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STENDEC

The Sleep Thread 😴

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From the abstract at least, this appears to be sort of a strange study....this was the study population:

 

patients with idiopathic (IH) and symptomatic (SH) hypersomnia plus sleepiness refractory to available stimulants (modafinil, methylphenidate, mazindol, sodium oxybate, and d-amphetamine)

 

and this was the dosing and duration:

 

A total of 78 patients with IH (n=65%, 78% women) and SH (n=13%, 54% women) received pitolisant 5-50 mg once per day over the course of five days to 37 months.

 

This is what is listed under adverse events in the prescribing information for Wakix,

 

In the placebo-controlled clinical trials conducted in patients with narcolepsy with or without cataplexy, the most common adverse reactions (occurring in ≥5% of patients and at twice the rate of placebo) with the use of WAKIX were insomnia (6%), nausea (6%), and anxiety (5%).

 

I'd tend to agree with you about modafanil being controlled....it's not physically addictive and doesn't produce euphoria so the only reason to schedule it is that people can "abuse" it to run themselves harder and this new drug has the same liability.

 

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I remember reading about Pitolisant for so long that I assumed they gave up on commercializing it. Interesting to see it finally hit the market.

 

Half-life is 10-12 hours. Slightly better than Modafinil, but that still leaves a lot of the drug in your system by the time you go to bed. I've always thought that the ideal wake-promoting drug would be something with a short half-life in an extended release formulation to form more of a plateau during the day.

 

Solriamfetol is another wake-promoting drug that was also approved this year: https://en.wikipedia.org/wiki/Solriamfetol It's a more typical norepinephrine and dopamine reuptake inhibitor

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I decided to move my phone charger to the other side of the bedroom. This accomplishes multiple things - it keeps me from looking at my phone while I'm in bed, and it forces me to get out of bed to turn the alarm off. I've been getting up consistently at 5:45 feeling pretty decent. Looking at my phone before going to sleep and hitting snooze over and over were both fucking me.

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I sometimes wake between 4 and 5 am on autopilot. I have to fight to get back to sleep, and then it requires the use of ear plugs and an eye mask to block the light. Any light will honestly get me up and moving.

 

I have pretty reliably been sleeping until 0600-0630. Sometimes by alarm, but mostly just waking up naturally.

 

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1 hour ago, STENDEC said:

How long has it been that way? I don't know how old you are but it seems like this started when I was about 40...

 

Ever since I was a little kid. I remember being 6 and wandering around the house keeping myself entertained at 5 in the morning until my parents woke up. 

 

It really made late nights out drinking in college a bear because no matter how late I was up or drunk I got I would be awake around 6:30-7 suffering from a hangover. I just can’t sleep in.

 

The silver lining to it is I am really productive during those hours with lots of energy and motivation. At least I’m not awake and tired at the same time. 

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Hard to tell exactly what it is (terrible webpage and I didn't want to watch the video of a boring doctor droning on about statistical analysis, also the easily-faked email wall is interesting, too). It's a headband of some kind? That's a cool approach. I think more work in the non-invasive paths to sleep need to be considered. The medical implant in your chest thing that shocks your throat thing...I'm sorry, medical devices don't have rigorous enough regulation for my taste.

 

We've been promised head-wearable devices to change our lives since the 60s...maybe Ian can contact them and Make Them Great Again!

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The Fisher Wallace stuff has been around for years in different forms. They're one part science, one part quackery, and one part aggressive marketing department. Now that we've all clicked that link, we'll be seeing Fisher Wallace ads for months.

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I'd just like to note for the record that triazolam (Halcion) is the best drug I have ever used for insomnia, bar none.

 

At 0.125mg it permits rather than induces sleep...I drift off like I've never had insomnia and my sleep for the next six hours is deep and refreshing and I wake up with no hangover....it is, of course, a benzo so is subject to all of the liabilities of that class of drugs but as a sleep aid, it is truly remarkable. 

 

I'd love to be able to take it every night but given the issues with tolerance and dependence that exist with this class of drugs, I will reserve it only for special circumstances.

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The brain's cerebrospinal fluid (CSF) pulses during deep sleep and this appears to be tied to brain wave activity and blood flow, an exploratory study showed.

Large oscillations of CSF inflow to the brain appeared about every 20 seconds and were tightly coupled to functional magnetic resonance imaging (fMRI) signals of blood flow and electroencephalogram (EEG) slow waves, reported Laura Lewis, PhD, of the Boston University College of Engineering, and co-authors, who described this activity for the first time in Science.

 

Full Article

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On 10/28/2019 at 3:32 PM, STENDEC said:

I'd just like to note for the record that triazolam (Halcion) is the best drug I have ever used for insomnia, bar none.

 

At 0.25mg it permits rather than induces sleep...I drift off like I've never had insomnia and my sleep for the next six hours is deep and refreshing and I wake up with no hangover....it is, of course, a benzo so is subject to all of the liabilities of that class of drugs but as a sleep aid, it is truly remarkable. 

 

Are you worried about using benzos for sleep? I've always thought benzos were best reserved as a temporary fix for a short-term problem.

 

Also, I'm surprised your doctor is willing to write that prescription. I've been prescribed some weird things in the past, but lately my doctors have been hesitant to even prescribe small quantities of Zolpidem.

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On the topic of anxiety and sleep: I finally got a buspirone prescription. I finally just asked my primary doctor straight up for a 30mg buspirone trial for GAD. He said he hadn't used it much since his days as an army doctor, mostly because it's just not a popular treatment in the SSRI era.

 

This was another shot in the dark because I don't have GAD per se. However, I do feel vaguely anxious starting around 8-9PM at night and very anxious when I wake up in the middle of the night. My hope was that buspirone was the most benign option for putting a damper on that anxiety.

 

So far, mixed reviews. 30mg/day in two divided doses feels like too much. My mood flatlines during the day and it's difficult to get work done. I'm scaling back to 15mg/day for a while.

 

After 3 weeks, I will say that it does work for anxiety. I still wake up in the middle of the night, but it's much easier to fall back asleep. If I can get the side effects under control this might be a winner for 3-6 months at least.

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Slow Wave Sleep reduces anxiety

"Deep sleep had restored the brain's prefrontal mechanism that regulates our emotions, lowering emotional and physiological reactivity and preventing the escalation of anxiety,"

On a societal level, “the findings suggest that the decimation of sleep throughout most industrialized nations and the marked escalation in anxiety disorders in these same countries is perhaps not coincidental, but causally related,” Walker said. “The best bridge between despair and hope is a good night of sleep.

https://news.berkeley.edu/2019/11/04/deep-sleep-can-rewire-the-anxious-brain/

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Trazodone interferes with SSRI anti-depressant response:

 

https://www.ncbi.nlm.nih.gov/pubmed/29056986

Quote

In keeping with previous research, we found that trazodone exposure was associated with treatment non-response in adolescents taking SRIs. The findings should be interpreted cautiously since they are limited by small sample size. Future randomized controlled trials of trazodone in samples of adolescents taking SRIs for depression are warranted.

 

https://www.ncbi.nlm.nih.gov/pubmed/22251024

Quote

RESULTS:

Youth who received trazodone were six times less likely to respond than those with no sleep medication (adjusted odds ratio [OR]=0.16, 95% confidence interval [CI]: 0.05-0.50, p=0.001) and were three times more likely to experience self-harm (OR=3.0, 95% CI: 1.1-7.9, p=0.03), even after adjusting for baseline differences associated with trazodone use. None (0/13) of those cotreated with trazodone and either paroxetine or fluoxetine responded. In contrast, those treated with other sleep medications had similar rates of response (60.0% vs. 50.4%, χ(2)=0.85, p=0.36) and of self-harm events (OR=0.5, 95% CI: 0.1-2.6, p=0.53) as those who received no sleep medication.

 

I don't know if this is relevant for those of us who aren't taking SSRIs, but it's worth noting.

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