Cycling sleep medications

[serafim]

I have very severe insomnia; i don’t sleep for days on end if i’m not taking medication. The problem is, that every single med i take i eventually develop a tolerance to. It usually takes a few weeks to several months until i have to up the dose, so i can’t stay on 1 medication for very long. I tried cycling different medications, but it’s not working out so well. I manage to develop tolerance anyway, plus some of the antidepressant sleep meds are awful during the adjustment period. I’ve tried literally every sleep medication available to me (seriously) short of clozapine/olanzapine (i’m on LDA so can’t take those) and my insomnia is too severe for any supplements or sleep hygiene tricks to have any effect.

I’m also concerned about taking antidepressants sporadically, is it bad for my brain?

Is anyone in the same situation? Have you had more success with cycling sleep meds? Can you please describe your regiment in detail? I’m at the end of my rope here. If all of my meds stop working ill be at the risk of sleep deprivation induced psychosis

 

[lenora]

Hello @serafim. I'm a severe insomniac also...really, severe. I'm 77 years old and have been through almost every sleep med available until the age of approx. 75.

In my case, everything stopped working within one night or until 2:00 a.m. the next night. I talked it over with my longtime neurologist and he agreed with me....there was no point in taking anything as the problem was in a part of the sleep center that had been partially destroyed.

So life went.....I would get perhaps 3 hrs. max, and often nothing at all. I had myself cleared for things like bipolar illness.

I also suffer from anxiety/panic disorder. OK, anxiety is bad enough, but bad panic attacks take over your entire thinking process and you can't break the cycle. I've tried on my own, attended groups, and finally ended up on fairly mild meds that I would take only when things were heading out of control. Now I'm in a different level and rely on Xanax....yes, I'd prefer something natural, but there comes a time when you have to do what's best for your mind and body.

I always start with the lowest dose....usually a low dose XR pill cut in quarters. The same with an antidepressant and I take Lexapro and have no problems whatsoever. I also suffer from severe pain (FM)and take Lyrica. Again, start with a super low dose (cut the pill, if possible) and move up from there. Most doctors prescribe the lowest dose PILL, thus you just take less of that. Sometimes you're even told to do just that.

By accident, I found that if I took some of my meds (I have other problems, too) and vitamins (as some can cause insomnia), earlier in the day....like with lunch, others at 2:00 p.m., others at 5:30 p.m., one at 8:30 and the final one, an antihistamine....Vick's Ny-Quil OTC, I'm actually sleeping. I'm afraid to write that last sentence, but I want to help you if possible. I get good sleep and I've been on it for four days now. It may be that I'll have to change to another antihistamine, but if that's how I have to sleep, that's how it will be.

I've been to sleep clinics twice....total and complete waste of time, unless you have sleep apnea. Everyone else is sent away with the same med.

I've learned over the years that most doctors can't be relied on for every matter. They're specialists today and it's almost impossible to find a specialist who knows the entire human body. Besides, here in the U.S. they don't have time. Insurance dictates the incredible numbers of patients they have to see per day.

Some do their very best and some don't. I would suggest that if you see a doctor who's half-nice and respectful and need someone for a second appointment, that you go back to this doctor. By the 4th
appointment you should have built up some rapport. I do have an internist who knows the entire body, but even though she's older, she really doesn't know what the specialists want done. Please remember that the entire medical system is ruled by insurance codes. Totally. (No, I'm not in the medical field in any way.)

I hope this will help you somehow. This is my experience only and I hope it continues to work. No sleep is a hard thing to live with. I'm a reader, so I can always do that, go "into" the computer world, answer problems, write letters, etc. I wish you well. Yours, Lenora

 

[wolves2626]

I have hard time to time sleeping problem not severe like yours. after I use gabapentin for my neuropathy think it helps a bit to my sleep however sometimes I need to add melatonin or antihistamines too.
things getting strange it is a multifaceted syndrome.
do you use natural products like ashawanganda melatonin or apigenin? I heard apigening is a promising one.
May be some friends with severe insomnia drop by and help.

 

[Springbok1988]

I have never gotten much sleep using just one med on its own. Have you tried gabapentin in combination with another sleep med? That’s the only way I can get any sleep. I’ve found gabapentin and Quviviq (daridorexant) together help me sleep but not either on their own. I haven’t built up a tolerance to them like I have with other meds.
You could also try (if you haven’t already) indica varieties of cannabis. You’d have to find the right dose and strain for you but it could really help, if you live somewhere it is legal. I wouldn’t use it every night because it can lower sleep quality over the long term when used chronically. Just start low and go slow with it.

 

[serafim]

I have never gotten much sleep using just one med on its own. Have you tried gabapentin in combination with another sleep med? That’s the only way I can get any sleep. I’ve found gabapentin and Quviviq (daridorexant) together help me sleep but not either on their own. I haven’t built up a tolerance to them like I have with other meds.
You could also try (if you haven’t already) indica varieties of cannabis. You’d have to find the right dose and strain for you but it could really help, if you live somewhere it is legal. I wouldn’t use it every night because it can lower sleep quality over the long term when used chronically. Just start low and go slow with it.

weed actually makes my insomnia worse and it’s criminalized where i live anyway. yeah i have tried mixing medications but it doesn’t solve the issue of tolerance… i just get tolerance to 2 meds simultaneously

 

[serafim]

Hi @lenora , i’m glad you’ve found something that works for now. Thanks for sharing your experience, it’s good to know that i’m not the only one struggling with this

 

[heapsreal]

I have very severe insomnia; i don’t sleep for days on end if i’m not taking medication. The problem is, that every single med i take i eventually develop a tolerance to. It usually takes a few weeks to several months until i have to up the dose, so i can’t stay on 1 medication for very long. I tried cycling different medications, but it’s not working out so well. I manage to develop tolerance anyway, plus some of the antidepressant sleep meds are awful during the adjustment period. I’ve tried literally every sleep medication available to me (seriously) short of clozapine/olanzapine (i’m on LDA so can’t take those) and my insomnia is too severe for any supplements or sleep hygiene tricks to have any effect.

I’m also concerned about taking antidepressants sporadically, is it bad for my brain?

Is anyone in the same situation? Have you had more success with cycling sleep meds? Can you please describe your regiment in detail? I’m at the end of my rope here. If all of my meds stop working ill be at the risk of sleep deprivation induced psychosis

Do you find a time of the day that you do tend to sleep??
For me my body clock when my sleep went whacked, I tended to shift to a 5am - 9am time slot that I'd get some sleep. What I found helpful was changing my bed time to like 3am and take my meds. The meds helped me to fall asleep abit after 3am and sleep through to 5am when I'd normally get some sleep. Once padt 5am I could sleep until about 9am.

Then after a few days I'd take my meds abit early like1am or 2am and slowly work my way back to a normal bed time of 10pm, over a week or 2. I will say although I don't think melatonin helps me fall asleep, it does help with the body clock regulation. When I have run out of melatonin, my body clock goes whacked again.

I found when my body clock got out of whack, no meds helped. Can be hard initially to workout where your body clock is. When the body clock is out of whack, taking sleep meds is like giving someone a sleeping pill after 8hrs of sleep when they wake up in the morning, not very effective.

It's a constant battle, good luck👍

 

[Seadragon]

@heapsreal Do you still use a combo of Z drugs and others on a rotational basis for sleep? I wonder if this info might help the OP.

I have to use Z drugs nightly combined with a muscle relaxant. They still work but some nights better than others. I have severe sleep onset insomnia, delayed sleep phase disorder and suffer from chronic pain.

I used to take benzos but came off them about 10 years ago due to development of paradoxical effects and tolerance withdrawal.

Empathiase greatly with your problem @serafim.

 

[heapsreal]

@heapsreal Do you still use a combo of Z drugs and others on a rotational basis for sleep? I wonder if this info might help the OP.

I have to use Z drugs nightly combined with a muscle relaxant. They still work but some nights better than others. I have severe sleep onset insomnia, delayed sleep phase disorder and suffer from chronic pain.

I used to take benzos but came off them about 10 years ago due to development of paradoxical effects and tolerance withdrawal.

Empathiase greatly with your problem @serafim.

Yes, I mostly use zopiclone but will use zolpidem. I also take 5mg of valium. I rotate between a few different benzos as well. I find the benzo's help sleep initiation and I will add an antihistamine to help prolong sleep. I rotate the antihistamines too. Always keep melatonin (10mg) in my sleep stack to help try to keep a normal sleep cycle.

That's what I mostly do but if sleep is bad I will take seroquel occasionally. On the occasions where it totally goes off the rails, I revert to my initial post and go to bed alot later (4-5am) and then slowly over a week or 2, go to bed a little early each night until I get to 10pm.

But my sleep has been OK and alot more stable in recent times. I have had some success with high dose melatonin (80-100mg) and plan to trial it again as we have changed our life, downsized and move to a smaller town etc. I'm taking a break from work, so I will experiment with the high dose melatonin and stop other sleep meds, which I have done in the past for short stints successfully.

 

[Marylib]

I came to this thread today - in desperation - wondering if I could find something I haven't tried lately. It's a helpful thread so thanks to all of you. @lenora I hadn't thought of Nyquil in many years, so I am ordering some. So glad it is helping you. May the effect last a long long time.
@serafim I wish I had something to add that hasn't been covered already. So I will just say that cycling various sleep meds is how I have coped with tolerance also. At the moment, my old stand-by's such as trazodone and mirtazapine do absolutely nothing for me - might as well be taking a pill made of air... I managed a couple of hours of sleep today with a benzo and chilling myself with wet compresses and a fan. But that means no benzo's for a couple of weeks because of the usual reasons.
I do have an emergency med in case of what they call hypnogogic hallucinations from lack of sleep - quentiapine or Seroquel. I consider it emergency only because even a tiny sliver knocks me out the following day, and not pleasantly.
As @heapsreal says, the battle is constant so good luck everyone.

 

[lenora]

I'm glad you may receive some help, @Marylib. I use just one capsule of Ny-Quil at the moment and I've now had about 7 nights worth of good fortune. (Trust me, that has been good fortune!) I also think it has to do with moving my med times around, as I do take quite a few, twice a day, plus vitamins, herbs, etc.

Sorry that I miss your question @wolves2626, but no I haven't tried anything but melatonin of the two you mentioned. I have really bad luck with things like valerian (which does just the opposite of sleep) and even melatonin itself. I no longer try any of those products. Since they may work for you, by all means try them. I'm fortunate if I get one night's sleep, let alone more....so I'd have to be pleasantly surprised. Like the Ny-Quil has been a gift.

The odd thing is that I had been using it with my other meds, about an hour before bedtime, so I really think using it alone and moving all of the other meds has helped considerably. I think our brains, like our fingerprints are all different.

I don't nap, so perhaps that helps....I couldn't tell you. If I'm too tired I'll fall asleep with a cup of hot tea mid-air. It's always a balancing game for sure. Then I have my husband who sleeps like he's still 18 and he'll be 80 this year. (That actually helps me, I'm not worried about him.) Hands thrown up! Yours, Lenora

 

[serafim]

@Marylib why do you think mirtazapine and trazadone aren’t working anymore?

pregabalin used to reliably knock me out but it doesn’t work on its own anymore i’m so scared things will just keep getting worse. i don’t know why it stopped working, long tolerance breaks don’t make a difference. i’m scared all these meds i’m taking are making things worse in the long run. but what choice do i have? i can’t live on 2 hrs of sleep per day, i just can’t. i used to hate taking seroquel but i do now because it beats not sleeping. i have severe cfs and sometimes sleep is my only escape.

the only time i got respite from my insomnia was when i went on a beach vacation. maybe it’s something about the air or the altitude. insomnia came back as soon as i left the seaside.

 

[serafim]

the thing with all these drugs is that save for zopiclone and pregabalin they make me feel terrible during the day. Amitriptyline even makes me suicidal for the next few days. but what am i supposed to do? i can’t afford to take any of the drugs off rotation because i don’t have many options

 

[Marylib]

@serafim - wish you could live at the seaside forever. In answer to your question, I have no idea why those meds aren't working for me anymore.
@lenora - very happy to hear about your seven nights. Fingers crossed for you.

 

[Seadragon]

@Marylib why do you think mirtazapine and trazadone aren’t working anymore?

i have severe cfs and sometimes sleep is my only escape.

Agree, same for me.

the only time i got respite from my insomnia was when i went on a beach vacation. maybe it’s something about the air or the altitude. insomnia came back as soon as i left the seaside.

Wow, my experience is similar to this. Maybe it has something to do with ozone or/and cleaner, more oxygenated air.

Are you able to try Zolpidem? Maybe alternated with the Zopiclone and others? For me Zolpidem is the most effective sleep med (for sleep onset insomnia) and still works after many years though not quite as well as initially.

 

[heapsreal]

What I've found helpful for naps is a mildly boring podcast or other utube video, enough for me to sort of follow and then I drift off until the video finishes and then I wake up.

A good utube video I listen too every so often is a video on economics narrated by Thomas Sowel, a black American guy with a deep voice. It's about 3hrs long and I can follow it but honestly i find economics boring, so it can do the job of putting me to sleep for a granddad nap. The deep voice and the constant flow I think helps alot.

I think its called the history of economics but if you search that and Thomas Sowell, you should come across it. I've actually woken up with a good lather of dribble on my chin. You know it's a good sleep when that happens 🤣🤣👍

 

[wolves2626]

have you ever tried something like listening pink noise white noise etc? maybe it is awkward or silly these are mainly used for sleeping and even for tinnitus and hyperacusis treatment. you could find version's like 10 hour in youtube . sorry if it is not sensible.

 

[serafim]

Are you able to try Zolpidem? Maybe alternated with the Zopiclone and others?

it’s not available in my country, and also you can develop cross tolerance to medications of the same class

i wish we could all move to the seaside! people used to do that to recover from illness

 

[serafim]

@wolves2626 @heapsreal i appreciate you trying to help but when you have severe insomnia things like that don’t work. my insomnia is not caused by my mental state or poor sleep hygiene. it’s something in the body, i suspect it’s pro inflammatory cytokines because it gets even worse when i have an infection. i have tried all non-pharmaceutical interventions i could to no avail. and yeah i listen to boring audiobooks before falling asleep, mostly because it just takes me many hours to fall asleep and i need something to do in the meantime. it doesn’t make any difference for my insomnia

 

[heapsreal]

@wolves2626 @heapsreal i appreciate you trying to help but when you have severe insomnia things like that don’t work. my insomnia is not caused by my mental state or poor sleep hygiene. it’s something in the body, i suspect it’s pro inflammatory cytokines because it gets even worse when i have an infection. i have tried all non-pharmaceutical interventions i could to no avail. and yeah i listen to boring audiobooks before falling asleep, mostly because it just takes me many hours to fall asleep and i need something to do in the meantime. it doesn’t make any difference for my insomnia

When my cfs was bad and have that constant shitty feeling. If I took a Med for sleep and it worked during a bad insomnia spell, the extra sleep just made me feel less shitty. I think when viruses are reactivating and have alot of inflammation, even if you get a reasonable amount of sleep, you still feel shitty, just a different depth of shit. It's hard to even rest, not that you can do anything anyway, but your brain won't let you rest. Seroquel was probably the best Med for me when I couldn't sleep but there's times where nothing helps. Anaesthesia for 8hrs would be a great option if it were available. Good luck 💊😴