overall time, and sleep efficiency.
Posted by notfred on October 7, 2006, at 16:17:19
In reply to Re: Benzo Sleep, posted by rjlockhart on October 7, 2006, at 0:40:11
> Ask about Restoril or temazepam.
I liked temazepam, 30 mg, till I started having
significant word finding problems. I still needed to take Ativan as needed during the day and Ativan really made me sleepy if I also took temazepam at night. For the first 30 mins or so on waking I would slur my words a bit, on temazepam even if I did not take Ativan during the day.
Posted by Declan on October 7, 2006, at 18:24:20
In reply to Re: Benzo Sleep, posted by notfred on October 7, 2006, at 16:17:19
The single best thing I've tried for sleep is mirtazepine, because it increased the depth of sleep. I couldn't keep taking it because I preferred insomnia to the feel of mirtazepine in the morning. Cyproheptadine was kinda similar, with similar drawbacks. The tricyclics didn't do the same thing. Accepting that you need benzos for sleep and also that they damage it, what can you do except stuff (which you may have done) like cutting out drinking?
Posted by notfred on October 7, 2006, at 19:01:09
In reply to Re: Benzo Sleep, posted by Declan on October 7, 2006, at 18:24:20
> Accepting that you need benzos for sleep and also that they damage it, what can you do except stuff (which you may have done) like cutting out drinking?
You pick the one you can tolerate the best. I have significant middle and terminal insomnia (Ambien would be a great option if were not for this) and some parasomnias. I use sleep hygiene methods which help some but are not the total cure. Depression is also a primary cause of insomnia, so treating that may solve any sleep problems for some.If a med causes less stage 3 and 4 sleep but off the med you get less total sleep then you may be getting more stage 3/4 on the med as you are asleep longer.
Benzo's for sleep would be great for me if I did not take benzos during the day.
So to me it is a question of what you can tolerate
and if it gives you restful sleep. I worry less about effects to sleep cycles and more about getting restful sleep.
Posted by Phillipa on October 7, 2006, at 19:37:12
In reply to Re: Benzo Sleep, posted by notfred on October 7, 2006, at 1:12:26
After 30 years I still wake up once. And I've been able to completely stop when stress was not a problem. Love Phillipa ps I can cut down on valium and do sometimes by 5mg which is 25% of my nightly dose.
Posted by laima on October 7, 2006, at 19:50:10
In reply to Re: Benzo Sleep, posted by notfred on October 7, 2006, at 19:01:09
In the long run, respectfully, I worry you might run into deeper mood trouble if you disregard the crucial importance of deep stages of sleep. Those are the truely restorative stages for the mind. But yes, ANY sleep is better than none.> So to me it is a question of what you can tolerate
> and if it gives you restful sleep. I worry less about effects to sleep cycles and more about getting restful sleep.
Posted by Declan on October 7, 2006, at 19:56:26
In reply to Re: Benzo Sleep » notfred, posted by laima on October 7, 2006, at 9:54:47
So Laima, what do you do about this (if you haven't told us already)?
Posted by laima on October 7, 2006, at 19:57:49
In reply to Re: Benzo Sleep » laima, posted by Declan on October 7, 2006, at 19:56:26
Oh, I'm still dying to find out!
> So Laima, what do you do about this (if you haven't told us already)?
Posted by Declan on October 7, 2006, at 20:00:11
In reply to Re: Benzo Sleep » Declan, posted by laima on October 7, 2006, at 19:57:49
Well, I used herbs, tryptophan, other amino acids, niacin, not to speak of reducing my drinking to frighteningly low levels. Somethings better, anyway. I get 6 hours a night now.
Posted by laima on October 7, 2006, at 20:13:11
In reply to Re: Benzo Sleep » laima, posted by Declan on October 7, 2006, at 20:00:11
> Well, I used herbs, tryptophan, other amino acids, niacin, not to speak of reducing my drinking to frighteningly low levels. Somethings better, anyway. I get 6 hours a night now.
Thanks. Can you tell which herbs, and do you have any you might especially recommend? I'm scared of using tryptophan because I am using Emsam, and I saw a bottle of tryptophan which sternly warned against using it with any maoi.
Hey, by the way, I respect you and everyone else here very much, and I have been so frustrated lately about this "deep sleep" problem, because I've been told, and I've been reading snippets all over the place lately, about how a dearth of it exasperates mood disorders. I want to apologize if my own frustrations with the matter caused any of my comments to sound glib. I'm using klonopin for sleep now myself, despite knowing its shortcomings.
Posted by notfred on October 7, 2006, at 21:06:55
In reply to Re: Benzo Sleep » notfred, posted by laima on October 7, 2006, at 19:50:10
>
> In the long run, respectfully, I worry you might run into deeper mood trouble if you disregard the crucial importance of deep stages of sleep. Those are the truely restorative stages for the mind. But yes, ANY sleep is better than none.
>
Yep, while I do feel I get good restorative sleep
there is no way to know if I still have a deficit
of stage 3/4 that is causing mood problems.
Also, I am not a good person to use as an example
as sleep studies indicate my cycles are really messed up. I am not your normal insominac.If is will work for you, Ambien does not mess up
stage 3/4, it is too short acting to last past the second full cycle of sleep. It takes about 90 mins
to do a cycle: 1,2,3,4,3,2,REM. There is some evidence it does not mess with even 3/4 during the first full cycle of the night. But it is effective for those who only have trouble getting to sleep.It does not help with total sleep time or frequent wakings.
Posted by Phillipa on October 7, 2006, at 21:32:05
In reply to Re: Benzo Sleep, posted by notfred on October 7, 2006, at 21:06:55
But if you take valium and four hours wake is this destroying restorative sleep? I save 5mg to go back to sleep and sleep better then. I need at least 9 hours sleep. Always have even before meds. There has to be an answer. Love Phillipa
Posted by laima on October 7, 2006, at 21:34:05
In reply to Re: Benzo Sleep, posted by notfred on October 7, 2006, at 21:06:55
Ach- I tried ambien, and the CR. Not only did I not go to sleep for hours after taking it, I got into some very weird and embarressing behavior which I have no recollection of, though I've seen the evidence and heard the reports. (Whoops.)
Didn't work out so well in my case. Oh well.> >
> > In the long run, respectfully, I worry you might run into deeper mood trouble if you disregard the crucial importance of deep stages of sleep. Those are the truely restorative stages for the mind. But yes, ANY sleep is better than none.
> >
>
>
> Yep, while I do feel I get good restorative sleep
> there is no way to know if I still have a deficit
> of stage 3/4 that is causing mood problems.
> Also, I am not a good person to use as an example
> as sleep studies indicate my cycles are really messed up. I am not your normal insominac.
>
> If is will work for you, Ambien does not mess up
> stage 3/4, it is too short acting to last past the second full cycle of sleep. It takes about 90 mins
> to do a cycle: 1,2,3,4,3,2,REM. There is some evidence it does not mess with even 3/4 during the first full cycle of the night. But it is effective for those who only have trouble getting to sleep.It does not help with total sleep time or frequent wakings.
Posted by Declan on October 7, 2006, at 22:01:20
In reply to Re: Benzo Sleep » Declan, posted by laima on October 7, 2006, at 20:13:11
Gee thanks
The herbs that are recommended for depressives are called trophorestoratives in the excellent "Principles and Practice of Phytotherapy" by Mills and Bone. I the meaning to be that some herbal sedatives (like valerian) are inadviseable for depressives. The ones recommended are Avena officinalis (oatstraw), Hypericum perforatum (St John's Wort), Scuttelaria lateriflora (skullcap), Turnera aphrodisica (damiana), Verbena officinalis (vervain) and Withania somnifera (Ashwaganda). Not all thse are useful hypnotics (of course!). Skullcap, vervain and withania have been useful for me, (although I have heard of people having sleep problems with withania). I would add Zizyphus spinosa, the main herbal sedative in TCM.
Declan
Posted by notfred on October 8, 2006, at 15:20:33
In reply to Re: Benzo Sleep » laima, posted by Declan on October 7, 2006, at 22:01:20
> Gee thanks
> The herbs that are recommended for depressives are called trophorestoratives in the excellent "Principles and Practice of Phytotherapy" by Mills and Bone. I the meaning to be that some herbal sedatives (like valerian) are inadviseable for depressives. The ones recommended are Avena officinalis (oatstraw), Hypericum perforatum (St John's Wort), Scuttelaria lateriflora (skullcap), Turnera aphrodisica (damiana), Verbena officinalis (vervain) and Withania somnifera (Ashwaganda). Not all thse are useful hypnotics (of course!). Skullcap, vervain and withania have been useful for me, (although I have heard of people having sleep problems with withania). I would add Zizyphus spinosa, the main herbal sedative in TCM.
> DeclanIs it know or have you seen any studies on how these herbs effects stage 3/4 sleep ?
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