Posted by SLS on January 17, 2001, at 10:28:48
In reply to Re: options for sleep meds » stjames, posted by Ron Hill on January 15, 2001, at 18:23:12
> This thread is timely for my situation. I'm BP II and only recently hit upon a med combo that works well for me (300 mg b.i.d. Lithobid, 50 mg b.i.d. Wellbutrin, and 20 mg once per day Prozac). My one remaining issue is that I periodically have sleep disturbance problems.
>
> When the sleep problem presents itself, I have difficulty falling asleep and I wake about every three hours (i.e.; after two sleep cycles). After awakening, it is very hard for me to get back to sleep. Further, I suspect Prozac is adversely affecting my sleep architecture because I often do not feel fully refreshed after a nights rest.
>
> It is important that I find a solution to this problem because a lack of sleep pushes me into hypomania and the hypomania worsens the insomnia. Clearly, this snowball effect adversely affects my work productivity and quality of life.
>
> I invite any and all with an opinion to post your input to me regarding the approaches I should try in solving this problem. I have already implemented good sleep hygiene protocol. Further, natural OTC products such as kava kava, valerian root, and GABA sometimes work, but not always.
>
> Melatonin tablets (3 mg) help, but again, it is not always "powerful" enough. After reading a previous post on this thread, I plan to try sublingual melatonin. Is it ok to take melatonin three times each night (once at bedtime and once each time I wake during the night)? Will this multiple dosing technique allow me to get back to sleep in the middle of the night?
>
> After extensive research on the web, I have come up with the following list of possible solutions for my sleep problem. The list starts with what I consider the most likely best solution and continues rank ordered downward.
>
> 1. Add 7.5 mg Remeron prior to bedtime
> 2. Replace Prozac with about 15 to 30 mg Remeron
> 3. Add small amount Serzone prior to bedtime
> 4. Replace Prozac with adequate amount of Serzone
> 5. Add Sonata on as needed only basis, 10 mg at bedtime or, if necessary, 5 mg at bedtime and 5 mg in the middle of the night.
> 6. Add 10 mg Ambien at bedtime as needed
> 7. Increase amount of Lithobid or augment Lithobid with very slow upward titration of Lamictal.
>
> I value the time any and all of you spend responding with your opinion on this case. Thank you.
>
> -- Ron
>
> --------------------------------------------------
>
>
> > A small dose of a sedating AD, like Remeron, has worked well for me for 16 years. This avoids addictive sleep meds and one does not build tolerence.
> >
> > James
Thankfully, there are quite a few options. As has been mentioned, you can add one of the sedating antidepressants to be taken at bedtime. These would include Remeron (mirtazapine), Serzone (nefazodone), Desyrel (trazodone), Elavil (amitriptyline), and Sinequan (doxepin). Generally speaking, the dosages of these drugs that are effective to produce sleep are much lower than those used for depression. Another option is to use a longer-acting hypnotic such as Ambien or Ativan that will help you get to sleep and stay asleep..You have two aspects to your insomnia:
- Falling asleep
- Staying asleep
You can take one of the potent short-acting drugs to initially get you to sleep.
- Halcion (triazolam)
- Sonata (Zaleplon)
- Ambien (zolpidem)
- Imovane (zopiclone)To stay asleep, you can either use low dosages of one of the previously listed soporific antidepressants or a longer-acting hypnotic.
- Ativan ( lorazepam)
- Restoril (temazepam)
- Klonopin (clonazepam)
- Ambien (zolpidem)
- Dalmane (flurazepam)* With the exception of Restoril, each of these longer-acting drugs is capable of helping you get to sleep. You may want to try Ambien or Ativan first to see if they are also capable of getting you to sleep. I have had trouble staying asleep. I use Ativan. I try to take it every second or third day. It prevents me from becoming unacceptably sleep-deprived. It is my hope that this kind of dosing will help prevent tolerance and perhaps even entrain my sleeping pattern. This is only an experiment. I just started taking Ativan this past week. I’ll let you know how it goes.
Perhaps you can find a way of optimizing a single drug by discovering the best way to utilize melatonin. I think Dove had mentioned that it is not advisable to take melatonin beyond 3:00am. I think that is even too late based upon what I know about the natural course of melatonin secretion. I think you are better off not taking it any later than 1:00am
I used to have success with a Halcion / Ativan combination when I could not get to sleep at all for days. (Parnate + desipramine combination)
I would be curious to know what you decide. I have a hunch that your doctor already has a good idea as to how to handle the situation.
Good luck.
- Scott
poster:SLS
thread:51274
URL: http://www.dr-bob.org/babble/20010111/msgs/51859.html