Misc Sleep quality: gabapentin vs. baclofen vs. pregablin

[Hyperflux]

Which of the above three GABAergic drugs are best for increasing true sleep quality? I know that Xyrem (GHB) is the best but it's hard to get prescribed. Phenibut is a nice alternative for increased slow wave sleep which I use once a week. My sleep physician is willing to prescribe me one of the above but I want to do my research first.

 

[freesolo123]

Gabapentin dose nothing for me Pregabalin knocks me old cold, never took baclofen.

 

[aspiringchemist]

pregabalin is by far the most potent of the three and will likely create the most noticeable effect.

gabapentin will be similar to pregabalin in effect profile but is far less potent per mg and not as consistent in delivering effects.

baclofen is not a gabapentinoid though often gets lumped in with pregabalin, gabapentin, and phenibut. It's actually a gaba-b receptor agonist. I don't find it sedating at all in doses up to 50mg which is above the recommended amount for a single dose.

I imagine GHB is great at initiating sleep but due to its short duration of action could likely cause some severe rebound insomnia. I believe I've read accounts of people waking up when the effects of xyrem wear off.

I've been prescribed all 3 of these drugs and currently take baclofen for chronic musculoskeletal pain. For sleep I would choose pregabalin personally out of the 3 you mentioned. Though over pregabalin I would choose a z-drug (Zolpidem, eszoplicone etc) or a long acting benzodiazepine like diazepam or clonazepam.

 

[candidsurprise]

Both gabapentine and pregabalin are very good for improving the quality of sleep for me. Pregabalin is better at inducing sleep though. Phenibut is also great at improving the quality of my sleep but conversely makes it harder for me to get to sleep. Never tried baclofen. GHB in low doses is very poor at inducing sleep. In high doses is the best sleep inducer on earth. GHB negatively affects sleep quality though for me. Benzos are amazing at inducing sleep but affect sleep quality negatively. I found that ambien is slightly worse than benzos at inducing sleep, but doesn't affect sleep quality negatively. All the above mentioned drugs except benzos and ambien actually reduce the amount of sleep that I need. I have hypersomnia which means that my health is affected negatively unless I sleep 10-12 hours. GHB, phenibut, pregabalin and gabapentine reduce this to 8-10 hours.

By far the best sleep aid for me has been mirtazapine. For me mirtazapine was superior to trazodone. Seroquel is the most overrated for sleep in my experience, and in fact worsened my insomnia despite exacerbating fatigue. Mirtazapine actually made my sleep length worse though. That is the only bad thing I have to say about it.

 

[Lifee]

Baclofen or pregabalin all the way! It really just comes down to personal preference. IMO/IME I would go with the baclofen. It’s similar to phenibut but different. I think baclofen is a better choice as well because I’d say tolerance rises a lot slower with baclofen compared to pregabalin. YMMV!

 

[aihfl]

900mg of gabapentin used to knock me out pretty quickly but I've been on it for so many years it does nothing anymore. Tolerance to gabapentin is established pretty quickly. Baclofen did nothing. Never been on pregabalin since it's still under patent in the US and costs a left nut.

Seems kind of odd that your doctor gave you these three options. Sedating antidepressants like mirtazapine or trazodone, or Z-drugs like zolpidem or even benzos are more first-line sleep remedies IME.