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My sleep has dropped off a cliff. About 5 hours in the last 3 nights combined. I was already teetering towards depressive episode and this is gonna be the last straw without a change. The new wrinkle is it is now early waking in combo with my usual can’t fall asleep.

I don’t love taking extra sedation in oct/nov cuz the short days wear on me enough as is, but In the past two weeks I’ve had two separate instances of being up 48+ hours straight. 
 

my first line PRN is ODT alprazolam, but since this now involves early waking Im not sure thats the right option anymore.

Thoughts? Tried almost all Benzos and taking another sedating AP with cloz is tough for several reasons. I don’t really have any ideas

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5 hours ago, Iceberg said:

Thoughts? Tried almost all Benzos and taking another sedating AP with cloz is tough for several reasons. I don’t really have any ideas

This might be a long shot, but have you tried Belsomra?.......I've never tried it, but just putting that out there.

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I guess I could, but my pdoc isn’t a big fan from what he’s seen with other patients of his. Typically We’ve tried a more short term/PRN approach with the hope that my rhythm will regulate, and it often does. If he feels that I’m going to need something every night for however long belsomra will probably be considered 

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9 minutes ago, Butterflykisses said:

Could you increase your clozapine? Sorry if you already mentioned that.

 

just talked to pdoc. he mentioned an increase but we both decided that should be last resort. His plan was to try the alprazolam at bed and then again if I wake up. If that doesn't work, he said i could move the morning 50mg and use it like a sleep prn and just not take it the next morning if i do. the final idea was moving the bid dosing to all in one night dose, just temporarily until things resolve. I said that this would fuck my mornings, so he agreed to hold off on that for now.

He seems to think I'm a bit mixed. I think he was a bit surprised because ive been mostly stable for a few months. One thing. He suggested Ambien CR even though reg ambien didn't work - and i kinda shot it down because i was skeptical that the CR would be much better (a previous pdoc swore it wasn't) If anyone has experience there, that would be great. I know that theoretically it should be better for my current early waking, but i feel like if ambien did nothing for me as a 15 year old, it probably won't cut it now 

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I have taken Ambien generic for a long time (years) and I've found that which generic you get makes a huge difference. I think the one made by Torrent labs is ten times better than any of the other ones I've tried. I'm not usually sensitive to which generic I'm using and can't tell the difference, but there was a huge difference with Torrent labs. 

I use the regular non-extended dose. I've never had the name brand so probably it would be even better, but I will never find out in this lifetime!

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theres actually a chance that he rxd me the brand. guy was crazier than me. if option xanax and option move dose fails i will revisit cuz a cloz raise is really unfavorable, he agreed with me on that 

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Eszopiclone was also useless up to 6 mgs. We once talked about sonata but figured that if I was already 0 for 2 it might be best to look at other places where I’ve had at least partial response at some point 

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@Iceberg

Shoot me down if I’m dumb, but you have been trying all your current PRN meds right like the halcion and the Thorazine? Any increase in those as a possibility since you know they do help as a PRN?

Have you tried low dose seroquel IR with clozapine for sleep? Or tried zyprexa with clozapine? Were these trials before you tried the clozapine?

Saphris put me out like a light but ymmv.

Hmmm. I will let you know if I think of anything else. I am sorry if this wasn’t much help. 

Edited by Wonderful.Cheese

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Thanks @Wonderful.Cheese not stupid at all. I should update my sig, because the odt alprazolam has mostly replaced the halcion. The Thorazine is still in play, but my pdoc would rather do a small bump in cloz than have to manage possibly 2 prns (Thorazine +nirivam) at the same time. We did talk about seroquel IR, but if we’re gonna do an AP add on it would probably be Thorazine for the short term cuz we know it’s very effective. Ideally, the long term would be no add ons, so we’re hoping that we find an option that gets me back in rhythm, which has worked before. If I do need something else in the long run, than that’s probably a different conversation. Seroquel used to not work at night but then hit me like a ton of bricks in the morning, while Thorazine hits me hard both at night and the next morning. I’m done with zyprexa. Lots of issues there and I’m not going back  

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