Benzos sleep problems

[ethnobot781]

For nearly 5 years, up until ~1 year ago, I used to take Nitrazepam for insomnia. Not nightly, my prescription was for 7 doses per month. I suffer from chronic but intermittent insomnia involving difficulties in both getting to and remaining asleep. Something beyond my control seems to send my sleeping pattern out of kilter and from that point it deteriorates until normal sleep is nigh impossible and remains that way until treated. My sleep hygiene is excellent, which helps but doesn't solve the problem. Taking the tablets for just a few consecutive nights seems to reset things so that sleep is then possible for at least 2 weeks more without further meds but it always recurs eventually. I have tried zopiclone (which failed to work at all even at high doses) and temazepam (which would get me to sleep a little over half the time but only for 2-4 hours max making it much less effective at resetting my sleep pattern for a period of time) but nitrazepam had a way better effect on my quality of life. Occasionly it would leave me a little wooly in the morning but nothing that a good strong coffee didn't fix.

About a year ago I was going through a sustained better patch with sleeping (something that happens from time to time) and being aware of the problems of addiction and tolerance I cut down and then quit the nitrazepam under my doctor's supervision with no problems. I was most bothered about cross tolerance as I occasionallly use diazepam for anxiety (this is a last line of defence, usually I can cope without and the script is for 5x5mg monthly which I don't always collect, but on those occasions when I have to take it I really need it to work hence the desire to avoid taking other benzos unnecessarily). Unfortunately this inevitably led to the removal of the nitrazepam from my repeat meds list.

Now I'm suffering fairly badly with insomnia again. The first time the problem recurred severely I ended up visiting the doctors twice. The doctor is not the same doctor that originally prescribed the meds unfortunately plus prescribing guidelines have changed so he treated almost like a new problem. The first time he gave me a temporary increase in my diazepam script. Diazepam I find to be a good anxiolytic but fairly mild for me (which usually suits me). As a sleep aid I found it rather hit and miss. A max prescribed dose of 10mg would help a bit, but not consistently, so around 4 days after finishing treatment things were bad again. The second time I got a few doses of nitrazepam and predictably it worked well, just over 3 weeks with no problems. It wasn't a repeat prescription however and now things are starting to get worse again.

Given that the longer it takes to sort out the problem the worse it gets and that appointments can take over a week to get for non-emergencies I'm tempted to just ask when I get back to the doctors for a small number of doses on monthly repeat but I just got through persuading them I needed my pain relief put back up again due to pain in a new area of spine and I don't want to be accused of drug seeking!
I was wondering:
1) If people think that sounds like returning to using nitrazepam a few doses per month on average is actually sensible for me
2) How I should best approach my relatively new doctor about it (in general terms, since I lack confidence at the mo, not "what to say to get drugs" lol)
3) If anyone has any ideas about other therapies or approaches which could help my weird insomnia.

Cheers, Ethnobot

 

[Nikolai]

I dont know more than a doctor will about what could help your insomnia really. A couple years ago I had major problems sleeping related to pain trouble and anxiety. I was prescribed 5 to 10mg's of diazepam at night which I took almost every day for about 6 months. It helped though not completely. and I quit taking it when my pain and sleep improved. I suppose being prescribed a benzo daily for sleep is not an option with most doctors because of addiction potential.

What about Lunesta or something else that is prescribed to help people sleep? I doubt OTC med's like benadryl will help. Maybe some others know some non-medication ways to improve sleep.

 

[Captain.Heroin]

I was wondering:
1) If people think that sounds like returning to using nitrazepam a few doses per month on average is actually sensible for me
2) How I should best approach my relatively new doctor about it (in general terms, since I lack confidence at the mo, not "what to say to get drugs" lol)
3) If anyone has any ideas about other therapies or approaches which could help my weird insomnia.

Cheers, Ethnobot

Ethnobot; I skipped over the first few parts of your post, I will come back to read that part. I figured I'd answer your main questions.

1) Yes, it is sensible. 7 doses per month? That's once every 4 days you need a sleeping pill. No biggie! You can't get physically addicted at that rate of use, and it'd be next to impossible to become psychologically addicted to that rate of benzo use if you haven't already.

However, I would strongly urge you try different doses of temazepam; it doesn't interrupt your REM sleep unlike other benzos (not sure if nitrazepam does; I think it has some similarities to temazepam).

I would also recommend trying out Atarax (hydroxyzine hcl in tablet form) for insomnia; it works well on the nights I don't want to take a benzo.

2) Bring your old medicine bottles to the doctor, explain how often you take your meds, and how well the meds work for you. Explain what happens when you don't take your meds.

That's all you need to do; you won't come off as a drug user for asking for seven benzo pills a month. Really! - It might be different in the UK, but I can't see them being so stingy that 7 pills per month is too much. I can understand if they don't want to write you a full 30 count prescription, but really, 7 pills is next to nothing.

3) You could have a sleep study done, to see if there's anything biological causing your issues. However this is costly compared to 7 pills per month.

If temazepam did not work well for you/didn't keep you asleep throughout the night, then I think you know what works best for you, and you should be able to get the medication that works right for you.

Best of luck! I experience insomnia too, but 7.5mg of temazepam is just right for putting my ass to sleep for 5-7 hours and waking up refreshed in the morning.

 

[pstyles89]

Hey I completely understand your situation as I am also someone who suffers from insomnia(however mine is all the time unfortunately, not intermittent)

I've literally been on every sleep med available on the market it seems, some with little benefits but others that work wonderful. I find that benzos do not work effectively as sleep aids for me(including temazepam, although it is the best of the benzo sleep aids IMO). As stated before, hydroxyzine, which is an antihistamine, has been proven to help with short term issues, although personally it gave me all sorts of weird side effects. Following ill give you a list of different meds you can try out with your doctor.

1. Temazepam(works good for short periods, somewhat ideal for your situation)
2. Triazolam(I dont recommend it, but it works for some people)
3. Lunesta(Another drug that works well when used in small amounts, I had success for a few weeks before the sedative effects started diminishing)
4. Ambien(Another nonbenzo which works kinda like lunesta, I found this drug to be very impairing and only useful for short periods of time)
5. Trazadone(Somewhat like an antidepressant with anxiolytic effects, I know many people who have taken this for YEARS. IMO its either very effective or not at all)
6. Hydroxyzine(I stated above how I feel about this)
7. Serequel(My absolute dream sleep med. Took it for 2 years as an off label prescription from my doc, worked amazing. Unfortunately I developed bad RLS from continued use so I had to quit, but for anyone seeking a safe long term sleep med I will promote serequel all day)

Hope that helps. Many of the meds I listed were ineffective for me but could be completely different for you. Insomnia sucks so I hope you find something that works!

 

[debaser]

Did anybody try trimipramine, aka Surmontil? It's a tricyclic antidepressant, it's the most sedative of them, just before amitriptyline which is less sedating.

I was prescribed Surmontil for a solid 8 years before switching to Laroxyl (aka Elavil aka amitriptyline), for other reasons, but Surmontil is a real winner when you have to be put to sleep.
It's also used for withdrawal of alcohol and opiates, besides being a good antidepressant.

Anyway you could give it a try, assuming you're ok with tricyclics.

 

[ethnobot781]

It'll take a week or two to get a non-urgent appointment with a doctor I trust so I think I'll use the time (maybe at 4am when I've nothing better to do ) to make myself a list of bullet points to take to the appointment with me so I can run through how long I've had the problem for, the pattern it follows, how it affects me, why I stopped the meds and why I feel that something similar would be useful now. Then suggest agreeing a medicine and a dose and having it put on repeat at around 7 doses/month for an agreed number of months, to be reviewed at that time.

That should at least sound reasonable and thought-through and allow me to cover the basics fluently in the first half of a standard appointment, allowing the doctor to ask questions and make suggestions in the remainder, instead of my taking up a whole appointment block rambling through it all in a disorganised way and fluffing up what I meant to say.

Thanks for all the suggestions people, I'll look in to them between now and my next appt too.

 

[Captain.Heroin]

It'll take a week or two to get a non-urgent appointment with a doctor I trust so I think I'll use the time (maybe at 4am when I've nothing better to do ) to make myself a list of bullet points to take to the appointment with me so I can run through how long I've had the problem for, the pattern it follows, how it affects me, why I stopped the meds and why I feel that something similar would be useful now. Then suggest agreeing a medicine and a dose and having it put on repeat at around 7 doses/month for an agreed number of months, to be reviewed at that time.

That should at least sound reasonable and thought-through and allow me to cover the basics fluently in the first half of a standard appointment, allowing the doctor to ask questions and make suggestions in the remainder, instead of my taking up a whole appointment block rambling through it all in a disorganised way and fluffing up what I meant to say.

Thanks for all the suggestions people, I'll look in to them between now and my next appt too.

That's the best way to go about it. Some people might not bring up the set medication days and months because the doctor likes to do that part, but overall asking for what you know you need/etc, and stating why first, is a great way to go about it.

I am sure a doctor will hear you if you explain what your symptoms are like and what being without medication is like, etc.

 

[Nikolai]

There are also anti-depressant's that are prescribed sometimes to help sleep like Amitriptyline, thats another. I would ask about Lunesta, or maybe ambian. Needing only 10 or less per month doesnt seem that bad, but I dont really know much about those sleeping aids.