Why do antipsychotics offer a "groggy" form of sleep compared to benzos?

[cowardescent]

I know you might say this is anecdotal but I think there definitely is truth to this. I've been prescribed anti-psychotics and benzos for sleep. The anti-psychotics were (risperidone, quetiapine, and aripriprazole). I was also prescribed benzos on their own and they were (diazepam and alprazolam).

I think I can say without a doubt that the benzos acted as a "cleaner and pleasant" sleep aid compared to anti-psychotics. Anti-psychotics just left me feeling groggy and tired after I woke up and though got me sleepy, didn't keep me asleep. The only one that kept me asleep was quetiapine but the groginess is not worth it IMO.

Benzos help me sleep like a baby while anti-psychotics make me feel drained. And sometimes if I take too many it feels like when you're withdrawing from stimulants. That point when you're so tired and lethargic but can't sleep, it's awful. I tried taking Abilify once on a flight cause my doctor said it was good for sleep and it just left me feeling like that along with a shitty restless leg.

Can the pharmacology of these drugs explain it?

 

[sekio]

I was under the impression that morning "grogginess" was caused by the drug's action continuing after you've woken from sleep. Not only are antipsychotics usually H1 antihistamines to some extent (which causes sedation, grogginess etc, and is why 1st gen antihistamines can double as soporifics) but they block dopamine, serotonin, & adrenergic receptors which are all important for wakefulness and functioning.

Aripiprazole (Abilify) has a half life of 74 hours and an active metabolite that has a half life of 94 hours. (= 21-28 days to clear from your system)
Even quetiapine has a half life of 7 hours with an active metabolite lasting 9-12 hours. (= 2 to 4 days to clear entirely)

The benzodiazepines are more tolerable because they have shorter actions: diazepam has a long half life but redistributes to fatty tissues, alprazolam presumably does the same, and as a result they have a "peaky" effect that tapers off pretty rapidly. Many short lasting benzodiazepines were once prescribed for sleep induction but it's less common nowadays, as we are aware that daily use of BZDs will produce a nasty dependency.

 

[AlphaMethylPhenyl]

^And with less dependency-creating meds like rozerem/doxepin/trazodone/suvorexant and the knowledge that "non-benzodiazepines" like ambien can still produce a nasty dependency just the same.

 

[Gaffy]

I feel you man, haldol gets me to sleep when using but the sleep just isn't good. Benzo's, on the other hand, are perfect for it, along with some alcoholic beverages.
The thing is, let's take risperidone as an example, its action is dopamine and serotonin antagonism, so basically the parts of your brain that regulate awareness and being awake. The benzos act as agonists of a part of the brain that regulates sleep and anxiolysis, among other things, resulting in the same patterns for dopamime as the usual when a normal person goes to sleep, but with an added rest-giving part of the brain that is over-active. The antipsychotics, on the other hand, just "de-activate" a part of your brain, which in my opinion never feels very good, that your physician might have ruled out as being the cause for your insomnia. Have you tried giving a small dose antipsychotic along with some benzos a go? Ot just drop the antipsychotics, I am supposedly schizophrenic but I do just as well if not better without them.

 

[sekio]

The antipsychotics, on the other hand, just "de-activate" a part of your brain,

Damn right, haloperidol is a chemical sledgehammer, it antagonizes so many receptors it ain't funny. Dopamine, adrenergic, histamine, serotonin, sigma receptors... all antagonized. When I was given high dose haloperidol, after a period of hazy unconciousness, it rendered me unable to execute any movements or muscular actions. I guess I know how Parkinsons feels now? It seemed like a chemical straightjacket to me.
(side note: a guy in the psych ward once told me the cure for AIDS is "a little blue pill that looks like Haldol". OK, buddy.)

Antipsychotics are not my first choice for sedatives to get someone to bed. Definitely not anything like risperidone or haloperidol: too long acting, too nasty. Quetiapine (Seroquel) is sometimes prescribed at low doses, as is trazodone, but those are really not much better. Amitryptiline is sometimes used cause it has some H1 antagonism. Most of the sedative action can actually be replicated by first generation antihistamines - many antipsychotics block H1r, and it just so happens that histamine is one of the chemicals your brain uses to measure wakefulness. Blocking histamine's action on H1 receptors in the brain results in a sedative hypnotic effect, though tolerance does grow fairly rapidly, meaning it's better used only occasionally. Diphenhydramine is a classic example. I remember reading that doxylamine succinate is actually more potent as a soporrific than phenobarbital, if you can believe that.

I am supposedly schizophrenic but I do just as well if not better without them.

I hope you know what you're doing. I've had schizophrenic acquaintances who are fine on medication but without it, they are way more scattered and less functional at the best of times, and at the worst of times they end up socially outcast or in deep legal shit. One person I knew ended up wandering the streets at night armed to the teeth with a kitchen knife, baseball bat, and can of mace, screaming threats at the empty air to whoever was beaming thoughts to his head. Methamphetamine was involved too, I think, but still: not a good scenario.

Better to be medicated and a little fuzzy-headed than a threat to your friends and future, I figure.

 

[RestoredByzantineEmpire]

I know you might say this is anecdotal but I think there definitely is truth to this. I've been prescribed anti-psychotics and benzos for sleep. The anti-psychotics were (risperidone, quetiapine, and aripriprazole). I was also prescribed benzos on their own and they were (diazepam and alprazolam).

I think I can say without a doubt that the benzos acted as a "cleaner and pleasant" sleep aid compared to anti-psychotics. Anti-psychotics just left me feeling groggy and tired after I woke up and though got me sleepy, didn't keep me asleep. The only one that kept me asleep was quetiapine but the groginess is not worth it IMO.

Benzos help me sleep like a baby while anti-psychotics make me feel drained. And sometimes if I take too many it feels like when you're withdrawing from stimulants. That point when you're so tired and lethargic but can't sleep, it's awful. I tried taking Abilify once on a flight cause my doctor said it was good for sleep and it just left me feeling like that along with a shitty restless leg.

Can the pharmacology of these drugs explain it?

Depends on what exactly you mean by 'groggy'. Of course, the benzodiazepines are GABA agonists along with ethanol and z drugs etc., and antipsychotics are of course dopamine antagonists, and are on the low end of drugs to use as a sleep aid, for me at least, because the antipsychotics dont always work for sleep yet they make me very 'unnaturally' tired, often failing to put me asleep, but also making me feel like sedated shit. Being a dopamine blocker kind of explains the general lethargic shittiness. The sedation from dopamine blockers feels more like being idled after sustaining a head injury or something, and for me not only does fuck all for anxiety, but sometimes seems to trigger it along with palpitations, etc. In contrast, my experience benzos has been more positive. I've taken mostly heavy doses of alprazolam and clonazepam recreationally, and more recently IV diazepam and lorazepam for alcohol withdrawal in hospital . Benzos, even in moderate let alone huge IV doses sedate me above and beyond what quetiapine or the like could do, with the added benefit of making you very calm, especially helpful in shitty situations. With benzodiazepines, not only sleep, but GABAergic sedation through the next day is guaranteed. I know that doesn't answer your question per se, but it is my experience. Now I'm on methamphetamine, doing some hash oil, taking maybe 2 shots of vodka per hour, and have lab grade diethyl ether with BHT. With this continuing COVID 19 social isolation, I decided to just floor it into the hillside with tonight's drug use.

 

[dopamimetic]

Try a pure H1-antihistamine like diphenhydramine or doxylamine to compare. They are certainly less groggy (and toxic) than the antipsychotics, which by all means, should be used only in, well, psychosis... quetiapine low-dose maybe being an exception, it is an expensive, but usable sleep aid. Wouldn't take it for too long either, I know the incidence in below 100mg is very low but dyskinesia isn't exactly funny.

Haloperidol, ugh that this stuff still isn't scheduled says all about what the drug politicians care about health and toxicity. Stimulants are narcotics, but a fucking sledgehammer isn't one?
(At least in German, narcotic means Betaeubungsmittel = something to induce anesthesia and I guess English is similar)

 

[Shady's Fox]

I was under the impression that morning "grogginess" was caused by the drug's action continuing after you've woken from sleep. Not only are antipsychotics usually H1 antihistamines to some extent (which causes sedation, grogginess etc, and is why 1st gen antihistamines can double as soporifics) but they block dopamine, serotonin, & adrenergic receptors which are all important for wakefulness and functioning.

Aripiprazole (Abilify) has a half life of 74 hours and an active metabolite that has a half life of 94 hours. (= 21-28 days to clear from your system)
Even quetiapine has a half life of 7 hours with an active metabolite lasting 9-12 hours. (= 2 to 4 days to clear entirely)

The benzodiazepines are more tolerable because they have shorter actions: diazepam has a long half life but redistributes to fatty tissues, alprazolam presumably does the same, and as a result they have a "peaky" effect that tapers off pretty rapidly. Many short lasting benzodiazepines were once prescribed for sleep induction but it's less common nowadays, as we are aware that daily use of BZDs will produce a nasty dependency.

This.