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So I tend to try out meds for a long while before deciding to make a switch. Sleeping is one of the hardest things for me to do. I can't seem to get a med that will help. I also have OCD and anxiety which has also been difficult to manage (though helped a bit by stimulants).

I've tried Luvox and Anafranil for the OCD/anxiety. Both were supposedly sedating but neither made me sleepy in the slightest. I've tried Vistaril (up to 100 mg 3x day), Gabapentin, Buspar, Zoloft, Trazodone, and most recently Sonata. Yes I'm aware this is a bit unorganized, but my point is that nothing I take seems to be "sedating" as they're supposedly known to do. I wouldn't want to be "sedated" either, just not anxious and able to sleep.

I'm thinking of asking the psych for something else. She doesn't like Z-drugs but felt that Sonata was safe enough to take. Sometimes it'll work with Trazodone, but it's a hit or miss really and if I do get to sleep on them it's too long and not restorative. I've been recently prescribed Klonopin, as needed for panic attacks (father had a stroke recently and taking over has been overwhelming) but I can't really say for certain that it works. It could just be that the panic attacks dissipate on their own. 

What do I do? I feel like I've tried almost every "type" of med in terms of drug class. 

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Posted (edited)
2 hours ago, Persona_Is_Life said:

   What do I do? I feel like I've tried almost every "type" of med in terms of drug class. 

What was the highest dose of Trazodone that you tried?.....I take 200mg for sleep.

According to what you said, about what you've tried,  you haven't tried any low-dose atypical anti-psychotics (AAPs) for sleep, such as Seroquel....There are also other AAPs that some docs will give (in low doses) for sleep.

If you don't want to try an anti-psychotic, the antidepressant Remeron (mirtazapine) might also be a decent choice to try--In general, it's more sedating at lower doses.: https://en.wikipedia.org/wiki/Mirtazapine

Mirtazapine has also been used in the treatment of anxiety disorders.

Edited by CrazyRedhead

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Uh ...a few thoughts take it or leave it just some ideas. Belsomra, I second the remeron, maybe a TCA like really low dose doxepin, and my personal favorite halcion although you my never get a script for it I have a pretty liberal pdoc. It might be time to bite the bullet and try a sedating AP. Seroquel 25-50mg and zyprexa 2.5-5mg are two common ones but most of them can help with sleep (saphris especially). Personally I sometimes need a typical antipsychotic as a last resort sometimes. Thorazine is a sedation bomb, but again, good luck with that conversation. You can also combine them in various combinations sometimes (I did remeron+ ativan and Thorazine plus Valium)  

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Ah, I forgot about Belsomra......It does work for some, but tends to be a little on the expensive side....Some insurances won't cover it, but if you have insurance you could call and check.

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Posted (edited)
11 hours ago, CrazyRedhead said:

What was the highest dose of Trazodone that you tried?.....I take 200mg for sleep.

According to what you said, about what you've tried,  you haven't tried any low-dose atypical anti-psychotics (AAPs) for sleep, such as Seroquel....There are also other AAPs that some docs will give (in low doses) for sleep.

If you don't want to try an anti-psychotic, the antidepressant Remeron (mirtazapine) might also be a decent choice to try--In general, it's more sedating at lower doses.: https://en.wikipedia.org/wiki/Mirtazapine

Mirtazapine has also been used in the treatment of anxiety disorders.

Honestly APs terrify me. I don't really want to be sedated, and I don't want to be in a cognitive fog. I have school and a job that requires attention to detail. I could give Mirtazapine a try, but I'm also worried it'll aggravate my insomnia like all the other antidepressants did. Trazodone didn't help much at all, and when it did it was only in combination with Sonata and I would oversleep. ADs seem to "wake" my brain up as opposed to quieting it down. With Luvox I swear my poor brain was climbing up the walls.

 

7 hours ago, Iceberg said:

Uh ...a few thoughts take it or leave it just some ideas. Belsomra, I second the remeron, maybe a TCA like really low dose doxepin, and my personal favorite halcion although you my never get a script for it I have a pretty liberal pdoc. It might be time to bite the bullet and try a sedating AP. Seroquel 25-50mg and zyprexa 2.5-5mg are two common ones but most of them can help with sleep (saphris especially). Personally I sometimes need a typical antipsychotic as a last resort sometimes. Thorazine is a sedation bomb, but again, good luck with that conversation. You can also combine them in various combinations sometimes (I did remeron+ ativan and Thorazine plus Valium)  

Anafranil is a TCA. Not as potent as Doxepin in terms of sleep, but great for the OCD. It was one of my favorite meds but did dampen my cognitive abilities somewhat. I really don't want to try APs. I know there are other drugs in the same class as Sonata (i.e. Ambien, Lunesta, etc...) but my psych wouldn't go for it. My pharmacist did say though that only Ambien would really work. :(

 

I'm also a bit leery towards benzodiazepines. Their addiction potential, withdrawal, and memory loss issues don't appeal to me. I agreed on the Klonopin because the panic attacks do suck and I need a somewhat clear head to deal with everything that's going on in my life at the moment. "Analysis paralysis" sucks. 

 

I might be willing to give Belsomra a go. I have state insurance though and doubt they would cover it.

Edited by Persona_Is_Life
Additional response.

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Sorry I just missed that u tried anafranil. Unfortunately you might have to go with the least worse option. AAPs at low dose typically don't cause 24 hr Brain fog especially instant release ones like seroquel. I understand your hesitation though but I think "antipsychotic" gets a bad reputation that isn't totally warranted. 

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I second @Iceberg mention of halcion/triazolam. Similar to sonata in respect to duration of action, time to start working, but sonata IMO is much, much weaker for insomnia if the other treatments you mentioned didn't help much, and too easy to fight the sleepy dazed feeling and stay up unintentionally. Halcion has the potential to do this also, but I find it's hypnotic properties to be stronger than that of any z-drug, love that taking halcion with food isn't affected with respect to it's absorption or effectiveness like what happens with z-drugs when taken after a meal (AKA they just don't work at all in this case). I had to starve myself 2-3 hours back when I was using Ambien just to ensure it would be best absorbed, same with Lunesta and Sonata. If your dr doesn't like giving z-drug, well then I wouldn't expect to be given halcion by a long shot. IME Sonata is nothing special by any means, not very effective, and still has some similar side effects as halcion.

If you liked doxepin, maybe you could check out Silenor, just doxepin rebranded as a lower dose, I think 3mg, indicated for insomnia only. Remeron/mirtazapine seems on the same level of sedation as seroquel; both also have similar hangover effects but I would say seroquel produces more cognitive impairment. Remeron 7.5 or 15mg worked great, and around 50-150mg seroquel for similar sedation. Have you tried Elavil/amitriptyline? I believe it's a trycyclic AD, my dad has success with it for insomnia. I wouldn't jump to older generation APs like thorazine to only treat insomnia unless you've exhausted almost every other hypnotic/sedative. Zyprexa is infamous for inducing metabolic disorder and even pre-diabetes, sometimes full-blown type 2 diabetes if you use it and aren't very cautious, testing your blood sugar, etc.

Have you tried Rozerem? It works on the body's melatonin receptors, therefore inducing a more natural sleep state, not the kind of sedation we see with seroquel, for example. When it works, it usually works pretty well for those people. Lyrica might also be something to consider; I see you have tried neurontin (which i swear doctors are not afraid what so ever to hand that out) and lyrica is similar just somewhat stronger. Between 300-450mg I would get a nice sleepy feeling and drift off into dreams easily. Ativan could be a back-up plan if your inquiry about halcion gets shot down; 1-2mg is pretty decent for sleep, but seriously not every single night of the week. If you use a benzo such a halcion or ativan for insomnia it is extremely important to give yourself at least 2-3 nights every week where you are not taking the medication. If you feel you cannot go without a sedative every night, then it might be worth considering getting a medication that is not easy or quick to build tolerance or dependence (such as seroquel or doxepin) for the nights you are not taking the benzo, i.e. halcion, ativan, valiumm etc. 

But as of right now, how is the Sonata working for you? Are you also still using trazodone for sleep as necessary? What about the clonazepam, are you using that strictly for bedtime sedation or for other purposes, such as anxiety? Really might be worth doing some consolidation by getting rid of Sonata and clonazepam and replace those 2 medications with a single, more effective benzodiazepine for insomnia, if neither the clonazepam or sonata are cutting it and helping you get the sleep you deserve. My mommom and pop both swear by clonazepam for insomnia, but for me it doesn't really do the trick. Crazy how the same exact meds effect everyone very differently, even those whom we share a huge amount of DNA and genetics with, 

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My doc has the philosophy that you can use benzos everyday in order to get in a really good sleep rhythm and then back down or taper off to PRN and see if your body holds the rhythm. Of course I'm BP1 so I need it a lot during manic episodes 

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Or maybe a low dose of ur  klonipin+low dose remeron. I hate combos for sleep but I guess it can be a necessary evil. Have you tried Benadryl (high dose)? 

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On 1/4/2018 at 10:58 PM, Iceberg said:

Sorry I just missed that u tried anafranil. Unfortunately you might have to go with the least worse option. AAPs at low dose typically don't cause 24 hr Brain fog especially instant release ones like seroquel. I understand your hesitation though but I think "antipsychotic" gets a bad reputation that isn't totally warranted. 

Right now mine are but im

on seroquel

and latuda

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Halcion is rarely prescribed anymore. Very popular in the 70's, it has the same side effect as the Z-drugs. Sleepwalking, sleep driving, sleep eating and lastly sleep sex. There were some serious car accidents on halcion, I think the president was in one and blamed it on the halcion. Tends to cause retrograde abnesia....you forget what happened before you took the pill and during the pills effect. You wake up and have no idea you wrecked the car. Want to wake up having sex with someone you don't know, in a place you don't know ? Halcion.

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On ‎2‎/‎6‎/‎2018 at 8:13 AM, mmaryland said:

I second @Iceberg mention of halcion/triazolam. Similar to sonata in respect to duration of action, time to start working, but sonata IMO is much, much weaker for insomnia if the other treatments you mentioned didn't help much, and too easy to fight the sleepy dazed feeling and stay up unintentionally. Halcion has the potential to do this also, but I find it's hypnotic properties to be stronger than that of any z-drug, love that taking halcion with food isn't affected with respect to it's absorption or effectiveness like what happens with z-drugs when taken after a meal (AKA they just don't work at all in this case). I had to starve myself 2-3 hours back when I was using Ambien just to ensure it would be best absorbed, same with Lunesta and Sonata. If your dr doesn't like giving z-drug, well then I wouldn't expect to be given halcion by a long shot. IME Sonata is nothing special by any means, not very effective, and still has some similar side effects as halcion.

If you liked doxepin, maybe you could check out Silenor, just doxepin rebranded as a lower dose, I think 3mg, indicated for insomnia only. Remeron/mirtazapine seems on the same level of sedation as seroquel; both also have similar hangover effects but I would say seroquel produces more cognitive impairment. Remeron 7.5 or 15mg worked great, and around 50-150mg seroquel for similar sedation. Have you tried Elavil/amitriptyline? I believe it's a trycyclic AD, my dad has success with it for insomnia. I wouldn't jump to older generation APs like thorazine to only treat insomnia unless you've exhausted almost every other hypnotic/sedative. Zyprexa is infamous for inducing metabolic disorder and even pre-diabetes, sometimes full-blown type 2 diabetes if you use it and aren't very cautious, testing your blood sugar, etc.

Have you tried Rozerem? It works on the body's melatonin receptors, therefore inducing a more natural sleep state, not the kind of sedation we see with seroquel, for example. When it works, it usually works pretty well for those people. Lyrica might also be something to consider; I see you have tried neurontin (which i swear doctors are not afraid what so ever to hand that out) and lyrica is similar just somewhat stronger. Between 300-450mg I would get a nice sleepy feeling and drift off into dreams easily. Ativan could be a back-up plan if your inquiry about halcion gets shot down; 1-2mg is pretty decent for sleep, but seriously not every single night of the week. If you use a benzo such a halcion or ativan for insomnia it is extremely important to give yourself at least 2-3 nights every week where you are not taking the medication. If you feel you cannot go without a sedative every night, then it might be worth considering getting a medication that is not easy or quick to build tolerance or dependence (such as seroquel or doxepin) for the nights you are not taking the benzo, i.e. halcion, ativan, valiumm etc. 

But as of right now, how is the Sonata working for you? Are you also still using trazodone for sleep as necessary? What about the clonazepam, are you using that strictly for bedtime sedation or for other purposes, such as anxiety? Really might be worth doing some consolidation by getting rid of Sonata and clonazepam and replace those 2 medications with a single, more effective benzodiazepine for insomnia, if neither the clonazepam or sonata are cutting it and helping you get the sleep you deserve. My mommom and pop both swear by clonazepam for insomnia, but for me it doesn't really do the trick. Crazy how the same exact meds effect everyone very differently, even those whom we share a huge amount of DNA and genetics with, 

Wow this is a lot of info! :)

I don't get sleepy or dazed at all with Sonata, or Trazodone, actually no med I've taken has done that. I've never had Doxepin, I just know it's more potent than Anafranil. I haven't tried other TCAs but Anafranil (and also Luvox, though not a TCA) seemed to make my insomnia considerably worse when I was on them. Luvox especially, it was like my brain was climbing walls at night. I have not tried Rozerem, and it's an interesting one. A natural sleep state would be great. Gabapentin made me nauseous as all hell. Couldn't get though the month. 

 

I really liked the idea of Sonata because it's short acting so I wouldn't experience a "hangover." I didn't get sleepy on the meds, but when I did eventually sleep I felt worse waking up if I had taken them (the Trazodone that is). The clonazepam is for anxiety. I've been having a rough time since my Dad had a stroke and suddenly everything is a lot harder. I've had to take over everything, and it is overwhelming. It also doesn't make me sedated, but it seems to help with the anxiety. I try to use it as infrequently as possible though.

 

Has anyone here gotten to a point where you're so "used" to the insomnia you're starting to think you might not need a good amount of sleep anymore? 

 

@Iceberg, I've considered trying to take a benzo for a few weeks straight hoping it might create a "habit." Glad I was on the right track with that thought. I've tried Benadryl many times with no success. I was so desperate once I took a couple then took another one when I realized it wasn't working , then another one, and another. I think I ended at 8? I know it was stupid, but at least I didn't seem to get hurt from it.

 

@notloki, retrograde amnesia terrifies me. I'll skip the Halicon. Haha.

Edited by Persona_Is_Life
A detail.

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