Advice of additional medications I can take for insomnia?

[zaqqaz]

Hi everyone, I have been suffering from insomnia my entire adult life, currently I am on the below rotation of medications. Is there anything else I can be prescribed to help with sleep (I am getting approximately 2-3 hours at most with these medications). My sleep is also being interrupted by nocturnal awakenings, I typically need to urinate and by the time I get back to bed I have trouble falling back asleep - this is when I typically take the Sublinox but it doesn't seem to work that well.My Current Medications- Seroquel IR (300 mg)- Trazodone (200 mg)- Zopiclone (7.5 mg) - Sublinox or zolpidem tartrate (10 mg)My lifestyle is good - I don't drink or smoke, I make sure I get exercise when I can. Right now the sleep it too debilitating but all I need is roughly 5 hours to feel good and function. Any thoughts? I really appreciate any insight.Thank you.

 

[fermonos]

Maybe it's your diet? I know eating certain foods or not getting enough of certain foods can affect sleep a lot.

 

[truenamebrand]

Hi everyone, I have been suffering from insomnia my entire adult life, currently I am on the below rotation of medications. Is there anything else I can be prescribed to help with sleep (I am getting approximately 2-3 hours at most with these medications). My sleep is also being interrupted by nocturnal awakenings, I typically need to urinate and by the time I get back to bed I have trouble falling back asleep - this is when I typically take the Sublinox but it doesn't seem to work that well.My Current Medications- Seroquel IR (300 mg)- Trazodone (200 mg)- Zopiclone (7.5 mg) - Sublinox or zolpidem tartrate (10 mg)My lifestyle is good - I don't drink or smoke, I make sure I get exercise when I can. Right now the sleep it too debilitating but all I need is roughly 5 hours to feel good and function. Any thoughts? I really appreciate any insight.Thank you.

For whatever reason, neither zolpidem OR eszoplicone put me to sleep the handful of times I used them. They both just made me feel strange. Seeing as both as essentially just as addictive as benzos, and aren't working well for you, you could ask to switch to a benzo instead.

Also, unless I'm having awful anxiety at the time, 0.2mg of clonidine knocks me right out. The problem is it's extremely short-acting and won't help you STAY asleep...

 

[nancy145]

That's quite a heavy cocktail of sleep meds. Perhaps ask your doctor if you should switch to Seroquel XR? You'll have to take it earlier because it takes longer to kick in, but it lasts longer (and so does the peak) which could help you sleep throughout the night. Try drinking less water before bed to, so you won't have to go to bed in the middle of the night. All of the meds you're on are pretty strong, but there's some weaker over the counter meds you could add on to try to help just a little bit. Melotinin is a natural hormone that your brain produces to help with sleep, but you can take more. 3-5 mg is recommended for sleep, but you can take pretty much however much you want. Its not dangerous at high doses, unless you have bipolar, in which case it could cause mania, but unless you do it's fine. If you do take high doses reguarly though, you can't lower it back down because your brain produces less and you won't be able to sleep. Benadryl is very effective for sleep too, it's powerful enough to even compare to prescription sleep meds. 100 mg is the official maximum safe dose, but 200mg is likely not to cause problems. Fatality can't happen until 600 mg, so don't worry about that. Higher doses than 200 mg can be harmful to your heart and cause delirent effects (like a really powerful hallucinogen that usually results in a bad trip), but it's just weird patterns and colors until like 350 mg, so if you go a little over it isn't a serious issue. Some people are more sensitive to it than others, so there's tiny chance you could get slight hallucinations at 200 mg, but if you do just lower the dose a bit. Its not unpleasant until you get to really high doses. Ask your doctor if you could increase your prescription med doses too. Seroquel really doesn't have a limit on a safe dose, so he might up that. Trazodone however, can cause penis damage at doses above 200 mg, so you can only up that if you're a female. Theres plenty of other habits and dietary stuff you can do too, but this is mostly a website about drugs, so I can't really help you there. There is a healthy living forum though, you could ask about it there. Hope things get better for you.

 

[zaqqaz]

Maybe it's your diet? I know eating certain foods or not getting enough of certain foods can affect sleep a lot.

Thank you fermonos, I'm seeing a naturopath doctor and she didn't see anything in my diet that was a cause for concern. I generally eat healthy and don't consume sugar/junk food.

 

[zaqqaz]

That's quite a heavy cocktail of sleep meds. Perhaps ask your doctor if you should switch to Seroquel XR? You'll have to take it earlier because it takes longer to kick in, but it lasts longer (and so does the peak) which could help you sleep throughout the night. Try drinking less water before bed to, so you won't have to go to bed in the middle of the night. All of the meds you're on are pretty strong, but there's some weaker over the counter meds you could add on to try to help just a little bit. Melotinin is a natural hormone that your brain produces to help with sleep, but you can take more. 3-5 mg is recommended for sleep, but you can take pretty much however much you want. Its not dangerous at high doses, unless you have bipolar, in which case it could cause mania, but unless you do it's fine. If you do take high doses reguarly though, you can't lower it back down because your brain produces less and you won't be able to sleep. Benadryl is very effective for sleep too, it's powerful enough to even compare to prescription sleep meds. 100 mg is the official maximum safe dose, but 200mg is likely not to cause problems. Fatality can't happen until 600 mg, so don't worry about that. Higher doses than 200 mg can be harmful to your heart and cause delirent effects (like a really powerful hallucinogen that usually results in a bad trip), but it's just weird patterns and colors until like 350 mg, so if you go a little over it isn't a serious issue. Some people are more sensitive to it than others, so there's tiny chance you could get slight hallucinations at 200 mg, but if you do just lower the dose a bit. Its not unpleasant until you get to really high doses. Ask your doctor if you could increase your prescription med doses too. Seroquel really doesn't have a limit on a safe dose, so he might up that. Trazodone however, can cause penis damage at doses above 200 mg, so you can only up that if you're a female. Theres plenty of other habits and dietary stuff you can do too, but this is mostly a website about drugs, so I can't really help you there. There is a healthy living forum though, you could ask about it there. Hope things get better for you.

Thank you nancy145, I was on a dose of Seroquel XR (100 mg) for a long period of time. The side-effects were too strong and the hangover/half-life when I tracked it lasted about 20 hours, the cumulative effect of lack of sleep and being perpetually hung-over from this medication were causing me to become suicidal. In addition I noticed increase heart-rate and increased anxiety while on the XR. Would anyone suggest any benzodiazepines that could be safe to take with my current rotation of drugs?

 

[cduggles]

Zaqqaz, I feel your pain. Insomnia is awful.

Are you open to any other recommendations other than a benzodiazepine?

If not, how long do you want the effects to last? Do you use benzos now or have you recently? If yes, what kind and how much?

For insomnia, I've done everything from sleep hygiene (haha) to heavy meds (everything you've done except trazadone).

Seroquel: Of all your other meds, Seroquel still 'works' for me, but I just feel half-asleep the whole next day and the sleep was not restful. I don't use it anymore.

Here's what I can think of:
-Carisoprodol (Soma)
-Benzos: Clonazepam or alprazolam (Xanax)
-Mirtazapine (Remeron)- atypical antidepressant
-Melatonin & other natural stuff
-Clonidine
-Doxepin

My opinions and experiences:
-I don't recommend Carisprodol because dependence and abuse potential are high and the withdrawal.

-Same for benzodiazepines and as truenamebrand mentioned above, they don't last long. Withdrawal ranges from not pleasant to hellish.

-Mirtazapine worked for me until it didn't.

-Melatonin has milder effects for me than Seroquel, but exactly the same 'dirty' sleep. Oh, and it plunges me into deep depression (which is a documented side effect of this "harmless" and "natural" sleep aid).

-Anything else natural (e.g., valerian, chamomile) has no effects or side effects for me.

What works for me:

-Clonidine less than or equal to 0.1 mg. I don't use it very often or in high dosages because it lowers blood pressure. Studies indicate it doesn't produce as much R.E.M. sleep.

-Doxepin (Silenor) puts me to sleep and I stay that way.
It's NOT controlled and low-dose doxepin is for patients with sleep maintenance insomnia, which is waking up frequently or early in the morning and not falling back asleep. It works for insomnia at doses in single-digit mg doses (3-6 mg). It does NOT work better if you take higher dosages.
http://www.mdedge.com/currentpsychiatry/article/64062/sleep-medicine/doxepin-insomnia

Note: I have also used Ramelteon (Rozerem) successfully, but it is indicated for late sleep onset, which isn't your problem.

Good luck!
Best, CD

 

[zaqqaz]

Zaqqaz, I feel your pain. Insomnia is awful.Are you open to any other recommendations other than a benzodiazepine? If not, how long do you want the effects to last? Do you use benzos now or have you recently? If yes, what kind and how much? For insomnia, I've done everything from sleep hygiene (haha) to heavy meds (everything you've done except trazadone). Seroquel: Of all your other meds, Seroquel still 'works' for me, but I just feel half-asleep the whole next day and the sleep was not restful. I don't use it anymore.Here's what I can think of: -Carisoprodol (Soma)-Benzos: Clonazepam or alprazolam (Xanax)-Mirtazapine (Remeron)- atypical antidepressant -Melatonin & other natural stuff -Clonidine -DoxepinMy opinions and experiences:-I don't recommend Carisprodol because dependence and abuse potential are high and the withdrawal. -Same for benzodiazepines and as truenamebrand mentioned above, they don't last long. Withdrawal ranges from not pleasant to hellish. -Mirtazapine worked for me until it didn't.-Melatonin has milder effects for me than Seroquel, but exactly the same 'dirty' sleep. Oh, and it plunges me into deep depression (which is a documented side effect of this "harmless" and "natural" sleep aid). -Anything else natural (e.g., valerian, chamomile) has no effects or side effects for me. What works for me:-Clonidine less than or equal to 0.1 mg. I don't use it very often or in high dosages because it lowers blood pressure. Studies indicate it doesn't produce as much R.E.M. sleep.-Doxepin (Silenor) puts me to sleep and I stay that way. It's NOT controlled and low-dose doxepin is for patients with sleep maintenance insomnia, which is waking up frequently or early in the morning and not falling back asleep. It works for insomnia at doses in single-digit mg doses (3-6 mg). It does NOT work better if you take higher dosages. http://www.mdedge.com/currentpsychiatry/article/64062/sleep-medicine/doxepin-insomniaNote: I have also used Ramelteon (Rozerem) successfully, but it is indicated for late sleep onset, which isn't your problem. Good luck! Best, CD

Thank you so much, cduggles - I don't know how to thank you enough as this list was very informative, I'm going to discuss these medications with my physician. Ideally, I'm looking for something with a 8-hour half-life at most, the Seroquel XR side-effects alone were debilitating and was driving me up the suicidal path, I've built up tolerance for Seroquel IR (300 mg) so I am ok with this for now... Out of the list provided: I've been on Remeron and Clonazepam...it's been a while since I was on them however, and they might help given I've recently added Trazodone. Thank you to everyone who contributed to this thread: I'll be sure to look into particular the Silenor, Clonidine, and possibly Restoril. I've had difficulties coming to terms with my sleep disorder, but part of me adapting is coming to terms with something feasible, which for me is just getting 5 hours a night. If I can get this, I would be happy as at least I can function. I don't think its too much to ask but its hrad getting there in spite of current medications...

 

[keeping]

that's quite the collection. i don't think you can really do much more than you already are medication-wise - there are benzos but they shouldn't be used longer than 4 days due to addiction.

have you tried stuff like white-noise machines? i've had insomnia for most of my life and i find that white-noise is the perfect thing to stop my thoughts from racing and settle me down, even if i don't fall asleep i get noticeably dozier than without.

 

[fatjong]

Interesting to say the least.

It is great that you are eating healthy at the moment. But are you aware of the sleep nutrients that exist? to give you an example milk is often consumed at night and works great as a sleep inducer, because it contains calcium which is rich in tryptophan. Tryptophan is an amino acid that the body needs in order to synthesize serotonin, which is a neurotransmitter that primarily affects mood regulation. Melatonin is a hormone that helps regulate circadian rhythm for healthy sleep patterns.

To check out more sleep nutrients I can highly recommend you to check out this infographic about 9 sleep nutrients

http://napseason.com/9-powerful-nutrients-good-nights-sleep/

 

[nancy145]

Thank you nancy145, I was on a dose of Seroquel XR (100 mg) for a long period of time. The side-effects were too strong and the hangover/half-life when I tracked it lasted about 20 hours, the cumulative effect of lack of sleep and being perpetually hung-over from this medication were causing me to become suicidal. In addition I noticed increase heart-rate and increased anxiety while on the XR. Would anyone suggest any benzodiazepines that could be safe to take with my current rotation of drugs?

If you got those effects from XR, just stick with IR. If your dose gets increased, pay close attention to if you get those symptoms again. If you do, go back to 300 mg and tell your doctor asap. I wouldn't reccomend a benzo here, they're super addictive and have the worst withdrawal symptoms out of all drug classes, except maybe some rare and obscure research chemicals. They're normally used as a PRN (as needed) for anxiety, so addiction is less likely. Taking one daily is a death sentence for long term addiction. They also aren't any more effective for sleep than any other of the meds you are on, unless anxiety is the main factor in your inability to sleep. As for interactions, there isn't really any additional danger with adding a benzo as long as you take it in prescribed doses or if you quit them at the same time, but the dangers of Benzos alone aren't worth the positive effects here. Along with what I said before, you could also try using kava root or cannabis (indica). Kava is 100% legal for all forms of use and is safer than caffeine, unless taken daily for over 3 months, I'm which case liver damage can occur. Not very effective, probably in between melatonin and benadryl, but no harm in adding it on. As for the cannabis, it's a bit riskier here than most people would assume. It sounds like you don't use any illegal drugs here, if you already do this isn't really a concern, but if not you're bringing in a legal issue here. Cannabis itself isn't too dangerous, but it can possibly worsen or bring out schizophrenia/psychosis. Normally that only happens after long periods of time using it daily in large amounts. However, sleep deprivation can also bring out schizophrenia/psychosis. When mixing those two together, the risk is pretty high. Usually if you know about this beforehand, and have good self control, you can just take a break when you begin to get paranoia regularly. Cannabis can cause dependency though, especially if used for a specific problem, so when you quit you would have worse insomnia. If you begin to expierence minor symptoms of potential schizophrenia and quit, the worsened insomnia could make it even worse. I'm not a medical cannabis doctor though, so it could be worth the risk here, so if you live in a legal medical state it's worth at least seeing one.

 

[keeping]

there's also the first-generation anti-histamines with pronounced sedative effects such as promethazine and hydroxyzine hydrocloride (aka Attarax.)

i've been prescribed both for sleep and they both did the job - prometh i found made me too groggy in the mornings, whereas hydroxyine was a little too gentle, if you understand. they can also both increase the effects of opiates so be careful there if you're on any pain meds.