Friday, October 26, 2007

Perchance to Dream

I've been having trouble sleeping sometimes lately. Oh, who am I kidding? I've always had intermittent insomnia, lately it's bothering me more for some reason. I'm lucky: if I don't sleep well, I don't feel it the next day, and so I've learned not to worry so much about it. If I go a few days with restless nights, I start getting irritable, and then I usually sleep well for a bit until the cycle repeats. A friend insists I'd sleep better if I turned off the computer and TV by 10 or 11 pm. I'm usually IN bed by 11:30, and I'm not much of a TV watcher, so I don't think that's it-- I sometimes get on the computer after that if I can't sleep, but I've tried first. Then she said it's the Diet Coke I have with dinner. Fine, I've given up caffeine after 9 am. I've had no Diet Coke in almost two weeks. I don't miss it, but it's not making much difference. Some nights I sleep well, others I don't. Last night, by the way, Roy was in my dreams....

So with that as a prelude, the New York Times has an interesting piece on sleep medications. I prescribe sleep medications sometimes, and I really don't think they're a problem for short term issues-- someone who sleeps poorly because of an acute stressor. And SSRI's often disrupt sleep, for some people the combination of an SSRI with trazodone seems to be helpful for both sleep and depression. Getting back to the New York Times article, "Sleep drugs found mildly effective but wildly popular"-- Stephanie Saul writes,

But if the unusual pitch makes you want to try Rozerem, consider that it costs about $3.50 a pill; gets you to sleep 7 to 16 minutes faster than a placebo, or fake pill; and increases total sleep time 11 to 19 minutes, according to an analysis last year. If those numbers send you out to buy another brand, consider this, as well: Sleeping pills in general do not greatly improve sleep for the average person.

The article goes on to say that while total time asleep is increased by 25 minutes or so, that sleep satisfaction amongst insomniacs is greatly increased. The article goes on to theorize why that is, to talk about some specific problems with certain hypnotics, and to say that the perfect sleep agent hasn't been found.

And with this thought, I've changed the sidebar poll-- Please vote for your favorite sleep medication. In Roy's honor, I've tried to be a bit more complete. And once again, in my pursuit of useless data, I don't care who you are, if you take or prescribe it, or if you merely like the idea, just tell us your favorite.

Oh, and finally, I should have put this on my last post about the Red Sox, but if you didn't know it, Red Sox pitcher Curt Schilling is a blogger-- do check out . Funny, but his posts get more comments than our Shrink Rap posts get. I wonder why.


Gerbil said...

Okay, this is truly weird. I had a dream about Roy last week as well.

Roy, are you practicing your paranormal skills again?

Anonymous said...

I'm really having a hard time believing that they don't help more... I feel like I get a huge benefit!

Anonymous said...

Seroquel seems to knock me out pretty well. If I take the full 25mg that I'm perscribed, I sleep for 13+ hours with no problem and still feel sleepy for an hour or so after I wake up.

Good thing 12.5mg doesn't do that to me... it would make school rather hard.

Midwife with a Knife said...

I get a lot of sleep disruption from the prednisone, but it's mostly maintenence insomnia, rather than a sleep onset problem, and most hypnotics are better for sleep onset than maintenence. (although when I was on 60mg of prednisone, I couldn't go to sleep at all).

When I take something for sleep, Ambien is what I usually use, relatively low risk of dependance, generally effective for sleep onset. Almost no side effects for me, although both Ambien and Lunesta give me the weirdest vaguely unpleasant taste in my mouth.

Ladyk73 said...

Once on a inpatient med merry-go-round....I stayed up all night despite a dose of Ambien. That made me feel really weird.

I took trazadone for a while, it really works well....and so cheap!

Right now...I am on 100mg of seroquel (damn that's alot) and I go to sleep fast, but I have been getting up before my alarm. weird

I am so drugged up. My medicine cabinet looks crazier than I do.

Anonymous said...

i take trazodone with my ssri's and mood stabilizers. without it, i stay up for days on end and become hypomanic. i've also noticed that once i began taking trazodone, my dreams were so much more vivid, and i was able to remember them in greater detail when i woke up. it gives me more of a deep, restful sleep.
it's not always just about how many hours of sleep you get. a lot depends on how well you're sleeping during that time as well.

NeoNurseChic said...

I have always had sleep problems. For awhile, it was insomnia, but it rarely is anymore. For the last 2 years, I've been so tired that I can literally sleep anytime, anywhere - very rarely do I have trouble sleeping. Although sometimes I sleep for about 30-90 minutes and then wake up and can't get back to sleep all night. (Must be related to my broken hypothalamus! hehe) So that being said, I don't take sleep meds anymore. I also have restless leg syndrome, as does my mother, brother, grandmother.

The biggest problem for me with sleep meds is that the ones advertised solely for sleep (ambient et al) are like taking water for me, but the ones that have more broader uses (benzos, antipsychotics like zyprexa - which I never used for sleep, just noting that it buys me a cluster-headache-free-sleep) make me so groggy and need to sleep like 15+ hours.

I used to take klonopin nightly for RLS/insomnia. But then my psychiatrist felt like I was taking concerta and ritalin during the day, only to take klonopin at night. Bad cycle there. So then I came off klonopin and went to ativan. Plus on klonopin I had such a hangover. On ativan, I still was so blasted tired in the morning. So finally we went down to serax. And now I have serax prn. I only take it when I just can't sleep. Problem is, by the time I finally get fed up with the insomnia and want to take a med, it's after 2-4am, and it's almost too late to be worth taking anything. I don't want to take it before midnight if I'm not going to have trouble sleeping! It also depends on how early I have to get up the next day. Jason FREAKS when I take a sleeping pill. He ends up waking up several times during the night and putting his hand on me to make sure I'm breathing. I think it's funny - he says it scares the crap outta him - he thinks I'm going to die. I said with one sleeping pill, I think I'll live. ha...

All in all, I still vote for the benzos. They work when I need them to - and the weaker meds like ambien don't do squat for me. Wish they did. The worst insomnia was when I was in the hospital for so long for headaches - you can only sleep so much. I'd usually sleep right through the first 3 days, but then have a tough time sleeping. How much time can a person spend in bed? And the meds make ya feel jittery. They'd prescribe ambien at night until finally I'd beg for ativan. And even then I'd sometimes wake up.

The only med that would guarantee to knock me out for hours 30 minutes after taking it was the geodon injections. I dreaded getting them, especially during the precious hours that my parents were visiting. Get that shot and it's lights out for the night!

Hope you have more restful sleep, Dinah!

Take care,
Carrie :)

HP said...

I had a patient who claimed peanut butter late at night helped...I've heard that from several other people since but I can't stand the stuff so I have no idea if there is any truth to that.

I have trouble sleeping sometimes, like MWAK I think it's a prednisone thing. Hope you get some good sleep soon.


Rach said...

I agree with Anon#2. I also put down seroquel which i use for emergencies only. I take 12.5 mg and sleep 16 or17 hours.

Gerbil said...

Benadryl puts me to sleep quite effectively, which would be great except I reserve it for when my allergies are out of control. Not only does it knock me out, but a single dose also give me a 36-hour hangover! (And the last time I took it I got some bizarre, and thankfully rare, side effect that included paralysis of some muscle in my eyeballs... ugh.)

For me, the best sleep aid is a glass of warm milk with some nutmeg in it. It's tasty, soothing, has no side effects (unless you're lactose intolerant), and is perfectly natural. Hooray for tryptophan!

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jcat said...

Voted for Ambien, which generally isn't as effective as I'd like, but I'm limited in what I can take because of being on call for work. The benzos work great, but I am so out of it when I get woken up that I can hardly find the PC, never mind fix work problems. And Seroquel gives me such vivid nightmares that I throw myself right off the bed - scares hell out of the cats!
Even with 10 - 20mg of Ambien, I wake up 6 or 7 times in the night. And conversely, can fall asleep in the bath almost every morning, even after taking theoretically activating meds like Ritalin...

FooFoo5 said...

I am trying to figure out why that gentle voice pitching Lunesta with butterflies during commercials of Sunday Night Football suggests you "not operate heavy machinery or drive a car" until you've determined whether you're too zooted on Lunesta. Who is the audience for this warning?

And while these "zzz" drugs, Ambien/Zolpidem, Sonata/Zaleplon and Lunesta/Eszopiclon (the analog of Zopiclone) are peddled hard as "non-benzos," they act on the same benzo receptors to cause sedation. They walk & talk like any short half-life benzo; same side-effects as Halcion which was taken off the market (loss of memory for events, senambulation); and the same drug scheduling because of risk as benzos.

And just in case you were wondering about CA state prisoners with a psych diagnosis (I'll bet that's what was keeping you up!): Diphenhydramine, Trazadone, and Seroquel, in that order. And it gives me some perspective about Seroquel used for sedation (and it's no bargain either) because, if its Seroquel, I generally see orders for 300 mg., and that would be $11 a pill.

Me, 10:00 pm with a good book (I'm lovin' the short-stories of Flannery O'Connor), and I start a line with Versed... Like a baby, I tell you.

FooFoo5 said...

PS Firefox does such a good job of blocking out all "questionable" material, I can never see your Google Ads or your surveys. Sorry.

Alison Cummins said...

Interestingly, you posted about sleep meds at the same time that Shasowfax posted about stimulants.

Does anyoneone report sleeping better with Modafinil? I have taken amphetamines (completely different class of drugs) and my experience was that when I was awake I was more awake... and when I was asleep I was more asleep. Don't know if Modafinil would do the same thing.

Midwife with a Knife said...

alison: I've always wanted to try modafinil for those long nights on call. It sounds almost like magic! But so far, I've used restraint.

Anonymous said...

I voted for Melatonin as prescribed by my neurologist to help with migraines. It really does work in my opinion! And it has no side effects.

My second favorite is Benadryl. I keep the chewable tabs next to my bed so that I can take it without having to get up at 4am (I'm an early AM waker). Again, very few side effects and takes care of my allergies nicely.

I used Trazadone extensively for several years. It worked well and blocked out the really disturbing dreams I was having on Inderal, but I would be very groggy in the morning for a few hours. I ended up giving up on it when I gradually had to keep upping the dose to 200mg.

I now use Seroquel for really nasty, persistent insomnia (which hasn't happened since I started Melatonin). I HATE taking it because it knocks me on my rump so bad that I can barely get up in the morning, and I'm still barely conscious by noon. I only take it when my insomnia starts to get really severe, and I begin to worry about manic episodes.

I've never used a hypnotic, so I can't comment on those.

jcat said...

Alison : pdoc prescribed Modafinil for me at one stage when I was battling with getting off the couch all day. He gave me a long lecture on side-effects, insisted that I come see him just to get BP and pulse taken in the morning before getting it at the chemist in the hospital and coming back to the rooms so he could check readings again after an hour.

Soooo embarassing....he had to wake me up in the waiting room! And of course - he couldn't resist telling me that I was snoring too.

WritingMom said...

I'm on Cymbalta, which gives me insomnia, so I take Ambien CR every night. Fortunately, I have good health insurance, so the drugs are covered. I've take regular Ambien in the past, and I can feel a difference with the CR; it's not as abrupt. I'd rather not have to take any of the drugs, but dealing with recurrent major depression is worse.

NeoNurseChic said...

Sherri, Cymbalta gave me insomnia, too.

One of the things I was amazed by when I did my psych rotation was the amount of meds people take and still walk around. I remember talking to one gentleman who had schizophrenia, and he was on like 5 different meds, all of which I had been given for headache, either in the hospital or to try as abortives. Every med he listed had made me sleep for like 20 hours straight, even when receiving them several days in a row (so that the side effect would wear off), and this guy could not sleep and was on all those meds. I really felt badly for him!

Any time they say the sleepiness will wear off the longer you're on the med, I'm leery. It never works that way for me! Ah well...

Take care,
Carrie :)

Anonymous said...

Maybe I'm misreading (I'm sleepy!), but I'd like to read the study, because this is odd: "Sleeping pills in general do not greatly improve sleep for the average person," not the average insomniac. If many of their subjects fall asleep w/in 20 min anyway (I think I've read the "average person" takes 7 minutes), of course the drug is unnecessary won't change the onset time by much. I'm also not sure if it means the increased sleep time is due to simply having more time to sleep or due to the drug's effects, another critical question that makes a difference outside the lab.

I've had 10mg Ambien every work night for the last 1.5 months and would be either miserable or jobless without getting around 7 hours versus 3-4. Still feel a bit sleep-deprived; even so I've never slept better, especially not when I have regular early-morning engagements. One thing I like about it is that it doesn't make me tired and knock me out, it just seems to flip a switch when I lie down with my eyes closed. Which is good, because I swapped it with my similar-looking T4 one school day.

On the other hand, Tuesday I wasn't thinking and took it around 2:30 or 3am before work; my boss commented I'd seemed drunk 8-10ish. Later, couldn't remember making an overseas call I couldn't push back or even taking the pill, so I was freaked out for a few days until I figured out what happened.

Anonymous said...

Starting late June I developed a vile case of insomnia. I can usually fall asleep, then wake up anywhere between midnight and 2 am and then its toss and turn toss and turn.


Tried Trazadone and it actually gave me insomnia, nasty heart palpitations and speeded up my heart rate by 40 beats a minute. Had I not already been highly athletic, this would've scared the crap out of me. So--scratch the trazadone.

Diphenhydramine---150 mgs doesnt help much.

Melatonin and Valerian plus magnesium seem to help me get to sleep at 9 pm, but dont do much to help me after I wake up in the middle of the night.

30 mg of Restoril gaves me about 5 hours of sleep.

So...I wait until I wake in the middle of the night, then bomb myself with the Restoril.

I try to avoid taking the stuff more then 3 times a week, because ETOH addiction runs big time on my mother's side of the family, so I reserve the Restoril for the 3 days a week that I do gonzo workouts, to ensure that I get enough sleep to recover. isnt fair. All this heavy stuff happens to us in middle age, and that is when it becomes more difficult to sleep, rather than easier to.

As if this isnt enough, a pair of 30 something males live above me and they tramp around like a herd of elephants. Periodic pleas and reminders are only partially effective.

One of them came stomping in at 3:30 in the morning with a lady friend.

I stood on a chair in the kitchen and yelled upward through the ceiling that it was three thirty in the goddamned morning and if they wanted to walk around, take their shoes off.


Anonymous said...

Ambien makes me, to use the clinical terminology, go batshit insane. I take the pill, I lie down and wait to go to bed. Three hours later, I'm doing things that I shouldn't be doing. Actual examples of things I have done while on Ambien: shaved my head (I'm female); called my congressman and left a long, rambling message on his machine; re-programmed several computers in my university's computer lab to play Britney Spears's "Toxic" during start-up; went downtown and smoked pot outside an IHOP with men I randomly met at a bar.

My psychiatrist thought I was experiencing mania, which I agreed with, but you know, I never had any problems when I didn't take Ambien. It took me a while to figure this out, but once I did, I sure as hell stopped taking the damn thing.

AlwaysTomboy said...

I usually don’t have any trouble sleeping, and when I’m depressed, I’ll sleep 16-18 hours easy and still feel exhausted. But every now and then when I get really stressed, I’ll go through a period where I have trouble sleeping. Usually it’s trouble falling asleep. My brain gets bogged down with so many racing thoughts and What Ifs that I just can’t shut it down long enough to go to sleep, but once I’m asleep, I’m good for the night.

Lately, I’ve been having both trouble falling asleep and trouble staying asleep. I blame my antidepressant, but the antidepressant works (for once), so it’s not going anywhere. I’d rather deal with insomnia than depression. Melatonin seems to help, but I swear it gives me AM headaches.

I took a 12.5mg Ambien CR once when I was really exhausted and really desperate and didn’t like that at all. I still woke up in the middle of the night and couldn’t go back to sleep, but I was too foggy and disoriented to do anything. My doc doesn’t advise diphenhydramine, since it’s known to not play nicely with my antidepressant. 4mg of Valium knocks me out, but I don’t have a script for Valium any more.

I haven’t wanted to start yet another prescription medication, but I’m starting to lean that way. Based on the info my doc gave me, Sonata is the one I think I want to try. I kind of like that it doesn’t last long, so I could try to get to sleep on my own and if I’m still awake at, say 1am, it wouldn’t necessarily be too late to take the Sonata then.

So I voted for Sonata, even though I’ve never actually taken it myself or known anyone who has.