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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by myco on February 18, 2009, at 15:50:06
hey,
Going to a gp who specializes in sleep disorders tommorrow at his clinic. I am prepared to ask for restoril (temazepam) to help insomnia perhaps 2 or 3 days a week. I want to be able to demonstrate responsibility in using it therefor I would like to know how commonly one must use this (or benzo's in general) to develop tolerance. I know as little as one week everyday can increase tolerance likelihood but what about 2 days a week then some other type of sleep aid the others? Is that acceptable as a negotiation tool (an educated statement from a patient to a doctor) for him?
thnx
Posted by yxibow on February 18, 2009, at 18:19:49
In reply to Temazepam (Restoril): 2 or 3 d/wk = no tolerance?, posted by myco on February 18, 2009, at 15:50:06
> hey,
>
> Going to a gp who specializes in sleep disorders tommorrow at his clinic. I am prepared to ask for restoril (temazepam) to help insomnia perhaps 2 or 3 days a week. I want to be able to demonstrate responsibility in using it therefor I would like to know how commonly one must use this (or benzo's in general) to develop tolerance. I know as little as one week everyday can increase tolerance likelihood but what about 2 days a week then some other type of sleep aid the others? Is that acceptable as a negotiation tool (an educated statement from a patient to a doctor) for him?
If a doctor is really competent in sleep disorders they may want to issue as few sleep agents as possible if not any. Have you had or does this doctor work with people who do "sleep studies" (you go in for a night and you're observed) ?
I don't think its productive to have a "negotiation tool" -- it is the psychiatrists' DEA license and their prescription pad.But suggestions that you might have heard I don't see why you can't present it, I'm sure the doctor is familiar with many agents and I don't see that you have to have the mindset coming into an appointment sort of thinking that the doctor will view suggestions as almost choices for addiction.
Just an opinion.
Restoril is a metabolite of Valium and yes, if you have ever taken or are currently taking other benzodiazepines, there will be diminishing returns.Its not a particularly strong benzodiazepine, Dalmane is stronger.
But yes, if you take it consistently for some weeks I imagine tolerance for sleep can be built up, even if it helps with anxiety which is a rare use for Restoril.
You would have better luck with a short to medium term pseudo-benzodiazepine, especially Lunesta which has been studied for that purpose.
But with all things there is diminishing return and that is really an individual thing and what sort of sleep disorder you have.
I know for myself I have a fairly significant sleep disorder and I have been through the gamut of choices -- that doesn't mean to reflect on how you would respond to things though.
Beyond that, there are TCAs such as amitriptyline and doxepin, tolerance buildup may vary but they can contribute a little to depression if you have that.
There are other agents, antihistamines that act more as sleep agents (e.g. doxylamine, Unisom), but I would probably go with the first choices.
Ultimately "natural sleep hygeine" is the best thing but it takes quite a while, weeks for the body to adjust from a lack of sleep and keeping yourself up in the day to shifting toward a more normal pattern. I'm not saying that it is easy at all and I haven't been successful at that yet.Many naps and caffeine will contribute to things too, of course.
-- hope that helps
Jay
Posted by raisinb on February 18, 2009, at 18:34:04
In reply to Temazepam (Restoril): 2 or 3 d/wk = no tolerance?, posted by myco on February 18, 2009, at 15:50:06
Hi--
Doctors have very different stances on benzodiazapines, so maybe he'll even suggest it himself. I always get the best results when I go in with an open mind and am honest about how I'm feeling, then talk with the doctor about the best choice. If the doctor doesn't listen, then it's time to get a new one.Best of luck tomorrow. I hope he is helpful and empathic.
Posted by myco on February 18, 2009, at 19:01:36
In reply to Re: Temazepam (Restoril): 2 or 3 d/wk = no tolerance? » myco, posted by yxibow on February 18, 2009, at 18:19:49
Hey,
It's more than just a simple disorder. I take nardil so my almost complete lack of sleep (2-4h a night on a good night) is med induced.
The need for a "negotiation tool" (and by the way, I totally agree that the whole idea of this is in my opinion the wrong path) stems from horrible experiences with gps who are "sleeping pill" (said with content and a turned up nose) phobic. The doc who rx'd nardil for me wont give me one and on top of that antagonizes me on purpose for asking for one...serious...check out this post of the last convo I had with this idiot:
http://www.dr-bob.org/babble/20090213/msgs/880525.html
So it's probably just an insecurity of mine to have to have something to "negotiate" with...to meet a new gp half way because I seriously dont know how much longer I can go without sleep before f*ck*ng up something in my life (job, my impending grad school start, etc...) I'm in my 11th week now with no sleep or crappy amount of sleep (2-4h best). The gp did give me traz but I spit it back after 2 weeks and said it doesnt work well can we change then he refused to add something else as if I was given my one chance. I know I know go get another doc....and I am, first new one tommorrow.
My issue with the nardil insomnia is not inability to get to sleep, thats easy with herbal teas and doxylamine but I cant stay asleep...if I wake up and I always do after mostly about 2h...i am screwed, I often begin my day with shower and coffee at 3am knowing no way in hell can I get back to sleep.
So ya im scared and want to accommodate a new doc as best I can to do anything I can to get him to help me. I dont like the idea of a doc with other ideas about sleep...ie meditation, music etc with nardil insomnia...ive tried them to no avail.
So i'd like a good benzo to keep me knocked out for ideally 6-8h (even if its just 2 or 3 days a week).
Nobody answered my question about how often you must use a benzo like restoril or dalmane to get tolerence (ie would 2 days a week be ok to avoid it)?
Apparently I cant take TCA's although many on here will tell you that. Canadian dr's are quite careful with meds...not as easy here as it is the states to get rx's. We take after the brits more this way.
I can't even do naps dude...my eyes hit a state of doozy and half closed but brain never shuts down. I sit there until I go "bah, this isnt working I wanna watch tv or something"
bloody frustrating ya know
thnx
myco
Posted by Phillipa on February 18, 2009, at 20:51:50
In reply to Re: Temazepam (Restoril): 2 or 3 d/wk = no tolerance? » yxibow, posted by myco on February 18, 2009, at 19:01:36
Myco after 37 years on benzos I may have tolerance but still sleep fine. Do wake in about 4-6 hours and take a small amount of valium. Xanax and valium at bedtime. And that's horrible about the not sleeping. Love Phillipa
Posted by myco on February 18, 2009, at 23:02:03
In reply to Temazepam (Restoril): 2 or 3 d/wk = no tolerance?, posted by myco on February 18, 2009, at 15:50:06
ok...I found a few papers that suggest no tolerance can be shown for temazepam (restoril) over at least a 3 month period of chronic use...even one study suggests an inverse tolerance...the med actually becomes more effective over time with chronic use. Interesting considering benzo's are most notable for tolerance issues with chronic use. So perhaps this may be a potentially more acceptable and less "harmful" benzo in the eyes of a socially conservative gp. Albeit addiction/withdrawal issues still exist with temazepam.
myco
Posted by myco on February 19, 2009, at 19:33:14
In reply to Temazepam (Restoril): 2 or 3 d/wk = no tolerance?, posted by myco on February 18, 2009, at 15:50:06
Sleep Doc gave me 30mg restoril (temazepam) for insomnia relating to maoi induced inability to stay asleep to be taken a couple of times a week then a rx for L-tryptophan (500mg) to be taken the remaining nights not on temazepam (despite some opinion tryptophan would be a bad choice with a maoi...he wasnt concerned at all at this dose). With the temazepman he confirmed what I read in studies that tolerance to it doesnt seem to develope in most people like the other benzos and in fact some people actually lower the dose over time. I remember Phillipa mentioning she actually lowered her dose of valium over time...temazepam is derived from valium.
I'm free LOL of the "sleeping pill" phobic gp nightmare I was lost in for many weeks.
Now...will it work...
myco
Posted by Phillipa on February 19, 2009, at 20:49:14
In reply to Sleep Dr rx'd me temazepam + L-tryptophan, posted by myco on February 19, 2009, at 19:33:14
Myco yup sleep tight pleasant dreams!!!!! Love Phillipa
Posted by myco on February 20, 2009, at 0:02:44
In reply to Re: Sleep Dr rx'd me temazepam + L-tryptophan » myco, posted by Phillipa on February 19, 2009, at 20:49:14
This is the end of the thread.
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