So what (Presciption) Medicine should I try next for my sleep?

[msf]

I´ve found that diet has a big impact on the efficacy of Trazodone for me.

 

[*GG*]

I´ve found that diet has a big impact on the efficacy of Trazodone for me.

Care to expand upon that response?

GG

 

[Oci]

@ggingues and all...

I experienced years of insomnia and so read this thread with interest. Presently I am doing a taper from Zopiclone, a Z-drug like Ambien and Lunesta. It is a pseudo-benzo with the same withdrawal problems as benzos. The taper must be done very slowly to avoid bad side effects ie insomnia, anxiety, muscles tightness and GI problems etc.

I have done a lot of research and most of these sleep drugs are really bad news. It is H*** to get off them. I suggest that you look at benzobuddies.org before you start on the big guns. Another good source is benzo.org.uk

So, what to do? I am presently sleeping quite well after years of problems. I believe it is because I am getting my life and body in better balance. Please look seriously at some of the supplements, lifestyle changes and sleep promotion behaviors. If you are presently on benzos or Z-drugs, read up on them on sites above.

@ggingues I have now reduced/tapered Zopiclone from about 1- 1.5 of a 7.5 mg tablet by a daily taper of 1%. I am now taking @1/2 at bedtime and 1/4 when I wake in the night. I use manicure scissors to cut off little bits to get the correct amount on a jeweler's scale I bought on Amazon. Taper is going well.

I truly wish I had never started on the Zopiclone or any other Benzo-like drug. They may work in the beginning but then you get to interdose withdrawal, memory problems, strange neurological problems. Most need to keep on increasing the dose as the body adapts to the drug.

Be careful! Be knowledgeable as to what you are getting yourself into! Or already are in.

 

[Oci]

Thought some might be interested in this:
https://selfhacked.com/2016/03/20/top-25-methods-for-better-sleep-and-circadian-rhythm-entrainment/

 

[perrier]

@ggingues and all...

I experienced years of insomnia and so read this thread with interest. Presently I am doing a taper from Zopiclone, a Z-drug like Ambien and Lunesta. It is a pseudo-benzo with the same withdrawal problems as benzos. The taper must be done very slowly to avoid bad side effects ie insomnia, anxiety, muscles tightness and GI problems etc.

I have done a lot of research and most of these sleep drugs are really bad news. It is H*** to get off them. I suggest that you look at benzobuddies.org before you start on the big guns. Another good source is benzo.org.uk

So, what to do? I am presently sleeping quite well after years of problems. I believe it is because I am getting my life and body in better balance. Please look seriously at some of the supplements, lifestyle changes and sleep promotion behaviors. If you are presently on benzos or Z-drugs, read up on them on sites above.

@ggingues I have now reduced/tapered Zopiclone from about 1- 1.5 of a 7.5 mg tablet by a daily taper of 1%. I am now taking @1/2 at bedtime and 1/4 when I wake in the night. I use manicure scissors to cut off little bits to get the correct amount on a jeweler's scale I bought on Amazon. Taper is going well.

I truly wish I had never started on the Zopiclone or any other Benzo-like drug. They may work in the beginning but then you get to interdose withdrawal, memory problems, strange neurological problems. Most need to keep on increasing the dose as the body adapts to the drug.

Be careful! Be knowledgeable as to what you are getting yourself into! Or already are in.

Thanks for your thoughtful post. My daughter was put on Klonopin when she fell ill. Now after a few years she's trying to taper off this drug, which is over prescribed. She's on Klonopin and Loramet. These are terrible benzos. She's not sleeping, except for a couple of hours per night. The taper is super slow .5 percent or less per month.

What supplements do you use?

 

[msf]

Care to expand upon that response?

GG

I already have in this thread: http://forums.phoenixrising.me/index.php?threads/the-amazing-trazodone.44277/

It might not work for everyone, but it´s pretty easy to test: just try the FODMAP diet for a week whilst taking Trazodone, and then eat pizzas and curries for a week and compare the sleeping times.

 

[Oci]

Thanks for your thoughtful post. My daughter was put on Klonopin when she fell ill. Now after a few years she's trying to taper off this drug, which is over prescribed. She's on Klonopin and Loramet. These are terrible benzos. She's not sleeping, except for a couple of hours per night. The taper is super slow .5 percent or less per month.

What supplements do you use?

I will send a PM

 

[Oci]

This is very interesting and valuable IMO.
http://www.talkaboutsleep.com/succe...py-and-a-gradual-structured-tapering-program/

Read the whole article! I am going to increase my taper speed. My sleep and well being have improved as I taper.

Sleep diaries and all-night sleep recordings showed that patients in the combined group and CBT alone
experienced the greatest subjective improvement in sleep (e.g., sleep dairies). Sleep recordings revealed
that all subjects showed more deep sleep, and less light sleep, as a result of medication tapering.
The results of this study suggest that a combination of a structured sleep medication tapering program
and CBT is the most effective approach to reducing and eliminating sedative-hypnotic use. Despite the
fact that patients in this study used sleeping pills almost nightly for 20 years, 85% of patients were able to
eliminate the medications entirely within an average of 7 weeks. There were no significant withdrawal
symptoms in these patients due to the fact that the medication taper was gradual and was combined with
CBT, and sleep improved as a result of the medication taper and discontinuation. The reductions in
medication were generally well-maintained at long-term follow-up at one year.

 

[Oci]

I already have in this thread: http://forums.phoenixrising.me/index.php?threads/the-amazing-trazodone.44277/

It might not work for everyone, but it´s pretty easy to test: just try the FODMAP diet for a week whilst taking Trazodone, and then eat pizzas and curries for a week and compare the sleeping times.

Diet alone will improve sleep. Find the right diet for you!

 

[msf]

Yes, that is true, but Trazodone will improve it still further.

 

[Oci]

For some people! I found trazodone improved sleep for a few days and then it worsened.

 

[msf]

Well, there are always outliers. Trazodone is a hypnotic that seems to have other beneficial effects on sleep in ME patients.

 

[zzz]

I currently take 45 to 60 mg of Remeron at night.

From the prescribing information for Remeron:

Evidence gathered in preclinical studies suggests that mirtazapine [Remeron] enhances central
noradrenergic and serotonergic activity. These studies have shown that mirtazapine
acts as an antagonist at central presynaptic α2-adrenergic inhibitory autoreceptors and
heteroreceptors, an action that is postulated to result in an increase in central
noradrenergic and serotonergic activity.

In other words, Remeron will increase your levels of norepinephrine, which tends to keep people awake.

Again from the prescribing information:

Mirtazapine is a potent antagonist of histamine (H1) receptors, a property that may
explain its prominent sedative effects.

This, of course, is what you want. So the question is, how do these two effects balance out with dose? It turns out that the norepinephrine effects of Remeron go up much faster with dose than the histamine increasing effects. In other words, the higher the dose, the less effective Remeron is at promoting sleep.

From Tuning the Brain, p. 256, by Dr. Jay Goldstein:

Remeron (mirtazapine), in a dose of 45 to 60 mg at bedtime, is an effective antidepressant as monotherapy, and it can be added on to any of the other antidepressants because it has a unique mode of action. It should be remembered that the sedative effect of Remeron is inversely proportional to the dose, which is counterintuitive to most physicians and patients. Therefore, if Remeron is being used as a sleeping pill, it should be prescribed in a low dose, such as 7.5 mg at bedtime. Because it has an effect on the alpha(2) autoreceptor, the higher the dose of Remeron that is ingested, the more norepinephrine is released. Norepinephrine tends to counteract the sedating effects of Remeron, which are caused by its H(1) receptor antagonism.

So in other words, you are taking the standard antidepressant dose of Remeron, which has only modest sedating properties. According to Dr. Goldstein, a much lower dose, such as 7.5 mg, would have a far more sedating effect. I have tried a 7.5 mg dose myself, and have found it to be extremely sedating.

Of course, at the lower doses, the antidepressant effects of Remeron are less pronounced.

 

[Oci]

From the prescribing information for Remeron:


In other words, Remeron will increase your levels of norepinephrine, which tends to keep people awake.

Again from the prescribing information:


This, of course, is what you want. So the question is, how do these two effects balance out with dose? It turns out that the norepinephrine effects of Remeron go up much faster with dose than the histamine increasing effects. In other words, the higher the dose, the less effective Remeron is at promoting sleep.

From Tuning the Brain, p. 256, by Dr. Jay Goldstein:


So in other words, you are taking the standard antidepressant dose of Remeron, which has only modest sedating properties. According to Dr. Goldstein, a much lower dose, such as 7.5 mg, would have a far more sedating effect. I have tried a 7.5 mg dose myself, and have found it to be extremely sedating.

Of course, at the lower doses, the antidepressant effects of Remeron are less pronounced.

Wow! Very interesting! I don't take Remeron but do take Doxepin at a very small dose - ie 3 mg - which is called Silenor. I read that it works in different ways at different doses too. High dose as an antidepressant, low dose as an antihistamine for sleep maintenance.

They charge way more for 3 mg Silenor than for 10 mg Doxepin!

Do you recommend the book by Goldstein? Just looked it up. Not an easy read! I don't have CFS and so perhaps not for me.

 

[LisaGoddard]

I've had chronic insomnia for many years and the med that really helped is Mirtazipine (15 mg at night). It makes me sleep right through the night. Also it doesn't give me a 'hangover' in the morning. I've been taking it for about 6 years now.

 

[Oci]

Lisa, Mirtazipine is Remeron - discussed above in post from ZZZ

From Tuning the Brain, p. 256, by Dr. Jay Goldstein:
Remeron (mirtazapine), in a dose of 45 to 60 mg at bedtime, is an effective antidepressant as monotherapy, and it can be added on to any of the other antidepressants because it has a unique mode of action. It should be remembered that the sedative effect of Remeron is inversely proportional to the dose, which is counterintuitive to most physicians and patients. Therefore, if Remeron is being used as a sleeping pill, it should be prescribed in a low dose, such as 7.5 mg at bedtime. Because it has an effect on the alpha(2) autoreceptor, the higher the dose of Remeron that is ingested, the more norepinephrine is released. Norepinephrine tends to counteract the sedating effects of Remeron, which are caused by its H(1) receptor antagonism.

Good to know that it works well as a sleeping pill.

I don't suppose, however, that a crossover to it would eliminate all the side effects of benzo withdrawal....just the insomnia part.

 

[*GG*]

From the prescribing information for Remeron

So in other words, you are taking the standard antidepressant dose of Remeron, which has only modest sedating properties. According to Dr. Goldstein, a much lower dose, such as 7.5 mg, would have a far more sedating effect. I have tried a 7.5 mg dose myself, and have found it to be extremely sedating.

Of course, at the lower doses, the antidepressant effects of Remeron are less pronounced.

I have been on Remeron since 2009, I started at a low dose of 15 mg, have had to increase it over the years, over 6 yeas now! Doesn't seem like that much when you consider I take it night after night for years. And I did cut the doses (15mg) in 1/2 when upping what I needed to help me sleep. Seems like 75 mg of Trazadone with 45 mg of Remeron is doing the trick at this time.

Really did a lot yesterday, so got a pretty good refreshing sleep of 12 hours

GG

Although i did awake with a headache, think that is because of how hard I exerted myself yesterday.

 

[Little Bluestem]

I've been using L-tryptophan for some months now and it has been a life changer. It makes me go to sleep really fast and using half the dose to wake up has let me get my circadian cycles somehow in order.

@Owl42 - What doses are you taking?

 

[*GG*]

So in other words, you are taking the standard antidepressant dose of Remeron, which has only modest sedating properties. According to Dr. Goldstein, a much lower dose, such as 7.5 mg, would have a far more sedating effect. I have tried a 7.5 mg dose myself, and have found it to be extremely sedating.

Of course, at the lower doses, the antidepressant effects of Remeron are less pronounced.

Thanks for this info, I have cut down my dosage to 15 mg as a start, guess I should try 7.5 mg even I was getting concerned that I was going to need to find a new sleep med. I should have mentioned this with my specialist, don't see him for another 6 months. Although, I can send him an email once I get others things straightened out!

GG

 

[Owl42]

@Little Bluestem 100mg to sleep and 50mg to wake up