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Hi all,

We all know that benzo tolerance builds up, and that they would lose efficacy quickly if used nightly for sleep.

Insomnia has been bad lately, and I used up two weeks; worth of sleepers (valium and ambien) in five days. This is unsustainable, due to tolerance and being reliant on prescriptions.

Thence, I am looking for something that is OTC (or at least not controlled) that is ambien-like:

1. Quick Acting

2. Powerful

3. Short half-life

I don't like APs due to the stoopidfying effect (read Zyprexa/Seroquel).

Any suggestions?

kava is banned here, of the sedating antihistamines I'm looking at Cyproheptadine or Diphenhydramine - are there others?

Thanks and may you all sleep soundly.

r.

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Hi Raining.

Unfortuanately have no suggestions other than to comiserate. Unlike you, I cannot take ambien as it makes my depression exponentially worse. And relying on seroquel, as I have done, well I'd almost rather stay up all night. The hangover is wicked.

In reading your meds, I'm amazed that 30mg of remeron and 200mg of Luvox doesn't put you out. 30 mg of Remeron would stupor me for days.

All the best,

Leopard

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[link=http://www.pharmacorama.com/en/Sections/Histamin_3.php"'>http://www.pharmacorama.com/en/Sections/Histamin_3.php" target="_blank]http://www.pharmacorama.com/en/Sections/Histamin_3.php[/link]

I have little pharmaceutical knowledge especially with these, so I had to Google....from the results of my Googling, I'd tend to think any of these H1 antihistamines mentioned as being so in this article would be sufficiently sedating (but some have nasty side effects)... the only other drawbacks would be the interactions with your meds.. I just did a check on aidsmeds and they are of the moderate variety mostly "patients should be monitored for potentially excessive or prolonged CNS and respiratory depression" etc... but also it seems cyproheptadine is a serotonin antagonist and would interfere with your Luvox... oh and they seem to hate Zyprexa and Seroquel (both anticholinergics) ... heh I fed in all the meds you have told me you use and those two antihistamines and got 51 interactions... you might want to take a look sometime ;)

But of course discuss with your GP or someone suitable (I'm guessing you wouldn't be talking to your pdoc?)...

I don't really understand why he won't give you more though.. I mean if you need them... *shrug*

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Have you come across amitryptiline? (Elavil) It is off labeled in small doses (10-25mg) for insomnia....tho the first few days come with the groggy hangover? it seems to fade.....a medium point between benzos and ambien which aren't working and the nuclear powered seroquel?

just my two cents.....non OTC though.........

cheers

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  • 2 weeks later...

Another antihistamine you might consider is doxylamine succinate. I have the generic, but I think the brand name is Unisom II. It has worked for me when benedryl won't, and I haven't had any morning after effects, as long as I take it by about 10pm. Later than that and it gets kind of hard to get out of bed, but doesn't leave me with the benedryl hangover.

Elavil worked for me, too, for a long time, but is prescription.

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Er.. any chance that insomnia is due to underlying manic process? If so, I'd have to say that my brain, at any rate, won't let me sleep til the hypo/mania gets slowed down. Back before we figured out that I'm not allowed to take ADs, even sedating ones, we'd stack up more Remeron, nortriptyline, etc., and I'd just get more wired and more weird. And, yeah, I know, it's a sticky situation, because of course the sleep deprivation doesn't exactly help with stability...

Of those antihistamines you list, cyproheptadine is rather sedating.

Of the old-school APs, I find trifluoperazine and perphenazine fairly sedating, especially the trifluoperazine.

None of these are OTC. As far as OTC solutions... mine have usually been (in no particular order) rigorous sleep hygiene, sex, no alcohol for at least 4 hours before bed, and a warm bath about 30 minutes before bedtime.

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A warm bath and sex do it for me, too. A cup of some sort of tea. A boring book.

I keep Unisom around for really bad nights when I just feel wired, but I think the ultimate solution is taking the appropriate drugs for your diagnosis and then work on the sleep hygiene. I'm also a big proponent of yoga----not to teach you the headstand, but to teach you relaxation techniques to still the mind and help the warm bath and other things to work.

It's a real pain when you can't sleep.

olga

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Doxylamine gives me really crappy sleep with really crappy hangovers.

I have never tried diphen - it doesn't seem to be very popular here in oz.

I will get some cypro with my next mail order meds.

I could do a Soma & Whisky, but I doubt that would be any "sustainable".

Silver: Don't think it's mania, but don't think it matters either. When you need sleep, you need sleep, right?

xtry: interesting methocarbamol, but not on the oz pharmacopoeia.

r.

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Silver: Don't think it's mania, but don't think it matters either. When you need sleep, you need sleep, right?

Yes and no. Again, if there is mania, and it's not contained, not much is going to help with sleep. And, as above, sleep deprivation's a good 'on-switch' for mania. Dunno. Just learned over the years that when my sleep (or the sleep of anyone in my family) falls apart, it's a very reliable harbinger of mood wonkiness to come, and even more so when something that used to work for sleep stops working. Changes in things like response to an established med are worrisome.

Is Rozerem / ramelteon on-formulary yet for you? It's a drug many people aren't crazy about, but it has its moments. If you want to avoid "stoopidifying", it might be worth consideration. It is not dramatic and doesn't give you the floaty sleepy feeling, but it can be good for helping reset the brain-clock (especially in conjunction with sleep hygiene 101.)

Seems to be bipolar-safe from what I've read.

Heh. We should have little stickers with a Gorey cartoon of Edgar Allan Poe and a "Bipolar Safe!" slogan for some meds. And Edgar crashing on a bicycle and a "May Worsen Cycling!" sticker for the no-no meds.

Damn, where'd that come from?

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Don't know your background re: sleep.

You're focused on long term use of meds. I suspect that can never really be successful, but maybe.

However - again, not knowing you - I would second Olga's post.

(Not the warm bath and sex! Well, maybe - but I don't know. ;) )

But the 'sleep hygiene'.

Have you looked at your sleep patterns? Looked into sleep studies?

I spent MANY years getting next to NO sleep and priding myself on it! And even when I started sleeping fitfully and it became an annoyance and I started to - finally - feel I was maybe 'sleep deprived' I could still do all nighters whenever I felt like it with no "apparent" ill effects. (I suspect I just was used to whatever ill effects existed and woouldn't have known what to even look for!)

I did a sleep study and found ONE technique that actually helped. I'm too lazy to apply it any more, but I should.

Set a specific time to get up. An 'appropriate' time for your circumstances. Then ALWAYS get up at that time. Never do anything in bed except sleep - or sex. No reading, TV etc. in bed. Go to bed only when you feel sleepy. Even if that means staying up all night. If you're in bed and can't sleep, get up. Don't lay in bed not sleeping. Don't take naps.

There ARE other techniques that they teach. Some include drugs. This was the only one that felt right to me - an worked.

(My sleep averages eventually crept up to 5 1/2 hours of 'good' sleep. (Not the depressive on and off crap that I'm back to now!)

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Silver: Don't think it's mania, but don't think it matters either. When you need sleep, you need sleep, right?

Yes and no. Again, if there is mania, and it's not contained, not much is going to help with sleep. And, as above, sleep deprivation's a good 'on-switch' for mania. Dunno. Just learned over the years that when my sleep (or the sleep of anyone in my family) falls apart, it's a very reliable harbinger of mood wonkiness to come, and even more so when something that used to work for sleep stops working. Changes in things like response to an established med are worrisome.

Is Rozerem / ramelteon on-formulary yet for you? It's a drug many people aren't crazy about, but it has its moments. If you want to avoid "stoopidifying", it might be worth consideration. It is not dramatic and doesn't give you the floaty sleepy feeling, but it can be good for helping reset the brain-clock (especially in conjunction with sleep hygiene 101.)

Seems to be bipolar-safe from what I've read.

Ambien kicking in, so might not be very coherent.

Rozerem is apparently approved here, but maybe not yet registered, so I can't find it. And besides, being Rx-only doesn't make it sustainable, and melatonin didn't work for me (I read a study saying that 3mg of Melatonin equates 10mg Temazepam. Made me laugh so hard I couldn't sleep.).

I'm actually quite happy with my Valium/Ambien/Zyprexa combo, but the problem is docs don't like prescribing it, and consequently I try to stash instead of using it whenever I need it. (If that trinity doesn't work, then I'm definitely in Mania-land).

r.

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  • 2 weeks later...

I'm a Benadryl junkie. Because of my job, I'm legally not allowed to take anything Ambien-like. I take between six and eight a night. After an hour or so, I can hardly keep my eyes open. I work as a Paramedic, and I'm not allowed to take any Schedule 4 (Narcotic or Narcotic-Like) drugs 24 hrs before my shift. The Benadryl puts me to sleep quick, and allows me to wake up whenever I need to without a druggy hangover. The only downside is that, if I sleep for less than 2 hours, I get a cloudy feeling that dissapates after about 30 minutes of being up and moving around.

Having taken drugs like Clonipin (I know i'm spelling that wrong) and I even gave Ambien a shot, I didn't like the loopy, hallucinogenic effect it put on me.

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  • 2 weeks later...

Thence, I am looking for something that is OTC (or at least not controlled) that is ambien-like:

1. Quick Acting

2. Powerful

3. Short half-life

Wow, you guys are all missing a major OTC solution: Melatonin

Melatonin is the hormone produced in your body which normally induces sleep. I've found it to be more powerful than the anti-histamines.

It's got a few advantages and disadvantages.

Advantages:

Fast acting

It usually knocks me out within an hour of ingesting it.

Natural

It's 100% natural to your body. The dose, however, is very unnatural. It basically just overloads the normal sleep mechanism.

Effective

It knocks me out cold. Don't take it if you plan on driving anywhere.

Non-addicting

Unlike a benzo, it usually doesn't cause dependence.

Disadvantages:

Drowsiness

Sometimes it leaves me drowsy in the morning. The standard dose is 3mg, so I usually halve that and I'm fine. 1.5mg works well for me. If I wake up in the middle of the night, I will be extremely drowsy. If I'm not careful, I'll fall over walking to the bathroom - literally.

Depression

It tends to amplify my depressions, so I cannot take it if I have depression related insomnia. As long as I'm taking Lamictal, I can take Melatonin without any negative mood effects though.

Melatonin is a great OTC "drug," but have you ever considered why you can't sleep? Have you ever considered that it might have something to do with the stimulant you are taking? What time during the day do you take your wellbutrin? Try to take it all as early as you can if it messes with your sleep. If it still messes up your sleep, consider asking your doc about another drug.

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Wow, you guys are all missing a major OTC solution: Melatonin

Been there. Done that. Doesn't work.

I read a study somewhere that says 3mg of Melatonin is equivalent to 10mg of temazepam - made me laugh so hard that I couldn't sleep for a week.

r.

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Been there. Done that. Doesn't work.

I read a study somewhere that says 3mg of Melatonin is equivalent to 10mg of temazepam - made me laugh so hard that I couldn't sleep for a week.

Hmm...maybe it just works well for me. In my case, It makes antihistamines look like tic-tacs.

So, have you considered the effects of the wellbutrin on your sleep? Wellbutrin gets me wired.

If you consume any caffeine, you're definitely setting yourself up for failure.

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Wellbutrin does get me wired, and causes insomnia and anxiety. But we've considered the mood-lift it offers, and decide that it's more worthwhile to treat the side-effects symptomatically.

The problem with benzos and the Z-drugs is that I build up tolerance really quickly, and are thence not sustainable. (And Ambien ceilings out at 15mg - once you're tolerant to the 15mg dose, it's useless for me).

Melatonin is like tic-tacs to me - or maybe it's just because i haven't found a good brand.

r.

So, have you considered the effects of the wellbutrin on your sleep? Wellbutrin gets me wired.

If you consume any caffeine, you're definitely setting yourself up for failure.

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  • 3 weeks later...

Last night was so interesting...

4mg periactin, 5mg ambien, 5mg zyprexa... and does work...

So I took 50mg of diphenhydramine, in the form of berry-flavored benadryl.

Knocked me out for 14.5 hours.

Tonight I am trying 8mg of periactin. It does seem to have a calming effect, but doesn't seem to knock me out (yet?). I'm taking my pm luvox in the am, so the periactin won't render it useless.

What is the usual dose for diphen anyway? (Unisom gel-caps are 50mg, but is that overkill?)

And does anyone know what dose of periactin to use for sleep? Would it interfere with SSRI's, and thence cause depression?

Cheers,

r.

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Cool site.

You can take more diphen. I've taken 100 mg before bed in the past. Works great and is out of my system faster than trazodone or Seroquel (my other sleep meds).

No experience with periactin, but there is an epocrates entry on it if you want to see what it says. I don't see anything on use for sleep...does say it can decrease SSRI effect...good doctor question.

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