Insomnia: Best Treatment Options

[toobent]

I have severe, chronic insomnia that my Psychiatrist has prescribed me Seroquel for, which I've refused to take. He's also prescribed me Prozac which I also refuse to take. He is convinced my insomnia is a result of bipolar and depression. A diagnosis he made after just 2 20 minute consults. He persistently denies me alternative treatment options so I'm waiting for my appointment with a new shrink in 3 weeks. While Seroquel does put me to sleep, it causes nervousness and RLS within about 1 hour of dosing, and the following day I am in a stupor and suffer major anhedonia, lack of motivation and become somewhat apathetic. It is a really bad drug as far as I'm concerned and despite its effectiveness in enabling sleep the negative effects make it a no go for me. I just won't take an SSRI and considering I am not depressed in the slightest (I have suffered depression for <12 months over 10 years ago) there is no way I will take Prozac as the potential deleterious effects far outweigh any probable reason that use of this dangerous SSRI would prove beneficial.

I have tried:

1. Alprazolam at reasonably high doses (4-6mg) which were effective in putting me to sleep, remaining asleep, and waking refreshed with little hangover effects.
2. Etizolam at prescribed doses of 1-2mg which were very effective at putting me to sleep, but I would always wake after 6 hours and could not return to sleep. I suffered no hangover effects the following day though.
3. Zolpidem at 20mg which proved the best at making me fall asleep, but similarly to Etizolam I would wake about 6 hours later unable to return to sleep. Zero hangover effects too, which is a big plus.

Problems I encountered were abuse of Alprazolam to the point where 8-10mg were required to put me to sleep. I since tapered right off Alprazolam altogether and as of the last 1-2 weeks have been alternating between 1mg Etizolam and 20mg Zolpidem each day to facilitate sleep. I am at a point now where it appears 2-3mg of Etizolam is required (which is still within the prescribed insomnia treatment range of 2-4mg), but I am attempting to keep my benzodiazepine intake at 10mg Diazepam equivalence per day so am reticent to increase my Etizolam dose. Strangely enough 20mg of Zolpidem still does the job, which is equivalent to 10mg Diazepam.

Which medications have you found conducive to enabling quick sleep onset, enabling you to remain asleep for at least 7, preferably 8 hours, and suffer no hangover effects the following day at therapeutic doses? I need to experiment with other alternatives. So far I think Zolpidem is the most effective but use should not extend beyond 2-3 weeks, yet my condition will persist upon ceasing administration of medication. My lifestyle is tailored to address my pathology. I train hard 4 days a week, study hard, get plenty of sunlight and have very healthy dietary habits. I should be exhausted of a night time, but no matter how hard I trained that day, how much study or sunlight I subject myself to and how little sleep I had the night before I always fail to fall asleep. ALWAYS. And when I eventually do in the early hours of the morning, I wake frequently anyway.

Also, when I see my new Psychiatrist should I be completely honest with him regarding my concern taking off-label prescriptions of potentially harmful drugs such as Seroquel and Prozac when my pathologies are insomnia and GAD with occasional panic attacks, not schizophrenia or depression, which is what the aforementioned drugs should be prescribed to treat? And should I voice my disapproval and dissatisfaction of my previous Psychiatrists hasty diagnosis and off-label prescribing habits?

Thanks.

 

[Thorns Have Roses]

Check out my post in this other thread. Flurazepam and Quazepam seem to be the superior options for long-term treatment of insomnia. They're gonna have a hangover effect since they've got lengthy durations, but it'll decrease with time (yet they will maintain their efficacy as hypnotics).

Your no-hangover options aren't going to be as good at keeping you asleep (you might be able to get by with 6 hours, that's pretty common for adults), and are less likely to be effective for more than a few weeks. At least, AFAIK.

Hopefully that makes up for going off on ya in that other thead.

 

[toobent]

Very nice! Thank you. I must admit I'm grateful Zolpidem and Etizolam are allowing me even 6 hours sleep, but given I'm an athlete and studying my degree at the moment I really need 8 hours at a minimum. If it weren't for my training I'd be satisfied with 6, but sleep is as important as my training and the lack of it really impairs my performance athletically and sometimes academically.

I don't remember you giving me a hard time? Most people here tend to be respectful and some seem really well educated on drugs.

Is it wise to divulge my own research and desire to try Flurazepam and/or Quazepam with my new Psychiatrist or do you think he would take offence?

And thanks, Never, whatever our history was I appreciate your help.

 

[Epsilon Alpha]

Trazadone is a good option if you'd like to discuss that with your doctor. I'm not the biggest fan of Z-drugs or benzo's for insomnia but truth be told I don't know as much as I should about bipolar related insomnia.

Pregabalin or gabapentin might be options to discuss as well as while they kind of suck at putting you to sleep they do keep you asleep with minimal side effects.

 

[ThisIsAHeresy]

A strong indica.

 

[toobent]

I'm amazed at how this shrink diagnosed me with bipolar in 2 short sessions without me divulging much at all about my life. It was quite impressive how through nothing but observation he realized how labile and fickle I am. Psychiatrists are smart as hell.

I value my bipolar though, it enables me to be really enthusiastic about things I take an interest in, albeit to the neglect of responsibility

I'll bring up Flurazepam, Quazepam, the *gaba*s, and Trazadone with this new Doc. I really don't want or need Seroquel and Prozac, I just need to sleep.

Lol @ loud pack. I smoked that primo kush for over a decade till I realized it had made me lazy and unsociable, but it is without doubt the best sleeping aid I've ever had. I miss the pleasant aroma of freshly chopped herb garnished with the caramel coloured dried Camel leaf that permeates my olfactory glands as I pack a bowl of Cheese.

 

[ThisIsAHeresy]

I smoked that primo kush for over a decade till I realized it had made me lazy and unsociable, but it is without doubt the best sleeping aid I've ever had.

Moderation is key.

If you're conscious about your health, I don't suggest dumping various pills in your body. (Semi-)synthetic chemicals aren't really something that you should primarily rely on. (I've never enjoyed putting something synthetic into my body).
There's also the whole deal with withdrawals. Based on what I've used (and still use) to help with my insomnia, weed is the best, with the least amount of "side effects", and minimal "withdrawals" (all mental; feels similar to that groggy feeling from lack of coffee in the morning). Benzodiazepine withdrawals are horrendous.
And, only actual pill/chemical that actually helped with my sleep was quetiapine (Seroquel). But, I've always felt like complete shit when I woke up.
I've only used benzos for my anxiety. I've never seen how they would help insomnia.

I recommend sticking with weed. I also suggest cutting down from the tobacco as well, since nicotine contributes to insomnia.

(Side note: I'm aware that drugs affect everyone differently. In the end, you should use whatever fits your needs the best).

 

[toobent]

TIAH, you're right, but I can't moderate. Well, I sort of can, but I was unable to with weed. I haven't smoked as an addict for about 4 years now. Every few months I will have a few cones when I catch up with certain friends. Actually I smoke about 3 half cones and can't even punch them, but I thoroughly enjoy it. I eat well, sleep well and wake up fine on these infrequent occasions. I moved interstate a while back and do not know where to get on at my new home, which is the way I want to keep it. Due to my addiction to weed for so long it is the one drug I am literally scared of indulging on any sort of regular basis as I am not confident that I would not pick up the habit again.

You make a good point about withdrawals. As I think back I have suffered both physical and mental withdrawal symptoms from every substance I've abused except weed. Quitting did renew my insomnia though, and there were some psychological effects but nothing like the depression and anxiety from benzo and opioid withdrawals. Your health argument is not so congruent with me as the chemical nutrients and pesticides used in cultivating dope are carcinogenic at worst, deleterious as best, and naturally grown pot never did a thing for me.

By the way, I don't smoke tobacco. I did use it for spin, usually 4:1, i.e. chop 4 grams of loud with 1 gram tobacco just to smooth it out a bit.

Generally speaking I think I agree with you, but my experience leaves me unable to trust myself with weed. That said, I end up abusing every substance that provides me with any pleasurable effect. From drugs to activities such as training and sex. I think it's part of being bipolar. I can't do anything in moderation or half-assed. I always take everything to its limit, then drop it 6 months later and move onto something else

And zannies + weed = awesome. Then again Oxycodone or [insert any depressant drug] + weed = awesome.

 

[ThisIsAHeresy]

I can't moderate.

Moderation is extremely difficult. It requires a lot of commitment and willpower, especially with opiates/opioids, benzos, and other various downers/sedatives. But, hey. Smoking weed all the time IS "healthier" than (insert your preferred method of administration) downers all the time, is it not?
Also, you could try alternating weed, and something else, like an herbal tea. (There's a HUUUUUGE variety of herbs that help with insomnia). Granted, it won't be near as "abusable" or "enjoyable" as consuming a bunch of downers. But, this could help with your dilemma with not being able to properly moderate.

As I think back I have suffered both physical and mental withdrawal symptoms from every substance I've abused except weed. Quitting did renew my insomnia though, and there were some psychological effects but nothing like the depression and anxiety from benzo and opioid withdrawals.

(Well, this is if you continue on with consuming downers). You could try kratom to alleviate the opiate/opioid and/or benzo withdrawals. I've discovered that smoking weed after drinking kratom tea helps as well. Just another suggestion that could help.

By the way, I don't smoke tobacco. I did use it for spin, usually 4:1, i.e. chop 4 grams of loud with 1 gram tobacco just to smooth it out a bit.

Makes sense, ahaha. I always roll spliffs and pack bowls with a weed/tobacco mix. In my opinion, it tastes better; then again, I smoke tobacco.

And zannies + weed = awesome. Then again Oxycodone or [insert any depressant drug] + weed = awesome.

I KNOW HOW YOU FEEL. I love mixing downers and weed. Downers make my mind feel all "cloudy" and "muddy", and the weed clears it up.

(Wow, that was quite a bit of a digression...)
But, yeah... Based on what you've experienced, I think it's fair to conclude that weed > downers (benzos, opiates/opioids, sedatives, etc), medicinal-wise. With your dilemma with weed, I think it wouldn't hurt that much to try what I've suggested above. (Might put a little dent in your wallet, but health is a bigger priority than money, no?)

 

[Psychonauticunt]

Which medications have you found conducive to enabling quick sleep onset, enabling you to remain asleep for at least 7, preferably 8 hours, and suffer no hangover effects the following day at therapeutic doses? I need to experiment with other alternatives.

Temazepam
Onset of about 30-60 minutes, gave me 6-8 hours of sleep. No active metabolites, no residual hangover effects. Tolerance built quickly, though, so I took them in a pattern of taking them every 2 nights and then taking one night in between with no medication, even if I did not sleep that night. Otherwise I had to double the dosage around 5-7 days after starting. 20-40mg was enough to guarantee sleep.

Lormetazepam
This is not prescribed in many countries, but this was much like temazepam, only stronger. 1-2mg was enough for a good 8 hours' sleep.

Diazepam
Fast onset, and relatively sedative - biphasic half-life, which major effects lasting around 6-8 hours, but residual effects (which to some are sedative during the next day - I don't find much strong hangover effects after 4-5 days of starting once tolerance sets in) persist for the next day or two due to long-acting active metabolites. 15-20mg was good for a night's sleep.

Flurazepam
Same as diazepam - long-acting metabolites, but I found them mostly anxiolytic, not sedative. The drug itself is sedative for about 8-10 hours. Some also find its metabolite sedative, though, so it differs from person to person. 15-30mg.


----

I find your experiences different to mine, though. I find alprazolam non-sedative, and also short-acting - I would only maybe sleep 4-5 hours on it, and at a high dose. I could only sleep for 2-3 hours on zolpidem. Etizolam would give me a decent 7-8 hour rest. Having that in mind, maybe you ought to try:

Lorazepam
Not sedative at all for me - in fact, I used it as a daytime anxiolytic - but in many countries it is prescribed for insomnia. No active metabolites, duration about 8 hours, shouldn't leave hangover effects. 1-2mg, fast onset of about 30-60 minutes.