Jump to content
STENDEC

The Sleep Thread 😴

Recommended Posts

Until last fall, I never had much trouble sleeping aside from the fact that since my early 30's I've rarely be able to sleep past 5AM regardless of when I went to bed.

 

After Labor Day, I developed some bad insomnia and anxiety (not sure which caused which) Trying to fall asleep became a torturous exercise where I would doze off and then suddenly jerk back awake...like falling asleep behind the wheel of a car...and this would happen over and over for most of the night.

 

After sort of trying to will it away for a couple of weeks and trying varying doses of melatonin and doxyalamine and diphenhydramine, I made an appointment to see my GP and he Rx'd  temazepam and zaleplon which worked pretty well but didn't seem like a tenable long-term solution especially because he'd only scripted 30 temazepam. I was also experimenting with etizolam because I knew I could get more of it but most of the information I had said this was no better than a benzo in terms of dependence and tolerance.

 

So I made an appointment with a psychiatrist who was really great to work with. He started me on buspirone and hydroxyzine twice a day and at that point, it worked great for my overall anxiety and did improve my sleep some but the hyperarousal was still an issue. I also tried trazodone and doxepin on top of the other drugs for sleeping without much success. I also started reading everything I could find on insomnia and started CBT twice a week.

 

Gradually, I was able to get a better handle on things and after six weeks, the buspirone seemed to have really kicked in and  maybe the CBT was also helping and I was no longer feeling generally anxious. The hydroxyzine made me voraciously hungry all the time and I gained almost 20lbs between Thanksgiving and Christmas so I eventually weaned myself off that and continued with the zaleplon for sleep and restarted the etizolam at night. I was only taking 0.5mg of etizolam but 10-20mg of zaleplon each night and was surprised to find that I didn't develop tolerance to either over time nor did I feel chemically dependent on them although it was still difficult to sleep without them.

 

Fast forward to February and I decided to try the hydroxyzine again just for sleep but now, my overall state was a lot calmer and a single 50mg dose before bed had me feeling like a zombie for the whole next day...my norepinepherine levels must have been off the chart back in the fall as I was able to take 50mg twice a day and still feel basically "normal" and still have trouble sleeping without some additional drugs.

 

So hydroxyzine was out and my bedtime routine was to take 0.5mg of etizolam about an hour before going to bed and then 10mg of zaleplon right when I was going to bed....this fairly consistently resulted in me falling asleep within 30m and staying asleep most of the night with 15-25% of total sleep time in "deep sleep" stage. Although it is easy to come by and seemed to be working without creating tolerance, I still wasn't thrilled with the idea of continuous benzo analog use. So I decided to retry trazodone and was pretty thrilled with it this time...50mg produced some of the best sleep I've had in months...many vivid dreams and, according to my fitness tracker, 40-60% of my sleep is "deep sleep" and I am still waking up around 5am but I feel really well rested.

 

I've eliminated the etizolam completely and my next move is to start backing off on the zaleplon and see if I can fall asleep without it.

 

 

 

 

Share this post


Link to post
Share on other sites

Melatonin is great for getting to sleep, but it tends to contribute to daytime sleepiness, and it works so fast that if I take it before bedtime, there's not intimate time, so it needs to be timed well to not interfere with life!

Share this post


Link to post
Share on other sites

It makes me acutely sleepy for about 15 minutes 30-40 minutes after I take it but otherwise, it just makes me feel good. In some clinical studies, it stacks up pretty good against benzos without some of their liabilities.

 

I was on 30mg BID but since I've been using trazodone regularly for sleep, I've backed down to 15mg in the morning and 30mg before bed.

Share this post


Link to post
Share on other sites

One of the things I've  recently discovered disturbs my sleep is alcohol...I had always assumed it was a depressant but apparently, its also a pretty potent cardiac stimulant. So much for the nightcap....

 

Drinking alcohol makes your heart race
More research needed to see if higher heart rate increases risk of heart rhythm disorder
March 19, 2018

The more alcohol you drink, the higher your heart rate gets, according to research presented today at EHRA 2018 Congress, organized by the European Society of Cardiology.

 

Binge drinking has been linked with atrial fibrillation, a phenomenon called "the holiday heart syndrome." The connection was initially based on small studies and anecdotal evidence from the late 1970s. The Munich Beer Related Electrocardiogram Workup (MunichBREW) study was conducted by researchers from the LMU University Hospital Munich Department of Cardiology, supported by the German Cardiovascular Research Centre (DZHK) and the European Commission. It was the first assessment of the acute effects of alcohol on electrocardiogram (ECG) readings. The study included more than 3,000 people attending the 2015 Munich Oktoberfest. ECG readings were taken and breath alcohol concentrations were measured. Age, sex, heart disease, heart medications, and smoking status were recorded. Participants were, on average, 35 years old and 30% were women. The average breath alcohol concentration was 0.85 g/kg. Increasing breath alcohol concentration was significantly associated with sinus tachycardia of more than 100 beats per minute in 25.9% of the cohort.

 

The current analysis of the MunichBREW study looked in more detail at the quantitative ECG measurements in 3,012 participants. The researchers investigated the association between blood alcohol concentration and four ECG parameters: excitation (heart rate), conduction (PR interval, QRS complex), and repolarisation (QT interval). Increased heart rate was associated with higher breath alcohol concentration, confirming the initial results of the MunichBREW study. The association was linear, with no threshold. Alcohol consumption had no effect on the other three parameters.

 

"The more alcohol you drink, the higher your heart rate gets," said Dr Stefan Brunner, a cardiologist at the University Hospital Munich, Munich, Germany, who is one of the lead authors. The researchers are currently investigating whether the increase in heart rate with alcohol consumption could lead to heart rhythm disorders in the longer-term.

 

Dr Moritz Sinner, another lead author, said: "We cannot yet conclude that a higher heart rate induced by alcohol is harmful. But people with heart conditions already have a higher heart rate, which in many cases triggers arrhythmias, including atrial fibrillation. So it is plausible that the higher heart rate following alcohol consumption could lead to arrhythmias." He added, "Most people in our study were young and healthy. If we conducted the same study in older people or heart patients we might have found an association between drinking alcohol and arrhythmias."

 

The authors speculated that alcohol creates an imbalance between the sympathetic (fight or flight) and parasympathetic (rest and digest) nervous systems. They are currently investigating how it does this.


 

Share this post


Link to post
Share on other sites

All of the suggestions for improving sleep that I've read/heard say to not drink before bed, so that makes sense.

 

I had to switch from Zyrtec to Allegra recently, and I've noticed poorer quality in sleep.

Share this post


Link to post
Share on other sites
1 hour ago, Kimbo said:

I had to switch from Zyrtec to Allegra recently, and I've noticed poorer quality in sleep.

 

Not entirely surprising. Zyrtec is cetirizine which is the major metabolite of hydroxyzine and is sedating enough to be prohibited for pilots to use before flight.

Share this post


Link to post
Share on other sites
20 minutes ago, Emperor G_D said:

My heart is acutely affected by alcohol. Even a single drink will do it.

 

I've noticed this as well. In fact I think my sleep initially got run off the rails by going to bed drunk and my pulse got elevated enough that it woke me up in a panic.

Share this post


Link to post
Share on other sites
2 hours ago, Something Anonymous said:

It’s a shame GHB is so tightly scheduled; that’s something I would really like to try. 

 

Xyrem, the prescription version of GHB, is the poster child for distorted drug pricing. Last time I looked, Xyrem was in the range of $10,000 per month at the doses used in narcolepsy treatment. I doubt anyone is actually paying $10K per month for their Xyrem, of course. Really, it's just a game to extract the maximum amount of money from insurance companies as possible.

 

Jazz Pharmaceuticals even has a dedicated program to reimburse patients for their out-of-pocket expenses related to Xyrem, including co-pays and plan deductibles. Their goal is to make the out-of-pocket costs as minimal as possible so they bill the insurers whatever they want. Quite the racket. I expect insurance companies have developed some extremely rigorous procedures to get Xyrem pre-authorized.

 

After reading some narcolepsy forums, Xyrem seems somewhat hit or miss. Some people with cataplexy rave about it. Others complain about the inevitable side effects. I don't think I'd want to go near it except as a last resort for narcolepsy treatment.

 

Vice had a so-so interview with a narcolepsy patient about his Xyrem use: https://www.vice.com/en_us/article/xd7k8n/i-take-nine-grams-of-ghb-every-night-to-treat-my-narcolepsy-882 They reach a bit at the end with the dark web connections as Vice tends to do, but it's an interesting anecdote from the guy taking the Xyrem.

Share this post


Link to post
Share on other sites

Great post, @STENDEC. Thanks for sharing.

 

I'm surprised your GP skipped straight to benzos rather than trying good old Ambien CR or even regular Ambien first. Temazepam has a relatively long half-life. I'd be concerned about next-day sedation.

 

Do you notice any negative effects of the buspirone? Any diminished attention span or reduced workout drive?

 

I've always been interested in buspirone as a lightweight anxiety damper with minimal side effects, but I've never been able to try it. I've asked to separate doctors in the past decade about buspirone, and both of them were quite negative about it. They didn't seem to think it did much of anything. My low-grade anxiety has never been bad enough to warrant SSRIs, and certainly not benzos, but I've always wondered if low-dose buspirone could possibly be a net win.

Share this post


Link to post
Share on other sites

I think it was the associated anxiety that led him to try Restoril. And it does work pretty well for sleep purposes at least for me as does my wife's Ativan. 😉

 

The psychiatrist I saw next is not a fan of Ambien and was only going to go there as a last resort. He was also reluctant to go straight to an SSRI which I appreciated.

 

As for the Buspar, from my perspective, it is a great drug. I notice essentially no unwanted effects from it even at the max dosing. No sexual side effects, no increased appetite, no loss of drive or emotional numbness....it actually reminds me of how I felt on bupropion minus the stimulatory effects. It's also cheap as dirt. I think one of the reasons it gets dismissed is that it doesn't work well in people who have already been on benzos for anxiety, I think because it doesn't interact with the GABA receptors at all. So if you been using Xanax for your GAD, switching to Buspar is not going to give you the same feeling. It also takes weeks to really start working...almost a month in my case.

 

The other drug I am pretty pleased with is trazodone. 50mg before bed and my sleep quality is great, I have lots of very cool, vivid dreams and no sedation the day after.

 

 

 

 

Share this post


Link to post
Share on other sites
9 hours ago, Something Anonymous said:

It’s a shame GHB is so tightly scheduled; that’s something I would really like to try. 

 

Baclofen (β-(4-chlorophenyl)-GABA) is a closely related and yet unscheduled drug...I've wondered how it might work for insomnia.

Share this post


Link to post
Share on other sites
4 hours ago, STENDEC said:

 

Baclofen (β-(4-chlorophenyl)-GABA) is a closely related and yet unscheduled drug...I've wondered how it might work for insomnia.

 

Interesting. I didn't notice any positive or negative changes when I used baclofen, though I wasn't looking for any, either.

Share this post


Link to post
Share on other sites

Stendec, when you've taken melatonin the past, 1) was it taken on an empty stomach 30-60 min before target sleep time/bed? and 2) have you tried different brands of it?  I've been dependent on melatonin for sleep each night for almost 15 years and one thing I can tell you is that on the label claimed mg-normalized basis, all brands are not equal.

 

For example, to me all of the gummy versions (even the cheap store/generic brands) and the expensive tablet versions have equal potency/efficacy but the cheap tablet versions are far less effective, some to the point where I'm suspicious that they contain any melatonin at all.  I don't know the reason for this but if you've only tried one brand and didn't reap much benefit or notice a strong effect, I'd suggest trying the gummies.

Share this post


Link to post
Share on other sites

I was using a big dose for a while...10mg and it worked pretty well for sleep maintenance. But I got suspicious that it was starting to create the conditions for sleep paralysis...the whole thread is here.

 

Anything less than 10mg doesn't seem to do much at all for me but I've never tried gummy versions.

 

 

Share this post


Link to post
Share on other sites
On 4/2/2019 at 8:28 PM, nightop said:

I'd suggest trying the gummies.

 

Coming from anyone but you, I would have been more inclined to discount this but now you have my curiosity piqued....I shall try a gummy version.

Share this post


Link to post
Share on other sites
57 minutes ago, STENDEC said:

 

Coming from anyone but you, I would have been more inclined to discount this but now you have my curiosity piqued....I shall try a gummy version.

Well, don't get your hopes up too much -- you may be a true non-responder, but if you get the gummies, I would take 5 mg on empty stomach (chewed not swallowed..) first to see if you notice anything and then if not, move up to 10 or 15 mg on empty stomach on a subsequent night.  Again, even the generic brands of gummies are good from my experience.

 

EDIT:  Another interesting sleep supplement is l-theanine.  I recall a long discussion on it and ALCAR on the AL/M&M forums with virtualcyber (if my memory serves me still) if you can find it somehow.  That plus magnesium and melatonin can be really fun for lucid dream stuff IME.

Share this post


Link to post
Share on other sites

I have had good luck with the gummies. I seem to only need half a gummy (2.5mg) to notice effects. 5mg makes me too groggy the next day.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

×
×
  • Create New...