Apr 17, 2008
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.
-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:
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.