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Whats a good long term sleep aid?


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#1 obsessed

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Posted 11 April 2010 - 02:44 PM

Hello All,

I’ve had insomnia since I was 13. Throughout teenage years, i just dealt with it. I basically stayed awake writing or listening to music for the hours I couldn’t sleep. Then later on a starting smoking weed, which worked. But after a while, didn’t really care to smoke weed anymore. I transitioned to Tylenol PM and took that for years, but because I also drink, I eventually switched to OTC sleep aids (unisom etc) to avoid liver/kidney damage. I'm 28, and up until now no doctor Ive every had has taken me seriously when Ive discussed my difficulty sleeping. Recently, I was instructed to 'stop taking OTC sleep aids immediately,' as apparently years of use can cause a toxic level of something in your system. So, in place he recommended Melatonin, with Valium as PRN. It’s kinda working, but not well. My problem has always been staying asleep, not falling asleep. So, when I wake up and take a Valium Im able to go back to sleep but groggy by the time my alarm goes off as result. Also, taking the Valium regularly builds tolerance, so I cant see how that will be good, especially not when I need it for anxiety.

SO, after all that background, my question is: What sleep aid works best for long term use?



Thanks, I appreciate any feedback.
Dx: GAD and Panic Disorder
Rx: Pristiq 50mg


#2 klingon001

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Posted 11 April 2010 - 03:01 PM

Wow, I didn't know that years of using OTC sleep aids could build up toxic shit in my system. Thanks for the tip!

Sorry that I have no advice. I have the same problem as you.

#3 Sam_I_Am

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Posted 11 April 2010 - 03:46 PM

Hello All,

I’ve had insomnia since I was 13. Throughout teenage years, i just dealt with it. I basically stayed awake writing or listening to music for the hours I couldn’t sleep. Then later on a starting smoking weed, which worked. But after a while, didn’t really care to smoke weed anymore. I transitioned to Tylenol PM and took that for years, but because I also drink, I eventually switched to OTC sleep aids (unisom etc) to avoid liver/kidney damage. I'm 28, and up until now no doctor Ive every had has taken me seriously when Ive discussed my difficulty sleeping. Recently, I was instructed to 'stop taking OTC sleep aids immediately,' as apparently years of use can cause a toxic level of something in your system. So, in place he recommended Melatonin, with Valium as PRN. It’s kinda working, but not well. My problem has always been staying asleep, not falling asleep. So, when I wake up and take a Valium Im able to go back to sleep but groggy by the time my alarm goes off as result. Also, taking the Valium regularly builds tolerance, so I cant see how that will be good, especially not when I need it for anxiety.

SO, after all that background, my question is: What sleep aid works best for long term use?



Thanks, I appreciate any feedback.



I'm going through the same thing now (and I'm not fully through on the other side yet), so the advice I offer won't be that great. I have taken something for sleep basically every night for the past 7 years (since age 19.) It started out as Tylenol PM, Benadryl, and other diphenhydramine-products and remained that way for 4 years, tried the herbal remedies too (Melatonin and valerian were sugar pills for me, kava worked somewhat but that can cause liver damage with long term regular use.) No doctor ever told me that years of diphenhydramine use will cause a toxic build-up-- they just said that "other things work better." (I'm sure use of other meds can cause toxic build-up too.) Thus, at 23, I started taking various prescription meds for sleep (Klonopin, Ambien, Lunesta, and Seroquel were the biggies for me.) As my goal is to sleep off of sleep meds, I just went off the Seroquel (with the Dr's approval of course) and am just getting by with the k-pin at night.

The tricky thing is, no sleep medication is really approved for true "long term" use. The ones that are approved for long-term use (Lunesta and Ambien CR) have only been studied for 6 months (that's supposedly the definition of long-term). All the z-drugs contain the caveat "with your doctors approval" (i.e. you shouldn't take this for more than 7 days unless with your doctors approval), so in theory they can all be used "long term" until your doctor no longer "approves". (And many many people take them for years with doctors approval and seem to do okay, other than having a hell of a difficulty getting off of them.) Other medications that are often used for sleep (i.e. seroquel, trazodone, elavil, etc) are off-label, so their use for sleep hasn't really been studied at all....however, the long-term safety of the older drugs, like trazodone and elavil, has been established for other conditions. Other people do use benzos for sleep, both the "sleeping pill" kind (i.e. restoril, halcion) and the "anxiety kind" (xanax, ativan, klonopin, valium.)

It's hard to know which method would be the right one for you because none of them are ideal and have their own risks and drawbacks. What helps to know is the underlying CAUSE of the insomnia. If it is anxiety, perhaps a nightly benzo is the answer (for people w/o history of addiction). If it's depression, perhaps a sedating antidepressant. If it's anxiety or agitation (and/or if there is a history of addiction), perhaps seroquel or a sedating AAP. If there's a chance there could be a physical cause (i.e sleep apnea or something), then the intevention would be entirely different. By the way, have you ever done a sleep study before?
Dx: PTSD; MDD (in partial remission) and/or Dysthymia (take your pick); PMDD
Rx: Zoloft 100mg, Klonopin 1mg, Trazodone 100mg, weekly CBT-based therapy
Past Rx: Wellbutrin (SR and XL), Lexapro, Cymbalta, Paxil, Lamictal, Seroquel, Abilify, Perphenezine, Ritalin, Concerta, Ambien, Lunesta, Sonata, Vistaril



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#4 sorrel

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Posted 11 April 2010 - 04:26 PM

Trazodone is fine long-term, if it works for you.




#5 obsessed

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Posted 11 April 2010 - 06:49 PM


Hello All,

I’ve had insomnia since I was 13. Throughout teenage years, i just dealt with it. I basically stayed awake writing or listening to music for the hours I couldn’t sleep. Then later on a starting smoking weed, which worked. But after a while, didn’t really care to smoke weed anymore. I transitioned to Tylenol PM and took that for years, but because I also drink, I eventually switched to OTC sleep aids (unisom etc) to avoid liver/kidney damage. I'm 28, and up until now no doctor Ive every had has taken me seriously when Ive discussed my difficulty sleeping. Recently, I was instructed to 'stop taking OTC sleep aids immediately,' as apparently years of use can cause a toxic level of something in your system. So, in place he recommended Melatonin, with Valium as PRN. It’s kinda working, but not well. My problem has always been staying asleep, not falling asleep. So, when I wake up and take a Valium Im able to go back to sleep but groggy by the time my alarm goes off as result. Also, taking the Valium regularly builds tolerance, so I cant see how that will be good, especially not when I need it for anxiety.

SO, after all that background, my question is: What sleep aid works best for long term use?



Thanks, I appreciate any feedback.



I'm going through the same thing now (and I'm not fully through on the other side yet), so the advice I offer won't be that great. I have taken something for sleep basically every night for the past 7 years (since age 19.) It started out as Tylenol PM, Benadryl, and other diphenhydramine-products and remained that way for 4 years, tried the herbal remedies too (Melatonin and valerian were sugar pills for me, kava worked somewhat but that can cause liver damage with long term regular use.) No doctor ever told me that years of diphenhydramine use will cause a toxic build-up-- they just said that "other things work better." (I'm sure use of other meds can cause toxic build-up too.) Thus, at 23, I started taking various prescription meds for sleep (Klonopin, Ambien, Lunesta, and Seroquel were the biggies for me.) As my goal is to sleep off of sleep meds, I just went off the Seroquel (with the Dr's approval of course) and am just getting by with the k-pin at night.

The tricky thing is, no sleep medication is really approved for true "long term" use. The ones that are approved for long-term use (Lunesta and Ambien CR) have only been studied for 6 months (that's supposedly the definition of long-term). All the z-drugs contain the caveat "with your doctors approval" (i.e. you shouldn't take this for more than 7 days unless with your doctors approval), so in theory they can all be used "long term" until your doctor no longer "approves". (And many many people take them for years with doctors approval and seem to do okay, other than having a hell of a difficulty getting off of them.) Other medications that are often used for sleep (i.e. seroquel, trazodone, elavil, etc) are off-label, so their use for sleep hasn't really been studied at all....however, the long-term safety of the older drugs, like trazodone and elavil, has been established for other conditions. Other people do use benzos for sleep, both the "sleeping pill" kind (i.e. restoril, halcion) and the "anxiety kind" (xanax, ativan, klonopin, valium.)

It's hard to know which method would be the right one for you because none of them are ideal and have their own risks and drawbacks. What helps to know is the underlying CAUSE of the insomnia. If it is anxiety, perhaps a nightly benzo is the answer (for people w/o history of addiction). If it's depression, perhaps a sedating antidepressant. If it's anxiety or agitation (and/or if there is a history of addiction), perhaps seroquel or a sedating AAP. If there's a chance there could be a physical cause (i.e sleep apnea or something), then the intevention would be entirely different. By the way, have you ever done a sleep study before?


I wish I didnt have to rely on sleep meds either, but I can’t imagine ever being able to sleep without them. It’s hard for me to understand what normal sleep is, as it has been so long that I have had that. Also, I have no idea what causes my insomnia. Various people have speculated, but never concluded anything. I haven’t ever done a sleep study, but I should. I would assume its anxiety based though. Right now I’m starting a new medication for anxiety (Pristiq,) but it’s making my insomnia worse at the moment. And I do use a benzo, but I would rather not, as I don’t want to build tolerance and have it be ineffective when I have a panic attack ;)

It makes since that none of them are for 'long term' use, as natural sleep is the most healthy/restful in theory. And for various reasons, it probably isn't good to rely on something to help you sleep forever. I just don’t see how it’s possible without the help. Like I said, this has truly been an issue most of my life.





In any case, thank you for all the info. And good luck!!! Sounds like what you’re doing now is working, and I hope it continues :)
Dx: GAD and Panic Disorder
Rx: Pristiq 50mg

#6 Tenebrae

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Posted 11 April 2010 - 07:28 PM

Trazodone works for me and I've been on it for years.
It's an old school AD

Some people find it too sedating the morning after tho
YMMV

good luck
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#7 bpladybug

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Posted 11 April 2010 - 07:52 PM

Hello All,

SO, after all that background, my question is: What sleep aid works best for long term use?



Ambien is good, Lunesta might help, and what might really work is Seroquel. 25 mgs of Seroquel which is an Atypical Antipsychotic. 25 mgs is a tiny itty bitty dose. But don't expect a GP to prescribe this. You might want to go to a Psychiatrist just for a consultation about the insomnia. Good luck!

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Treatment: 900 mgs Lithium, 900 mgs Neurontin, 400 mgs Seroquel, Xanax prn, Temazepam, fish oil, vitamins, Vit. D 5, 000 IU, exercize, some talk therapy and CBT Therapy. Exercize helps as does the Light Box; 30 mins every morning. I also have physical health challenges.


#8 peppermintpatty

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Posted 11 April 2010 - 08:03 PM

I'm just hazarding a guess here (I'm not a doctor, not authorized to give medical advice, yadda yadda, legal disclaimer bullshit ad nauseum), but if you were taking Tylenol PM your doc probably told you to go off it because acetaminophen (probably spelled that wrong) taken in large enough quantities can cause liver failure. In other words, it's the Tylenol and not the PM that's the issue.

I also suffer from insomnia. When I first developed it I had no health insurance, so the p-doc I was seeing at the time (I was a guinea pig in one of his research studies and he agreed to continue seeing me after I completed the study) would give me a handful of Lunesta samples and would write me a prescription for a very small quantity of Ambien (like, 2 or 3 pills). Then I'd alternate between the 2 and only take it when I had to get a good night's sleep and be up early the next morning. He also did me the favor of writing the Ambien for 10 mgs, then I'd chop the pills in half. More bang for the buck.

To make a long story short, Lunesta started to make me feel faint when I took it, so I dropped it completely and now I'm just on Ambien. I've probably been on it consistently for at least 3 years. I'm still at 5 mgs and I only take it 5 days a week when I have to be up early for work. I skip it on the weekends. I've never had a problem with it.

Hope this helps.

DX: GAD w/dysthymia
Every Day Meds: Namenda 15 mgs, Doxepin 100 mgs
Only-when-I-need-'em Meds: Klonopin 0.5 mgs, Xanax 0.5 mgs, Ambien 5 mgs, Remeron 7.5 mgs

Meds That Were So Awful For Me I Wouldn't Take Them Again If You Held a Gun To My Head: Effexor, Provigil, Zoloft

#9 obsessed

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Posted 11 April 2010 - 09:10 PM

Well, thanks everyone for all the feedback... Things to discuss with my doctor. Maybe its time to try Ambien. Once I get my GAD under better control, Id like to do a sleep study to address what is causing the insomnia. I guess I’ve just gotten complacent about it over the years, and simply wanted a short term fix thats turned into a very long term fix.

I wanted to clarify, my doctor was concerned that repeated use of sleep aids containing Doxylamine could lead to toxic levels in the system. He did not explain further, and I understand this could be incorrect. At the time I was being evaluated for a 'heart click,' which turned out to be Mitral Valve Prolapse, and other symptoms that were later attributed to GAD... in any case, the sleep aid raised concerns. He suggested melatonin, and said we would revisit if it didn’t work. its time to revisit I think.

Thanks again.
Dx: GAD and Panic Disorder
Rx: Pristiq 50mg

#10 vanderk

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Posted 12 April 2010 - 07:47 AM

Was the Mitral Valve Prolapse diagnosis confirmed? If it was, that becomes your chief issue. A couple of axioms are at work here: 1)anxiety simply kills sleep, and 2)long term sleep aids become a trap. Your brain literally un-learns how to dial down and initiate sleep. Of the many meds suggested, the least likely to do damage to you is Trazodone. Yep, it's heavy-handed and notorious for a sleep-hangover that lasts until mid-morning.

But if the core issue is the prolapsing Mitral valve, treating that may solve the whole lot for you.
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#11 wondernut

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Posted 12 April 2010 - 07:51 AM

if I drink alcohol I do not sleep well at all ..I know this is a little to obvious but if you give up drinking you may sleep better? alcohol really does kill a good sleep
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#12 obsessed

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Posted 12 April 2010 - 12:54 PM

Was the Mitral Valve Prolapse diagnosis confirmed? If it was, that becomes your chief issue. A couple of axioms are at work here: 1)anxiety simply kills sleep, and 2)long term sleep aids become a trap. Your brain literally un-learns how to dial down and initiate sleep. Of the many meds suggested, the least likely to do damage to you is Trazodone. Yep, it's heavy-handed and notorious for a sleep-hangover that lasts until mid-morning.

But if the core issue is the prolapsing Mitral valve, treating that may solve the whole lot for you.


Yes, after several test, the cardiologist diagnosed borderline MVP with trivial regurgitation. he said treatment is not necessary at his time, ill just have annoying symptoms to deal with. and now at 28, i have a cardiologist Ill be seeing every 6 months to monitor my heart condition. Nice. that said, my primary care doctor thought it was time to start treating my GAD. So, the two are being regarded as separate issues, but sure the hell mimic the same symptoms.

The concerns I have about trazadone are that im already on an AD and i cant have that hangover feeling in the morning (im up at 6am and not home till 10pm) as I have to be as clear and alert as possible. Also, I can fall asleep without problem. I just cant stay asleep. Even taking something, I wake up at least 3 times throughout the night and lay there for a while. the problem is when i wake up and lay there for hours. that is not cool ;) eheh.
Dx: GAD and Panic Disorder
Rx: Pristiq 50mg

#13 Hume's doona

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Posted 12 April 2010 - 01:13 PM

I take temazepam. It's a benzo specifically for sleep. I take it PRN though, not every night.

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#14 notfred

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Posted 12 April 2010 - 06:13 PM

The problem with the Z (Ambien, Sonata) drugs is most are better suited for problems falling asleep and not early morning awaking. I have no problems getting to sleep but staying there is another thing. Meds that I have found that work are doxipin, temazepam, trazodone, Remeron, and Lunesta. Presently I use Lunesta and find it gives 6 1/2 to 7 hours of good sleep. I have been on it almost 4 years so tolerance is not an issue for me. I find the drawback on Lunesta is while it lasts long enough it is not strong enough (at 1,2, or 3 mgs) to keep me asleep. So I take a large dose, 6 mgs, which works just fine with no AM grogginess. However, I have to beat my insurance with a stick every year to get approved for 6 mgs.

In terms of AM grogginess, I find that on waking I have been hugely sedated (not on Lunesta but on the other 4) but once I start moving I am OK. It just makes getting out of bed difficult.

You have to be willing to try things instead of dismissing them out of hand. You never know, YMMV.

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Edited by notfred, 13 April 2010 - 09:12 AM.


#15 Maceo

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Posted 13 April 2010 - 04:17 AM

Remeron. It is officially an antidepressant but I found it to be a very effective sleep aid and did not build a tolerance to it the way I did to all benzo's, z-drugs and OTC sleep-aids.

#16 Guest_nileas_*

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Posted 16 April 2010 - 04:31 PM

I'm a sleep-onset insomnia person. Meaning I have trouble falling asleep. I am also an unsuccessful napper. I took Remeron (Mirtazapine) for quite awhile after using OTC Tylenol PM and such. It's an anti-depressant but sometimes prescribed for the convenient, sleepy side effect.

It worked for a couple of years and was awesome. I feel asleep within about 45-60 minutes after taking it and slept like the dead. However it can make it very difficult to get up in the morning if you don't allow yourself enough time to sleep. The other side effect is weight gain (they use this drug to increase appetite for elderly patients). Mine wasn't too significant but I exercise pretty frequently. It's not really working so much for me now (I'm onto crappy, crappy generic Ambien) but you could give it a shot.

#17 crtclms

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Posted 17 April 2010 - 06:20 AM

My sleep has sucked since i hit puberty. My p-docs have always treated it as a behavioral issue, and I am not denying that there is that possibility. But every attempt I have made at sleep hygiene for the last 25 years has completely bombed

I am just straight out asking for a sleep aid. I tried my p-doc's suggestions for how to fall asleep faster, and they are not working. At. All. I feel like taking a sleeping me make me more like an addict, because I am already on benzos. Although oddly, just being on the benzos doesn't give me the same feeling of trepidation.

Dx: Bipolar 1; GAD; Migraine w/ Aura; Migraine w/o Aura; Renal Tubular Acidosis (caused by Zonegran); Status Migrainosus
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Currently Shelved: Abilify; Amerge; Anaprox; Atenolol; Buspar; Cafergot; Cymbalta; Depakote; Di-Hydro-ergotamine, injected; Gabapentin; Geodon; Imitrex Tablets; Klonopin; Maxalt; Namenda; Nortriptyline; Norvasc; Propranolol; Prozac; Risperidone; Relpax; Sansert; Sumatriptan injectables; Tegretol; Trazadone; Zoloft; Zolpidem; Zomig; Zonegran


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#18 Catnapper

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Posted 17 April 2010 - 11:22 AM

You mention your GP but not a pdoc, or maybe I missed it. A pdoc is much better at figuring out what to do about GAD, insomnia, etc. I like my GP a lot, but he's a good enough doc to know that a specialist is better at knowing which meds to use and will have a lot more experience with successful combinations and off-label usage.

One non-med thing that I have found helps tremendously is to sleep in complete darkness. I use black-out drapes, drape a tea towel over the stove light, unplug the satellite box, cover up the red light on the tv, etc. Also, I don't look at any blue light sources for at least an hour before bedtime - no computer, tv, cell phone. It all does seem to make a huge difference. Having 24 hour light available hasn't been a great thing for us as a species, so elimating it while sleeping is restorative. Good luck to you.
New Improved Diagnosis: Probably BP II (instead of MDD recurrent), or as the pdoc said, "There's clearly some sort of cycle going on." The more I think about it, the more I think he's right. I've started a mood stabilizer and feel better, so I have my fingers crossed I'll stay far away from the abyss.

RX: Generic versions of Lamictal 200 mg, Wellbutrin SR 300 mg, Ambien 10 mg, Gabapentin 900 mg (for hot flashes), lots of vitamins and fish oil tablets.
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#19 Cetkat

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Posted 17 April 2010 - 03:16 PM

Lunesta lasts for the full 8 hours. Sonata only lasts for 4. Ambien CR also works all night, as does Trazodone.

Trazodone is the most likely to give you a hang-over out of these, but that usually goes away with time.

I've tried all of these and Ambien and Trazodone are the most effective for helping you get to sleep, but that's not really your problem.

I would try the Lunesta first since it stays in your system the whole night, then give Trazodone a try - as it is my favorite out of all of these and works very well.

I saw a mention of Seroquel somewhere, and I'd stay away from that as it'll make you very drowsy the next day & that doesn't always go away. Traz doesn't give you as bad a hangover as Seroquel.

There's also an issue with Ambien in that it has a tendency to make you sleep walk, eat, and even sometimes drive. I love it, but refuse to take it anymore due to those issues.

I hope you find something that works well for you. ;)

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Dx: Major Depression w/ Dysthymia and Panic Disorder, ADHD, Fibromyalgia
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#20 Thomas

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Posted 17 April 2010 - 03:26 PM

I have taken Restoril (temazepam) for years and it works well for me, most of the time. I still have the occasional bout of insomnia, but they are few and far between.

Tommy
Dx:BP1, OCD, Diabetetes Type 2, Hypertension, Gastroparesis & kidney stones
Rx: Abilify 20 mg., Klonopin 6.0 mg., Restoril 30 mg. Cymbalta 120 mg. , Lamictal 400 mg., Cogentin 1.5 mg. Crestor 10 mg. hydrochlorothiazide 25 mg., Hyzaar 100/25 mg., domperidone 20 mg. and Levemir Insulin 40 units, Actos 45 mg.,Proprananol ER 80 mg., Hydrocodone/APAP 40 mg./4000 mg., tizanidine 1 mg., Fiorocet 3 mg.





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