Medication-resistant Insomnia (HELP!)

[ravenette]

Hey there guys, I need your help. I'm running out of ideas for myself. I have had insomnia for as long as I can remember, and usually trazodone has always worked for me. But I was on it for about 5 years so it pretty much has no effect on me. I've been trying to new things that I've requested from my doctor, but my body seems to adapt within a week, making sleep hard to come by. Here's a list of the things I've tried:

Trazodone: on it for 5 years, doesn't really have any profound effect on me anymore even at 400mg.

Ambien: 10mg- Works for a few days, then stops working

Remeron: 7.5 mg worked for about a week or two and now doesn't even make me tired.

Doxepin: 75mg x 2 - worked for about a month then the dose had to be increased.

Lunesta: worked for me when I was much younger but my insomnia has progressed to the point where it doesn't make me tired, and would not care to try it again.

I can't remember any more that I've been on. I think this might be the list. I'm wondering if anyone out there shares this quick adaptation to medication like I have. I know everyone is different and different things work for everyone, but what is worth giving a try? I'm willing to try older medications too. I have recently been looking into to Restoril and wondering if that will help. I also am *trying* to get my doctor to switch me from Klonopin to Ativan because I know that Ativan is very sedating for me. If anyone has any insight I would really really appreciate it, I am getting tired (no pun intended) of not sleeping. Oh also to add, I try to not have caffeine after 5-ish.

[rowan77]

Seroquel at very low doses is said to help people sleep when nothing else has worked. I take it for Bipolar and the sleepiness side effect is great!!

I have also taken temazepam(Restoril) and find it great for sleep. Another hypnotic I find works well for me is flurazepam (Dalmane). Only thing is that Dalmane has a long half life so sometimes people have a hangover effect the next morning. Personally I didn't, even at 30mg.

What about your sleep hygiene?? Do you practice good sleep hygiene?

[ravenette]

Seroquel at very low doses is said to help people sleep when nothing else has worked. I take it for Bipolar and the sleepiness side effect is great!!

I have also taken temazepam(Restoril) and find it great for sleep. Another hypnotic I find works well for me is flurazepam (Dalmane). Only thing is that Dalmane has a long half life so sometimes people have a hangover effect the next morning. Personally I didn't, even at 30mg.

What about your sleep hygiene?? Do you practice good sleep hygiene?

This might sound dumb, but what is sleep hygiene? lol

[rowan77]

Hey, that's not a dumb question. I remember when my pdoc first mentioned good sleep hygiene I was like....WHAT???

Sleep hygiene is a variety of different practices that are necessary to have normal, quality nighttime sleep and full daytime alertness.

The most important sleep hygiene measure is to maintain a regular sleep and wake pattern seven days a week. It is also important to spend an appropriate amount of time in bed, not too little, or too excessive.

Some good sleep hygiene practices include:

• Avoid napping during the day
  
• Avoid stimulants such as caffeine, nicotine, and alcohol too close to bedtime.
  
• Exercise can promote good sleep. Vigorous exercise should be taken in the morning or late afternoon. A relaxing exercise, like yoga, can be done before bed to help initiate a restful night's sleep.
  
• Food can be disruptive right before sleep; stay away from large meals close to bedtime.
  
• Ensure adequate exposure to natural light. Light exposure helps maintain a healthy sleep-wake cycle.
  
• Establish a regular relaxing bedtime routine. Try to avoid emotionally upsetting conversations and activities before trying to go to sleep. Don't dwell on, or bring your problems to bed.
  
• Associate your bed with sleep. It's not a good idea to use your bed to watch TV, listen to the radio, or read.
  
• Make sure that the sleep environment is pleasant and relaxing. The bed should be comfortable, the room should not be too hot or cold, or too bright.
  

Edited for corrections

[ravenette]

Oh ok, then yes I do practice good sleep hygiene. I follow all of those rules!

[williamockham]

I can at least speak to remeron. While I adapt to lower doses, higher ones have consistently worked for me (30-60mg). Some people do adapt, I'm sure, but at least this has been my insomnia cure for well over a year.

Amitriptyline would consistently knock me out, too, but I only took it at antidepressant doses (150mg+), where the side-effects start becoming pretty nasty. Not sure how it would do in the 10-25mg range, but you could try this too. Works for some.

Getting into the less prescribed meds, you have Halcion, a *very* short acting benzo. The older barbituates (e.g., Seconal). GHB (Xyrem). I doubt anyone would prescribe the latter two unless you first had a sleep study and failed to respond to every other medication out there.

[ravenette]

I can at least speak to remeron. While I adapt to lower doses, higher ones have consistently worked for me (30-60mg). Some people do adapt, I'm sure, but at least this has been my insomnia cure for well over a year.

Amitriptyline would consistently knock me out, too, but I only took it at antidepressant doses (150mg+), where the side-effects start becoming pretty nasty. Not sure how it would do in the 10-25mg range, but you could try this too. Works for some.

Getting into the less prescribed meds, you have Halcion, a *very* short acting benzo. The older barbituates (e.g., Seconal). GHB (Xyrem). I doubt anyone would prescribe the latter two unless you first had a sleep study and failed to respond to every other medication out there.

amitriptyline definitely doesn't work for me i know that. i forgot that, that was the first thing they put me on years and years ago!

[Blart752]

I also have this problem too. Have you ever tried Lyrica? It's a little better than neurontin IMO for sleep. But for some people it doesn't work.

[ravenette]

I also have this problem too. Have you ever tried Lyrica? It's a little better than neurontin IMO for sleep. But for some people it doesn't work.

I refuse to try lyrica because of the major weight gain side effect. I know it *may* help my fibromyalgia, but at this point gaining weight is more of a risk to my health than anything. I haven't been on neurontin in awhile because it's so expensive and I can't afford it. One thing I think I am too scared to try though is seroquel. I have heard of too many people having MAJOR health issues while taking it. And that just freaks me out.

[bpladybug]

I take Restoril and I like it a lot.

And of course there is low dose Seroquel.

that should knock you out

I started at the lowest dose .25 and WHAM I slept.

Gradually, over time we increased the dose as needed.

[ravenette]

I take Restoril and I like it a lot.

And of course there is low dose Seroquel.

that should knock you out

I started at the lowest dose .25 and WHAM I slept.

Gradually, over time we increased the dose as needed.

yeah i was thinking about restoril among other things. seroquel is one thing i won't try!

[Cetkat]

There's Saphris. I've gotten so used to Seroquel that it doesn't sedate me, but the Saphris had staying power sleep-wise when I was on it. I don't know if you want to go the multi-AAP route though.

[hammock]

I take high dose seroquel in the day, as an antipsychotic, but I have had the insomnias real bad, my whole life. I take:

temazepam, for two nights. then ambien, for two nights. then a lunesta, once.

then start over.

this keeps the meds working. this rotation is the only way I get reliable sleep hours. I spent thirty five years trying every other known combination of non-medical treatments to insomnia, including strict sleep hygeine, vitamins, herbs, melatonin, etc etc etc

mine is bad enough to need medication. I shift my sleep an hour or so later each night without them and have no real pattern to my sleep.

My doctor prescribes enough of each for me to take them alternately like that. the best sleep I get is the nights I take the temazepam.

seroquel in any dose, and benadryl, make me wired and alert, not drowsy.

[Blart752]

There's Saphris. I've gotten so used to Seroquel that it doesn't sedate me, but the Saphris had staying power sleep-wise when I was on it. I don't know if you want to go the multi-AAP route though.

Also, there is seroquel XR. I haven't slept for about a week. I think there's something wrong with that. But in the morning it doesn't seem to matter.

[Justclaire]

I alternate Tamazepam/zopiclone/night off this routine has worked really well for me for the last year or so. My (new) pdoc wants me off them asap but I will fight my corner on this one.

Claire

[y58]

My pharmacist told me that if a sleeping pill is taken 3 or less times per week, most people will not develop a tolerance to it,

[claudineriddle]

Here I am suggesting you a few natural remedies for insomnia

In sleep disorders, your normal sleep cycle is disrupted. That is why, when you are suffering from any sleep disorders, especially insomnia, you need to develop and follow a regular sleeping schedule every single night. Together with following a sleeping schedule every single night, it is also very important to wake up the same time every morning.

1. Sleep for longer periods of time, rather than sleeping in fragments. It is better to sleep straight for 6 to 8 hours daily, than taking naps several times per day. Sleeping in fragments can cause daytime drowsiness and may affect daytime functionality.
   
2. Make up for missed or lacked hours of sleep. Let’s say you were only able to sleep for 5 hours last night, and normally you sleep for 8 hours every night, sleep at least 3 hours earlier your bedtime schedule to make up for your lost sleep. You can also take a nap during the day to make up for lost sleep. But remember napping for too long or napping during late in the afternoon can prevent you from falling asleep at night.
   
3. Never drink caffeinated beverages, such as coffee, tea, sodas, or energy drinks, later than 2 o’clock in the afternoon. Caffeine’s half-life is six hours, which means that after 6 hours from your last caffeine intake, you still have half of the caffeine’s content inside your body.
   
4. Turn off or Dim the lights when it is time for sleeping. Bright lights can stimulate your mind to work, which can prevent it to relax. Dimming or turning your lights off in the room can help your mind relax and induce sleep.
   

[phatemu]

Ritalin is 'activating' and may cause insomnia.

[melissaw72]

Plain old Benadryl works from me if I am desperate. Talk to your DR first though to make sure it doesnt interfere with any other meds.

[Cuttlefish]

If you're like me and use technology into the night among other things, I've found that wearing sunglasses with a deep red tint help. The idea behind it is red light doesn't affect melatonin production as much as other kinds. There are expensive certified glasses, but I just grabbed a ten dollar pair at wal mart that have thick rims and are kinda like ski glasses. You want deep red or amber. It could easily be a placebo affect, but I've found it's helped a lot.

[CrankyMe]

Reviving an old thread. Wheeeee!

Have you had your thyroid checked? I didn't see that mentioned in your thread or your Dx.

[Samd128]

Ive not tried very many medications but have insomnia and have had this for atleast 8 years (getting worse over the years). I can not fall asleep at all when i do fall asleep i dont stay asleep and wake about every hour and when the sun comes out im wide awake. I stay tired all day but still cant ever sleep. I get about 15-25 hours of sleep a week. And 0 hours of good sleep. When i do sleep im not fully asleep and am somewhat aware of the noises or people around me when there are any and i have crazy dreams and nightmares sometimes waking up to new bruises, but dont sleep walk. I finally went to the doctor because it got this bad in the past 2 years.

2mg of Klonopin calms me for about an hr

25mg-50mg of seroquel did nothing along with taking 20mg of flexeril

I got perscribed 15mg of restoril today, i took it at 9:30pm and it cleared my thoughts but hasnt made me tired or made me feel buzzed (some have said that happened).

I guess the best advice i can give is keep trying different meds and hopefully you will find one that works great. You may also have to keep flip flopping from 1 to another back to the other.

[hammock]

I just noticed that one of the replies in here is "sleep longer and continuously"

this made me laugh, what great advice, if only us insomniacs would just go to sleep our problem would be solved, haha

[gizmo]

I find that the med to solve my insomnia depends largely on what maintenance meds I'm taking at the time. I'm currently on trazadone for insomnia when needed. It works well PRN for me now, but when my BP meds were different, it did nothing for me.

For a long time, I took 2mg xanax to sleep, and it worked. But I got off Xanax several years ago. I tried other meds such as restoril, ambien, sonata, amitryptilline, seroquel. Sometimes they worked, and sometimes they worked only on the second or third try. I even used relaxation meditations on my iPhone for awhile. They worked great at first, and then stopped working.

So I'd suggest for treatment-resistant insomnia, especially if you've chsnged your mental meds, that you go back and retry some of the ones that didn't work for you before. And play with the dosages. Because you may just find that works for you now.

[Gearhead]

Getting decent sleep has been a lifelong problem for me. Single meds do not work. My current combination of 75 mgs Seorquel IR, to put me to sleep, and 12.5 mgs Ambien CR, to keep me asleep, works pretty well, certainly better than anything else I've ever tried. The Seroquel XR and topiramate that I also take at bedtime are probably helping, too, but they're not specifically for sleep.

There are other things that I have to do, though, on top of take the right meds. I avoid all caffeine. One cup of decaffeinated tea, finished before noon, is all I can drink. I put up curtains in my bedroom that are seriously opaque, and I sealed up all the cracks, because otherwise I'm awakened at first light. I sleep with earplugs. I spend an hour or so in a dimly lit room before I go to bed.

[mamadweezil]

so frustrating! i've tried everything myself. the ONLY thing that works for me is seroquel at bedtime but i don't know if i'd really take it at a low dose if i were not bipolar. and at 600mg i still toss and turn some nights, especially if i am travelling.

i've done trazadone, no effect, restoril; no effect, my remeron doesn't make me sleepy. ambien, zomig, neither work. benzos alone don't work.

[notfred]

My pharmacist told me that if a sleeping pill is taken 3 or less times per week, most people will not develop a tolerance to it,

I have been doing 6 mgs of Lunesta for 5 year every night and it works as well today as 5 years ago.

[Wooster]

mamadwezil,

Slurroquel looses its sedating qualities at higher doses for some reason. It's my understanding that at lower doses it tends to function like an antihistamine.

[december_brigette]

My pharmacist told me that if a sleeping pill is taken 3 or less times per week, most people will not develop a tolerance to it,

I have been doing 6 mgs of Lunesta for 5 year every night and it works as well today as 5 years ago.

How did you swing 6mgs? I thought 3mgs of lunesta was the max. Does your pdoc/sleep dr have to get authorizations from insurance and all that nonsense so you can get what works for you?

db

[hammock]

yeah my seroquel wakes me up, makes me perky. but then again benadryl makes me hyper too.

[Christina Chivonne Pruitt]

I also Have taken so many different sleep meds..This is my first night with temezapam I have had insomnia literally since I was al ittle kid. The doctor started on 30 mg of this temezapam and it is totally not working. I laid in bed for like 2 hours and then decided to get up, This really stinks..I get crazy after not sleeping, sometimes going for days. I was hospitalized once for sleeping as little as 6 hours in 9 days!!! I was bat- crap crazy!!