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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Jaded on August 27, 2002, at 14:06:59
I took 10mg Ambien for sleep for over 4 years (along with Prozac, lithium, and Depakote for Bipolar). Then it quit working and I switched to Dalmane. It worked for about 6 months, then the doc switched me to chloral hydrate. It didn't work at all. He said the only thing left that would work was Seconal or Nembutal and he wouldn't prescribe them because of their lethality in suicide attempts (I have made 2 attempts before). So we discontinued sleeping meds altogether last December. I haven't gotten a single night's sleep since. I take 1-2 hours to fall asleep, and then only sleep for 30-45 minutes at a time. I seem only to get REM sleep because I dream vividly *every* time I doze off. It has been 8 months since I have had a decent night's sleep, and I think lack of sleep is starting to make me cycle again. Anybody have similar experience or advise?
Posted by Guy on August 27, 2002, at 14:28:21
In reply to Long-term insomnia since quitting Ambien, posted by Jaded on August 27, 2002, at 14:06:59
I think you should consult a competent psychiatrist. (Your doc obviously has a lot to learn if he says there are no other options.) You need help in sorting out all these medication issues. Are you still taking some meds? If so, they could be contributing to your insomnia.
Posted by fachad on August 27, 2002, at 14:44:25
In reply to Long-term insomnia since quitting Ambien, posted by Jaded on August 27, 2002, at 14:06:59
Remeron and doxepin are both very potent sleep aids. They are not contolled substances like the other meds you have tried.
You may not have slept for 8 months, but I'll bet that if you took 150mg to 300mg of doxepin, you would sleep, very soundly, and for a whole night, maybe the next day too. Surmontil (trimipramine) is even better than doxepin, but it does not suppress REM so it may not be as good a choice for you.
-fachad
> I took 10mg Ambien for sleep for over 4 years (along with Prozac, lithium, and Depakote for Bipolar). Then it quit working and I switched to Dalmane. It worked for about 6 months, then the doc switched me to chloral hydrate. It didn't work at all. He said the only thing left that would work was Seconal or Nembutal and he wouldn't prescribe them because of their lethality in suicide attempts (I have made 2 attempts before). So we discontinued sleeping meds altogether last December. I haven't gotten a single night's sleep since. I take 1-2 hours to fall asleep, and then only sleep for 30-45 minutes at a time. I seem only to get REM sleep because I dream vividly *every* time I doze off. It has been 8 months since I have had a decent night's sleep, and I think lack of sleep is starting to make me cycle again. Anybody have similar experience or advise?
Posted by Jaded on August 27, 2002, at 19:34:02
In reply to Re: Long-term insomnia since quitting Ambien, posted by Guy on August 27, 2002, at 14:28:21
I have tried other non-controlled drugs since then. I have taken trazodone, Remeron, Zyprexa, Vistaril, & Benadryl. Unfortunately, I have been unable to take antidepressants recently as they have provoked several hypomanic and one full-blown manic episode. I stopped taking Zyprexa because (1) I had gained 50+ pounds, and (2) I lost my insurance and I can't afford it. And besides that, none of them really helped.
Posted by Robin.d.j on August 27, 2002, at 19:45:49
In reply to Other meds I have tried, posted by Jaded on August 27, 2002, at 19:34:02
I have been really depressed and have even thought about killing myself , thats how bad I feel since I started taking effexor XR ..not to mention total isolation...I suggested to my doctor when I first went to see him prescribing me trazodone ..do you think it might help me ...I don't know what to do ..see my lower thead and then you might see where I am right now??? Thank you
Robin
Posted by joy on August 27, 2002, at 20:03:25
In reply to Other meds I have tried, posted by Jaded on August 27, 2002, at 19:34:02
I have found Xanax .5 to do the trick. Ambien is not great for sleeping for many; only 4 or 5 hours at most. I have no problem with insomnia anymore. I combined Xanax and 50 mgs Trazodone, but find I don't need the Trazodone. Good luck.
Joy
Posted by McPac on August 27, 2002, at 22:19:28
In reply to Long-term insomnia since quitting Ambien, posted by Jaded on August 27, 2002, at 14:06:59
Jaded
I have very similar sleep problems.
Try Remeron, about 7.5 milligrams (the LOWER dose seems to work much, much better for sleep!)
Posted by Jerrympls on August 27, 2002, at 22:21:39
In reply to Re: Long-term insomnia since quitting Ambien, posted by Guy on August 27, 2002, at 14:28:21
If I am correct - if you are only getting REM sleep that's not good - there are a couple other deep sleep stages you're missing. I have taken Ambien on and off since it was first on the market. Sometimes it works better than others - but there were times I seemed to have a tolerance for it. So, my doc and I tired Restoril, Dalmane, Halcion, Ativan, Cerax, Sonata, and nothing worked. Finally I said he brought up barbituates and said that he would prescibe them but I had to understand that it would be short term only (4 weeks) because rapid tolerance develops. I hadn't had any suicide attempts so perhaps that's one reason he actually prescribed them. But, I felt so good because I felt trusted and I felt he was actually trying to help me and make my life a little less painful. He prescribed me Nembutal 200mg. First night nothing. Second night a little and third night I was out. I had the most restful wonderful sleep on Nembutal than I have evern had on any med or OFF any med. No hangover in the morning - for me - and no ill effects to my mood (ex: didn't make me more depressed). The Nembutal completely straightened out my slee-wake cycle and stopped me from craving and eating food at night. I didn't feel drugged and if I had to get up to go to the bathroom I could - it wasn't as if I was in a medicated coma or something. Anyway, they did become less effective over the course of a month and I went off them with no problems. Of course, I had rebound insomnia and went back to Ambien - which byu that time seemed to have erased any tolerance.
I can totally empathize with you. I hope you can know restful sleep soon - even if it is not with a barbituate.
Posted by jay on August 27, 2002, at 22:44:44
In reply to Other meds I have tried, posted by Jaded on August 27, 2002, at 19:34:02
> I have tried other non-controlled drugs since then. I have taken trazodone, Remeron, Zyprexa, Vistaril, & Benadryl. Unfortunately, I have been unable to take antidepressants recently as they have provoked several hypomanic and one full-blown manic episode. I stopped taking Zyprexa because (1) I had gained 50+ pounds, and (2) I lost my insurance and I can't afford it. And besides that, none of them really helped.
Hi:
I feel for you and your situation, because I went through a similar thing. So, I went and did a ton of research. I came up with a couple of things that may help.
You are likely having a nasty 'REM rebound'...stuck in that REM phase of sleep. I also know (from personal experience and research) that Depakote really intensifies the REM stage. Also...atypical antipsychotics like Zyprexa will do so..and I have heard some mixed things on Remeron..nothing too positive regarding REM. Trazadone is the same..and Benadryl doesn't last long enough through the night.
First off, it is "hell-ishly" uncomfortable...and I think can cause many further problems. There are a few options to *majorly* reduce the REM phase of sleep. (Which is actually shown to be rather extended in depressives.)
I take Effexor XR, close to bed, at 150mg's, which seems to knock down *majorly* the amount of REM sleep I have. Very few *vivid* nightmares...or weird dreams that just make me feel horrible. A Medline search showed Effexor also to be the most powerful REM supressor available.
The thing is..it can really cause problems with insomnia for awhile until you get used to it. Your pdoc can put you on a *temporary* high dose of say temazepam (another sleeping pill) with the Effexor, say for a month, until you get the sleep straigtened out. Also, you may want to try *permanent* Clonazepam with the Effexor. (Or whatever you choose...it is a good REM supressor.)
If you want to add to your Prozac (and not switch the drug), adding either Nortriptyline (first) or Imipramine (second) is an option, as at good doses, they are REM supressors. The other tricyclics aren't as strong REM supressors, and even the metabolite of Imipramine, Desipramine actually *increases* REM (or phase of) sleep.
I spent a few years trying to desperately find a reason why I was having the type of sleep you are, as it was just making me horrible. I've not only done the research, but tried most of the *experiments* above...and have had the best of luck.
I hope this info can and will help you..and anyone else with similar problems. You don't want to completely *rid* REM sleep..as we need it...but it is likely all out of whack due to your depression. (Plus..again..drugs like Depakote don't help...but can still be used with others that tame the REM phase of sleep.)
Good luck...and please post any questions you have! Relief is near..believe me...:-)
jay
Posted by racf on August 28, 2002, at 12:43:51
In reply to Long-term insomnia since quitting Ambien, posted by Jaded on August 27, 2002, at 14:06:59
> I took 10mg Ambien for sleep for over 4 years (along with Prozac, lithium, and Depakote for Bipolar).
I have taken Ambien for 2 years now. I like you would take 1-2 hours to fall asleep. And, when I did it was for only short periods of time. I take 10mg, but break them in half and that works just fine. I tried the other night to go to sleep without them and it was horrible if I got an hours sleep that night I was lucky.
Posted by susan C on August 28, 2002, at 18:14:17
In reply to Long-term insomnia since quitting Ambien, posted by Jaded on August 27, 2002, at 14:06:59
have you had a sleep study done?
Posted by velaguff on August 28, 2002, at 21:13:02
In reply to Long-term insomnia since quitting Ambien, posted by Jaded on August 27, 2002, at 14:06:59
This isn't medically approved, but it works fairly well for me. Believe me, your doctor probably won't approve. I just got lucky. There are, I think, only 2 types of OTC sleep aids: Doxylamine (Sp?), or Unisom, and Diphenhydramine (Sp?) Sominex. I have an RX for Ambien. 10mg is the maximun allowable dose. Insufficient. I need 20mg. I rotate a double dose (twice the recommended amount on the box) of the Doxy and Diphen, along with 20 mg Ambien. Every 3rd day, a double dose of Doxy, Diphen, or Amb. It works. I never develop a tolerance to any ONE medication, and I nearly always sleep at least 5 hours; most times that's enough. The desire to sleep more isn't due to necessity, but to the desire to escape depression via sleep. I told my MD that I was taking a double dose of all these things, and, given my history of resistance to medications, (thank god) he didn't object. I think that there's a large margin of error in the dosaging of most sleeping pills, and most other meds. What is that they call it, the amount of a drug that will kill 50% of those who take that amount? LD-50, I think. That'd be a great name for a heavy metal rock band.
Posted by Jaded on August 29, 2002, at 12:32:41
In reply to Re: Other meds I have tried, posted by Robin.d.j on August 27, 2002, at 19:45:49
> I have been really depressed and have even thought about killing myself , thats how bad I feel since I started taking effexor XR ..not to mention total isolation...I suggested to my doctor when I first went to see him prescribing me trazodone ..do you think it might help me ...I don't know what to do ..see my lower thead and then you might see where I am right now??? Thank you
> First, let me comment on Effexor XR. It can be very stimulating (especially for the first few weeks) and can cause agitation. I have taken it and felt it was one of the better anti-depressants as far as response goes, but a lot of people need Ativan or Klonopin along with it to "take the edge off." You asked about my opinion of trazodone (AKA Desyrel). I took it for almost a year (along with Prozac) as an anti-depressant, and then years later as a sleep aid. Most studies have shown trazodone to be a rather weak anti-depressant, and I would agree with this assessment. I does have *prominent* sedative effects. It made me feel very drowsy...but I still didn't fall or stay asleep. As far as your using it to combat suicidal depression goes...I would not recommend it. I would try something with a stronger antidepressant effect. If you are dead against Effexor, I would try Remeron. It was the best (and fastest) antidepressant I have ever used.
> Robin
Posted by menolly57 on August 29, 2002, at 21:33:12
In reply to Other meds I have tried, posted by Jaded on August 27, 2002, at 19:34:02
Trazodone was, and is, the most reliable sleep aid for me. Nothing ever came close. Ambien never gave me more than 4 hours' sleep; Temazepam was definitely better but I did not want to get addicted, so I weaned off of it back onto Trazodone. I think it may contribute to the taste distortion problems I've had lately, but those problems seem less bad than they did a few weeks ago, and I really needed the sleep badly.
Paxil made me gain weight, but it always gave me a full night's sleep when I took it before bedtime. It's too bad that antidepressants have caused you such trouble. I wish I could say something more helpful. Good luck and hang in there, Jaded -- and Robin too. I really hope you get the help you need.
Posted by Collette1 on September 1, 2002, at 13:15:54
In reply to Long-term insomnia since quitting Ambien, posted by Jaded on August 27, 2002, at 14:06:59
Experiments with my Pdoc have brought me to this regime: 150 mgs trazodone, .5mg Xanax, 1 benedryl and 1 "Soma". My doc wished I didn't take the benedryl but says it is OK to use all of these. No one ever suggests Soma, but it really is a help in falling asleep. These pills help me to both FALL asleep as well as STAY asleep, which seems to be a different issue. I hope this helps. Collette
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