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Ideas for rotating sleep meds

Discussion in 'General Treatment' started by CBS64, Jan 11, 2013.

  1. CBS64

    CBS64

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    I just started taking sleep meds due to severe insomnia from a concussion (I also have CFS) and would like to rotate them so my body doesn't get addicted and I don't have withdrawal symptoms when I stop. I'm looking for ideas for drugs I can use to do this. I can't take Sonata or Ambien, as they give me tinnitus. And I can't take Rozeram because I have an autoimmune condition. I just started Klonopin (this week) with Doxepin and also have been taking Restoril with Doxepin. But the Doxepin makes me feel really groggy the next day. I tried Trazadone this week, which didn't help me fall asleep but I could take it with the Restoril to prolong sleep (Restoril alone will help me fall asleep, but I wake up an hour later). My doc said if I'm going to rotate, take the Klonopin 2 nights and then the Restoril the 3rd night (not sure why - I think he thinks the Klonopin may help with the post-concussion symptoms). Does anyone have any other ideas as to another sleep med I could take so that I'm at least rotating 3 of them? Something that initiates sleep or prolongs sleep. I'd love to find one that isn't a benzo, like Restoril and Klonopin.

    Thanks!
  2. Sushi

    Sushi Moderator and Senior Member Albuquerque

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    Just a thought about this: Seems like you would have to consider the half-lives of these drugs so as not to be unintentionally mixing drugs. For instance, klonopin has a long half-life.

    Sushi
  3. Jenny

    Jenny Senior Member

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    I've found Zopiclone to be very helpful.

    Jenny
  4. adreno

    adreno 3% neanderthal

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    Gabapentin.

    Glycine, though not a drug, helps greatly with sleep.

    What dose of doxepin did you use?

    Amitriptyline (10mg) gave me the most blissful sleep of my entire life. Unfortunately, I couldn't tolerate the side effects.
  5. taniaaust1

    taniaaust1 Senior Member

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    Funny how drugs work completely different for all of us .. Amitriptyline worked nil on my sleep and gave me a severe side effect which lasted up till 5mths after I stopped it (nearly required me to have surgery as it stopped my bowel peristalisis from working and caused my bowel to be damaged).

    Doxepin.. didnt help my sleep at all

    Klonopin didnt help my sleep either... but was helpful to my constant anxiety of that time and stimulated nervous system.

    You dont mention trialing Melatonin.. this can be useful to get to sleep up to 2 hrs earlier IF someone has circardian rhythm issues which many of us with ME/CFS do. In my case I need 3mg taken 45mins before bed (and I found slow release in my case didnt help thou some others find it the other way around). I've used this alone and at other times use it with other of my sleep things.

    You could also try anti-histamines.. they help many for sleep who have ME/CFS (im not sure thou if they use similar receptors as the benzo drugs .. I think they are a Z drug???, so I cycled from both these at times except a constant small Klonopin dose I was taking for a while daily which wasnt for sleep). I had no issues with being on a low dose of klonopin long term daily and coming straight off it it but some do.

    The over the counter anti-histamine I buy is Doxylamine Succinate http://en.wikipedia.org/wiki/Doxylamine_succinate ...its sold in 25mg pills but I found a quarter of a pill was enough for a while. Take care with these as with these too body can build up intollerance requiring a raised dose..so I suggest this is another thing to use cycled (I'll use it only 2-3 times per week). Ive was cycling these for about 8mths and built up tollerance once or twice (after I took them at night for several weeks daily, I had no issues with tollerance if I took them only 2-3 times per week). When I did build up tollerance from daily use, I then went up to half or 3/4 of a pill so didnt reach the standard dose one buys them in anyway... just went super careful with them so it wouldnt happen again.

    In my case taking in combination Doxylamine Succinate and the melatonin taken together is equal to the good sleep effects the Temazepam has on me. (even when the melatonin wasnt working by itself.. it would help the Doxylamine Succinate to work stronger). Maybe you could try something like that if the Temazepam is leaving you drowsy next day. (I dont know which drug thou has a longer half life.. going for the ones with the shorter half lives should leave you less drowsy the next day). Also maybe try taking them a bit earlier if they do that to you.

    The other I take for sleep isTemazepam which I can see is called Restoril where you are ...(where as Klonopin didnt work for me for sleep..the benzo Temazepam does). This too is very easy to develop tollerances to and I did and had to raise my dose at one point (just taking it several times per week is enough to build up a tollerance so best only once or twice a week at the most.. not taking it two days straight). If its making you wake up feeling sedated.. maybe you could try it at a lower dose? . I suggest to always try these drugs at the lowest dose possible eg starting at quarter of a pill. Dont unneccessaryily take more then what helps.

    I know some CFS specialists include the herb Valerian in their mix of sleep things they get patients to take (I think Dr Sarah Myhill suggests that to some of her patients). In my case Valerian dont work for me at all.

    I never got my sleep drug cycling quite right and still thought I could of done with another drug in the mix as I didnt want to be taking the anti-histamine and melatonin (3 times per week) or the Temazepam (Restoril) (1-2 per week, thou I tried to avoid taking twice per week) . So had 2 days per week where I'd break from either of these and just took the melatonin by itself so didnt sleep as well then thou it helped "slightly". So I was still looking for another thing to add to the mix hence me trialing more things at that point but finding they failed in my case.

    One thing which helped was completely boarding up with wood board my bedroom windows so I could sleep in better (as the slightest light in the room stopped me from sleeping well.. the time displays on electric clocks will affect my sleep, I need a pitch black room) and I also discovered that the electric blacket.. if I slept with it on.. that affected my sleep worst too. So watch out for possible EMF things or any kind of light playing a a part in sleep issues.

    But anyway.. what I was doing got me throu the very severe insomina I had (I had 3 different sleep issues going on at once) and fortunately right after cycling my sleep stuff for a while and not developing any more tollerances once I was doing that cycling .. my sleep issues have actually stopped to a point that thou I still get to bed very late (between 12-3am which is very good for me as that's only mild insomina).. so I feel like I dont need them anymore so currently arent taking anything for sleep but always have them on hand just in case (or in case I need to get up early in the morning and hence take something).

    Best luck
  6. CBS64

    CBS64

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    I think Zoplicone is in the same drug class as Sonata and Ambien, which both caused tinnitus, so I probably wouldn't be able to take it. Thanks anyway for the idea.
  7. CBS64

    CBS64

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    I hadn't thought of that, but it's a very good point. Will check with my doc about this. Thanks
  8. taniaaust1

    taniaaust1 Senior Member

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    If you are rotating to avoid tollerance build ups.. I dont understand how switching between Klonopin and restoril (Temazepam) would help as they both are normal Benzo drugs so still hitting the same receptors so they arent getting a break. (I think the dose of Klonopin can be quite important too as usually the smaller doses dont carry the same kind of risk as the higher doses do). A "Z" drug thou it hits the same receptors may be slightly better thou still carries risk.

    Wikipedia has info on drug half lives and easy to look things like that up if you want to check to see how long a drug stays in your system compared to another drug. Half life is the the time it takes for the half the drug to be out your system... one half life you have 50% of the drug still.
  9. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    zopiclone is similar to lunesta but still worth a try even if other Z drugs werent for u as its slightly different. If u can i think its good to have a few night a week where u dont take a benzo but somethingelse.

    what dose of doxepin do u use, some find 10mg more then enough?

    Trazadone i find doesnt put me to sleep but when used with a low dose benzo greatly improves sleep.

    I think u will find some meds dont really help with falling asleep but can help sleep mainteneance, this is where u could maybe add melatonin, but mostly i have found i need a low dose of a benzo to initiate sleep?

    Other meds worth looking into are different antihistamine, diphenhydramine, phenergan and doxylamine, periactin, atarax. Amitriptyline has been mentioned, mirtazapine. If using antidepressants in low doses for sleep it should be ok to alternate nightly or every few nights as being a low dose interactions shouldnt occur but worth talking to doc about it. Lyrica and neurontin are worth looking into as well and also help with pain. Baclofen is another med i have found useful for sleep but again i have to use it with something else but it greatly improves sleep quality.

    Its trial and error as to what works and some u will find are better in a combination. I usually take a low dose zopiclone or zolpidem with 1 of the antihistamines and neurontin. I mainly use neurontin for leg pains so its a nightly med for me. The next night i may use a low dose valium and trazadone, neurontin. I will alternate these 2 combo's for a few nights and then alternate the antihistamines for one combo and alternate the antidepressants for the other night. I may swap zopiclone and zolpidem around too.

    Natural stuff i also use for sleep tryptophan in doses of say 3000mg, with active vit b6 called p5p, but would take this if using an antidepressant(serontonin syndrome). Phosphatidyleserine(PS) at 500mg helps with high night time cortisol and something that has really improved my sleep quality the last few months. occassionally i will use melatonin but doesnt seem as helpful as tryptophan for me. I use natural stuff nightly too, mostly the PS, the other stuff i use for a few nights and then take a break.

    Trying to treat adrenal hormones and getting the right cortisol rhthym i find helpful as well which is what PS has helped me with. worth getting a 4 times a day saliva test of cortisol for this too.

    Above is what i have found helpful, i hope u get something sorted for you. I think you are doing the right thing by alternating sleep meds. if u find a benzo stops working dont increase the dose just stop taking it for awhile and maybe substitute it with another med, always try to keep doses low, so if a time comes u want to get off them then it should be an easier process.

    good luck,
    cheers!!
  10. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    agree with Tania, if u try zopiclone/lunesta it should be better to alternate with, even though it works on gaba receptors its suppose to work on them differently to traditional benzo's. Baclofen is a muscle relaxer and works on gaba B receptors where other benzo's work on gaba A, also said to be less tolerance issues etc with gaba B receptor meds. U may find a combo of things i listed without a benzo will help u to sleep that u can use a few nights a week which will help any tolerence. But as much as its mentioned that benzo's worsen sleep architect, for some reason i still think they give better sleep then any one med, maybe its because of our cfs/me brains?? Maybe their calming affect helps us through the next day too??
  11. taniaaust1

    taniaaust1 Senior Member

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    I had another thought of a drug from a different drug class which hasnt been mentioned, thou it would all depend on your symptoms if this would be also a good thing to trial for sleep or not is Clonidine. I noticed the other day when I was reading some other things its used for, that its being used off label for insomina in some. as it has a bit of a sedative effect. A quote on this drug from Wikipedia
    http://en.wikipedia.org/wiki/Clonidine

    Sleep hyperhidrosis is night sweats.

    Clonidine is sometimes used for those who have the hyperadrenalic kind of POTS as it lowers adrenaline (so hence also can help anxiety caused by that as well as help those of us who get adrenaline rushes. I used to get like adrenaline rushes which would wake me up at night) and can work as a BP balancing drug too (for those of us who's BP is unstable and swinging.. going both high and low eg mine was swing between 170/137 when standing and 89/60 when im laying.. this drug balances BP).

    I dont think thou I'd recommend to trial this if you have "only" low BP (thou it hasnt affected the low side of my BP much) but anyway I just wanted to point out that this drug too can be helpful for insomina in some (along with helping some other ME symptoms too) if taken before bed. From other ME/CFS patients comments Ive come across in the past.. it seems that one will like this drug or really hate it due to getting side effects (I dont get any side effects from it Interestingly thou it can treat insomina.. it can also have the side effect of insomina in some).

    Ive never tried it for sleep so far as I take my dose (of half a pill) for my POTS and high noradrenaline in the morning but will change it to night to see if that works on my insomina if it goes bad again.
    Lotus97 likes this.
  12. CBS64

    CBS64

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    I wondered about whether rotating them would work since they are both benzos. I will ask my doc again specifically about this. That's why I'd rather take a non-benzo too. I tried Lunesta last year (part of a pill) and it gave me disturbing side effects and didn't help me sleep, so I'm leary about trying it again now, since my brain is still healing from the concussion. I live in the US, so can't buy Zopiclone, but it sounds like it's just another name for Lunesta, right?
  13. CBS64

    CBS64

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    I live in the U.S., so I don't think I can buy Zopiclone here. Does anyone else know if it's possible?

    [/quote]what dose of doxepin do u use, some find 10mg more then enough?[/quote]

    I was taking part of a Doxepin capsule, but just tried the liquid form last night (3 drops or 3mg) and have much less grogginess today. I took it with .5mg of clonezepam. I feel some grogginess from the clonezepam, but maybe this gets better the longer you take it (this is only the 2nd time I've taken it). The downside is that I didn't feel like I got deep enough sleep and I only slept for 6 hours. Is it common with this drug combination to not get deep sleep? Also, the tinnitus started up again shortly after taking the meds last night. It wasn't as loud as it was before when I took Sonata and Ambien, but I'm concerned it could get worse. It's not bad right now.

    [/quote]Trazadone i find doesnt put me to sleep but when used with a low dose benzo greatly improves sleep.[/quote]

    Which benzo do you take the Trazadone with? I have a bottle and was thinking about trying it with the Restoril or the Clonezepam to see if I could get deeper sleep, but I didn't know how well those drugs would combine. I've heard the clonezepam is supposed to be very synergistic with Doxepin, but haven't heard about how well it works with other sleep prolongers.

    [/quote] I think u will find some meds dont really help with falling asleep but can help sleep mainteneance, this is where u could maybe add melatonin, but mostly i have found i need a low dose of a benzo to initiate sleep?[/quote]

    Unfortunately, I can't take melatonin due to the autoimmune condition (which is separate from the CFS). But it seems that I definitely need something to initiate sleep and something else to prolong it.

    [/quote]Other meds worth looking into are different antihistamine, diphenhydramine, phenergan and doxylamine, periactin, atarax.[/quote]

    I have tried diphenhydramine/Benadryl, but it didn't help me sleep. Do you think doxylamine or phenergan would work any better than Doxepin at prolonging sleep or with help going into deep sleep?

    Amitriptyline is on the list of drugs that can cause tinnitus, so I'd prefer to avoid that one.

    [/quote] If using antidepressants in low doses for sleep it should be ok to alternate nightly or every few nights as being a low dose interactions shouldnt occur but worth talking to doc about it. [/quote]

    Yes, I wondered about whether it was a good idea to alternate Doxepin and Trazedone, since they are both anti-depressants.

    [/quote] Natural stuff i also use for sleep tryptophan in doses of say 3000mg, with active vit b6 called p5p, but would take this if using an antidepressant(serontonin syndrome). Phosphatidyleserine(PS) at 500mg helps with high night time cortisol and something that has really improved my sleep quality the last few months. [/quote]

    I tried the Phos Serine, but it didn't work for me. Unfortunately, I can't tolerate the tryptophan
  14. CBS64

    CBS64

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    Is Gabapentin similar to clonazepam/klonopin, but just not a benzo? The SHINE protocol lists Gabitril under sleep aids. Is this similar to Gabepentin?

    I've been trying glycine, but it doesn't help at night. Sometimes when I take it in the morning it helps me go back to sleep, but only some of the time.
  15. adreno

    adreno 3% neanderthal

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    No, gabapentin doesn't target GABA receptors like benzo's and Z drugs. It's name is a bit misleading. It inhibits calcium channels, thereby inhibiting neuronal activity.
    taniaaust1 and heapsreal like this.
  16. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    same with lyrica which i find abit more sedating then gabapentine.
  17. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    what dose of doxepin do u use, some find 10mg more then enough?[/quote]

    I was taking part of a Doxepin capsule, but just tried the liquid form last night (3 drops or 3mg) and have much less grogginess today. I took it with .5mg of clonezepam. I feel some grogginess from the clonezepam, but maybe this gets better the longer you take it (this is only the 2nd time I've taken it). The downside is that I didn't feel like I got deep enough sleep and I only slept for 6 hours. Is it common with this drug combination to not get deep sleep? Also, the tinnitus started up again shortly after taking the meds last night. It wasn't as loud as it was before when I took Sonata and Ambien, but I'm concerned it could get worse. It's not bad right now.

    [/quote]Trazadone i find doesnt put me to sleep but when used with a low dose benzo greatly improves sleep.[/quote]

    Which benzo do you take the Trazadone with? I have a bottle and was thinking about trying it with the Restoril or the Clonezepam to see if I could get deeper sleep, but I didn't know how well those drugs would combine. I've heard the clonezepam is supposed to be very synergistic with Doxepin, but haven't heard about how well it works with other sleep prolongers.

    [/quote] I think u will find some meds dont really help with falling asleep but can help sleep mainteneance, this is where u could maybe add melatonin, but mostly i have found i need a low dose of a benzo to initiate sleep?[/quote]

    Unfortunately, I can't take melatonin due to the autoimmune condition (which is separate from the CFS). But it seems that I definitely need something to initiate sleep and something else to prolong it.

    [/quote]Other meds worth looking into are different antihistamine, diphenhydramine, phenergan and doxylamine, periactin, atarax.[/quote]

    I have tried diphenhydramine/Benadryl, but it didn't help me sleep. Do you think doxylamine or phenergan would work any better than Doxepin at prolonging sleep or with help going into deep sleep?

    Amitriptyline is on the list of drugs that can cause tinnitus, so I'd prefer to avoid that one.

    [/quote] If using antidepressants in low doses for sleep it should be ok to alternate nightly or every few nights as being a low dose interactions shouldnt occur but worth talking to doc about it. [/quote]

    Yes, I wondered about whether it was a good idea to alternate Doxepin and Trazedone, since they are both anti-depressants.

    [/quote] Natural stuff i also use for sleep tryptophan in doses of say 3000mg, with active vit b6 called p5p, but would take this if using an antidepressant(serontonin syndrome). Phosphatidyleserine(PS) at 500mg helps with high night time cortisol and something that has really improved my sleep quality the last few months. [/quote]

    I tried the Phos Serine, but it didn't work for me. Unfortunately, I can't tolerate the tryptophan[/quote]

    Zopiclone i dont think u can get in america but lunesta is very similar.

    Besides z drugs the only benzo i use is valium and very occassionally mogadon.

    Antihistamines doxylamine i think is one of the most sedating but tolerance does occur quickly with these things. diphenhydramine i find on its own doesnt put me to sleep but helps deep sleep when i use it with a z-drug or benzo.
    Phos serine is another thing that own its own doesnt seem to do alot but combined with a sl;eep med increases sleep quality.

    Some of the muscle relaxers may help, baclofen? i find again i need to use with another med but some find on its own puts them to sleep. another is tinazadine(spelling?) which can help initiate sleep?
  18. CBS64

    CBS64

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    Update: I've been taking Clonazepam (.5mg) and liquid Doxepin (3mg) with magnesium glycinate (200mg) everynight. I gave up on the idea of rotating it with Restoril because they are both benzos and I learned that Clonazepam has a half-life of up to 50 hours, so it would stay in my system for days anyway. Also, I would only sleep an hour with the Restoril+ Doxepin combination and have to take more Restoril to go back to sleep.

    I'm getting about 6 to 61/2 hours/night with the Clonazepam/Doxepin/Mag and I wake up once or twice during the night. I'm feeling some grogginess during the day, which I'm hoping will get better the longer I take it. Any thoughts on this?

    But I'm very concerned about my body getting addicted and having withdrawal symptoms and rebound insomnia when I try to get off it. Because I'm trying to heal my brain from the concussion, the most important thing I need now is sleep, so that means I have to take something and can't go off it for a few days at a time until it clears out of my system. Does anyone know how long you have to take clonazepam before the body starts to get addicted to it?
  19. Shoesies

    Shoesies Senior Member

    CBS64, I do not know how long you have to be on a benzo before addiction. I took one xanax at bedtime for two weeks, had severe withdawal symptoms and am tapering off. Ambien prescribed two weeks ago...now have read a bit that it is very like a benzo...tapering off that. I suppose I will have to find the underlying cause of the insomnia. Naturopath says he has herbals that will help. Will give it a shot. Please be cautious about tapering off these meds. Wishing you improved sleep.
  20. Lotus97

    Lotus97 Senior Member

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    With Trazadone it depends on which generic brand you're taking. PLIVA/Teva USA is completely worthless. Apotex is supposed to be good. Right now I'm taking Elavil/Amitriptyline 75 mg and Zyprexa 2.5 mg. I didn't really have too much problems with Elavil although some people gain weight on it. Zyprexa I wouldn't recommend to anyone unless as a last resort. Side effects of Zyprexa include weight gain, high cholesterol, and high blood sugar possibly leading to diabetes. I've had problems with generic Ambien not working (Qualitest), but I think there are other generic brands that work better. There are potentially serious side effects of Ambien though. You can blackout (just like being drunk and not remembering anything) and do all sorts of things from sleepwalking, eating, having conversations with people (possibly saying weird things so warn your roommates/family members), having sex:oops:, or even driving a car.

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