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Dr. Bob is Robert Hsiung, MD,
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Posted by laima on October 7, 2006, at 10:08:23
In reply to Benzo Sleep, posted by Guy on October 6, 2006, at 18:10:07
Re-reading your post, I hope I haven't been insensitive to your plight. I apologize. A crisis time isn't the time to debate the long-term pros and cons of medications which can help you through.
I've tried zyprexa before too, with disasterous results- it didn't agree with me. If the clonazapam, the longest acting benzo, is still making you wake up anxious, perhaps there are other options? I know some people are using seroquel, for example.
I am pretty sure other people are using lyrica, also.I tried rozerem- which I would give mixed reviews- it didn't feel as potent as a benzo-hypnotic- but it sure didn't cause any early wakening, either. Perhaps it might work for you? It's supposed to be utterly different than other sleep medicines, and the doctor offices seem full of samples due to the advertising blitz going on. Not a benzo or hypnotic, I hear.
As for that early AM panic you describe, I've experienced that, too- waking up early with a flash of urgent panic- both when using shorter acting benzos to sleep, and if I use klonopin long enough to develope a good tolerance. My doctor explained that's the point where the drug wears off. His suggestion was to take it later in the evening to stave off that flash of wakening.
Yes, the more I read and hear about sleep, the more absolutely clear it is that Stage 3/4 is critical for mental well being. The experts seem to agree about that just about unanimously. We hear so much about dreams...but they are nothing compared to that deep sleep. No wonder so many sleep meds always have that "not for long term use" disclaimer.
Good luck to you- and watch out on those sleep meds- if you are anything like me, you may find yourself then waking up at 4-5am in a panic.
> I have severe GAD, panic and insomnia. When I take clonazepam, I sleep though the night, but I awaken feeling anxious and unrested. I also experience chronic pain, perhaps due to fibromyalgia. Could all this be because the benzo is preventing stage 3/4 (deep, restorative) sleep? I have recently been on Zyprexa, but it made me feel very ill, almost as if I had been poisoned (large bags under my eyes and terrible flu-like symptoms). I'm feeling really desperate and suicidal as more and more doors slam shut in my face. Do I go back on the clonazepam (shallow sleep) or continue with Zyprexa (flu)? I'm lost in the land of meds. Peace to all my fellow-sufferers...may the sweet rains of autumn wash your tears away.
Posted by laima on October 7, 2006, at 10:32:22
In reply to Benzo Sleep, posted by Guy on October 6, 2006, at 18:10:07
A couple other non benzo, non hypnotic sleep options I've been offered, but lack experience with, include antidepressents like trazadone (?), and siniquan.
Posted by Guy on October 7, 2006, at 10:57:24
In reply to Benzo Sleep, posted by Guy on October 6, 2006, at 18:10:07
Thanks, Laima, for your suggestions. Unfortunatly Seroquel has an even worse flu effect on me than Zyprexa. I'm currently taking 125 mg Doxepin (a sedating tricyclic). I still have anxiety, and I know the sedation will soon wear off, leaving me scrambling for something else to help me make it through the night. Yes, Stages 3 and 4 sleep are essential for mental health...I firmly believe millions of people are trapped in a vicious cycle of suffering because the medical establishment has been unable to grasp this simple fact. Drop me a babble-mail if you have time and I'll tell you a bit more about my dilemma.
Posted by notfred on October 7, 2006, at 11:08:58
In reply to Stages 3 and 4 sleep, posted by Guy on October 7, 2006, at 10:57:24
I find Lunesta, 6 mg, gives very good restorative
sleep and I wake refreshed. I have been on it 7 months and it works as well today as it did when I started.
Posted by laima on October 7, 2006, at 11:38:45
In reply to Re: Stages 3 and 4 sleep, posted by notfred on October 7, 2006, at 11:08:58
Really? That's good to hear.
> I find Lunesta, 6 mg, gives very good restorative
> sleep and I wake refreshed. I have been on it 7 months and it works as well today as it did when I started.
Posted by notfred on October 7, 2006, at 16:12:08
In reply to Re: Stages 3 and 4 sleep » notfred, posted by laima on October 7, 2006, at 11:38:45
However, I cannot find any studies that indicate
if/how Lunesta effects Stages 3 and 4. The monograph
says it improves sleep latency, overall time, and sleep efficiency.
Posted by notfred on October 7, 2006, at 16:17:19
In reply to Re: Benzo Sleep, posted by rjlockhart on October 7, 2006, at 0:40:11
> Ask about Restoril or temazepam.
I liked temazepam, 30 mg, till I started having
significant word finding problems. I still needed to take Ativan as needed during the day and Ativan really made me sleepy if I also took temazepam at night. For the first 30 mins or so on waking I would slur my words a bit, on temazepam even if I did not take Ativan during the day.
Posted by Declan on October 7, 2006, at 18:24:20
In reply to Re: Benzo Sleep, posted by notfred on October 7, 2006, at 16:17:19
The single best thing I've tried for sleep is mirtazepine, because it increased the depth of sleep. I couldn't keep taking it because I preferred insomnia to the feel of mirtazepine in the morning. Cyproheptadine was kinda similar, with similar drawbacks. The tricyclics didn't do the same thing. Accepting that you need benzos for sleep and also that they damage it, what can you do except stuff (which you may have done) like cutting out drinking?
Posted by notfred on October 7, 2006, at 19:01:09
In reply to Re: Benzo Sleep, posted by Declan on October 7, 2006, at 18:24:20
> Accepting that you need benzos for sleep and also that they damage it, what can you do except stuff (which you may have done) like cutting out drinking?
You pick the one you can tolerate the best. I have significant middle and terminal insomnia (Ambien would be a great option if were not for this) and some parasomnias. I use sleep hygiene methods which help some but are not the total cure. Depression is also a primary cause of insomnia, so treating that may solve any sleep problems for some.If a med causes less stage 3 and 4 sleep but off the med you get less total sleep then you may be getting more stage 3/4 on the med as you are asleep longer.
Benzo's for sleep would be great for me if I did not take benzos during the day.
So to me it is a question of what you can tolerate
and if it gives you restful sleep. I worry less about effects to sleep cycles and more about getting restful sleep.
Posted by Phillipa on October 7, 2006, at 19:37:12
In reply to Re: Benzo Sleep, posted by notfred on October 7, 2006, at 1:12:26
After 30 years I still wake up once. And I've been able to completely stop when stress was not a problem. Love Phillipa ps I can cut down on valium and do sometimes by 5mg which is 25% of my nightly dose.
Posted by laima on October 7, 2006, at 19:50:10
In reply to Re: Benzo Sleep, posted by notfred on October 7, 2006, at 19:01:09
In the long run, respectfully, I worry you might run into deeper mood trouble if you disregard the crucial importance of deep stages of sleep. Those are the truely restorative stages for the mind. But yes, ANY sleep is better than none.> So to me it is a question of what you can tolerate
> and if it gives you restful sleep. I worry less about effects to sleep cycles and more about getting restful sleep.
Posted by Declan on October 7, 2006, at 19:56:26
In reply to Re: Benzo Sleep » notfred, posted by laima on October 7, 2006, at 9:54:47
So Laima, what do you do about this (if you haven't told us already)?
Posted by laima on October 7, 2006, at 19:57:49
In reply to Re: Benzo Sleep » laima, posted by Declan on October 7, 2006, at 19:56:26
Oh, I'm still dying to find out!
> So Laima, what do you do about this (if you haven't told us already)?
Posted by Declan on October 7, 2006, at 20:00:11
In reply to Re: Benzo Sleep » Declan, posted by laima on October 7, 2006, at 19:57:49
Well, I used herbs, tryptophan, other amino acids, niacin, not to speak of reducing my drinking to frighteningly low levels. Somethings better, anyway. I get 6 hours a night now.
Posted by laima on October 7, 2006, at 20:13:11
In reply to Re: Benzo Sleep » laima, posted by Declan on October 7, 2006, at 20:00:11
> Well, I used herbs, tryptophan, other amino acids, niacin, not to speak of reducing my drinking to frighteningly low levels. Somethings better, anyway. I get 6 hours a night now.
Thanks. Can you tell which herbs, and do you have any you might especially recommend? I'm scared of using tryptophan because I am using Emsam, and I saw a bottle of tryptophan which sternly warned against using it with any maoi.
Hey, by the way, I respect you and everyone else here very much, and I have been so frustrated lately about this "deep sleep" problem, because I've been told, and I've been reading snippets all over the place lately, about how a dearth of it exasperates mood disorders. I want to apologize if my own frustrations with the matter caused any of my comments to sound glib. I'm using klonopin for sleep now myself, despite knowing its shortcomings.
Posted by notfred on October 7, 2006, at 21:06:55
In reply to Re: Benzo Sleep » notfred, posted by laima on October 7, 2006, at 19:50:10
>
> In the long run, respectfully, I worry you might run into deeper mood trouble if you disregard the crucial importance of deep stages of sleep. Those are the truely restorative stages for the mind. But yes, ANY sleep is better than none.
>
Yep, while I do feel I get good restorative sleep
there is no way to know if I still have a deficit
of stage 3/4 that is causing mood problems.
Also, I am not a good person to use as an example
as sleep studies indicate my cycles are really messed up. I am not your normal insominac.If is will work for you, Ambien does not mess up
stage 3/4, it is too short acting to last past the second full cycle of sleep. It takes about 90 mins
to do a cycle: 1,2,3,4,3,2,REM. There is some evidence it does not mess with even 3/4 during the first full cycle of the night. But it is effective for those who only have trouble getting to sleep.It does not help with total sleep time or frequent wakings.
Posted by Phillipa on October 7, 2006, at 21:32:05
In reply to Re: Benzo Sleep, posted by notfred on October 7, 2006, at 21:06:55
But if you take valium and four hours wake is this destroying restorative sleep? I save 5mg to go back to sleep and sleep better then. I need at least 9 hours sleep. Always have even before meds. There has to be an answer. Love Phillipa
Posted by laima on October 7, 2006, at 21:34:05
In reply to Re: Benzo Sleep, posted by notfred on October 7, 2006, at 21:06:55
Ach- I tried ambien, and the CR. Not only did I not go to sleep for hours after taking it, I got into some very weird and embarressing behavior which I have no recollection of, though I've seen the evidence and heard the reports. (Whoops.)
Didn't work out so well in my case. Oh well.> >
> > In the long run, respectfully, I worry you might run into deeper mood trouble if you disregard the crucial importance of deep stages of sleep. Those are the truely restorative stages for the mind. But yes, ANY sleep is better than none.
> >
>
>
> Yep, while I do feel I get good restorative sleep
> there is no way to know if I still have a deficit
> of stage 3/4 that is causing mood problems.
> Also, I am not a good person to use as an example
> as sleep studies indicate my cycles are really messed up. I am not your normal insominac.
>
> If is will work for you, Ambien does not mess up
> stage 3/4, it is too short acting to last past the second full cycle of sleep. It takes about 90 mins
> to do a cycle: 1,2,3,4,3,2,REM. There is some evidence it does not mess with even 3/4 during the first full cycle of the night. But it is effective for those who only have trouble getting to sleep.It does not help with total sleep time or frequent wakings.
Posted by Declan on October 7, 2006, at 22:01:20
In reply to Re: Benzo Sleep » Declan, posted by laima on October 7, 2006, at 20:13:11
Gee thanks
The herbs that are recommended for depressives are called trophorestoratives in the excellent "Principles and Practice of Phytotherapy" by Mills and Bone. I the meaning to be that some herbal sedatives (like valerian) are inadviseable for depressives. The ones recommended are Avena officinalis (oatstraw), Hypericum perforatum (St John's Wort), Scuttelaria lateriflora (skullcap), Turnera aphrodisica (damiana), Verbena officinalis (vervain) and Withania somnifera (Ashwaganda). Not all thse are useful hypnotics (of course!). Skullcap, vervain and withania have been useful for me, (although I have heard of people having sleep problems with withania). I would add Zizyphus spinosa, the main herbal sedative in TCM.
Declan
Posted by notfred on October 8, 2006, at 15:20:33
In reply to Re: Benzo Sleep » laima, posted by Declan on October 7, 2006, at 22:01:20
> Gee thanks
> The herbs that are recommended for depressives are called trophorestoratives in the excellent "Principles and Practice of Phytotherapy" by Mills and Bone. I the meaning to be that some herbal sedatives (like valerian) are inadviseable for depressives. The ones recommended are Avena officinalis (oatstraw), Hypericum perforatum (St John's Wort), Scuttelaria lateriflora (skullcap), Turnera aphrodisica (damiana), Verbena officinalis (vervain) and Withania somnifera (Ashwaganda). Not all thse are useful hypnotics (of course!). Skullcap, vervain and withania have been useful for me, (although I have heard of people having sleep problems with withania). I would add Zizyphus spinosa, the main herbal sedative in TCM.
> DeclanIs it know or have you seen any studies on how these herbs effects stage 3/4 sleep ?
Posted by Declan on October 8, 2006, at 23:09:07
In reply to Re: Benzo Sleep, posted by notfred on October 8, 2006, at 15:20:33
Posted by notfred on October 9, 2006, at 0:06:34
In reply to Re: Benzo Sleep, posted by notfred on October 8, 2006, at 15:20:33
Rosenberg R, Caron J, Roth T, et al. An assessment of the efficacy and safety of eszopiclone in the treatment of transient insomnia in healthy adults. Sleep Med 2005;6:15–22.
Sleep architecture did not change significantly in any of the treatment groups, except with eszopiclone 3.5 mg, when compared with placebo. The 3.5-mg group experienced a statistically significant decrease in total time spent in non–rapid-eye movement (NREM) stage 1 sleep and rapid-eye movement (REM) sleep, as well as a statistically significant increase in time spent in NREM stage 2 (P ≤ .05) sleep. Stages 3 and 4, which are the restorative stages of sleep, did not
change significantly in any of the treat-
ment groups.
Posted by laima on October 9, 2006, at 10:12:20
In reply to Study shows no changes, Lunesta Stage 3/4 sleep, posted by notfred on October 9, 2006, at 0:06:34
Thanks. That's good news. Not to be difficult, but what if one is in need of INCREASING their stages 3/4 sleep? This makes it sound as though if one is deficient, it won't change, just won't get worse (?)
> Rosenberg R, Caron J, Roth T, et al. An assessment of the efficacy and safety of eszopiclone in the treatment of transient insomnia in healthy adults. Sleep Med 2005;6:15–22.
>
> Sleep architecture did not change significantly in any of the treatment groups, except with eszopiclone 3.5 mg, when compared with placebo. The 3.5-mg group experienced a statistically significant decrease in total time spent in non–rapid-eye movement (NREM) stage 1 sleep and rapid-eye movement (REM) sleep, as well as a statistically significant increase in time spent in NREM stage 2 (P ? .05) sleep. Stages 3 and 4, which are the restorative stages of sleep, did not
> change significantly in any of the treat-
> ment groups.
Posted by laima on October 9, 2006, at 10:14:15
In reply to Re: Benzo Sleep, posted by notfred on October 8, 2006, at 15:20:33
> I the meaning to be that some herbal sedatives (like valerian) are inadviseable for depressives.
This is interesting! I never knew. Anyone know why? Thanks.
Posted by notfred on October 9, 2006, at 13:38:21
In reply to Re: Study shows no changes, Lunesta Stage 3/4 sleep » notfred, posted by laima on October 9, 2006, at 10:12:20
> Not to be difficult, but what if one is in need of INCREASING their stages 3/4 sleep? This makes it sound as though if one is deficient, it won't change, just won't get worse (?)
>The study was on "normals" with no sleeping problems.
One is deficient of stage 3/4 because they cannot get enough total sleep. You spend ~10% of total time asleep in stage 3/4. Staying asleep longer allows for more 90 min cycles, each where you pass through stage 3 and 4. I think the goal is to increase total time while not effecting stages too much. The goal is allowing for more 90 min cycles so you can have a proportional increase in each stage of sleep.
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