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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by jono_in_adelaide on October 23, 2011, at 2:12:48
A lot of us seem to suffer insomnia, and worry about the GAGA sleep meds losing their effectiveness over time.
Although there is some evidence that Ambien and benzos do maintain their efficiency long term for many patients, the concern is still valid, so i thought I'd start a thread with my idea.
That is rotating a GABA med (Ambien or a benzo) with a med that works on histamine and the 5HT2 receptors (doxepin or Seroquel)
Taking one one night, and the other the next night, would enable sound sleep every night, without the body getting tolorant to the effect of either.
Posted by sigismund on October 23, 2011, at 2:21:40
In reply to For the insomniacs - rotating sleep meds, posted by jono_in_adelaide on October 23, 2011, at 2:12:48
What kind of hangover does Seroquel have?
I found amitriptylline(sp?) and mirtazepine intolerable with that.
I forget what the problem was with doxepin? Quality of sleep? Nasal congestion?
Cyproheptadine was like mirtazepine. Good for quality of sleep and terrible the next day. Largactil, forget it.
With many of these drugs I would prefer, on balance, not to sleep much.
Posted by jono_in_adelaide on October 23, 2011, at 2:34:05
In reply to Re: For the insomniacs - rotating sleep meds, posted by sigismund on October 23, 2011, at 2:21:40
Never tried doxepin, but I have used amitriptyline and Prothiaden, and they did cause hangover (all are similar and very long acting)
The halflife of Seroquel is much shorter (and it has no anticholinergic properties), i found it gave a deep, refreshing sleep with no hangover, so that would be my pick..... Ambien or temazepam one night, Seroquel the next.
Having said that, some people seem to find low dose doxepin (10mg or so0 very helpful
Posted by floatingbridge on October 23, 2011, at 3:44:05
In reply to Re: For the insomniacs - rotating sleep meds, posted by jono_in_adelaide on October 23, 2011, at 2:34:05
Doxepin was pretty awful. Yes, a very long hangover and poor quality sleep. I wanted it to work.
Seroquel is an antihistamine? I have paradoxical reactions to antihistamines which is inconvenient. I was unable to tolerate seroquel.
It's 1:30 am here. I fell asleep with gabapentin but now am very awake, so it will be tenazepam, my last resort.
Usually gabapentin is enough to keep me sleeping.
Posted by sigismund on October 23, 2011, at 5:40:07
In reply to Re: For the insomniacs - rotating sleep meds » jono_in_adelaide, posted by floatingbridge on October 23, 2011, at 3:44:05
What was awful about Seroquel for you?
Short acting mirtazepine would be good if there was such a thing.
Since I stopped the gabapentin the swelling in my feet and hands has gone down.
And I was only taking 300mg at night.
Posted by sigismund on October 23, 2011, at 5:44:10
In reply to Re: For the insomniacs - rotating sleep meds, posted by jono_in_adelaide on October 23, 2011, at 2:34:05
Depth of sleep is important to me, which was why I liked mirtazine (until the next day).
I can make some use of agomelatine, but not as is suggested.
I take the dose in two halves when I awake through the night, two lots of 12.5mg.
If I was to take 25 before sleep I would sleep a few hours and that would be it. Doubling the dose would make it worse.
Plus Chinese herbs and plus 1.5g trytophan and 200mg pyridoxyl 5 phosphate.
Posted by Phillipa on October 23, 2011, at 11:02:26
In reply to Re: For the insomniacs - rotating sleep meds » jono_in_adelaide, posted by sigismund on October 23, 2011, at 5:44:10
Remeron at l5mg did absolutely nothing for sleep for me and also was on benzos at the time. Hard time in life then for me. So I just stopped the remeron still have an unopened bottle of it sealed and all. Just didn't work for me. Phillipa
Posted by jono_in_adelaide on October 23, 2011, at 17:56:21
In reply to Re: For the insomniacs - rotating sleep meds, posted by Phillipa on October 23, 2011, at 11:02:26
If you want a non benzo sleep aid, seriously, try Seroquel 25-50mg an hour before bedtime.
It gives a refreshing sleep, and its half life is such that hangover is minimal. It works in the same was as the antidepressant sedatives (Histamine and seretonin antagonism) but its half life is such that it has more or less worn off after 8 hours. I expect you'd become tolorant if you took it every night, which is why I was suggesting for chronic insomnia that you rotate it with Ambien or Temazepam or somthing similar.
Dont be concerned by it being an antipsychotic - at 50mg/day it has no antipsychotic properies
The only down side is that it is so damned expensive atm (still under patent) but not for long.
I got mine off of the net from India, $10 for 100 x 50mg tablets..... would have cost $150 here in Australia, because insurance will only cover it for mania or psychosos, not for insomnia or anxiety states
Posted by floatingbridge on October 23, 2011, at 18:02:39
In reply to Re: For the insomniacs - rotating sleep meds » floatingbridge, posted by sigismund on October 23, 2011, at 5:40:07
It made my skin crawl. Not to mention scare the daylights out of me.
Posted by jono_in_adelaide on October 23, 2011, at 18:20:22
In reply to Re: For the insomniacs - rotating sleep meds » sigismund, posted by floatingbridge on October 23, 2011, at 18:02:39
How did it scare the daylights out of you? What happend?
Posted by linkadge on October 23, 2011, at 18:47:01
In reply to Re: For the insomniacs - rotating sleep meds, posted by jono_in_adelaide on October 23, 2011, at 18:20:22
A very interesting discussion (one that is very dear to my heart).
I am working on a list of meds and supplements that could be used in rotation for insomnia.
I just *hate* wasting my time with ones that don't work (where you get into the pattern of taking one after the other ineffectively).
I prefer mirtazapine to seroquel. I think that mirtazapine is the most potent h1 blocker (in ratio to the other actions). I don't like seroquel much. Not sure why, but it acutaly has not worked routinely for me.
Amitriptyline also does not work routinely.
Zyprexa works, but the effect lasts for days afterwards (feeling yucky).
Linkadge
Posted by floatingbridge on October 23, 2011, at 18:58:49
In reply to Re: For the insomniacs - rotating sleep meds, posted by jono_in_adelaide on October 23, 2011, at 18:20:22
It's difficult to describe. I felt like a wild animal inside, but outside I was afraid to move or speak. I sat on my bed and kept rubbing my arms kind of mechanically. It was a terrible. I have no idea what that was about and refuse to take it again. I have no idea what the dose was. It was years ago.
Obviously, this is an atypical reaction. I would love for it to have been sedative.
Posted by Phillipa on October 23, 2011, at 19:18:37
In reply to Re: For the insomniacs - rotating sleep meds » jono_in_adelaide, posted by floatingbridge on October 23, 2011, at 18:58:49
FB wasn't for me either. Couldn't speak although words in head, dizzy almost fainted in am. Doc stopped it next day then my skin dried out and seriously cheeks seemed to pucker up so strange. Never again for me either. Phillipa
Posted by sigismund on October 23, 2011, at 19:34:06
In reply to Re: For the insomniacs - rotating sleep meds, posted by linkadge on October 23, 2011, at 18:47:01
The main thing for me is to keep alcohol way down.
This was never a problem for me. Now, if I have enough alcohol to feel better, it is already too much for sleep that night.
Which is terrible. I need a drink now and then. I am unsure as to what to do. Compared to what I used to drink I drink nothing now.
Posted by Phillipa on October 23, 2011, at 19:40:27
In reply to Re: For the insomniacs - rotating sleep meds, posted by sigismund on October 23, 2011, at 19:34:06
Would you believe over 15 year without but I slept like a baby with 4-6 beers. And to boot felt great the next day. Love PJx
Posted by jono_in_adelaide on October 23, 2011, at 19:50:26
In reply to Re: For the insomniacs - rotating sleep meds » sigismund, posted by Phillipa on October 23, 2011, at 19:40:27
I guess the precise drug involved comes down to individual preference, but I think the idea of rotating a GABA type drug with an H1/5HT2 type drug is pretty sound if you are one of those who needs a hypnotic every night..... its a matter of finding precisely which drugs work for you.
I have found the sedating tricyclics (amitriptyline, dothiepin) were too long acting and left me feeling dopey the next day, where as Seroquel didnt. Given mirtazepines half life (and propencity to produce weight gain) I dont think it would be for me, but it is great for others.
Posted by jono_in_adelaide on October 23, 2011, at 19:53:58
In reply to Re: For the insomniacs - rotating sleep meds » sigismund, posted by Phillipa on October 23, 2011, at 19:40:27
Link, whats on your list?
My list would look like this
GABA med - take one night
Ambien
Lunestra
Temazepam
Flurazepam Nitrazepam
Lorazepam
Alprazolam
Chloral Hydrate
H1/5HT2 drug - take on alternate nightSeroquel
Remeron
Doxepin
Amitriptyline
Promethazine
Diphenhydramine
There are many others of course, but you get the idea. I dont know much abot herbal supplements, what are your suggestions?
Posted by floatingbridge on October 23, 2011, at 20:47:24
In reply to Re: For the insomniacs - rotating sleep meds, posted by jono_in_adelaide on October 23, 2011, at 19:53:58
Gabapentin? 900mg at night. My doc says drink a good amount of water with it. There is a theory since it's excreted through the kidneys, there will be little hangover.
Posted by Chairman_MAO on October 24, 2011, at 21:43:37
In reply to For the insomniacs - rotating sleep meds, posted by jono_in_adelaide on October 23, 2011, at 2:12:48
You can do this if you want. Personally, I have in the past used 2mg lorazepam qhs for years to sleep just fine. Worked much better than anything else I've tried except GHB.
Right now, I'm physiologically dependent on clonazepam so lunesta is of limited usefulness. I use 3mg of it along with 100mg of Vistaril.
I'm not sure that switching off every other day would actually completely eliminate tolerance.
Posted by jono_in_adelaide on October 24, 2011, at 23:50:07
In reply to Re: For the insomniacs - rotating sleep meds » jono_in_adelaide, posted by Chairman_MAO on October 24, 2011, at 21:43:37
"I'm not sure that switching off every other day would actually completely eliminate tolerance"
Possibly not, but tolorance would be a damned sight less likely than when one takes the same drug every night without a break.
I wonder if any controlled studies have been done into this? No drug company would ever do it, because they want you to take their pill every night, not rotate theirs with somebody elses.
Posted by Chairman_MAO on October 31, 2011, at 20:49:33
In reply to Re: For the insomniacs - rotating sleep meds, posted by jono_in_adelaide on October 24, 2011, at 23:50:07
> "I'm not sure that switching off every other day would actually completely eliminate tolerance"
>
> Possibly not, but tolorance would be a damned sight less likely than when one takes the same drug every night without a break.
>
If the non-benzo drug works in the first place, what's the point of switching on and off? Why not just use that each night?> I wonder if any controlled studies have been done into this? No drug company would ever do it, because they want you to take their pill every night, not rotate theirs with somebody elses.
>
>
You can check; not all studies are funded by drug companies, although it has gotten ludicrous these days. GHB works every night indefinitely, but good luck getting that.
This is the end of the thread.
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