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  • BDD Moderators: Keif’ Richards

Rank most sedative drugs as sleep aids

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muvolution said:
Zyprexa and Seroquel are at best 3rd line sleep aids, so If (you don't have a medical history of drug abuse) and you've already tried :

1. Z-Drugs. These are the new first line sleeping drugs. Zolpidiem, Zolpiclone, etc. (Ambien, Lunesta...)
2. Benzodiazapines. (as myself and someone else mentioned Tamazepam is at the highest end of this scale. If you are only on valium or clonzapam right now, try going to a more effective benzo.
3. Chloral Hydrate. This is old, and has some abuse liability but few side effects, is extremely effective, and has almost no long term side effects.
4. Barbituates. high abuse liability, but work well and don't have long term side effects.
5. Anti-cholrigenics/ Alergy pills. Benadryl, Hydroxizine (that should probably be at like #2 since it works well and has no dependence liability) Meclazine, Cyclizine, Dihydramine, etc.
6. and then if nothing else worked : Zyprexa or Seroquel which are atypical antispychotics an aren't really indicated for sleep although they do work well for it because psychiatrits have been convinced by EliLilly and Co. that they can be used off-label which was the subject of huge lawsuit regarding olanzapine a couple of years ago, so if you are currently receiving olanzapine for sleep (and not manic bi-polar disorder or schizophrenia or sundry other psychiatric conditions more sever than typical depression or anxiety) then your psychiatrist is doing something wrong.

The logic of prescribing Seroquel or Zyprexa, which have serious long-term side effects (not to piss off anyone that HAS to take them for the conditions they were designed for) is the same as prescribing someone an Opiate or barbituates(including alcohol) or that shit they use in anesthesia for sleep. they all have side effects (dependence and abuse, and some long-term effects as well) and were NOT designed for sleep, it is a side-effect.
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The above is good advice. I have a lot of trouble sleeping. Most of it stems from my job as I work 24 or more hours at a time. My personal experience is as follows:

1. Absolute best sleep aid I've ever tried is chloral hydrate. I have an rx for midrin (migraine med with chloral hydrate) and the first time I took it was probably one of the best nights of sleep of my life.

2. Xanax/Valium/Ativan/etc. work very well without leaving me with a groggy feeling the next day. I usually take a low dose (0.5 mg xanax or 5-10 mg valium or 1 mg ativan) when I take them.

3. Ambien worked VERY well but made it difficult to wake up. I was about two hours late for work the first time I took an ambien.

4. Chlorpheniramine/Benadryl/etc. work for sleep but make me feel very groggy the next day.

5. Promethazine works well with minimal grogginess.

6. Pain meds (hydrocodone, oxycodone, etc.) do eventually make me sleep once the initial high has worn off.

7. Midazolam made me lose an afternoon. I took about 3 mg IV and I woke up that evening, not sure how I made it to bed. Good sleep, but I don't like not remembering what happened.

8. Muscle relaxants (flexeril, zanaflex, etc.) work reasonably well for me. Zanaflex works better than flexeril.

9. Trazodone knocked me out at first (low dose - 25 mg) but doesn't so much now. I usually take 25-50 mg if I have at least 6-8 hours available for sleep. I don't take it if I know I have to get up at a certain time the next day.
 
Of the benzos that I've tried and I'm a benzo adventurer so I've tried many (around 14 different benzos - so far). And the most sedating in order are listed below.

1. Triazolam
2. Nitrazepam
3. Temazepam
4. Flunitrazepam
5. Phenazepam
6. Midazolam (took it orally)
7. Estazolam
8. Flurazepam
9. Diazepam
10. Alprazolam/Lorazepam


I have yet to try loprazolam, lormetazepam, nimetazepam, and brotizolam. So when I get to try some of these, that list up there is going to change drastically. I can probably guarantee that everything from 5 to 10 will all be eliminated from the list. Brotizolam may take the top spot, as I've heard people say it's like triazolam only harder.
 
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euphoricc said:
xanax is by far fast acting and willl lay u flat ambien did not help me
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Actually, according to a 1993 British study and then several others in Sweden, Norway, Canada, Ireland and 2 in Australia ALL got the same result as the 1993 British study. Temazepam is the fasted acting benzodiazepine of all. It's the most rapidly absorbed and has the quickest onset of effects. This the reason why it is the most toxic benzodiazepine, because of how quickly it's absorbed and how fast it kicks in.
 
REALLY.................................. thats news and great i love xanax cause how fast it kicks in thanks for ur info tho....imma ask my doc:) what they for sa or gad srry for a million questions
 
euphoricc said:
REALLY.................................. thats news and great i love xanax cause how fast it kicks in thanks for ur info tho....imma ask my doc:) what they for sa or gad srry for a million questions
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Temazepam is an hypnotic prescribed only for severe to debilitating insombia, well that's what the international guideline says. You won't get something like temazepam for generalized anxiety disorder or social anxiety disorder - because you have to take those during the day and still be able to function (that's what alprazolam, clonazepam, lorazepam, bromazepam, and diazepam are for.

Temazepam has fast cerebral uptake. Therapeutic and supratherapeutic doses of the drug can manifest clinical effects of strong hypnosis, sedation, amnesia, and ataxia. So you can't take that and function during the day (unless of course you have a huge tolerance to benzos and then you can take just enough for you to be able to function and with the hypnotics the line between being functionall and totally out of it is very thin.
 
kokaino said:
Actually, according to a 1993 British study and then several others in Sweden, Norway, Canada, Ireland and 2 in Australia ALL got the same result as the 1993 British study. Temazepam is the fasted acting benzodiazepine of all. It's the most rapidly absorbed and has the quickest onset of effects. This the reason why it is the most toxic benzodiazepine, because of how quickly it's absorbed and how fast it kicks in.
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Really? Xanax & Halcion seem to kick in quicker for me. I never really noticed how fast Temazepam kicked in because I took it daily and it became just another medication I had to take for sleep. But in doses above 150mg its my favorite benzodiazepine.
 
K'd-OUT-in-AZ said:
Really? Xanax & Halcion seem to kick in quicker for me. I never really noticed how fast Temazepam kicked in because I took it daily and it became just another medication I had to take for sleep. But in doses above 150mg its my favorite benzodiazepine.
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Yeah, it is a fact. The reason temazepam doesn't kick in as fast as it should is because of the capsules. They hamper their absorption time and metabolism. It's why it comes in a capsule. Some States (maybe 2 or 3), not sure which ones require a specially coded pad to script temazepam (it's the only benzo with such requirement). You think the DEA didn't get a whiff of temazepam's rise to epidemic proportions of abuse in Europe, Australia, and Southeast Asia?

Well here's the Australian study link here.

I'll dig up the original British study too.

Edit: Here is what the British study (the bolded part is really all you need to read, but read all of it - very interesting):

Introduction:

Benzodiazepines are generally thought to be safe in overdose. Death after admission is rare and due to respiratory depression with aspiration of gastric contents. Over 10 years in the United Kingdom, however, 1512 fatal poisonings have been attributed to benzodiazepines with or without alcohol. These were compared with prescription data to establish a fatal toxicity index (deaths per million prescriptions) for each benzodiazepine. Similar indices have been derived for antidepressants and barbiturates. There were clear differences between benzodiazepines. Of drugs frequently prescribed, temazepam had the highest number of deaths per million prescriptions at 11.9 (95% confidence interval 10.9 to 12.8 ); above that of some tricyclic antidepressants. In contrast, oxazepam had an index of 2.3 (1.2 to 3.4), and the index for all benzodiazepines combined was 5.7.

Although there are potential sources of error in these studies, a bias that would lead to differences between compounds was not identified. Clinical studies can adjust for potential confounders which studies that use coronial data are unable to take into account. If differences between the benzodiazepines are supported by data from clinical studies this also adds credence to the fatal toxicity index which first noted these findings.

Our aim was therefore to determine if temazepam caused more sedation and oxazepam less sedation than other benzodiazepines when taken in overdose.

Method

This was a follow up study of consecutive presentations to hospital after self poisoning with benzodiazepines between January 1991 and January 1994. The department has a regional responsibility for all poisonings in the lower Hunter Valley (population about 350000). The data, collected prospectively by casualty doctors and subsequently verified by the clinical toxicology team, included patient's characteristics (age, sex), all drugs and dose ingested, coingested substances, regular medication, history of abuse of drugs or alcohol, or both, details of management, and complications of poisoning. The state of intoxication was determined by three different but overlapping methods. These were identical with those described by McCarron et al for assessing the severity of barbiturate intoxication. A point scale of conscious state (alert, drowsy, stuporous, coma 1–4) was used. Deeper levels of coma indicate loss of response to painful stimuli, inadequate respiration, and hypotension. The Glasgow coma score and McCarron score (a modified Glasgow coma score which includes scores based on vital signs) were also calculated.

Link to a chart for coma scores

Statistical Analysis

Because of the large additive effect on sedation, patients who ingested more than one sedative drug were excluded from further analysis. The outcomes analysed were whether patients were stuporose or comatose on presentation and the mean Glasgow coma and McCarron scores. The differences in potency between benzodiazepines were adjusted for by converting the amount (mg) ingested to defined daily doses.8 To investigate the strength of the associations between temazepam and oxazepam and the main clinical outcomes we calculated the odds of outcome in those exposed and those not exposed. Odds ratios were adjusted for age, sex, coingestion of alcohol, chronic benzodiazepine use, and dose ingested by logistic regression by using maximum likelihood or an exact method.
Previous SectionNext Section

Results

Details of coma scores and odds ratios (95% confidence intervals) for sedation for oxazepam and temazepam (compared with all other benzodiazepines)

During 1991–3, 542 patients with benzodiazepine poisoning presented to this hospital, 239 of these patients, however, had ingested either more than one benzodiazepine or coingested other sedating drugs. The drugs ingested by the remainder were temazepam (64), oxazepam (45), diazepam (113), clonazepam (24), flunitrazepam (21), nitrazepam (18 ), others (18 ). Table I compares the characteristics of patients ingesting these drugs.

Dscussion

Our results show that there are differences between temazepam, oxazepam, and other benzodiazepines in the degree of sedation they cause in overdose, and the observed differences are not due to confounding by age, sex, dose ingested, coingestion of alcohol, chronic benzodiazepine use, or history of drug or alcohol abuse. This provides a plausible explanation why temazepam and oxazepam have different fatal toxicity indices from other benzodiazepines.

The sedation produced by benzodiazepines in therapeutic doses and overdose has a poor correlation with measured drug concentration but is increased with rapid absorption. Temazepam is more rapidly absorbed and oxazepam is more slowly absorbed than most other benzodiazepines. Further research is required to determine if the rate of absorption is different in overdose and is sufficient to explain the differences in sedation. Slowing the rate of absorption may reduce toxicity, but this would also reduce their sedative effect in therapeutic doses. Drug regulatory authorities should be aware that changes in formulation of benzodiazepines may affect toxicity in overdose.

Pharmacodynamic factors such as benzodiazepine receptor affinity and potency may also be important. Because of the wide variations in half life, adjustments for dose by conversion into defined daily doses or diazepam equivalents is imperfect. These are designed to compare use rather than potency. Though they correlate reasonably well with sizes of prescriptions and tablets, they may not account for potency per tablet taken in overdose. Differences in potency could also explain the results in both our study and that of Serfaty and Masterton.
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(Source)
 
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^ Ditto. Every time I'm doing a little extra methadone I'm in for an agitated night at the least.
 
K'd-OUT-in-AZ said:
Opiates keep me awake. Even if I nod off I'll still be awake a few hours later. In fact I purposely try to stay awake so I can experience the euphoria as long as I can. But they still have the potential for sleep but my Bipolar doesn't really allow it.
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i've used codeine and hydrocodone for sleep with sucess but oxys can be a bit stimulating for sleep. its definately possible though.
 
If big difficulties to fall asleep : MIDAZOLAM (the best of the best)
If Insomnia : NITRAZEPAM
 
StaySedated said:
oxys can be used for sleep, although imo its a waste. hydrocodone would be a better opioid for sleep.
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Opioids are in no way hypnotics. Just because they make you drowsy, it doesn't that they are good for sleep.

StaySedated said:
i've used codeine and hydrocodone for sleep with sucess but oxys can be a bit stimulating for sleep. its definately possible though.
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Really? What a waste of opioids.
 
K'd-OUT-in-AZ said:
Is GHB rather effective? One of the few drugs I have never tried.
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GHB actually comes under the brand name Xyrem (sodium oxybate). Sodium oxybate is another name for GHB. It's actually indicated for narcolepsy and also excessive daytime sleepiness.
 
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