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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by krycek on April 12, 2008, at 19:07:24
Hi, I was wondering if anyone had any thoughts on what meds to ask about with my pdoc. I have been having severe insomnia for about 6 months, and it's getting really bad. I was given (not to be taken all at once obviously): Elavil, Trazodone, Klonopin, Ambien, Restoril. None of it is working. I am sleeping around 2 hours a night, i would be happy with 8 but I will take 5. Benzos for whatever reason have never been much help for me, maybe my metabolism is werid or something.
It's getting bad, I can't concentrate, I randomly zone out, I have conversations w/ people and then dont remember what we talked about. Sometimes I think that I am just thinking about something, I find myself actually speaking out loud.
Any suggestion for when I talk to her on monday.
P.S. I have tried herbal remedies--valarian root and the like. I have also self medicated w/alcohol. I know, not a good idea and it didn't even help. My husband enjoyed it though...if you know what I mean. :)
Thx
Posted by AnxiousAnnie on April 12, 2008, at 22:15:07
In reply to Insomnia--drugs not working, posted by krycek on April 12, 2008, at 19:07:24
Have you ever tried Seroquel?
The medication is used off label for insomnia for some patients.
Posted by Phillipa on April 12, 2008, at 22:52:20
In reply to Re: Insomnia--drugs not working » krycek, posted by AnxiousAnnie on April 12, 2008, at 22:15:07
Is it possible you have sleep aphnea? Maybe a sleep study to see what sleep or non sleep patterns are? Love Phillipa
Posted by undopaminergic on April 13, 2008, at 1:04:03
In reply to Insomnia--drugs not working, posted by krycek on April 12, 2008, at 19:07:24
Try the sedative antihistamine cyproheptadine - I think it's OTC. Failing that, diphenhydramine should work too. If necessary, you can try them in combination with Ambien or a benzodiazepine along with
I've also found that biperiden can help, and I know that clonidine can be useful.
If the problem persists, you can try a stimulant upon waking to help with concentration and alertness during the day, and furthermore, there may be drowsiness when it wears off, which can help with sleep.
Posted by ClearSkies on April 13, 2008, at 17:33:35
In reply to Insomnia--drugs not working, posted by krycek on April 12, 2008, at 19:07:24
Low dose of Remeron (like 7.5mg) has quite a sedative effect. Less effective at higher doses. I hope you get relief soon - thinking outside the box, like looking at off-label uses of some medications - might work for you.
I also use guided meditation at night to calm my mind, and aromatherapy (lavender, hops, etc.) to induce a sleepy atmosphere. Some say a tepid bath at night will also help. I say, when pharmaceuticals fail, start rallying all the means at hand!
ClearSkies
Posted by atmlady on April 13, 2008, at 20:17:21
In reply to Insomnia--drugs not working, posted by krycek on April 12, 2008, at 19:07:24
Hi, krycek. I really, really know where you're coming from - been there, boy have I! Have used Ambien, Trazodone, Xanax, alcohol, exercise, warm baths, OMG. Oh, don't forget the light box. What worked for me? This sounds really crazy, but..... Provigil.
I know, I know. It's a stimulant. But somehow, being really, really awake and alert throughout the daytime makes it easier to get to sleep. And not only that, if for some reason I DON'T sleep at night (cause for sure it still happens - it's just who I am), I won't feel bad the next day. Provigil just has a way of making you feel rested and alert, even when you're not. Check out this article:
http://www.newscientist.com/channel/health/mg18925391.300-get-ready-for-24hour-living.html
So like I said, I still have my rough nights, and I still sometimes take a little something to help me nod off, but I have no problems the next day from lack of sleep. Which takes a lot of the anxiety out of insomnia for me. Which relaxes me. Which.... well, you get the picture!
ANyway, just a thought ....
Posted by Dopamine123 on April 13, 2008, at 21:48:59
In reply to Re: Insomnia--drugs not working - a crazy idea, posted by atmlady on April 13, 2008, at 20:17:21
>Low dose of Remeron (like 7.5mg) has quite a sedative effect.
Yeah remeronn can be very effective for helping a person get to sleep. It is both a 5-ht2a antagonist and histamine antagonist. Both of those actions improve sleep. I take it for sleep, and find it works pretty good. I've tried diphenhydramine and I hated that drug. It makes me feel really weird.
This site has some really good information about supplements and drugs you can take for insomnia.
http://www.qualitycounts.com/fpinsomnia.htmRozerem is another drug, I don't know if you've taken it.
http://www.qualitycounts.com/drugs/insomnia/rozerem_ramelteon.htm
Posted by Phillipa on April 14, 2008, at 18:04:13
In reply to Re: Insomnia--drugs not working - a crazy idea, posted by atmlady on April 13, 2008, at 20:17:21
I feel that sleep is the body's way of repairing itself and is necessary to maintain healthy bodies. Phillipa
Posted by undopaminergic on April 15, 2008, at 2:27:42
In reply to Re: Insomnia--drugs not working - a crazy idea, posted by Dopamine123 on April 13, 2008, at 21:48:59
> >Low dose of Remeron (like 7.5mg) has quite a sedative effect.
>
> Yeah remeronn can be very effective for helping a person get to sleep. It is both a 5-ht2a antagonist and histamine antagonist. Both of those actions improve sleep. I take it for sleep, and find it works pretty good. I've tried diphenhydramine and I hated that drug. It makes me feel really weird.
>Cyproheptadine is a H1/5-HT2-antagonist too - you may wish to try it for comparison. The adrenergic alpha2-antagonism of Remeron is probably detrimental to sleep, and may be the reason why Remeron is said to be less sedative at higher doses.
Posted by undopaminergic on April 15, 2008, at 2:42:39
In reply to Re: Insomnia--drugs not working - a crazy idea » atmlady, posted by Phillipa on April 14, 2008, at 18:04:13
> I feel that sleep is the body's way of repairing itself and is necessary to maintain healthy bodies. Phillipa
>Sleep deprivation can have antidepressive effects, but if prolonged, hallucinations and other adverse effects develop - it is though to be the reason for manic psychosis and to be at least partially responible for stimulant induced psychosis. Normally, sleep deficits improve the depth, quality and length of the sleep that follows it, so it tends to correct itself.
Posted by atmlady on April 15, 2008, at 7:21:24
In reply to Re: Insomnia--drugs not working - a crazy idea » atmlady, posted by Phillipa on April 14, 2008, at 18:04:13
No doubt, Phillipa, I need lots of sleep - we all do! Which is why NOT sleeping is so awful! But I found that forcing myself to sleep with ambien did not give me that restful, restorative sleep we all need. I would wake up feeling sluggish and sleepy after the supposed 8 hours we all need. I complained to my pdoc that I didn't dream while on ambien, and I thought that was wierd. Why would the dreams go away? That's what made me think that ambien sleep is not REAL sleep. The article I posted says as much.
Now that I'm on Provigil, I am sleeping about 6.5 hours a night on average, but it's a hard, dreamy sleep, and I wake up feeling refreshed. Weekends I may sleep longer. And some nights, as I said, I may have difficulty sleeping, but at least the next day is not filled with brain fog!
Posted by atmlady on April 15, 2008, at 7:24:56
In reply to Re: Insomnia--drugs not working - a crazy idea, posted by undopaminergic on April 15, 2008, at 2:42:39
"Sleep deprivation can have antidepressive effects"
I know! Isn't that nuts? But I read the same thing. It reminds me of how restricted caloric intake is linked to living longer. Are we eating and sleeping too much for our own good?
Posted by Phillipa on April 15, 2008, at 19:25:34
In reply to Re: Insomnia--drugs not working - a crazy idea » Phillipa, posted by atmlady on April 15, 2008, at 7:21:24
Then that is excellent. Love Phillipa
Posted by Phillipa on April 15, 2008, at 19:27:54
In reply to Re: Insomnia--drugs not working - a crazy idea » undopaminergic, posted by atmlady on April 15, 2008, at 7:24:56
Read the same thing about eating. Small portions even fast food places some have reduced the size of portions. Never eat fast food though. Now I eat something like healthy choice. Or Lean Cuisine. Phillipa
Posted by elanor roosevelt on April 16, 2008, at 22:29:51
In reply to Insomnia--drugs not working, posted by krycek on April 12, 2008, at 19:07:24
just had a few months of wondering what had happened to my sleep than realized that the generic ambien was not working
Posted by yxibow on April 24, 2008, at 2:14:42
In reply to Re: Insomnia--drugs not working, posted by elanor roosevelt on April 16, 2008, at 22:29:51
In the end, using any agent (and I use trazodone for some periods of times) for sleep will result in tolerance. This includes OTC medication and herbal remedies as well. Eventually one rotates through medications so as to not become dependent on one. Its hard, I know.
The body really has to have natural sleep, and the core of it is getting to the core reason why there is a sleep disorder in the first place. This is where sleep studies among other things come in place. I probably need one myself. Consistent sleep time and exercise also helps (issues with that myself too.)
So the short of it, these are reasons why any agent doesnt last more than 4-8 weeks typically at prime level.I know this isnt a solution, but a cogitation
-- tidings
Posted by undopaminergic on April 24, 2008, at 6:04:30
In reply to Re: Insomnia--drugs not working, posted by yxibow on April 24, 2008, at 2:14:42
> In the end, using any agent (and I use trazodone for some periods of times) for sleep will result in tolerance.
>*May* result in tolerance. For some people, tolerance to the hypnotic properties of a benzodiazepine may develop in less than a week, whereas some find a particular solution to be effective for months or longer - for ever, in other words.
Posted by yxibow on April 25, 2008, at 2:19:04
In reply to Re: Insomnia--drugs not working, posted by undopaminergic on April 24, 2008, at 6:04:30
> > In the end, using any agent (and I use trazodone for some periods of times) for sleep will result in tolerance.
> >
>
> *May* result in tolerance. For some people, tolerance to the hypnotic properties of a benzodiazepine may develop in less than a week, whereas some find a particular solution to be effective for months or longer - for ever, in other words.
>All eventually develop tolerance, its a matter of months to years -- years, you're right... and I'm not talking like benzodiazepine tolerance, its a more subtle tolerance, due to a lot of factors including REM cycle, etc.
If one is not or hasn't taken benzodiazepines in a while, a larger dose of Lunesta will work and is readliy used in fact for more long term care. If one already uses benzodiazepines a lot the pseudo-benzo sleep agents arent very effective.
This is the end of the thread.
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