How to avoid Zopiclone addiction??

[JohnBoy2000]

Couple weeks ago, started taking reboxetine - and whilst it's been great thus far, and I hope will continue to improve - the insomnia, is prominent.

Now, I also take Mianserin (remeron analogue), which does assist with sleep but, once it's hypnotic effects wear off after 4 hours - the reboxetine induced insomnia takes over.

However, I tried a 3.5 mg dose of zopiclone one night, and it gave me 7 hours good sleep - and that, I can live with.

So - I'm hoping after a few weeks, a side effect tolerance will develop but, for the next period of time at least, it looks like I may have to augment with the Z drug.

However - a dependence is the last thing I need.
So - the doc that scripted them initially, he wrote out 15 pills, for a one month period - said if I took one every other night, chances of tolerance and dependence would be low.

Does that sound about right?

Then - in Stahls books - he's basically saying, tolerance doesn't really occur with Zopilcone, and long term use is essentially safe.


So - I turn to the all knowing bluelight.

Opinions?

 

[sadasaulna]

Dunno but I took Zopiclone nightly for two weeks years ago and by the end of the two weeks I barely noticed them anymore. Lovely stuff though.

 

[Cotcha Yankinov]

People seem to have different experiences with Z drugs related tolerance and withdrawal/rebound insomnia, as well as side effects.

First, let me say that a hypnotic is no substitute for mindfulness and breathing exercises for insomnia. People generally have no idea how to be mindful and usually have messed up breathing (that they're not even aware of) that is anxiogenic, and then wonder why they can't sleep without drugs.

Second, be wary of adding another drug into the mix to treat side effects of another drug, especially if insomnia is present without any drugs and has been worsened with the addition of more drugs.

Per the reports of ambien users, some people use it for a decade every night and it still works fine with apparently no side effects, other people gain tolerance after using nightly for a few weeks/months/years, and some people develop cognitive side effects like memory troubles.

There were some claims that Lunesta users did not develop tolerance. I think those claims are a bit potato as well.

 

[JohnBoy2000]

I had to double up to 7.5 mg last night for the effect - and that's only my 3rd night.

Insomnia on this reboxetine is pretty damn intense.

I might taper down to 6 mg - see how that goes cause, initially, it was actually improving my sleep.

 

[JohnBoy2000]

I'm trying to figure how potent the synergistic combination of an NRI with an Alpha 2 adrenergic blocker is, also.

Microdialysis studies of this combination show that NA levels can go from 100% increase on a stand alone NRI, to 1500% increase when used as an adjunct to an alpha 2 blocker due to the elimination of the negative feedback mechanism.

So in my case, the most potent alpha 2 blocker in mianserin at 60mg, with the most selective and potent NRI in reboxetine at 8 mg - I'm thinking it's possible the NA levels are increased so drastically and in such a prolonged fashion that, maybe it's just that that's bleeding over into night time and inhibiting my sleep - despite the alleviation of many other daytime symptoms.

Maybe knock it down by a couple mg's today - see what's up.

I wanted to go high early to "load" - get a high plasma drug concentration early, which is why I moved up to 8 mg so quick.

 

[Nagelfar]

I'm trying to figure how potent the synergistic combination of an NRI with an Alpha 2 adrenergic blocker is, also.

Microdialysis studies of this combination show that NA levels can go from 100% increase on a stand alone NRI, to 1500% increase when used as an adjunct to an alpha 2 blocker due to the elimination of the negative feedback mechanism.

So in my case, the most potent alpha 2 blocker in mianserin at 60mg, with the most selective and potent NRI in reboxetine at 8 mg - I'm thinking it's possible the NA levels are increased so drastically and in such a prolonged fashion that, maybe it's just that that's bleeding over into night time and inhibiting my sleep - despite the alleviation of many other daytime symptoms.

Maybe knock it down by a couple mg's today - see what's up.

Seems like you've got a pretty good insight yourself into probable cause.

I wanted to go high early to "load" - get a high plasma drug concentration early, which is why I moved up to 8 mg so quick.

Maybe this was a miscalculation, too.

 

[sekio]

Long term use of zopiclone is probably more tolerable than benzodiazepine usage, but at the same time, it's still a GABA-A positive modulator - just more selective for the sleep-regulating subtypes of GABA-A. So logically you'd expect to see some tolerance to its effects, and there's also the possibility that you may become mentally habituated to it, e.g. eventually it will get harder and harder to go to sleep without zopiclone.

For those reasons I'd do everything I could to combat the insomnia without adding a sedative in. Get some vigorous exercise in the afternoon/evening, have a hot shower before bed, try aromatherapy (lavender oil), and also practice good sleep hygiene. It may be that you can get away with no sleep aid at all, as long as you put the extra norepinephrine to use Sleep hygiene is something to concentrate on though. If you reserve your bed and bedroom for sleep exclusively, you'll find it becomes easier to sleep in your bed than if you do your homework, TV watching, or other mentally engaging tasks in bed.

Mianserin is actually a NRI as well, so maybe seeing about decreasing the dose of either reboxetine/mianserin, or changing when you take them (reboxetine first thing in the morning, up to 1/2 hr before you even get out of bed if possible; and mianserin about an hour before your planned bedtime.)

Also, there's applications like f.lux that adjust the color tone of your monitor, making it redder/less blue in the evening and early morning. It turns out that exposure to blue light causes the inhibition of natural melatonin release, which makes sense - blue skies are only seen in daytime, which is when many peple are most active. There are also versions of this for Android/iPhones too.

TL;DR: Use zopiclone only as a temporary band-aid, it's not a permanent fix for your sleep cycle if you can't sleep without it. There's a bunch of other simple lifestyle modifications that are more likely to yield the permanent changes you're looking for.

 

[Solipsis]

I tend to agree ^ you'd have to weigh the benefits of riboxetine and how likely you'd expect to find an alternative against the downside of having to take hypnotics. IMO even alternating days puts you at risk of tolerance and dependency, even if it may develop relatively slowly. Once every three days maybe, you really need to have a proper night's sleep one in three nights at least... but the upsides of those meds would have to be pretty huge it seems, to justify insomnia 2 out of 3 nights.
Assuming here that more regular Z-drug use is unsustainable eventually, that makes it more useful for a short while like a period when you need it especially, but in the long run it would be asking for sleeping problems on top of having to deal with your current structural problems in a different way.

Starting on Z-drugs should not be considered lightly, mostly comparable to benzos, and as a last resort only imo. It's rather selective making the whole issue more one-sided but I don't know of any evidence that the same principles don't apply for that iirc alpha1 effect. On the other hand, Z-drugs have been underestimated and thought of as safer than benzos whereas I don't think this has turned out to be true...

It's good that there is no alpha5 or 6 effect though iirc, which apparently make tolerance and dependency considerably worse.

f.lux plus a blue filter app on your phone are crucial for anyone at risk of insomnia, even just by having ADD like in my case (involving overly sensitive melatonin cycle), and just a good idea for anyone having any kind of sleeping problems. I agree that it's not just about problems falling asleep initially. If blue light (heh) screws up your natural melatonin peak that isn't any good for the later parts of your night cycle either.

Also, couldn't you supplement the antihistaminergic sedative effects which apparently wear off early from mianserin with another longer acting antihistamine? You might get drowsy as fuck but that seems safer than zopiclone if it works. Problem with those antihistamines is that they have such a dirty pharmacological profile and are apparently very hard to make more selective.

Writing a 15 pill script to take alternating days is one thing by the way (fine since it's incidental / for a short while only), it's an entirely different thing to make that a recurring structural script!

 

[Dresden]

Don't take anymore. Think about the drug as little as possible. Switch to another, less harmful drug for sleep. 150mg of diphenhydramine (Benadryl) combined with 20mg haloperidol (Haldol) makes me sleep deeply and for a long time. All sleeping pills are habit forming.

 

[Kdem]

I wouldn't take zopiclone long term.

Dresden, no offense but are you **** ? I don't know why you take Haldol but I hope nobody is going to take your advice to take 20 mg of Haldol ! My guess is that it would keep most people up, not in a good way. And that's a lof of diphenhydramine.

 

[Dresden]

I didn't recommend anyone else take it but rather just stated what I take.

 

[Cotcha Yankinov]

I had a lot of success with lower dose antipsychotics for insomnia personally, but since most have long half lives it's not like something that you can just take at night and not have it affect you the next day.