I am a terrible sleeper. With all the lights out and no noise in the room, it usually takes me about a half hour to an hour or more to fall asleep. With any lights on, or the TV on, or music (music is the worst, usually), I can't sleep at all. When I am exhausted, I can sleep okay, unless there's music on. I sleep okay in cars, too.
Skip to right now. I am very sick with what my doctor tells me is bronchitis and she has prescribed for me a sudafed-like pill I take in the morning along with a cough syrup with coedine in it to take at night.
Sweet. Lord.
I have never slept better. Last night I got 9 and a half hours of sleep. I usually average about five or six. I just took a few spoonfuls of this fantastic wonder drug and BAM! my bed was suddenly incredibly comfortable and warm and Holy God Almighty this feels good. Out like a light. And this was with my roomate and another guy who lives in the apartment in there at 12:30 playing video games on the damn computer (they used to keep me up a lot, I started kicking them out, but now that I passed out I fear I might've gotten them back on the wagon - the jerks). In summary, today, I have never felt better (okay, that's not true, I still have bronchitis, but you get the picture).
Now, the syrup can't last forever, and I don't really want it to. Coedine sounds an awful lot like something a guy could get powerfully addicted to and could be physically dangerous and, even worse, expensive.
So I figured I'd chuck this question out to the Hatrack gang. You all seem pretty informed on the medical side of the fence. What are some over-the-counter drugs that can help me fall asleep? Are these drugs even a good idea?
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Codeine is a narcotic. It is addictive. Alas, I have never found anything that works like it for sleep, except the anti-nausea pills I was taking when I was pregnant. (I ended up having to break them in half because a whole pill knocked me out completely). As an insomniac, I wish I could sleep like htat all the time, but, well, nothing else works that way.
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Benadryl makes me hyper half the time, and maybe a little yawny the rest. It is not anything near the same effect. And I've been on prescription sleep aids, but all they do is help me sleep for the 7 days that I'm on them, and then I go right back to my old sleeping patterns. I can't seem to re-train my brain at all.
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Mmmmm... I usually can't get to sleep unless I have a heavy blanket on me. This leads to problems in the summer and sweating to death.
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Well, although it is alluring, the whiskey option is a little bit too close to the whole "drug/addiction" problem there already is with coedine.
So, stuff like NyQuil is a bad idea? (I'm basing my knowledge of the sleep capabilties of NyQuil off of one episode of the Simpsons)
And which brand of Benadryl are we talking about, here?
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Valerian Root, in the herbal section. You can develop a resistance to it over time, and it can interact with anti-depressants in bad ways, but it is pretty benign otherwise.
When I was taking it frequently it took 4 pills to knock me out. Now, using less frequently, it only takes about two. I'll take three if I don't have to wake up in the morning for work. It's good stuff.
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You know, I wonder--it isn't uncommon for people with insomnia to be able to fall asleep in cars, and I know that with a fussy baby going for a drive can send them to sleep (at least for the duration of the drive), as can sittting them in their carseat on top of a running dryer. Are there any products out there that can be hooked up to a bed, making it vibrate slightly the way a car does? No, I'm not talking about something you'd put a quarter in at a motel. Something more subtle than that.
In terms of drugs you can take to induce sleep, keep in mind that while most of them will keep you unconscious for a certain length of time, this isn't really the same thing as sleep--you won't get nearly the rest from a night of drugged sleep as you will from a night of true sleep.
I've known people who swear by melatonin as a "natural" sleep aid, while other people I've known have claimed that it gave them horrible nightmares.
If you don't mind getting a perscription, Ambien is a drug that I've heard good things about. My wife and her brother both suffer from insomnia, and both of them have used it on and off for the past few years. Be forewarned, though, that Christine at least reports hallucinations (both seeing lights where they don't exist and saying that I look like "an iceman") before falling asleep with this drug. Also, while it's possible to wake up while under the drug's influence, you're unlikely to remember it the next day, even if something (like a bunch of friends coming over, waking you up, and convincing you go to bar hopping with them, as happened with my brother in law) results in your being awake for hours.
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It isn't. Because you DO fall asleep within 15-30 minutues of taking it. I mean, you can fight it off longer than that, but by and large, you're going to fall asleep.
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Whether or not it's good for you, I have been known to use Nyquil to get a night of dreamless sleep, when my stress nightmares got too bad to deal with.
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Wow Book, it sounds like you sleep just like me. I would be interesting to see what everyone says about getting a better nights sleep, since lately my sleeping (such as it was) has been even worse than normal. It's like my body forgot how to sleep - I'd wake up at really odd hours and not be able to go back to sleep. I never dreamed. When I woke up in the morning, I'd feel like I hadn't slept at all. It's just crappy.
When I was in college, my doctor prescribed some sleeping medication for me, to try to help prevent my migraines (in addition to helping me be more rested). I stopped taking them after several months because I just the hated the idea of being 20 years old and being dependent on sleeping medication to sleep at night. I have some medication that my current doctor prescribed to help me sleep when I'm experiencing depressive episodes (I suffer from a funky kind of periodic depression - only lasts for 1-2 weeks every few months), since the depression makes me sleep even worse, which makes the depression worse. etc. It works ok, but it doesn't knock me out - mostly helps me to stay asleep once I get there (and I have to time it just right, or it doesn't seem to have any effect at all).
Posts: 5879 | Registered: Apr 2001
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Yeah, mack is right. Not much good as a party drug if it renders you unconscious after a half hour or so, and wipes your memory of anything that might have happened to you if you were woken up while still under its effects.
Posts: 16059 | Registered: Aug 2000
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All of the over-the-counter sleep aids have Benadryl (diphenhydramine) in them in either 25mg or 50mg strengths.
Some of these are:
Unisom Nytol Simply Sleep Sleepinal Sominex
Also, Tylenol PM is simply Tylenol and Benadryl combined.
Even worse, these products are ridiculously expensive in my opinion when comparing how many doses one gets for $8.99
If diphenhydramine works for you and you want to use it as a sleep aid, look across the aisle and find some "Private Label" or "House Brand" Benadryl that is usually $5.99 for 100 tablets. Many drug stores carry this package size under the Healthline label...
I agree that diphenhydramine is safe and effective for mild to moderate occasional insomnia, but I recommend melatonin instead.
I recommend melatonin in the 1mg strength as opposed to 3mg sustained release formulations. I tell patients to take 1mg-3mg for about a week, and to titrate the dose upwards until the desired amount of sleep is achieved. Once melatonin has been taken for about a week, I tell patients to try taking it just as needed. Melatonin is a hormone secreted by the pineal gland of the brain, and sadly, there seems to be a virtual universe of research that could uncover more about what the pineal gland did or supossedly does, as most researchers conisider its role a vestigial one.
I too also like valerian root. Think of valerian root as an herbal alternative to Benadryl (diphenhydramine), which is a good thing, considering that Benadryl has prominent side-effects such as dry mouth and thirst, which might further aggravate an insomniac.
However, I still prefer melatonin over valerian root for one more very important reason. Melatonin may be able to help a person readjust their biological clock or reset their sleep cycle. Experts suggest that melatonin production occurs in the brain during darker nighttime hours. For persons who have done extensive traveling and are suffering from jet lag, melatonin may be able to help them sleep while away from home, and can also help them reset their sleep cycle when they return.
For those who have trouble falling asleep, melatonin will also help here as well. If a person is waking after 4,5 or 6 hours and wants to sleep longer, simply titrate the dose upwards to a maximum of 3mg before bed. As mentioned, melotonin does have its side effects, such as hallucinations or nightmares. Also if the dose is too strong, or if taken too late at night, there may be a "hangover" effect experienced in the morning upon waking.
As far as Ambien is concerned, this is an analog of older benzodiazepine based drugs like Restoril, Xanax, Valium, and Klonopin to name a few. Ambien works at the same receptor that benzos do, but was touted to have a less-addictive property that makes it safer to use for long-term insomnia. However, clinically, I have seen many patients are mildly addicted in as little as 7 days. Interestingly, Ambien is often described in accompanying literature to be used regularly for just 7 days, then to be used only occasionally for insomnia. However, the VAST majority of patients (meaning ALL of them) all take Ambien EVERY NIGHT to keep sleeping.
Now if this is the only way a person can sleep, then I do not see any long-term health consequences. But I do believe that this person needs to consider (and admit) that they may be chemically addicted. Does this mean anyone that takes Ambien is an addict? No. Can some patients take Ambien just occasionally and not be addicted to it? Yes. However, I would encourage these patients to see a sleep specialist and undergo tests to see if other therapies are possible.
On the down side, my friend who is an MD, pulmonologist, and sleep-study specialist has her husband taking Ambien and melatonin. So in many cases, Ambien is necessary and very appropriate!
Also worth mentioning, melatonin is sometimes used in weaning patients off of benzodiazepine based sleeping pills such as Valium and Xanax. Melatonin helps the weaning process as much as 50% in some studies...
Sorry, getting busy at work. Hope this helps...
Posts: 1870 | Registered: Mar 2003
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quote: For those who have trouble falling asleep, melatonin will also help here as well. If a person is waking after 4,5 or 6 hours and wants to sleep longer, simply titrate the dose upwards to a maximum of 3mg before bed. As mentioned, melotonin does have its side effects, such as hallucinations or nightmares. Also if the dose is too strong, or if taken too late at night, there may be a "hangover" effect experienced in the morning upon waking.
I use melatonin, myself, but always break apart the pills that I get into quarters and I sleep just fine. There is a slight hangover and some photosensitivity the next day, but that's nothing compared to the massive sinus dry out I get from benadryl and the resulting headaches and flu that come from all the protective mucus in my head going bye-bye. Personally, I think there is also a much stronger hangover from benadryl, but maybe that's just me.
Posts: 13123 | Registered: Feb 2002
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I suppose the clinically-minded person would call it "rebound" insomnia, whereas they cannot sleep soundly unless they keep taking Ambien nightly...
As quoted word for word from the PPI that is taped to the stock bottle of Ambien:
INDICATIONS AND USAGE
Ambien (zolpidem tartrate) is indicated for the short-term treatment of insomnia. Ambien has been shown to decrease sleep latency and increase the duration of sleep for up to 35 days in controlled clinical studies (see Clinical Pharmacology: Controlled trials supporting safety and efficacy).
(Then in a slightly different typeset)
Hypnotics should generally be limited to 7 to 10 days of use, and reevaluation of the patient is recommended if they are to be taken for more than 2 to 3 weeks. Ambien should not be prescribed in quantities exceeding a 1-month supply (see Warnings).
Theca, if my nose can become addicted to Afrin in as little as 3-5 days, I am quite sure my brain can become addicted to Ambien in 7...
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Also, I've heard that with melatonin, you need to go to sleep shortly after taking it or it's not very effective.
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Hmmm...I know that anecdotes don't equal evidence, but I actually took Ambien for months and had no trouble sleeping once I quit taking it. It was during hormone treatments for my infertility, and I had pretty severe insomnia.
Once I quit taking it, I saw no ill effects, I slept normally again. So I definitely don't think I was addicted.
Posts: 14428 | Registered: Aug 2001
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As I said before, I've tried many of the "sleep aids" that are supposed to help you "re-train" your brain and body. Doesn't work for me; I sleep the nights I take it, but am right back where I started when it's finished. Melatonin doesn't do anything for me, either good or bad, except apparently make me put on weight. (My mom used to make me take it.) Benadryl either makes me yawn but not really sleep, or makes me hyper on an unpredictable basis.
The only thing that ever works for me is self-hypnosis, imagery, and progressive relaxation. Those probably wouldn't work, either, if my dad hadn't trained me in them at such a young age.
I think my body and brain are just wired to a different cycle than most people's; if the world was up to me, we'd all go to bed between 2 and 4 am and not get up until around noon.
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The first time I took melatonin was from some jet lag from the 5-hour time difference between Chicago and a vacation to Hawaii. I took it for about 3 days and eventually threw the rest away.
Recently, I have had trouble staying asleep. I have been going to bed eariler than normal (say 9:30PM instead of 11PM or 11:30PM) and have been waking up around 3:30AM almost nightly.
So I bought some more melatonin. The 1MG, like I mentioned above. I took it about 20 minutes before I went to bed, and after 30-45 minutes of taking it, I felt like I was falling , as in the sensation you feel while dreaming of falling. It was very strange and strangely welcome. Anyway, I slept 7&1/2 hours that night, and felt great.
I skipped it the next night.
The third night, I woke up at 3:30AM and was a bit frustrated, and took 2MG (dumb idea). I had the next day off, but woke up like I had had WAY too much to drink the night before, and could not get out of bed until almost 10AM.
However, this is just anecdotal ramblings of my clouded experiences, and not very scientific.
The only point I would reiterate is that sleep aids should only be used short term, say 7-10 days. If longer therapy is required, it should be done in the care of a physician.
Now on the ranting side of this, I see far too many patients that get month after month of Ambien and take it NIGHTLY, even doubling up from time to time. I also have patients that exceed the manufacturer's recommended dose of 10MG nightly as well on a nightly basis. This is basically a clinically-controlled addiction to Ambien if given nightly for months or years.
I had one patient madder than hell at me and his doctor and basically asked very sincerely if I would at least warn patients who are taking Ambien. Consider this a chance for me to redeem myself, Theca... Posts: 1870 | Registered: Mar 2003
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Alucard, I don't usually prescribe ambien unless the patient has a fairly long-term sleep problem and other meds don't work, or they have severe insomnia from acute depression or anxiety. I rather expect the insomnia to return when the drug is stopped after seven days. If the insomnia was that easy to fix I don't usually need to use ambien. Although I have had patients use it for shift work and jet lag and none of those patients ever complained of insomnia post use
Yes, it is approved for short-term use only but the studies suggest it is safe, effective, and non-addictive for most patients who need it. The new drug in the ambien class, Lunesta, IS FDA approved for long-term use and I expect ambien will be approved too when they finish their studies and paperwork.
It isn't for every person who complains of insomnia, and I only use it long-term for patients who we have tried many other things first under the care of a doctor. Oh, I do use it for fibromyalgia patients long-term. It works SO well for that.
(I know psychiatrists who use the 20mg strength and it is given at the 20mg strength in other countries. The FDA always lags behind clinical practice.)
I completely understand your experience. However, as KQ has said, we are all hard-wired differently, or so we might like to think in order to explain our personal differences. I have seen people stop smoking with no difficulty, and I have had to wean patients off of Paxil (which is not even supposed to be addictive) over a series of months.
I am glad that you can sleep OK without Ambien, Belle. And as for anyone who needs Ambien to sleep, they have to be doing it under a doctor's care, which is none of my business anyway. Posts: 1870 | Registered: Mar 2003
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Sounds like I too have the same kind of sleep experience as Book and Ludosti, although I have managed to learn to sleep in (indirect, filtered) daylight. Assuming I am tired enough to sleep at all, I can go to sleep most any time of day. But unless I have been awake for a very long time, it will take me half an hour or more no matter what time it is. Too much light will still delay my sleep longer; lack of blankets does the same; and heat or noise (including music) can keep me awake almost indefinitely. Recently I have managed to go to sleep with the TV on, but this is clearly an anomaly caused by exhaustion. Even then I wake up every fifteen minutes or so.
On the other hand, once I am properly asleep, it takes some serious doing to wake me. I frequently wake up with pressure marks on my knees (as I did today) because they have been in the same position all night (or day); evidently I do not move in my sleep at all.
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I have read some suspect information on Vlad the Impaler that described him as an over-producer of melatonin, which helped to describe his aversion to sunlight from his resultant photosensitivity.
Basically, the author was hinting strongly that Vlad was seeking megadoses of melatonin for some sort of cognitive enlightenment and the ability to defy aging. But again, Sir Laurence Gardner is not exactly the most trustworthy source of information. He also hinted that Vlad had reverted to the ancient practices of "Starfire" and the drinking of the blood of a virgin to also increase his longevity of life. But again, this is a stretch performed out on a limb anyway...
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I wouldn't really call the problems with going off paxil an addiction problem. Although now that I think about it I don't know if we've found out why stopping paxil can cause flu-like symptoms. The severe depression that can occur during paxil tapering is more like a rebound depression I would think. Kind of like rebound hypertension when people are taken off beta blockers or clonidine. It definitely is a problem, though. Slow, slow tapers work best.
I have a lot of patients who refuse to try antidepressants because someone once told them they are addicting. Posts: 1990 | Registered: Feb 2001
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Theca, the patients I have helped are rarely depressed. They describe rebound headaches and a very pronounced "squishy" feeling that seems to affect them at the very core of their brain. The syndrome is very strange...
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Huh, I haven't seen those exact problems, but I don't really have hardly anyone on paxil. Doesn't really surprise me. The symptoms some people have when they go off effexor are very interesting also, have you seen that?
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Yes, as well as some mood swings and anger problems. No wait, that was when my wife stopped taking Effexor for migrane prevention...
But yes, Theca, I am a more than a little concerned with the sheer number of patients on Effexor. What will be interesting is how Cymbalta affects this, and in the long-run, if it is better tolerated than Effexor. But we digress...
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My alternative medicine book has Valerian mentioned. It says it is a perennial herb that contains alkaloids, actinidine, choline, glycoside, resins, tannins, valepotriates, valerenic acid, and volatile oils including limonene.
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The best sleep combo I got was counter intuitive. I got switched to Adderall for the ADHD during the day and still take 25mg Seroquel at night. If I don't take the Adderall and still take the Seroquel, I have a very restless night of sleep where I wake up constantly. If I don't take the Seroquel and do take the Adderall, the same thing happens. But if I take both, I sleep for 6-8 hours straight every night.
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*points to mack* See? We're all different. Many doctors I have talked to have never heard of people getting hyper because of Benadryl, either. Posts: 21182 | Registered: Sep 2004
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Have you considered taking GABA before bed? It is an aminoacid that convinces the body to sleep deeply and produce more HGH. (Some people take it for the first, some for the second, some for both.) I don't know if it has any associated side effects, though it can make you feel tingly and lightheaded for a few minutes after taking it. Maybe someone else here knows more about it.
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See? This is why the 'track is such a great resource. People actually know what they're talking about.
Posts: 2258 | Registered: Aug 2003
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Aside from all of the great medicinal suggestions above, I've found a few other things that help. On Saturdays I have to work split shifts, one from 4 in the a.m. until around 2 in the aft and then another from 7 p.m. until midnight. As such, if I am unable to sleep for those precious few hours in between, it is very difficult to make it to midnight (especially since I happen to be a morning person). So...
1. Having a fan on - one of those inexpensive, small ones - helps to make it not too silent while blocking out any outside noise. 2. Actually laying a small towel or t-shirt as if it was a blindfold over my eyes to block out any light (even with the curtains drawn, the middle of the afternoon is way too bright for me) 3. And this one will sound very stupid, but honestly it works for me - counting. Not sheep, mind you, just counting. I usually fall off in no time.
quote: And this one will sound very stupid, but honestly it works for me - counting. Not sheep, mind you, just counting. I usually fall off in no time.
Actually, not stupid at all. Counting backwards is part of my self-hypnosis routine.
Posts: 21182 | Registered: Sep 2004
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Just a thought, I don't know you or you're situation so I don't really know how feasable this is timewise, etc. but I find when I have trouble sleeping, excersie helps. Don't get me wrong, narcotics probably work better, but going and swimming a mile or two helps more than anything I've ever had that doesn't come in perscription form.
Posts: 187 | Registered: Jan 2005
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Cool. I've never had any experience with self-hypnosis..... Wait - I guess I have and just didn't know it! I've always heard of self-hypnosis helping with migraines, as well, but I always forget to find out how it works. Thanks for the reminder, ketchupqueen.
Posts: 142 | Registered: Jan 2005
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Melatonin taken before bedtime makes me very very sleepy the following afternoon. And when I take it the appropriate number of hours, based on that, before I want to fall asleep, it doesn't work at all. Valerian does absolutely nothing for me, either. I do, however, take Zopiclone for occasional insomnia, it works extremely well, and I have no side effects. When taking it, I have about 15 or 20 minutes to get me into bed. After that, I can't walk straight, I have no balance or coordination, and I'm basically a zombie.
Having said that, I would highly recommend anyone having any long term sleep problems go see a sleep specialist, and getting an overnight sleep study done to find out what is causing the insomnia. In my case, most of my insomnia was actually my apnea and periodic limb movement disorder rearing its ugly head. It seems that a lot of insomnia (most?) is caused by other sleep disorders not being properly diagnosed.
Posts: 8355 | Registered: Apr 2003
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Book, do you actually need more than 5 or 6 hours of sleep? If I get more than 6, I feel groggy all day and I'm fine with 4 or 5. Andrew needs 8 or he's a wreck (I don't know how he got through college and law school). It used to take me forever to get to sleep, but I've trained myself.
Here's what usually works for me: I go through bedtime rituals - brush my teeth, put on pajamas, put away mine and Andrew's clothes, check the house. I have a small lamp on my bedside table, with a low-wattage lightbulb. After getting into bed, I read for about 15 minutes. Sometimes, if I'm still keyed up, I listen to CDs that I've burned specifically for bedtime. I do some deep breathing and self-hpynosis (relax your toes...) and I'm usually out.
My best friend used to take Tylenol PM every night, but recently weaned herself off. She got a machine that plays various noises - rain, babbling brook, jungle, white noise, etc. It's helped her a lot.
A couple of other things that have helped people I know - a glass of wine an hour or so before bed and aromatherapy. Also, do not eat less than 2 (or is it 4?) hours before going to bed.
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If the insomnia was that easy to fix I don't usually need to use ambien. Although I have had patients use it for shift work and jet lag and none of those patients ever complained of insomnia post use![[Frown]](frown.gif)
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