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sleep deprivation

Apr 17, 2008 - 7 comments

Anyone who has detoxed and recovered off of opiates, knows how painful sleep deprivation can be. And unfortuanately good sleep is not something that we can get simply through an act of will. We can force ourselves not to take drugs, we can force ourselves to eat healthy, to excersise, to attend therapy or 12 step meetings...but we cannot force ourselves to get a good nights rest. It is true that you will not die from sleep deprivation, but it will hinder your bodies ability to repair itself in your recovery and sleep loss can wreak havoc with your overall mental health. Insomnia, given sufficient time, can induce anxiety, depression or even mania.

The following is intended to generate a discussion on which medications are available to us as addicts and which are not, in themselves, damaging to our recovery. I should start by saying that IMO, all benzodiazepines should be avoided unless you are suffering from a MAJOR psychiatric complaint such as bipolar 1 or Schizoprhenia. There are roughly fifteen benzodiapenes that have been discovered, these are the most common ones.

Xanax(alprozolam)
Valium(Diazepam)
Klonopin(clonazepam)
Ativan(Lorazepam)
Librium(chlordiazepoxide HCL)
Restoril(temazepam)

-if you absolutely MUST take one of these, your best bet is librium. It is the oldest, mildest, with the longest half life, which in this case is a good thing. Benzos will in fact cause rebound insomnia, lead to increased anxiety, induce depression, and are generally considered to be the most dangerous class of drugs to detox off of. Way worse than opiates.

Also to be avoided are the close relative of benzos, the Hypnotics. This class of drug is essentially a molecule or two away from a benzo, and like benzos works by affecting the neurotransmitter GABA or the related receptor sites. More and more people are showing up in rehabs, with addictions to Hypnotics. They include:

Ambien(Zolpidem)
Lunesta(Eszopiclone)
Sonata(Zaleplon)
Imovane(Zopiclone)

Also to be avoided are muscle relaxants like Soma and flexeril. they are not only addictive, but they will make you behave like a monkey and then not remember it later. If you're actively abusing opiates AND taking Benzos/hypnotics/muscle relaxants, then you are basically getting down on your hands and knees and begging for an overdose.

So given that these drugs need to be avoided, and if your doctor knows you're an addict then he shouldn't be scripting them for you. They are meant to be used for very specific forms of insomnia and for people without substance abuse issues. Take them at your own risk.

So what are your options then, assuming that you are working closely with a doctor, ideally a psychiatrist, there are lots of ways you can go. Some require a prescription and some do not. I will list/describe them in no particular order and please, feel free to add your own:

1.Trazodone(Desyrel)-Traz is an old school antidepressant. It is rather mild in its effects and nowadays it is rx'ed more for insomnia than for depression. It has a marked sedative quality, and no addiction potential whatsoever. Usually traz is taken for sleep complaints in doses ranging from 50-200mgs. For depression, the doses are higher, up to 600mgs. I was given trazodone soon after a detox, when I was jumping out of my skin, the pharmacist referred to it as "an oldy but a goody" and I tend to agree. This may be a first line option for a recovering addict. And even at the low dose, you may get some minor antidepressant effects. One note: traz tends to have a "window" of opportunity. Much like melatonin, it should be taken about a half hour before bed, with a small snack for best results.

2.Seroquel(Quetiapine) Seroquel.....ah seroquel. If you've tried pretty much everthing short of a large mallet to the noggin, and you still can't sleep, then seroquel may be just what you need. Officially, seroquel is an Atypical Antipsychotic(AAP) and at higher doses is used for bipolar disorder and Schizoprhenia. At the lower end, its a potent sleep med which works in a similar fashion as an antihistamine. The dosing range for seroquel is enormous, anywhere from 25mgs to 800mgs. For sleep 25-100mgs is all you'd need. Seroquel frankly saved my *** in early recovery, when I was desperate for sleep, and it also has a very pronounced anxiolytic effect as well, and as we know, sleep and anxiety tend to run in the same circles. A note: the first few times you take seroquel it is going to knock your **** in the dirt, so be prepared. Your tolerance to this overpowering sedative effect should be up by day three. In other words, give it a few days, and be prepared to sleep. Other medications in the same class as seroquel, such as Zypexa, Rispedal, Abilify, Geodon and Clozaril can also help insomnia, but should generally be avoided unless you are bipolar.

3.Remeron(Mirtazapine) is a tetracyclic andtidepressant. Often gets lumped in with the SSRIs, but it behaves differently. Remeron tends to be very sedating and is therefore commonly used when both depression and insomnia are a problem. Also used off label for Fibromyalgia, Arthritis and even Lupus, remeron is reputed to be really helpful for folks who have tried SSRIs but to no avail. It works on Serotonin and Norepinephrine and is generally taken at doses between 15-30mgs. Note: remeron is notorious for increasing appetite, it will make you ravenous, and while seroquel may have this effect also, you will likely gain weight just filling the prescription out for this drug.

4.Elavil-also an old school AD. And like Remeron has anticholergic qualities. Elavil is generally used for treatment resistant depression, in which there is also anxiety and insomnia. And like Trazadone, you will also be getting the added benefit of the antidepressant. This is not a first line med for insomnia OR depression for that matter and it does carry with it a host of negative side effects. Effective dose 25-100mgs taken at night.

5.Pamelor(Nortryptiline)-is a metabolite of Elavil, therefore it tends to have similar effects, but with less pronounced side effects. About 25mgs should do the trick, any more than 100mgs and you may need to get blood tests on a monthly basis.

6.Vistaril-hydroxizine is a powerful antihistamine. So you may think of it like benadryl on steroids. It is used for alcohol wds in many psych wards, has a strong anxiolytic effect and is reputed to be similar to seroquel in its effects. Anywhere from 50-100mgs will do the trick. Vistaril, is a good PRN(as needed) medication for insomnia. Long term use can lead to depression and weight gain in some cases.

7.Clonidine-one of the detoxing junkies best friends. Clon is a blood pressure med that also effects levels of Noradrenaline. In early recovery, this is prolly what you should try first and foremost. It is entirely non-addictive, knocks out your anxiety and allows you to catch some Zzz's. Long term use can also cause depression for the same reasons it helps in early recovery. So this is really not a good long term option for sleep.

8.Inderal/Propanolol-basically these are beta blockers, famous for their mild anxiolytic effect. Prop was often taken by musicians and stage performers b/c it reduces nervousness. Also not really great first line or long term options, but they certainly help.

9.Ramelteon/Rozerem-is the newest sleep aid on the market and is a novel hypnotic, in that it doesn't effect GABA, it works on Melatonin receptors. Here's the thing with Rozerem, it does tend to be safer than the hypnotics, however, it also tends to poop out/stop working faster and most people find that it either works great, or it doesn't work at all. We also don't have any long term studies on how it effects the brain over time. But then, as junkies, that was never really a concern.

I think we all know the basics of OTC sleep medications. The majority of these like Unisom, Nytol, sleepinal and even dramamine are really just the same drugs: diphenhydramine. Also the sedative drug in tylenol pm and most cough medications. Used long term, these medications will severely impair your ability to fall asleep naturally. IMO, much worse than many prescription meds. So avoid these if possible. And in particlar if you have come to rely on Nyquil or robitussin, you are playing with fire and could actually set off a psychotic episode with prolonged use.

Melatonin-is a naturally occurring hormone, supplemention does help induce sleep. However, long term use can cause depression.

Valerian-Good ol' valerian. Go ahead and buy yourself some valerian. It may not work, but it won't hurt. Valerian is a mild sedative and frankly if you can get away with just valerian, then godspeed.

there are also a host of other formulations of herbs that you'll find at a health food store containing things like California Poppy, chamomille and licorice. No harm in trying. But for some, its just not enough. A good place to start would be Herbal tea blends.

5-htp/L-tryptophan are also good OTCs to try. They are precursors to serotonin and famously what makes you tired after thanksgiving dinner. They should be taken at night, like melatonin, their effectiveness often wrests on when you take them, as well as how much you take.

Supplemental gaba: don't waste your money. Gaba can't cross the blood brain barrier. So it ain't gonna to work. A few meds like Neurontin and Gabitril mimic the effect of gaba and are therefore sometimes effective choices for anxiety. But I don't think either of them would be used simply for sleep.


**a disclaimer: I am not encouraging anyone to take these medications. They are merely options that exist and I have tried to focus on meds without the potential for addiction.

as with any medication, there is always risk of dependency.




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477746 tn?1254788147
by SableZen, Apr 17, 2008
I can verify that Seroquel can literally knock you out. I took half a one to help me sleep one night (from a friend that is Biploar)... and went from awake to asleep without even realizing it (no drowsiness - just *bam*, asleep) within about 20 min of taking it.

By the way, Unisom actually has doxylamine succinate as it's active ingredient, and not diphenhydramine. So if you need an alternative to diphenhydramine - Unisom is worth trying. Just know this because Unisom works for me while most other antihistamine based sleep aids don't for some reason.

477746 tn?1254788147
by SableZen, Apr 17, 2008
This is a great post by the way - great to have it all referenced in one place.

497950 tn?1255867527
by kgill78, May 03, 2008
Lots of great info!  Very helpful..I am on Neurontin myself and it works great for anxiety and sleep.  Also on Abilify  and Celexa.

306455 tn?1288865671
by flmagi, May 03, 2008
This is alot of really good info and should be put up in the health pages.

Avatar universal
by livia1881, Sep 29, 2009
This is great info. to have....I have been looking for alternatives to benzos, ambien, antihistamines so this is just what I was loooking for.

Avatar universal
by nietzschescorpse, Mar 31, 2011
Actually Unisom comes in two forms so be sure to check the ingredients: one version of Unisom--as the previous poster noted--contains doxylamine succinate. BUT there is another OTC med named Unisom which contains diphenhydramine--which is essentially Benadryl. So be careful when picking up a bottle of Unisom from the drugstore--for some moronic reason the manufacturers use the same name for two different sleep aids. People can react very differently to diphenhydramine versus doxylamine succinate... I know lots of folks find the latter medication stronger and find it lasts longer.

Personally, I've found neurontin helpful for sleep maintenance--good for relaxing before bed/staying asleep. Absolute crap for actually GETTING TO SLEEP which is my main issue. I relied on Ambien for a few years till it lost its utility, had to use more for same effect, eventually made my sleep worse (ah, the irony!).

Two weeks ago I took a friends advise since I am in the midst of an impossible insomnia episode (can go for literally a full week without any sleep... fear driving I'm so out of it). He said that he takes clonazepam for his insomnia and that the half-life of the medication was perfect for sleep issues.

Man, was he right. I was prescribed Xanax a while back for insomnia and thought it was the stupidest prescription ever for sleep issues--it was great for relaxing and staring at my ceiling for 2 hours, that was about it. Didn't last long enough for anything but the doctor I had kept informing me I was wrong--xanax was great for insomnia. Keep trying.

I finally had enough and stopped for 6 months. The xanax was wasted on me. But when this bad insomnia episode started, I needed something--but didn't want to revisit old options that I wasn't too keen on.

Personally I find the clonazepam to be perfect for doing 2 miraculous things in my case: (1) helping me GET to sleep effectively and (2) helping me create a stable sleep schedule--instead of staying up all night and falling asleep at 9am.

I realize clonazepam is one of the medications that can be abused and/or have rapidly rising tolerance--so I'll be careful. In my case there really is only one thing that matters--that I can get to sleep and that the sleep itself is decent. If I get 8 hours of good sleep, life falls into place--and I can deal with any of the stresses and anxiety that follows.

I just can't handle the oppressive insomnia my little brain seems set on drudging up whenever I have major professional deadlines. I'm the kind of person who can deal with anything--if there's a crisis I'm the one who can keep their head level... But I swear to god, there is no way I can function if I can't sleep--and a type-A personality can't solve this problem by getting a 4.0 GPA and having the perfect resume and being the captain of every team in existence. If you can't sleep, life eventually goes down the drain and your once agile mind turns to mush.

Whoever said earlier that after a while major bouts of insomnia can cause both depression and even mania--I'm convinced both are true. The depression is perhaps more obvious--because you simply don't want to exist in that horrible form of utter hopelessness--that seeping emptiness that surrounds you, seeps out of you. You no longer recognize yourself after so much sleep deprivation.

The mania side is the part I believe goes under the radar... I believe once you are in a bad insomnia cycle, once you finally sleep a bit you can't just jump right back into a healthy sleep-wake-life schedule. When you finally get some sleep, that first period is extremely bumpy--and your waking hours feel very manic at times, as if you want desperately to catch up with all the time you lost but tend to hyper-focus then get disoriented then hyper-focus again... In my experience it takes a few weeks of reliable, sound sleep before you can find a more even-tempered waking state that is less jumpy or 'manic'.

I don't know if I'm using the term 'mania' properly here... it may mean something far more serious than the way I am invoking it in my own case. But if I am correct--if only partially--this might mean something for those of us suffering from very dire cases of chronic insomnia who get diagnosed with such things like depression and bipolar 2 disorders---because I can honestly say in my personal case I only experience negative thoughts or slightly manic periods when my sleep-wake schedule is seriously screwed up. When it's stable and I sleep well, I can deal with whatever the world throws at me.

I'm just curious if this might mean something for the medical community and how they treat and diagnose insomnia vis-a-vis such things as depression/anxiety/bipolar and so forth. I've maintained the whole time I was treated for insomnia that it was the sleep deprivation that was the key culprit--not depression or anything else--but I continue to find it very difficult to get that point across. I'm completely healthy with the exception of the intermittent bouts of overwhelming insomnia--I get my thyroid tested every other year just to make the doctors happy. They still want to make things more complicated though--it seems as though depression/bipolar diagnoses are the go-to favorites. Basing the core problem on my inability to get to sleep because my brain likes to run in circles when I'm facing deadlines--basing the main medical problem on insomnia itself--it seems as though doctors find this too easy to be justifiable.

Anyway, I'm happy to report the clonazepam is making a great dent in my insomnia the past 2 weeks. Again, I know the tolerance/abuse potential, but my insomnia is a very hard nut to crack...

Let's just put it this way--my insomnia laughs at Seroquel... and I mean laughs at 300mgs of Seroquel, not just 25-100. My insomnia thinks Rozerem is a flavor-less M&M with a high co-pay. I personally believe it is marketed as a sleep medication with no abuse potential because it does not, in fact, work--hence the lack of abuse potential. Unless you really like flavor-less M&M's with high co-pays. Ambien--oh, how we used to work together so well! Alas, no more... now you just make me feel blue and lethargic. Tried Ambien CR   ONCE--as in ONE night--and awoke to find a fantastically horrific meal that I'd made and laid out on my desk, the main ingredient of which was Peppermint Flavored Coffee Creamer.... And I don't cook--I mean at all. Scared the **** out of me--so bye-bye Ambien CR... down the toilet you go. I won't try Lunesta because I've read some absolutely terrifying things about its ability to create addiction after only one week and then inflict rebound insomnia that is many times worse than the original case of insomnia the patient sought treatment for. Xanax, again, was too short acting to do anything. Only times it ever worked was after 3 days of not sleeping, then taking 2 mgs... would pass out for 4 hours... ah, wonderful sleep. But that was the limit of its use-value... and I still am a bit angry about being prescribed it for insomnia in the first place since it's apparently not a very good choice at all! I didn't know--and patient ignorance is the perfect guinea pig for the medical community...

Ok, now back to work. There certainly are alternatives to hypnotics and benzos... but personally I apparently need one or the other just to get me to sleep--nothing else seems to knock me out, not matter what dose.

But even though Seroquel doesn't work on me, I think I must be the only case in existence that is resistant. Everything I've read and everyone I've spoken to LOVES it as an off-label treatment as an insomnia medication.

And look into Neurontin. Again, it doesn't get me TO sleep--but it helps once I get there! and it's probably one of the safest treatments--off label--for insomnia out there. It's also non-addictive.

Good luck all...

Avatar universal
by 143247lala, Apr 10, 2015
No three 40 pills of 3 mg lunesta, 30gms of kolinopin and my flexiril should do the trick right!!??? I'm done.... Past done. By the way suicide isn't selfish ,it's selfless. Their all better without me.. I did what.I.could.and.never got.love.back

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