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Dr. Bob is Robert Hsiung, MD,
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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 ?
Posted by Declan on October 8, 2006, at 23:09:07
In reply to Re: Benzo Sleep, posted by notfred on October 8, 2006, at 15:20:33
Posted by notfred on October 9, 2006, at 0:06:34
In reply to Re: Benzo Sleep, posted by notfred on October 8, 2006, at 15:20:33
Rosenberg R, Caron J, Roth T, et al. An assessment of the efficacy and safety of eszopiclone in the treatment of transient insomnia in healthy adults. Sleep Med 2005;6:15–22.
Sleep architecture did not change significantly in any of the treatment groups, except with eszopiclone 3.5 mg, when compared with placebo. The 3.5-mg group experienced a statistically significant decrease in total time spent in non–rapid-eye movement (NREM) stage 1 sleep and rapid-eye movement (REM) sleep, as well as a statistically significant increase in time spent in NREM stage 2 (P ≤ .05) sleep. Stages 3 and 4, which are the restorative stages of sleep, did not
change significantly in any of the treat-
ment groups.
Posted by laima on October 9, 2006, at 10:12:20
In reply to Study shows no changes, Lunesta Stage 3/4 sleep, posted by notfred on October 9, 2006, at 0:06:34
Thanks. That's good news. Not to be difficult, but what if one is in need of INCREASING their stages 3/4 sleep? This makes it sound as though if one is deficient, it won't change, just won't get worse (?)
> Rosenberg R, Caron J, Roth T, et al. An assessment of the efficacy and safety of eszopiclone in the treatment of transient insomnia in healthy adults. Sleep Med 2005;6:15–22.
>
> Sleep architecture did not change significantly in any of the treatment groups, except with eszopiclone 3.5 mg, when compared with placebo. The 3.5-mg group experienced a statistically significant decrease in total time spent in non–rapid-eye movement (NREM) stage 1 sleep and rapid-eye movement (REM) sleep, as well as a statistically significant increase in time spent in NREM stage 2 (P ? .05) sleep. Stages 3 and 4, which are the restorative stages of sleep, did not
> change significantly in any of the treat-
> ment groups.
Posted by laima on October 9, 2006, at 10:14:15
In reply to Re: Benzo Sleep, posted by notfred on October 8, 2006, at 15:20:33
> I the meaning to be that some herbal sedatives (like valerian) are inadviseable for depressives.
This is interesting! I never knew. Anyone know why? Thanks.
Posted by notfred on October 9, 2006, at 13:38:21
In reply to Re: Study shows no changes, Lunesta Stage 3/4 sleep » notfred, posted by laima on October 9, 2006, at 10:12:20
> Not to be difficult, but what if one is in need of INCREASING their stages 3/4 sleep? This makes it sound as though if one is deficient, it won't change, just won't get worse (?)
>The study was on "normals" with no sleeping problems.
One is deficient of stage 3/4 because they cannot get enough total sleep. You spend ~10% of total time asleep in stage 3/4. Staying asleep longer allows for more 90 min cycles, each where you pass through stage 3 and 4. I think the goal is to increase total time while not effecting stages too much. The goal is allowing for more 90 min cycles so you can have a proportional increase in each stage of sleep.
Posted by laima on October 9, 2006, at 14:57:01
In reply to Re: Study shows no changes, Lunesta Stage 3/4, posted by notfred on October 9, 2006, at 13:38:21
Oh- if the study was with "normals' that explains some. But you know, I have had a couple sleep studies which confirmed I am spending sufficient time asleep, but that it is dissproportionately in stages 1, 2, and some REM. Almost none in 3 or 4- despite "enough" hours. Just blew threw those stages in a matter of a flash. So not sure what to do, and no one really had any coherent solution.> The study was on "normals" with no sleeping problems.
>
> One is deficient of stage 3/4 because they cannot get enough total sleep. You spend ~10% of total time asleep in stage 3/4. Staying asleep longer allows for more 90 min cycles, each where you pass through stage 3 and 4. I think the goal is to increase total time while not effecting stages too much. The goal is allowing for more 90 min cycles so you can have a proportional increase in each stage of sleep.
Posted by psychobot5000 on October 12, 2006, at 21:45:29
In reply to Re: Study shows no changes, Lunesta Stage 3/4 » notfred, posted by laima on October 9, 2006, at 14:57:01
A few thoughts
As for how to improve Stage 3 and 4 sleep, apparently evidence was found that valdoxan improved deep sleep. Here's a news brief on it, though I'm sure there's more specific info elsewhere:
http://www.drugresearcher.com/news/ng.asp?n=63465-servier-valdoxan-mt-receptor
Though of course it may be a while before it (hopefully) reaches the market.
Other than that, trimipramine (a tricyclic very similar to doxepin) increases total sleep time without (apparently) altering sleep patterns. Doxepin's sedating effect might be useful for the long-term as well--it is quite powerful, as I understand.
There was a concern about using tryptophan with EMSAM, but I do not think a weak, reversible inhibitor of MAO A like EMSAM would have enough effect on serotonin to be dangerous when used with tryptophan--especially not with 6 or 9mg doses. Why not ask your doc about it?
On builds up a resistance to antihistamines, but they are very useful to me, especially when used sparingly. Why not try benadryl 25 or 37.5mg, every 4 nights or so? It helps me.
For those with anxiety, and who can take some daytime sleepiness, Remeron will help sleep and anxiety (and OCD).
I also have (lately) gotten some help sleeping from Skullcap and even blue vervain. Skullcap seems to have been researched somewhat, and is -supposed- to be safe for depressive and anxious people. I'd recommend it. There appears to be no research on vervain, though it did seem to help me sleep.
Another relaxing herb that is supposed to be safe for depressives is chamomile. Passion flower I think was already mentioned. ...Hyland's 'Calms' contains a combination of 4 herbs that are supposed to be safe for depressives. It is fairly popular, and might be useful. I've taken it, and while it didn't help a lot, it also caused no problems.
But I do wish they'd bring out valdoxan/agomelatine. Melatonin agonist combined with 5-HT2c blocking? Sign me up! Not to mention that its potential profits would bring Servier more capital to develop and market other relatively novel medications.
Psychobot
Posted by notfred on October 13, 2006, at 15:28:47
In reply to Agomelatine may help Stage 3/4 / other remedies, posted by psychobot5000 on October 12, 2006, at 21:45:29
> On builds up a resistance to antihistamines, but they are very useful to me, especially when used sparingly. Why not try benadryl 25 or 37.5mg, every 4 nights or so? It helps me.
>Anticholinergic drugs like diphenhydramine (Benadryl) interact w/ dopamine indirectly as well as suppress REM sleep.
Posted by psychobot5000 on October 14, 2006, at 11:35:31
In reply to Re: Agomelatine may help Stage 3/4 / other remedi, posted by notfred on October 13, 2006, at 15:28:47
What do antihistaminic drugs do to dopamine? I've never found them to be depressive...but I'd like to know.
Posted by notfred on October 14, 2006, at 16:01:10
In reply to Re: antihistamines, posted by psychobot5000 on October 14, 2006, at 11:35:31
> What do antihistaminic drugs do to dopamine?
This is the end of the thread.
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