HELP! need advice on my best option for a long-term sleeping med

[Anon54]

I suffer for insomnia really bad. if i dont take something i cant sleep especially after ive started antipsychotics to help me sleep. off label for insomnia & anxiety.

I was taking 5-10mg of zyprexa (olanzepine) but i didnt like its long half-life so ive changed to 300mg of seroquel.
my dr says 5mg zyprexa=200mg of seroquel but i have a chart saying it only equals 75mg.
does anyone know the equivalent doses?

anyways i think zyprexa was better because it blocks dopamine at only 5mg where seroquel is only an anithistamine until 200mg or so.

i like the APs but im concered about Akathisia, weight gain & maybe eventually diabetes.
Ive tried otc antihistamines inc. diphenhydramine, doxylamine, & promethazine. but only get SOME sleep when i take 1.5 or even twice the most recommended dose.
dph ive read u should only use for a few days.
promethazine 7-10 days.
doxylamine 2 weeks & if u need longer than u can get permission off ya dr.
the OTC pills are good enough for me but i dont wanna take em long cuz it isnt recommended. & i dont know if they cause weight gain. Akathisia or possible diabetes long-term.
Does anyone know if the AHs can cause these problems?

now some night..... some nights i need nothing but its not often. otherwise i can find myself with only a few hrs of sleep of no sleep at all which just fucks me up the next day cuz im to tired to get motivated.

have i made a mistake turning to APs for just insomnia & anxiety? (although it doesnt really help with my anxiety directly but sleeping well helps with my anxiety so yeah.

is there any other sedating meds that dont have the possible long-term side effects of the APs.

im thinking mirtazepine?
i could give it another try but it gave me strange & lucid dreams which was pretty weird. if its much safer than APs i'll do that instead.

I dont know much about the "Z drugs" ive only had zolpidem which felt trippy & caused a little delirium but I think i took so much & im pretty sure ya get a tolerance, right?

benzos are out of the question. I can take 250mg of temazepam first thing in the morning if i wanted. it only makes me a little calmer. certainly not strong enough for the sleep issues i have.

can anyone help me. would it be safer just to take antihistamines 4-5 times a week or would that lead the worse health problems than the APs.

is there any other choices for me i can look into?

Basically Id like to here other ppl opinions who regularly, or most night take atleast something to help them sleep & what med is worked out for them the best out of all the ones uve tried.

thanks for any import. im really confused whether taking the AP approach was the best choice for my long-term future.

 

[tokenname]

I regularly use diphenhydramine for sleep...which only gives me a couple hours..and only at times..
but I find it necessary to be able to think sometimes..so
I go ahead and roll the dice w/it.

I'm completely anti-AP...but that's me..
I just don't need my brain messed up anymore than it already is

I don't know the long term use problems associated w/diphen...I should prob. look into that...8(
I only take the tablets .. nothing w/apap in them..

I've read ErgicMergic say doxylamine..is much better..I'll have to give that a go..
as I keep having to increase my diphen dosage..just to get a couple hours in..
and even then, it doesn't really work too great.

Lots of exercise..and staying busy...eat right....
but my problem is getting my brain to shut off..
which is what I'm assuming your problem is also...
not sure how to get around that..
I'm pretty sure..it's not supposed to stop yet..
but some stillness in the middle of the night
sounds nice...right?

look into melatonin maybe? ...it works for lots of peeps also...w/o all the dangers of AP's.

good luck...
I'm sure more ppl will come along w/more/better suggestions..

~token

 

[Alex000]

First, I suggest good sleep hygeine. Sleep in a comfortable place, don't over-stimulating before bedtime, keep it as dark as possible etc. You can look up other methods on-line, and I am sure you will find tons of techniques. But, the bottom line is you want to be able to enjoy sleep, and have it be a pleasant experience. As far as drugs go, you do have a large benzo tolerance, but a multi-drug cocktail might prove effective over just one hypnotic. I would not suggest you go on taking the neuroleptics, but the anti-histamines will likely loose their efficacy with prolonged periods of use, and are not the best thing to take daily. I think melatonin is a good suggestion, as token mentioned. It can be helpful. You suggested Remeron, and that is a possibility, but you would want to keep the dose low, like 15 mg. Also, TCA's could help with sleep. One TCA, doxepin (Sinequan or Silenor) is particularly sedating, but others are good too for this purpose. A TCA would likely be more sedating than Remeron. There are some risks with TCA's as their mechanism of action is a bit all over the place, and they do have some anti-psychotic properties and anti-histamine properties, too. If you do need a neuroleptic, I would go with Seroquel, as it is less potent and a little more tolerable than Zyprexa or others. Seroquel's effects are very dose-dependent and vary depending on the dose. If you do end up on a neuroleptic for a prolonged period of time, I would suggest you take it with Cogentin and/or Benadryl to keep the incidence of side-effects as low as possible.

I would not dismiss benzos altogether, but you do have a markedly high tolerance to them. Even a relatively low dose of a given benzo would help sleep if added to an already existing hypnotic like the ones discussed above. One benzo I was reading about that seemed favorable in terms of hypnotic properties that did not fade as quickly as those provided by other benzos was quazepam (Doral). It is similar in effect to z-drugs, so says Wikipedia, and has a half-life of 25 - 100 hours. It is equipotent to temazepam, although because there is no full cross-tolerance between benzos, esp. Doral, which seems to be particularly hypnotic, you would start at a lower dose than your usual temazepam dose. Another reason for this would be the long half-life which would allow for additional benefits after a steady plasma level has been attained. It comes in tablets of 7.5 mg and 15 mg. It is pregnancy category X, however, just to keep in mind. Other hypnotic benzos could be of use, of course. Triazolam (Halcion) could be beneficial due to the potency and very quick onset, but does have a very short duration of action, and tolerance rises more quickly.

Other sedative-hypnotics such as carisoprodol (Soma) or barbiturates could be considered, although barbiturates carry a host of risks, and depress the CNS significantly and in all ways. Phenobarbital, however, might be of help, or butalbital if you could tolerate the aspirin or APAP along with (could always do a CWE). Soma is not used as a hypnotic, but does, without a doubt, possess strong sedative and muscle relaxant properties, and is GABAergic. It does, however, lower the seizure threshold, something to keep in mind.

Opioids can be employed, as they are quite effective in some at producing a strong hypnotic effect, especially the more subjectively sedating ones such as morphine. If I am not mistaken, you do use opiates, so this is not new territory, however, using opiates for insomnia is still rather risky due to extreme addictive potential.

Hope this has helped some. Be wise with any combination, and always study the drugs you use, and educate yourself as much as possible. Start low, and go slow.

 

[Anon54]

thanks for a great response Alex000.
well i had 100mg of valium last night. I know its insane but barely felt a thing & i had 400mg of codeine. its unforunete cuz id been off it for quite a while now. & now its started so im back on it now.
I took a large dose of Seroquel last night 400mg. had no trouble sleeping for the first time in ages.
seroquel only started blocking dopamine at 200-250mg which is what i want cuz i have mild schizophrenia which is a condition of to much dopamine.
I was taking zyprexa. only 5mg. it blocks dopamine at that dose & on an AP conversion chart it says 5mg = 75mg of seroquel.
i wanted seroquel because of its shorter half-life so i dont keep tired all day but i think the seroquel at that dose compared to just 5 of zyprexa is more likely to cuz diabetes & Akathisia maybe but definitely weight gain.
my dr said 5mg of zyprexa =200mg of seroquel. not 75mg so i dont know which one is right.
Does anyone know its equivelent sedation doses?
does anyone know where i can find an AP conversion chart?
if im going to take an AP i wanna make the right choice so i dont have any long-term problems. but for now. i dont get any hangover from APs at all.
also is there any studies comparing which APs give u a greater risk of diabeties?

I may give mirtazepine another go. i just hope i dont get wrd dreams. cuz its like taking a stimulant & a downer cuz its an antihistamine. its a weird drug. high doses actually keep u awake AFAIK cuz it outweighs the antihistamine effect.

 

[Ms.Martini]

my doctor prescribed me 30 mg mirtazepine, but i found that i had to increase the dose to actually fall asleep, and when i did finally fall asleep, i'd sleep for like 18+ hours. Taking 2 mg of risperidone really helped me fall asleep, but I stopped taking it because of the weight gain side effect, NO THANKS! What I'm taking right now is methoprazine 15 mg. It has improved my insomnia, but sometimes, if no body wakes me up and my alarm isn't on, I'll end up sleeping all day. I've tried tramadol which really didn't work, maybe in higher doses than what I was suppose to take and I've also tried clonidine. Clonidine seemed to work at first, but I had to increase the dose because it wasn't' as effective. However, as you increase the dose, blood pressure also increases, which results in light headedness, dry mouth, and dizziness. I remember everytime i stood up, I'd have to stop for 10 seconds because everything would just black out.

 

[Kudi85]

I also have insomnia from Shift Work. It's so hard sometimes and my body isn't used to any set schedule. I saw a doc at an Urgent Care place last month and she gave me Temazepam after I had explained everything to her. Now i only got 15, all she was allowed to dispensed until i become a Patient there, but this drug really gave me restful restorative sleep ( hence Restoril name ) Ambien and Lunesta were bad experiences for me, personally, but I know they do work for plenty.

 

[SPC123]

If I had insomnia that bad I'd be asking for barbiturates. They aren't by any means front line, but they are still approved for treatment resistant insomnia. That said, if you are also schizophrenic you probably ought to be on an anti-psychotic anyhow.

 

[Trebuchette]

I don't like APs and SSRIs for off-label, but I did try trazedone and mirtazepine. Traz knocked me out but sometimes with headaches the next day (I don't get headaches). Mirtazapine stopped working for sleep after a week, but I kept trying it a month; I wasn't sleeping without benzos and a lot of effort (dark room, no stimulation).

Pdoc had me on melatonin; it's nice, but I didn't stay asleep long. Finally tried Lunesta last week, but it seemed to keep me awake longer than just melatonin, so now I combine the two. (Lunesta is expensive, though!) Still only getting 5-6hrs/night, but better than 1-2hrs.

 

[painenduser]

Sorry I have not read through all the replies to this as I just wanted to throw this idea out to you.. I few years ago, I had a shrink who prescribed to me Remeron (Mirtazapine) I did read that Trebuchette said it worked for a little while for him and that he wasn't sleeping with out Benzo's however, this can easily become a problem for anyone who has sleeping problems, one side effect to these medications can actually be insomnia. I had rather good luck with Remeron and I am one that has trouble falling asleep with Ambien, and Temazapam, but I found Remeron to be great. The reason I don't take it now is due to my liver Disease and my GI Dr doesn't let me take most meds I used to take. Now, my pain MGT Dr did try one drug with me that didn't do shit, but I have talked to other people and it seems to work great for them and that is Roserum. Here is what website say about this drug "Ramelteon is used to help patients who have sleep-onset insomnia (difficulty falling asleep) fall asleep more quickly. Ramelteon is in a class of medications called melatonin receptor agonists. It works similarly to melatonin, a natural substance in the brain that is needed for sleep." Again, did not help me, but I also did not give it a fighting chance which is getting into a nightly routine. That is my biggest problem which is the routine. Sometimes I think the routine is the most important part of the equation. Best of luck to you as I know that having sleep issues can be extremely frustrating!! Let me know what you come up with!! GL

 

[nAON]

Old thread and OP has been since banned, closing thread.