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Bueler

I can't take the insomnia!

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Please help. I have good sleep hygiene, get light in the day, darkness at night. 

I cannot sleep. I've tried seroquel, trazodone, Xanax, ambien, benadryl, melatonin (even in combination). 

I'm going to try and get an appointment tomorrow and ask for a barbiturate. 

Is there anything stronger to try before barbiturates? I'm really desperate. 

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Posted (edited)
11 hours ago, Bueler said:

Please help. I have good sleep hygiene, get light in the day, darkness at night. 

I cannot sleep. I've tried seroquel, trazodone, Xanax, ambien, benadryl, melatonin (even in combination). 

I'm going to try and get an appointment tomorrow and ask for a barbiturate. 

Is there anything stronger to try before barbiturates? I'm really desperate. 

You might have a problem getting a barbiturate.....They are really not prescribed for sleep any longer because they have a very narrow therapeutic window, which makes them more risky to use.

In the past, they were prescribed for sleep, but have largely been replaced by benzos and z-drugs, because benzos and z-drugs are much safer.......I highly doubt you will get a doc to prescribe you a barbiturate for sleep, IMO.

According to your list, there are still other things you could try.....Belsomra, Lunesta, Restoril, low-dose Remeron, low-dose Doxepin, to name a few.....

Also, are you taking your Wellbutrin in the morning?.......Taking it in the afternoon or evening could cause sleep problems in some people.

Edited by CrazyRedhead

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I have used promethazine in the past, it works well for sleep.  It’s not a controlled substance, a provider may prescribe it for you.  In fact it is dispensed by pharmacists in the U.K. for sleep.  Good luck with your doctor visit.

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I haven't been on CB in a long time but the insomnia problem is one that has been on my radar thanks to the shifting formulary of my health plan.  I would steer away from benzos of you take them on a nightly basis.  They just have too much baggage for addiction and tolerance and many are so short acting you can't expect sleep to last very long.

Its probably unusual to say this because there have been some negative vibes going on about taking the Z drugs for any length of time but I had been taking Ambien Cr for the last couple of years and had little to no problems as it helps me get to sleep and sleep for a decent length of time.  

I've had to go to a different drug and have been trying different doses of the generic for Lunesta.  I find a couple of things different.  For one I often dream at night and can remember some of them.  Which I feel is a plus!  With Ambien and prior to ambien having any memory of dreams was near zero.  In addition Lunesta seems to act quickly.  Its not like Ambien with a gradual feeling sleepy then sleepier its more sudden.  Bang I'm asleep.  I had rare instances of me talking in my sleep on Ambien (Nothing weird like driving cars, sex etc) but so far nothing like that with Lunesta.  The dose that works for me (Like everything it seems) is the stronger dose.  Lower doses do help me go to sleep but at the lowest dose (1mg) I was asleep for 3 hours.  At 2mg maybe 5 hours.  At 3mg I get around 7 hours of sleep.     One last comment.  I was told its a very dangerous combination to take benzos at the same time as a Z drug.  So if you do have Ambien or Lunesta prescribed you want to have 8 hours between that and taking benzos such as Xanax, Valium etc.  I guess the combo can in some instances stop you from breathing.   Good luck!  Sorry you have insomnia.  Its a bitch.

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Z drugs are the next step.Sometime they will lwt you take a large dose, like me, after traditional doses fail. I'm 20 years and counting at the same dose and doing great.

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Low-dose chlorpromazine (i.e. 25-100 mg) is sometimes used in people who don't respond to other meds for insomnia. Works very great for me, but I stopped it because it started giving me nightmares. Zyprexa can also be pretty effective but it's very susceptible to causing weight gain and diabetes.

Oddly enough, the antipsychotic thiothixene (a first-generation antipsychotic) is very effective when combined with a benzo for me. I also take 200 mg trazodone, either doxepin 10 mg or quetiapine 50-100 mg, and alprazolam 1 mg.

As @CrazyRedhead said, you will likely have trouble with getting a barbiturate prescribed for you.

Combinations of different meds with different mechanisms of action for promoting sleep would probably help, like 5-HT2A antagonism from trazodone, H1 antagonism of low-dose doxepin (10 mg) or low dose quetiapine, D2 antagonism from an antipsychotic (slightly higher doses of quetiapine (still not very potent for D2 antagonism), chlorpromazine), orexin receptor antagonism of Belsomra, melatonin receptor agonism from Rozerem, GABA-A receptor potentiation from a benzodiazepine or Z-drug (temazepam, lorazepam, estazolam, quazepam, flurazepam, zolpidem, eszopiclone, etc.). Obviously you wouldn't need all of these class of medications, but 2 or 3 might suffice (I take 3 or 4 meds for insomnia depending).

Mirtazapine is also a good med for insomnia, but watch out for weight gain and increased appetite.

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45 minutes ago, mikl_pls said:

Low-dose chlorpromazine (i.e. 25-100 mg) is sometimes used in people who don't respond to other meds for insomnia. Works very great for me, but I stopped it because it started giving me nightmares. Zyprexa can also be pretty effective but it's very susceptible to causing weight gain and diabetes.

Oddly enough, the antipsychotic thiothixene (a first-generation antipsychotic) is very effective when combined with a benzo for me. I also take 200 mg trazodone, either doxepin 10 mg or quetiapine 50-100 mg, and alprazolam 1 mg.

As @CrazyRedhead said, you will likely have trouble with getting a barbiturate prescribed for you.

Combinations of different meds with different mechanisms of action for promoting sleep would probably help, like 5-HT2A antagonism from trazodone, H1 antagonism of low-dose doxepin (10 mg) or low dose quetiapine, D2 antagonism from an antipsychotic (slightly higher doses of quetiapine (still not very potent for D2 antagonism), chlorpromazine), orexin receptor antagonism of Belsomra, melatonin receptor agonism from Rozerem, GABA-A receptor potentiation from a benzodiazepine or Z-drug (temazepam, lorazepam, estazolam, quazepam, flurazepam, zolpidem, eszopiclone, etc.). Obviously you wouldn't need all of these class of medications, but 2 or 3 might suffice (I take 3 or 4 meds for insomnia depending).

Mirtazapine is also a good med for insomnia, but watch out for weight gain and increased appetite.

I second looking into chlorpromazine. Worked for me when nothing else did 

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On 8/6/2019 at 7:22 PM, Iceberg said:

I second looking into chlorpromazine. Worked for me when nothing else did 

I also agree that low dose chlopromazine could help with sleep. When I was in the psych unit a few years ago the pdoc prescribed 50-100mg PRN as I had severe insomnia and it did the trick

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