Here is Dr Teitelbaum's list of ideas to try for improving sleep. Some are prescription and others are supplements.
You can try these in the order listed or as you prefer based on your history. ADJUST DOSE AS NEEDED TO GET 8-9 HOURS OF SOLID SLEEP WITHOUT WAKING OR HANGOVER. No going to the bathroom if you wake up unless you still have to go 5 minutes later. Mixing low doses of several treatments is more likely to help you sleep without a hangover than a high dose of 1 medication. You can take up to the maximum dose of all checked off treatments simultaneously. Do not drive if you have next day sedation (adjust your treatment to avoid this). If you're not sleeping 8-9 hours a night without waking on the checked off treatments, do not wait until your next appointment to let us know or contact your physician! Ambien, Klonopin, Xanax and Soma are considered potentially addictive, but in the dose and form that we use this is rarely a problem. If you have next day sedation, try taking the medications (except the Ambien) a few hours before bedtime. The antidepressants (e.g., Prozac/Paxil) can improve sleep a lot after 6 weeks. Taking calcium and magnesium at bedtime can help sleep. In addition YOU CAN TRY THE OTHER NATURAL&/OR NONPRESCRIPTION PRODUCTS IN COMBINATION FIRST TO SEE IF THEY GIVE YOU 8 HOURS OF SLEEP A NIGHT. ADD THEM IN THIS ORDER #23, 26, 27, 28, 37, 40, 41, 45A.
___ 22.**
Ambien (Rx, zolpidem) - 10 mg- ½ to 1½ at bedtime. If you tend to wake during the night, leave an extra ½ to 1 tablet at bedside and you can take it as needed to help you sleep through the night.
___ 23.**
Revitalizing Sleep Formula (30 ct or 90 ct) (Enzymatic Therapies/Integrative Therapeutics ) - Valerian 200 mg, Passion Flower 90 mg, L-Theanine 50 mg, Hops 30 mg, Piscidia 12 mg and Wild Lettuce 28 mg. Take 2-4 capsules each night 30 to 90 minutes before bedtime. It can also be used during the day for anxiety. If Valerian energizes you (occurs in 5-10% of people) use the other components. It is also excellent for anxiety. Do not take more than 8 capsules a day.
___ 24.*
Desyrel (Rx, trazodone) - 50 mg - ½ to 6 at bedtime. Although sedating, it can be used (50-250 mg at a time) for anxiety. Do not take over 450 mg a day (or 150 mg a day if on other antidepressants).
___ 25.*
Klonopin (Rx, clonazepam) - ½ mg - begin slowly and work your way up as sedation allows. Take ½ tablet at bedtime increasing up to 6 tablets at bedtime as needed. Can be very effective for sleep, pain and Restless Leg Syndrome. Klonopin may be addictive. Taking one quarter to one half tablets in the morning (not more) can actually decrease brain fog in some CFS patients.
___ 26.*
5 HTP (5 Hydroxytryptophan) - 200 to 400 mg at night. Naturally stimulates Serotonin. Don't take over 250 mg a day if you are on Prozac, Paxil, Zoloft, Desyrel or Celexa. Can help with pain and weight loss at 300 mg a day for at least 3 months. Or ___ Tryptophan 500 mg caps 1-6 at bedtime. Available at
www.vitaganza.com ($65 for 180 caps).
___ 27.
Calcium - 500-600 mg and Magnesium 100-200 mg at bedtime helps sleep.
___ 28.
Doxylamine (Unisom for Sleep) or Benadryl - 25 mg at night (antihistamines). May also help pain.
___ 29.*
Neurontin 300 mg (see #220A) - 1-2 caps at bedtime. Also helps pain and restless legs syndrome.
___ 30.*
Zanaflex - 4 mg ½-2 at bedtime for sleep (more for pain, see #230A). Stop if it causes nightmares.
___ 31.
Sonata (Rx) 10 mg - Take 1-2 capsules during the night if you wake after 3 AM or if you only have trouble falling (vs. staying) asleep. It's sedation only last 3-4 hours.
___ 32.*
Soma (Rx, carisprodol) - ½ to 1 at bedtime. This is very good if pain is severe. Soma may be addictive.
___ 33.*
Flexeril (Rx, cyclobenzaprine) - 10 mg - ½ to 2 at bedtime. Muscle relaxant - can cause dry mouth.
___ 34.*
Doxepin (Rx, Sinequan) - 5-10 mg, 1-3 capsules at bedtime or Doxepin liquid 10 mg/cc. If a lower dose is needed you can start with 1-3 drops at night. A powerful antihistamine. Some people get the greatest benefit with the least next-day sedation with a dose of less than 5 mg a night.
___ 35.
Elavil (Rx, amitriptyline) - 10 mg - ½ to 5 tablets at bedtime. May cause weight gain or dry mouth. Good for nerve pain and vulvadynia.
___ 36.
Remeron (Rx, mirtazapine) - 15 mg - 1 to 3 tablets at bedtime (especially helpful if you feel like you're "hibernating" during the day).
___ 37.
Melatonin - ½ mg - 1 mg at bedtime (available at health food stores). If you feel wide awake at bedtime, try 5 mg taken 3 to 5 hours before bedtime. Don't use a higher dose unless you find it more effective (.5 mg is usually as effective as 5 mg and may be safer).
___ 38.
Gabitril - 2 mg twice a day (see # 220B). Increase by a maximum 4 mgs daily each week to a maximum of 24 mg a day (optimal effect is seen at an average dose of 16 mg/day). Even 5 mg at bedtime can markedly improve deep sleep and can sometimes decrease next-day sedation. The main side effects are sedation, dizziness and gastric upset.
___ 39.
Lyrica (Rx-Pregabalin) - 50-250 mg a night (or 100-200 mg 3x day for pain).
___ 40.
Delta Wave Sleep Inducing CD/Tape - This helps with no side effects. Play it to fall asleep and if you wake during the night. They can be played throughout the night if desired (order from 800-333-5287 or from our web site at
www.Vitality101.com). You can use either of the CD's.
___ 41.
Kava Kava - 30% extract - 250 mg capsules - 1 to 3 capsules at night (if a rash develops add a B-complex 50 mg at night, and stop/decrease the dose/frequency of use. If the rash persists, see your family doctor). Do not use if you have liver inflammation. May rarely cause liver inflammation.
___ 42.
Xanax (Rx, alprazolam) - ½ mg - ½ to 4 tablets at bedtime. This is short-acting and gives a good 3 to 5 hours sleep with less hangover in the morning. Xanax may be addictive.
___ 43.
Permax (pergolide) (Rx) - (see #240). For Restless Leg Syndrome and pain.
___ 44.
Seroquel (Rx) - 25 mg - 1 at bedtime (an anti-schizophrenic medication).
___ 45.
Zyprexa - 10 mg - ½ -2 tabs at bedtime. After 6 weeks, also helps pain. Causes weight gain. (An anti-schizophrenic medication.)
___ 45A.
Cuddle-Ewe Mattress Pad - Use if pain interferes with sleep (800-328-9493, ext. 000 - company may offer a 90-day money back guarantee).
___ 46.
Xyrem (Rx, GHB) - an excellent sleep medication in fibromyalgia. Because the DEA claimed that it was being used as a date rape drug, it has gone from being inexpensive and over-the-counter to being tightly regulated and costing approximately $500 a month. If all else fails, this often works very well. Be sure to rinse your mouth well and swallow after taking liquid. If the medication is left to sit on your teeth, it can dissolve your enamel and damage your teeth. Take nine cc (4.5 g) at bedtime and repeat approximately four hours later when you wake up if needed. The first night you use the Xyrem, take it by itself without other sleep meds. You can then add back in one tablet of any sleep medication with each dose until you're getting good sleep for at least four hours with each dose.
___ 46A.
Lunesta (Rx) - 2-3 mg at bedtime. If taken with Sporanox, Nizoral, Diflucan or Zithromax a lower dose may be needed.
Can you remember what the other supplement for oestrogen levels was - I'm in the same boat too.
