![[dr. bob]](/dr-bob-sm.gif)
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 Zatar on March 8, 2015, at 18:18:11
I'm asking for a friend (no, REALLY). She is probably going through perimenopause, but has had horrible sleep maintenance issues for several months and cannot sleep more that 1 to 1-1/2 hours at a time and has been getting only 2-4 hours per night for months, and that is not a sequential 2-4 hours.
The problem is that she also has depression, possible panic attacks, gets migraines and has been having vertigo or rather something like it (where the room does not spin, but she feels like she is being PULLED to one side) and the meds she has tried either increase dizziness or worsen depression. Elavil 25 mg does not help sleep and worsens dizziness. Xanax 0.5 mg worsens depression. Meclizine didn't help dizziness. Hormone replacement therapy really not an option as her mother had breast cancer.
Brain MRI negative, lumbar puncture negative. Only some vestibular testing showed "unilateral vestibular hyPOactivity".
She desperately needs something for sleep as she has young kids and cannot drive. What meds can you suggest for sleep that do not cause/worsen depression that she can discuss with the new pdoc that she will be seeing soon? Neurontin? Remeron? How can she manage side effects as most meds that aid sleep seem to cause dizziness?
Thank you in advance.
-Zatar
Posted by linkadge on March 8, 2015, at 18:55:38
In reply to Horrible sleep problems, posted by Zatar on March 8, 2015, at 18:18:11
Hmm....
Antidepressants can be hit and miss in terms of improving / worsening insomnia (esp nighttime awakenings). I would consider something like Neurontin as an option to improve sleep maintenance. The amitriptyline might be causing / worsening the vertigo. Vertigo can be related to inadequate sleep. The brain is literally going into a sleep cycle while awake.
I would lower the amitriptyline (or change to doxepin which is better for sleep). Adding Neurontin would also not be a bad idea.
She might also consider magnesium supplementation (or at least baths with Epsom salts). I find a TSP of olive oil at bedtime can improve sleep maintenance. It helps the body produce oleamide, a natural brain produced sleep promoting agent.
I hope this helps.
Linkadge
Posted by baseball55 on March 8, 2015, at 19:34:41
In reply to Re: Horrible sleep problems, posted by linkadge on March 8, 2015, at 18:55:38
Many people find trazadone helpful for sleep. It has few side effects, is not habituating and does not build tolerance. Some people find it lasts too long and leaves them sleepy in the morning. I have not found that, myself.
Posted by Christ_empowered on March 8, 2015, at 22:59:23
In reply to Re: Horrible sleep problems, posted by baseball55 on March 8, 2015, at 19:34:41
neurontin, surmontil in place of the elavil, maybe (not an MD, just throwin random things out there for you...)
...baseball's trazodone idea is a good one. Remeron can be helpful, for some people...I don't think you're supposed to mix it with TCA drugs, but I could be wrong...
Posted by rjlockhart37 on March 9, 2015, at 1:17:26
In reply to Re: Horrible sleep problems, posted by Christ_empowered on March 8, 2015, at 22:59:23
rozerm....it's not a sedative, it works on melatonin receptors.....the depression caused by the benzos is because they work on GABA, and in ways it causes the othr nueros to lower......like alcohol, or anyhing with it, it makes me terribly depressed.....i mean just even a little alcohol....
there are the other heavy duty sleep meds the barbiturates which will definetly get anyone to sleep, but they would be worse than benzos for causing depression....
try Lyrica.....it works well on the mood from articles i've read and gives anxiety relief....that or the rozerm.....
Posted by Zyprexa on March 9, 2015, at 5:18:08
In reply to Horrible sleep problems, posted by Zatar on March 8, 2015, at 18:18:11
I'm going to suggest trazodone. A lot of people take this for sleep. Its an antidepressant. Its short acting which won't make sleepy in morning. My mom takes this for sleep. Some times she does not sleep through whole night. But gets to sleep very well and sleep about 6-8 hours. No one has said there are any side effects, but sleep.
Posted by Phillipa on March 9, 2015, at 9:53:19
In reply to Horrible sleep problems, posted by Zatar on March 8, 2015, at 18:18:11
That's what happened to me going through menopause which I didn't know was going on. The vertigo had something to do with the fact that hasimotos thyroidistis as also happening at the same time. I did go to the ER as couldn't walk with the dizziness and I also was given ativert. But a 2mg injection of ativan was also added. I had to stay on the antivert. And I admit a horrible feeling and scary and had to just stay put for I forget how long. So has thyroid been checked. Phillipa
Posted by herpills on March 9, 2015, at 10:34:20
In reply to Horrible sleep problems, posted by Zatar on March 8, 2015, at 18:18:11
I would consider Remeron. It's a good option if you are struggling with insomnia in addition to depression and anxiety. Whatever happens, this sleep issue really needs to be dealt with ASAP as there are many negative health consequences that come along with poor sleep. Trazadone may also be an option as baseball suggested.
Posted by Zatar on March 9, 2015, at 12:38:22
In reply to Re: Horrible sleep problems » Zatar, posted by Phillipa on March 9, 2015, at 9:53:19
> That's what happened to me going through menopause which I didn't know was going on. The vertigo had something to do with the fact that hasimotos thyroidistis as also happening at the same time. I did go to the ER as couldn't walk with the dizziness and I also was given ativert. But a 2mg injection of ativan was also added. I had to stay on the antivert. And I admit a horrible feeling and scary and had to just stay put for I forget how long. So has thyroid been checked. Phillipa
Thyroid ultrasound, TSH, T3, T4 all normal. I do know that if you have depression/anxiety issues, an out of whack HPA axis can cause thyroid-like symptoms not because your levels are low, but maybe the thyroid receptors or the feedback mechanism is not working right.Thanks for the thought...
-Zatar
Posted by phidippus on March 9, 2015, at 18:17:55
In reply to Horrible sleep problems, posted by Zatar on March 8, 2015, at 18:18:11
Suvorexent. It will help with sleep and mood.
Eric
Posted by babbler20 on March 12, 2015, at 23:18:40
In reply to Horrible sleep problems, posted by Zatar on March 8, 2015, at 18:18:11
Hi, I can empathize with your friend's situation. Insomnia has ruined my life for the last 7 years. I have tried every sleep aid imaginable and only two have worked for me. The first one to work for me was trazodone and the other was remeron. Trazodone did and still causes hypotension for me and I would advise against it. It also really stops being effective after a couple months, at least that was my experience. Additionally, the withdrawal is horrible every time you decrease by 25 mg. Remeron, is the best sleep aid I've ever taken. I can't imagine it not working for someone. I took it for 6 months and it was amazing. At first, I slept like 10 to 12 hours a day for about a month until I got used to it. It was life changing for me, however I did gain 60 lbs. If your friend can control his or her cravings for food on it then it is truly the gold standard and I could not recommend it more. I hope that helps.
Posted by babbler20 on March 12, 2015, at 23:22:32
In reply to Re: Horrible sleep problems » Zatar, posted by phidippus on March 9, 2015, at 18:17:55
Hi, not to be negative, but if you read the studies on Suvorexant, it helped people get to sleep like 10 minutes sooner and helped them sleep 10 minutes longer on average. It's a joke.
Posted by Lamdage22 on March 13, 2015, at 12:07:40
In reply to Re: Horrible sleep problems, posted by linkadge on March 8, 2015, at 18:55:38
-- I would consider something like Neurontin as an option to improve sleep maintenance.
Another vote for Neurontin!
Baclofen is nice, too.
Posted by phidippus on March 13, 2015, at 12:22:07
In reply to Re: Horrible sleep problems » phidippus, posted by babbler20 on March 12, 2015, at 23:22:32
For instance, in one study, people on the sleeping pill at the three-month mark slept 60.3 minutes longer, on average, while those on placebo slept 40.6 minutes longer -- a difference of more than 19 minutes.
"Nineteen minutes a night of more sleep for an entire month is a lot of additional sleep," Krystal says.
In the same study, those on suvorexant fell asleep about 25 minutes faster than at the start of the study; those on placebo fell asleep about 17 minutes faster.
Those on the pill spent about 48 minutes less time awake during the night than before the medication, compared to 25 fewer minutes for those on the placebo. For the second study, results were similar. "The fact [that] there is benefit on the sleep study finding and the self reporting finding is critical," Krystal says.
"What we've seen here and confirmed in [the later studies] is that suvorexant helps people with insomnia fall asleep faster and wake less," says Herring, who led the published study. "It is effective over the long term and well tolerated."The published study tested whether a range of doses, each given in a sleep lab to about 60 people suffering from insomnia, improved sleep better than an inactive placebo pill. Without knowing which was which, each study participant took either suvorexant or the placebo for four weeks, then switched to the other for another four weeks.
The main study measure was sleep efficiency -- that is, the percentage of an eight-hour night people slept. At the beginning of the study, participants average sleep efficiency was 66%. After falling asleep, they woke for an average 101 minutes during the night.
"There was a range of results, but generally sleep efficiency improved 5% to 13% compared to placebo," Herring says. "We also found that patients have 21 to 37 minutes less time awake during the night."
Insomnia Slideshow: 20 Tips for Better Sleep
Every Bit HelpsThat may not seem like a lot. But it could mean a lot to a person suffering from insomnia, says Richard Simon Jr., MD, director of the Kathryn Severyns Dement Sleep Disorders Center in Walla Walla, Wash.
"Insomnia patients seem to feel better and function better when they get 15 to 20 minutes more sleep," Simon says. "This is an intriguing study that shows this drug does improve sleep. That is big."
Suvorexant in Patients with Insomnia: Results from Two 3-Month Randomized Controlled Clinical Trials
W. Joseph Herringcorrespondenceemail
,
Kathryn M. Connor
,
Neely Ivgy-May
,
Ellen Snyder
,
Ken Liu
,
Duane B. Snavely
,
Andrew D. Krystal
,
James K. Walsh
,
Ruth M. Benca
,
Russell Rosenberg
,
R. Bart Sangal
,
Kerry Budd
,
Jill Hutzelmann
,
Heather Leibensperger
,
Samar Froman
,
Christopher Lines
,
Thomas Roth
,
David Michelson
Received: May 8, 2014; Received in revised form: September 5, 2014; Accepted: October 1, 2014; Published Online: October 22, 2014
DOI: http://dx.doi.org/10.1016/j.biopsych.2014.10.003
Publication stage: In Press Corrected Proof
showArticle Info
Abstract
BackgroundSuvorexant is an orexin receptor antagonist for treatment of insomnia. We report results from two pivotal phase 3 trials.
MethodsTwo randomized, double-blind, placebo-controlled, parallel-group, 3-month trials in nonelderly (1864 years) and elderly (≥65 years) patients with insomnia. Suvorexant doses of 40/30 mg (nonelderly/elderly) and 20/15 mg (nonelderly/elderly) were evaluated. The primary focus was 40/30 mg, with fewer patients randomized to 20/15 mg. There was an optional 3-month double-blind extension in trial 1. Each trial included a 1-week, randomized, double-blind run-out after double-blind treatment to assess withdrawal/rebound. Efficacy was assessed at week 1, month 1, and month 3 by patient-reported subjective total sleep time and time to sleep onset and in a subset of patients at night 1, month 1, and month 3 by polysomnography end points of wakefulness after persistent sleep onset and latency to onset of persistent sleep (LPS). One thousand twenty-one patients were randomized in trial 1 and 1019 patients in trial 2.
ResultsSuvorexant 40/30 mg was superior to placebo on all subjective and polysomnography end points at night 1/week 1, month 1, and month 3 in both trials, except for LPS at month 3 in trial 2. Suvorexant 20/15 mg was superior to placebo on subjective total sleep time and wakefulness after persistent sleep onset at night 1/week 1, month 1, and month 3 in both trials and at most individual time points for subjective time to sleep onset and LPS in each trial. Both doses of suvorexant were generally well tolerated, with <5% of patients discontinuing due to adverse events over 3 months. The results did not suggest the emergence of marked rebound or withdrawal signs or symptoms when suvorexant was discontinued.
Eric
ConclusionsSuvorexant improved sleep onset and maintenance over 3 months of nightly treatment and was generally safe and well tolerated.
Posted by babbler20 on March 19, 2015, at 23:12:35
In reply to Re: Horrible sleep problems » babbler20, posted by phidippus on March 13, 2015, at 12:22:07
> For instance, in one study, people on the sleeping pill at the three-month mark slept 60.3 minutes longer, on average, while those on placebo slept 40.6 minutes longer -- a difference of more than 19 minutes.
>
> "Nineteen minutes a night of more sleep for an entire month is a lot of additional sleep," Krystal says.
>
> In the same study, those on suvorexant fell asleep about 25 minutes faster than at the start of the study; those on placebo fell asleep about 17 minutes faster.
>
> Those on the pill spent about 48 minutes less time awake during the night than before the medication, compared to 25 fewer minutes for those on the placebo. For the second study, results were similar. "The fact [that] there is benefit on the sleep study finding and the self reporting finding is critical," Krystal says.
>
>
> "What we've seen here and confirmed in [the later studies] is that suvorexant helps people with insomnia fall asleep faster and wake less," says Herring, who led the published study. "It is effective over the long term and well tolerated."
>
> The published study tested whether a range of doses, each given in a sleep lab to about 60 people suffering from insomnia, improved sleep better than an inactive placebo pill. Without knowing which was which, each study participant took either suvorexant or the placebo for four weeks, then switched to the other for another four weeks.
>
> The main study measure was sleep efficiency -- that is, the percentage of an eight-hour night people slept. At the beginning of the study, participants average sleep efficiency was 66%. After falling asleep, they woke for an average 101 minutes during the night.
>
> "There was a range of results, but generally sleep efficiency improved 5% to 13% compared to placebo," Herring says. "We also found that patients have 21 to 37 minutes less time awake during the night."
>
> Insomnia Slideshow: 20 Tips for Better Sleep
> Every Bit Helps
>
> That may not seem like a lot. But it could mean a lot to a person suffering from insomnia, says Richard Simon Jr., MD, director of the Kathryn Severyns Dement Sleep Disorders Center in Walla Walla, Wash.
>
> "Insomnia patients seem to feel better and function better when they get 15 to 20 minutes more sleep," Simon says. "This is an intriguing study that shows this drug does improve sleep. That is big."
>
>
> Suvorexant in Patients with Insomnia: Results from Two 3-Month Randomized Controlled Clinical Trials
> W. Joseph Herringcorrespondenceemail
> ,
> Kathryn M. Connor
> ,
> Neely Ivgy-May
> ,
> Ellen Snyder
> ,
> Ken Liu
> ,
> Duane B. Snavely
> ,
> Andrew D. Krystal
> ,
> James K. Walsh
> ,
> Ruth M. Benca
> ,
> Russell Rosenberg
> ,
> R. Bart Sangal
> ,
> Kerry Budd
> ,
> Jill Hutzelmann
> ,
> Heather Leibensperger
> ,
> Samar Froman
> ,
> Christopher Lines
> ,
> Thomas Roth
> ,
> David Michelson
> Received: May 8, 2014; Received in revised form: September 5, 2014; Accepted: October 1, 2014; Published Online: October 22, 2014
> DOI: http://dx.doi.org/10.1016/j.biopsych.2014.10.003
> Publication stage: In Press Corrected Proof
> showArticle Info
>
>
> Abstract
> Background
>
> Suvorexant is an orexin receptor antagonist for treatment of insomnia. We report results from two pivotal phase 3 trials.
> Methods
>
> Two randomized, double-blind, placebo-controlled, parallel-group, 3-month trials in nonelderly (1864 years) and elderly (≥65 years) patients with insomnia. Suvorexant doses of 40/30 mg (nonelderly/elderly) and 20/15 mg (nonelderly/elderly) were evaluated. The primary focus was 40/30 mg, with fewer patients randomized to 20/15 mg. There was an optional 3-month double-blind extension in trial 1. Each trial included a 1-week, randomized, double-blind run-out after double-blind treatment to assess withdrawal/rebound. Efficacy was assessed at week 1, month 1, and month 3 by patient-reported subjective total sleep time and time to sleep onset and in a subset of patients at night 1, month 1, and month 3 by polysomnography end points of wakefulness after persistent sleep onset and latency to onset of persistent sleep (LPS). One thousand twenty-one patients were randomized in trial 1 and 1019 patients in trial 2.
> Results
>
> Suvorexant 40/30 mg was superior to placebo on all subjective and polysomnography end points at night 1/week 1, month 1, and month 3 in both trials, except for LPS at month 3 in trial 2. Suvorexant 20/15 mg was superior to placebo on subjective total sleep time and wakefulness after persistent sleep onset at night 1/week 1, month 1, and month 3 in both trials and at most individual time points for subjective time to sleep onset and LPS in each trial. Both doses of suvorexant were generally well tolerated, with <5% of patients discontinuing due to adverse events over 3 months. The results did not suggest the emergence of marked rebound or withdrawal signs or symptoms when suvorexant was discontinued.
>
> Eric
> Conclusions
>
> Suvorexant improved sleep onset and maintenance over 3 months of nightly treatment and was generally safe and well tolerated.
>As an insomniac, this is a useless amount of additional sleep. Also, think about all the studies they didn't publish. This is the most successful one the drug company could come up with and it's really insignificant.
Posted by phidippus on March 22, 2015, at 10:05:36
In reply to Re: Horrible sleep problems, posted by babbler20 on March 19, 2015, at 23:12:35
What have you tried for your insomnia?
'
Eric
Posted by babbler20 on March 23, 2015, at 23:13:34
In reply to Re: Horrible sleep problems » babbler20, posted by phidippus on March 22, 2015, at 10:05:36
> What have you tried for your insomnia?
> '
> EricHi, Remeron, Trazodone, all the Benzos, all the hypnotics(lunesta, rozerm, ambien, ambien cr etc),seroquel, and a couple other tranquilizers. I sleep between a total of 5 hours and 5 and a half hours 4 nights a week and three nights a week I sleep a total of between 6 hours and 6 hours and 30 min. I wake up 2 to 3 times a night and I'm up for a total of 1 hour and 30 min. I don't get a straight 6+ hours on good nights, rather it's a cumulative total. Not a great life. It's completely ruined my life for 7 years.
Posted by Elanor Roosevelt on April 22, 2015, at 20:22:55
In reply to Horrible sleep problems, posted by Zatar on March 8, 2015, at 18:18:11
doxepin
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.