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Armodafinil and benzodiazepines generally - best bets?

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Veritatem

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Dec 21, 2017
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I apologize if this isn't in the right place. Just looking for some advice or best bets from others with experience.

I work 12-hour days at random times. I have been prescribed armodafinil 150 mg tablets daily for several years. In addition, I am prescribed 1 mg alprazolam daily for anxiety and I use it off-label occasionally to handle acute insomnia (this insomnia is occasionally exacerbated by the armodafinil). As I understand, armodafinil moderately induces CYP3A, and thus reduces the systemic exposure to midazolam in the study I read by over 30 percent. I have noticed that the effects of my Xanax are markedly tamed the closer I take it to the Nuvigil and remain relatively tame even 12-14 hours after taking the Nuvigil. So without seeking out a barbiturate (NEVER the right answer for sleep or anxiety issues from my perspective) and without drastically increasing the Xanax dose, is there a more effective sedative to take to achieve sleep? I would be willing to try a different benzo, maybe, or perhaps a slight increase in the Xanax from 1 mg to 1.5 mg, but more benzos are rarely the answer to anything in my experience. Just for further background, I have tried diphenhydramine up to 75mg and doxylamine up to 50 mg (not together), as well as promethazine or trazodone in varying low to moderate dosages; none of these medicines were effective more than a day or two. I was interested in possibly talking to my doctor about trying triazolam, zolpidem, or even a low dose of an atypical like quetiapine (last resort only on that one) but I'm kinda stumped. I have tried suvorexant and it's pretty effective generally, but I don't know what, if any impact it would have when administrated within 24-hours of armodafinil, and it is still prohibitively expensive. Any suggestions?
 
I work 12-hour days at random times.
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That's gotta be awful for your sleep hygeine. You're really fighting an uphill battle here.

You can push diphenhydrasmine all the way to 200mg without getting problematic deleriant effects, some "extra strength sleep aid" pills are 150mg diphenhydramine.

How about cannabis? Or herbal stuff like valerian, chamomile, etc?
 
I have tried Valerian in the past as an extract. It wasn't much help on it's own, but I never really considered using it as an adjunct to Xanax. So that could be effective. I will give it a shot and report my findings.

Cannabis is a wonder medicine for this particular indication, but it does occasionally precipitate panic episodes in me once in a while. That, and I currently am subjected to random drug screens, so having THC in my system is playing with fire, unfortunately. It seems so disingenous for the law here in the U.S. to categorize cannabis as more dangerous and addictive than Xanax, alcohol, and even barbiturates for crying out loud, but I digress...?

Chamomile sounds interesting. I assume the tea is the most effective method? Sounds worth a try.

I considered melatonin as well, but honestly, I had a severe night terror a few years ago after taking it, the kind that keep a grown man disturbed and hypervigilant for a day or two. That was on a 5 mg dose, though. I could start at 1 mg9 and titrate up from there. Any experiences out there with melatonin for this indication?
 
I was going to suggest melatonin. Currently taking 4 mg of extended release melatonin at bedtime, and I can't say anything negative about it.

Another one I'd recommend is L-theanine, which is widely sold as a dietary supplement, sometimes in combination with melatonin. L-theanine is a sedating amino acid found in green tea - except in tea, its effects are partially counteracted by the caffeine, not to mention the fact that you'd have to drink a lot to take in the ~100mg found in a typical supplement capsule.
 
Benzos are not your friend. Use on a limited, occasional basis is still risky. Daily use isn't good AT ALL. Something happens and you run out, then you will know why. Most profitable dope in the history of medicine. Never before or since have more people been unnecessarily dependent on a single class of drug.
 
I dont think its possible for anyone to sleep normally randomly. That to me sounds like all the artists who died from sedatives to knock them out to deal with having to sleep with unpredictable hectic schedules.
 
yeah, at the end of the day humans are really meant to do 16 hours awake/8 asleep plus or minus a few hours here and there, the circadian rhythym is some tough shit to ignore, this is why 'shift work sleep disorders' are a thing.
 
Well I wouldn't go that far clubcard, occasional, limited use is just what benzos are for, IMO. I've had no problem for example, with the infinite-repeat automatically printed out every week nitrazepam script I have, I've had it ages, set at 10mg/d as 5mg BD, doctors were ASKED for a short term rx when I really did need it, but they got sloppy and lazy and dumber than two short planks and just added it to my repeat so I wouldn't have to come in for an appointment every time i needed it during the time I was going to (it was known how long the problem would be, with a date in mind specifically), and its been there ever since.

I only take it a couple of times a week at most though, albeit that means I get one, sometimes two doses from a box. But I haven't ended up dependent or anything (and thats something I'd watch out damn carefully for), even despite being on chlormethiazole for seizures.

And sleep cycle? as far as I'm concerned I'm meant to get at least 15-20 hours sleep a day :p. Or I should do, but I have no sleep cycle to speak of, and never have had one. It seems like its REALLY common in my kind, so much so that on one autistic forum I'm on its pretty much the butt of jokes, our sleep cycles. Its like trying to train a cat to code in 0x86 assembly language. By poisoning them with bicuculline and throwing bags of them at a keyboard. (no, I'm not someone who would poison cats, before anyone gets the wrong idea about me. I'm a huge animal lover, always taking in waifs and strays, underweight hedgehogs, injured birds, lizards, kidnapping a dog, once, that was being abused and rehoming her (was a kid and some assholes just threw her out on the street all day and expected her to fend for herself. So I went and befriended her, then just out and out stole her. It was either that or confront the household that was leaving her like that, and if I had, people would have gotten hurt pretty badly for it), even once had a little bird escape me, after I'd had to dive in front of a car on the way to a doctor appt, to scoop up this bird that had stunned itself flying into a bus shelter. Was going to take it to the vet after, but, after warming up in my hand, scooped up inside the arm of my trenchcoat, it decided to wake up and shoot out of my sleeve, twittering madly round my GP's office.

The look on his face was HILARIOUS!. I thought he was about to have a heart attack, and end up shitting himself on the floor=D

Sleep cycles though, it actually wasn't until I read about it, after I was old enough to have an internet connection, that I ever knew people usually had a cyclic sleep-wake pattern, because its something I've never had; I didn't think 'shit, there is something wrong with me here', because it was just not something I'd ever known, and if you have never had something you can't really miss it, if you don't know about it being the norm. I guess its akin to being cortically blind from birth, in that they can never adapt to a sighted life, missing out that point of development, with me, its like that with a sleep cycle. I get tired, eventually. Otherwise I just haven't got one.
 
Thanks to everyone for the replies. I would have posted results sooner if I had some type of free time (during which I wasn't trying to sleep), but thanks nonetheless.

@Hodor, I hadn't thought about L-theanine. Sometime this week I will experiment and see how it affects me at night. I'll post back with my experience.

@clubcard, I have to generally disagree with a few points. I do agree that benzos have serious risks, particularly in combinations and during abrupt withdrawal, not to mention potential cognitive deficits with extended use. However, it's certainly not "the most profitable dope in the history of medicine". (See OxyContin) A small dose, for me anyway, has been essential because I do have both extreme anxiety and also I have a lot of trouble sleeping due to these crazy hours; in addition, for me, barbiturates are simply out of the question. I do appreciate the concern, though. The benzo withdrawals are...extreme at best. Lethal at worst.

@sekio, you got it spot on in my opinion. Shift work disorders are definitely a thing. Hopefully before long I can at least get the shifts at the same time every day. Then I might be able to achieve some regularity.
 
Its a matter of usage patterns with benzos, barbs etc. Too often, as you well know, and either will fuck you in the ass sideways with a pointy stick. But now and again, they can turn a day that just seems determined to leave one a psychic trainwreck into one that you get to stay a human being, with all the bits it was born with in the right general locations.

Wouldn't reccomend barbs without extreme care though, the withdrawals make benzo WD look like fun, and in addition, the negative allosteric AMPAr modulatory action of barbs combined with their GABAergic effects makes for a pretty ideal anti-nootropic.

Out of curiosity, for those who have no natural sleep cycle, do the likes of shift work disorders still come into play, when there doesn't seem to be much to disrupt in the first place, because I find when I sleep...its whenever I can GET any sleep. I'm often as not up for days, sleep for a few hours, sleep in all day, up at night, sleep in at night, up for a couple of days, I honestly didn't understand that other people had a pattern to their sleeping, I just thought it was the way things were done, in my younger days.
 
@ Limpet, I found myself nodding in agreement when you said barbiturate withdrawal makes benzodiazepine withdrawal look like fun. Spot on.

I'm in the same boat on the sleep thing. Always worked a lot, always did different stuff. But never realized that there was a "normal" pattern to be had. I'm definitely learning as I go.
 
Lorazepam is not metabolized by any of the CYPs. It simply undergoes glucuronidation.
 
@veritatem-yeah, it nearly killed me. Wouldn't have happened in the first place, but I happened to get wrongfully arrested and remanded. Medical care? my ass. Throwing someone in a medical wing and giving them B vitamin supplements (presumably they thought it alcohol withdrawal, perhaps not familiar with the name 'veronal' might have heard 'alcohol')

Caused some permanent, or at least, very long lasting memory issues (since ~2004-2005, no resolution, although when I can get hold of it, memantine reverses much of the otherwise rather life-impairing deficit), and during the acute phase, I almost starved to death, no idea food was being thrown into the room (literally), didn't even know it was there. Withdrawal extremely protracted. I'm almost glad I was so delirious for the duration as to essentially be in a NDE for the time the physical WDs were present, because I was a chronic pain patient at the time, on high dose opioids as well. I really, really, don't know how I survived, because I was denied my prescription meds, including anticonvulsant meds (I'm supposed to be on chlormethiazole, back on it now, once I got out, but my seizures have definitely become the worse and more frequent for it), as well as things like clonidine, the tizanidine I take for the leg spasm caused by a failed knee surgery that left me with some nerve damage.)

Fucking pissed really, although there isn't much I can do about it. Expected to face a court whilst in full blown DTs...by the time I recovered from that, I looked like a jew survivor of the holocaust, right after the liberation of a concentration camp, I'd lost that much weight. Really, no idea how the hell I survived it. In a way, the DTs, although horrendous, were a sort of nasty-edged mercy, in that I wasn't aware of my body enough to feel the physical withdrawals. And I'm somewhat of a tough nut to crack, psychologically speaking, given my natural outlook on the world is an autistic's vulcan-esque logic, that much is, it seems, hard-wired, enough to carry through even to things such as psychosis (for example, of the things I remember, the illusion of a gigantic, predatory looking wasp, crawling all over the far wall, although separated from consensus reality, I still reasoned 'wasps do not exist in such sizes, ergo this must be a hallucination, might as well watch the fucker', after all, I am interested in entomology')

Screwed, certainly, but it seems that even in a falsified environment, I still retain a logical perspective, as relates to that environment, even though unable to distinguish it from the true surroundings. Strange, but then again I've always been wired up weirdly, these days I take odd stuff as par for the course.
 
@seep, it took a second but I just realized what you were saying to me. That's brilliant and common sense at the same time. I can't believe I overlooked that. In your experience, do you have any knowledge or experience on how lorazepam would compare to alprazolam (within the unusually generous therapuetic dosing range, naturally) for sleep/anxiety indications? I would hypothesize that it would be more effective initally since it is unaffected by the CYPs, therefore boosting systemic exposure relative to the benzos that are affected by CYPs, but like other benzos would probably lose effectiveness as a hypnotic fairly rapidly. As an anxiolytic, though, I'm curious if it would be more effective in the long run? Any experiences or thoughts?
 
lorazepam is the worst benzo that exists by far it fucking sucks almost doesnt even feel like a benzo more like high dose otc sleeping meds,no real substitute for alprazolam
 
I wouldn't say its the worst. There are always chlordiazepoxide, diazepam/nordiazepam and (EW!) oxazepam. Perhaps I'm a bit biased there because oxazepam causes nasty paradoxical reactions in me, but even if it didn't I've strong suspicions it'd be total fucking garbage.
 
AVOID nitro-bearing benzodiazepines. I spent a couple of years studying the class and they ARE more toxic and they ARE more dependence-forming. I suppose alprazolam is the most developed of the crowd and it says an awful lot that estazolam, with exactly 0 benefits over alprazolam, is licensed as a hypnotic. Upjohn made billions by getting alprazolam licensed to treat generalized anxiety disorder (GAD) and social anxiety disorder just MONTHS after these new conditions were defined in the DSM-IV. Estazolam is identical - the only subjective difference is duration.

I don't believe tepazepam is a good hypnotic either but compared to nitrazepam, nimetazepam and flunitrazepam, it is a lot safer. I happen to think clomethiazole is a better hypnotic and barbiturates just knock you down BUT they are rather dangerous. I do not trust the Z-drugs but depending on location, melotonin and/or ramelteon look much safer options.

As for benzos - diclazepam is just about the most persistent benzo. Taken once a week, you will slowly produce tolerance and dependence. Not a good idea... bloody strong and like fludizepam (as used in Japan) long, long T1/2.
 
Yeah I was considering mentioning temazepam as another cruddy benzo.

But avoid nitrobenzodiazepines? why? they are more potent, but they are better IMO. Of all the benzodiazepines which can be scripted on the NHS in the UK, the only ones I find truly superior, are nitrazepam and loprazolam. There is just something about nitrobenzos that for me, hits that sweet spot in terms of receptor binding profile that scratches the itch better than other benzos ever can, others cannot compare in the slightest. As for tolerance, I find that using them for 2 days out of a week at 70mg to 140mg, nitrazepam, its not caused me any physical dependency in over a year. I might use one, maybe 2 or three pills, spread over two individual doses of 5 or 10mg if need them, its been fine.

And toxic in what sense? more potently intoxicating and messy? sure, but that also means more effective and euphoric. Moggies or loprazolam (not lorazepam, thats kinda cruddy in my experience with it, but loprazolam is the good stuff. Are nitrobenzodiazepines really THAT bad? why would one want to avoid them altogether? nitrobenzodiazepines are the best of the benzos if you ask my opinion)

And chlormethiazole/barbs, yeah. Although misused in the wrong way chlormethiazole IS dangerous too, it does have a somewhat narrow TI. It actually acts a lot like the barbiturates, only with the difference that chlormethiazole doesn't block AMPA receptors like barbs do. I've tried one of the decent barbs with the blockade of AMPA receptors it makes a whole ton of difference compared to the cleaner barb site agonist chlormethiazole, the latter is really really clear headed and unlike the barbs, no action like an inverted nootropic.
 
I would recommend Mirtazapine for your sleep. Try to get off the xans, or at least reduce the dosage your currently taking. And yes. anything that induces cyp3a4 is going to drastically reduce the effectiveness of most benzos, xanax included.
 
Mirtazipine could work well if there is no obesity (mirtazipine will make you EAT). It causes sedation through histamine antagonism. In combination with modafinil, it may be a bit stimulating if one of its metabolites is an alpha-2 antagonist. Couldn't find data about that.

Veritatem said:
@seep, it took a second but I just realized what you were saying to me. That's brilliant and common sense at the same time. I can't believe I overlooked that. In your experience, do you have any knowledge or experience on how lorazepam would compare to alprazolam (within the unusually generous therapuetic dosing range, naturally) for sleep/anxiety indications? I would hypothesize that it would be more effective initally since it is unaffected by the CYPs, therefore boosting systemic exposure relative to the benzos that are affected by CYPs, but like other benzos would probably lose effectiveness as a hypnotic fairly rapidly. As an anxiolytic, though, I'm curious if it would be more effective in the long run? Any experiences or thoughts?
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Individual results are highly variable. I was prescribed it for a month and found it inferior to alprazolam as an anxiolytic, but somehow my sleep was deeper on it. Orally it's about half as potent as alprazolam but maybe you will need less, as you may have been clearing alprazolam like a champ.

Personally I've been out cold on as little as 1 mg of Ativan, and I've seen someone given as much as 200 mg IV (over 24 hours) and go into profound encephalopathy: possibly also because of the propylene glycol it's diluted in.
 
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