How risky would this be - again/Help!

[[...]]

Due to a non-benzo medical condition I'm not sleeping.  I'm lucky if I get a few hours and I can't really go on like that.  I have tried all the alternative stuff (e.g. valerian, melatonin) and tylenol pm and they don't help.  All the internet medical sites say that the medicinal options are benzos or one of the hypnotics (e.g. lunesta).  Neither is a long-term solution, I know already.  However, I think I need to be able to get one decent nights sleep per week so as to "catch up" and that if I could get that I'd be able to get by until I get my medical situation sorted out.

 

I'd have to get a prescription for lunesta and am a little concerned about side effects of that but I still have a number of ativan.  I've only been off the ativan a week now but I know what to expect from it (unlike lunesta).

 

So here's my question:  how much risk with regard to re-addiction/tolerance would I be taking if I took .5mg of ativan one night per week as a sleep aid ? (.5mg seems to be the dose most were prescribed for sleep so I'm sort of guessing on that).  Whatever the dose, I'm torn between really needing some sleep and being caught by the benzos again.  A doc who seems to know what he is talking about said I shouldn't be afraid to use the ativan if I really needed it and that occasional use wouldn't put me at risk for re-addiction.

 

You guys are the real experts in my opinion so I'm posing the question here.  Any opinions/comments will be greatly appreciated.

 

John

 

[[Pa...]]

Hi John,

 

I absolutely would not go back to the Ativan, I don't endorse Lunesta because of my horrific experience with hypnotics but I see that as a better alternative than taking Ativan.  I'm sure your Dr is well meaning and while it's true you could probably do it, why take the chance? 

 

Since you know all about dependency now, you know that the Lunesta will cease to be effective if taken on a regular basis because you'll develop a tolerance.  If taken on a regular basis the dose will have to be increased, and once a week is a regular basis.  Another thing you need to know is the drug will rob your body of it's natural ability to sleep. 

 

Please consider all of your options, I know you're a cautious person and will make the right decision for you.  I wish you well and hope the medical condition you have will soon allow you to sleep on your own.

 

Pam

[[ly...]]

Hi John,

 

I think if you took ativan just once a week for sleep you will be at very high risk to end up taking it 2 nights then 3 and so on, why risk it? I understand the need for sleep but there are so many other ways, have you tried any relaxation tapes? I heard someone say they use recordings of the rain because it is so relaxing,  maybe you should try something like that?

 

love lynn xx 

[[...]]

Yeah, Pam, the hypnotics really scare me.  I don't think I could do those.  Why do you see them as a better choice than ativan ?  Its all addictive, but I'm in a bind.  Assuming for now that I can limit my use to only .5mg one night per week what is my risk ?  Can one develop an addiction at that rate ?

 

Other opinions ?

 

John

 

[[Pa...]]

Let's look at this a different way...you're very newly off of the benzo, your sleep could still be affected by this.  There's a chance that the longer you're off of it, your sleep will improve.  If not, then maybe you could give yourself permission to take the Lunesta one night.  You could play it by ear, not assume that you'll need it once a week.  It's to be used on a as needed basis, not a predetermined one anyway.

 

Just take it slow John, see what happens and hope that you won't need it, that your preexisting medical condition will improve and you won't need to take such drastic measures. 

 

I know you were probably looking for others opinions and I'm sure you'll get them, I just wanted to offer up a different scenario.

[[Th...]]

Hi John,

 

You are still not that far out from being benzo free and that could be having an effect on your sleep issues. If you resort to a once a week rescue dose to break the non-sleep cycle, you should give yourself time again to see if you are able to sleep on your own before taking another one. Most do find help with other OTC meds, please read the insomnia thread to see if there is anything that might help. It is noted by Dr. Ashton that benzos do not give one a normal sleep as stated below...

 

Insomnia, nightmares, sleep disturbance. The sleep engendered by benzodiazepines, though it may seem refreshing at first, is not a normal sleep. Benzodiazepines inhibit both dreaming sleep (rapid eye movement sleep, REMS) and deep sleep (slow wave sleep, SWS). The extra sleep time that benzodiazepines provide is spent mainly in light sleep, termed Stage 2 sleep. REM and SWS are the two most important stages of sleep and are essential to health. Sleep deprivation studies show that any deficit is quickly made up by a rebound to above normal levels as soon as circumstances permit.

 

In regular benzodiazepine users REMS and SWS tend to return to pre-drug levels (because of tolerance) but the initial deficit remains. On withdrawal, even after years of benzodiazepine use, there is a marked rebound increase in REMS which also becomes more intense. As a result, dreams become more vivid, nightmares may occur and cause frequent awakenings during the night. This is a normal reaction to benzodiazepine withdrawal and, though unpleasant, it is a sign that recovery is beginning to take place. When the deficit of REMS is made up, usually after about 4-6 weeks, the nightmares become less frequent and gradually fade away.

 

Return of SWS seems to take longer after withdrawal, probably because anxiety levels are high, the brain is overactive and it is hard to relax completely. Subjects may have difficulty in getting off to sleep and may experience "restless legs syndrome", sudden muscle jerks (myoclonus) just as they are dropping off or be jolted suddenly by a hallucination of a loud bang (hypnagogic hallucination) which wakes them up again. These disturbances may also last for several weeks, sometimes months.

 

However, all these symptoms do settle in time. The need for sleep is so powerful that normal sleep will eventually reassert itself. Meanwhile, attention to sleep hygiene measures including avoiding tea, coffee, other stimulants or alcohol near bedtime, relaxation tapes, anxiety management techniques and physical exercise may be helpful. Taking all or most of the dose of benzodiazepine at night during the reduction period may also help. Occasionally another drug might be indicated (see section on adjuvant drugs, below).

[[...]]

I hear your concerns, Pam.  As for the once-a-week thought, I just meant to say that I wouldn't take it more than once a week even if I wasn't sleeping well.  That was my rationale for keeping it from becoming too frequent.

 

Don't mean to be a pest, but I'm still curious why you feel a hypnotic would be a better choice than ativan should I decide to take something.  Seems to me the hypnotics have lots of bad juju and are equally addictive.

 

Just to be clear, I don't want to take meds and so far have not but night after night without sleep starts adding up.  Its one of those "rock and a hard place" situations.  Maybe I'm weak but I'm starting to look around for an out.

 

 

[[Pa...]]

Don't mean to be a pest, but I'm still curious why you feel a hypnotic would be a better choice than ativan should I decide to take something.  Seems to me the hypnotics have lots of bad juju and are equally addictive.

 

 

 

John, I'm deathly afraid of both benzodiazepines and hypnotics.  I quit both cold turkey, the Klonopin in Oct 2007, the Ambien in Dec 2008.  It took over a year to heal from the Klonopin and a few weeks to heal from the Ambien.  Based on that, the hypnotic is the lesser of two evils.  However, I had suicidal ideation on the Ambien and it nearly took my life. 

 

I do not recommend either drug for sleep, both are dangerous in my opinion.

 

 

[[...]]

Thanks Pam.  My intuition is firmly in your camp; don't take any of the prescription meds.  All just seem to be risking a lot with no real guarantee.  However, some other part of me is desperately looking for an out and - somewhat like a used car salesman - wants to convince me to take a risk.  Maybe I'm just looking to get someone to say "sure kid, go ahead, you can control it and it might help."  Maybe the intuitive portion of me knows folks on this board aren't likely to support more drug use and hopes you'll talk me out of listening to the salesman guy.  Whew .... what convoluted, crazy babble.  This is what lack of sleep sounds like.

 

John

 

[[Pa...]]

Thanks Pam.  My intuition is firmly in your camp; don't take any of the prescription meds.  All just seem to be risking a lot with no real guarantee.  However, some other part of me is desperately looking for an out and - somewhat like a used car salesman - wants to convince me to take a risk.  Maybe I'm just looking to get someone to say "sure kid, go ahead, you can control it and it might help."  Maybe the intuitive portion of me knows folks on this board aren't likely to support more drug use and hopes you'll talk me out of listening to the salesman guy.  Whew .... what convoluted, crazy babble.  This is what lack of sleep sounds like.

 

John

 

 

Well, I'm glad you recognized you were babbling....I was going to have to say something!   Gees, get some sleep John--oh yeah that's what you're hoping for.

 

 

[[Js...]]

H

[[Js...]]

John, sorry for the first attempt to post, did something wrong and then lost the whole note.

 

so....this is an abbreviated version. I am not promoting this but Dr. Cohen recommended early on in my Cipro nightmare an old tricyclic AD called Doxepin for the insomnia that was brought on. Apparently at low dose levels, below levels prescribed for AD, it has a sedative effect. I don't know anything about it, am not promoting it nor have had any experience with it but it was a recommendation that I was given.

 

Good luck and I hope this improves for you,

 

Jim

[[Ma...]]

Hi John,

 

From what I can tell you've been off of the  benzos for a little while, but are having sleep trouble. I just wanted to share with you something that someone just recommended to me. It's not a Rx med, I really wouldn't want to do that here, rather, it's a homeopathic (all natural) sleep remedy called Quietude made by a company called Boiron. It should be available at health food stores and the like. She and her husband say it works. Just a thought. The link below takes you to a review site:

 

p.s. Please notify my it's not okay to offer suggestions like this. I apologize in advance if it isn't.

 

//www.buzzillions.com/reviews/boiron-quietude-sleeplessness-restless-sleep-60-ea-reviews?reviewSortBy=highestRatingFirst#bz-model-reviewTitle

 

Removed active link

[[Pa...]]

 

 

p.s. Please notify my it's not okay to offer suggestions like this. I apologize in advance if it isn't.

 

//www.buzzillions.com/reviews/boiron-quietude-sleeplessness-restless-sleep-60-ea-reviews?reviewSortBy=highestRatingFirst#bz-model-reviewTitle

 

Removed active link

 

Hi Matteo-- thanks for being cautious, we'd rather not have links to commercial websites. 

[[la...]]

Hi, John.  I'm another sedative-hypnotic survivor.  Advice:  Don't touch 'em.  For real.  Too much addictive potential, too many deaths, ain't worth it.  They're presented as an "occasional option" but too often, that's not how the story ends.

 

Toughing out a long bout of insomnia is a better option.  Your insomnia is not caused by a sedative deficiency, so don't take a sedative-hypnotic.  Be strong and patient, and keep working to solve the underlying condition.  In the meantime, explore ways to help your sleep a little without bringing in more addictive drugs.

 

I have some underlying health problems which aren't good for sleep.  However, I sleep enough to get by and feel pretty well most of the time by using a combination of natural remedies:  melatonin, GABA, L-theanine, and Niacinamide.  It's not a knockout cocktail by any means, but it works well enough that I'm off pharmaceuticals and mostly feeling okay.  Have you considered trying some natural remedies in combination, along with lowering your bar on what you expect for sleep?

 

I applaud you for not falling into the sedative trap.  Do steer clear.  They are still promoted as harmless, but I lost twenty years of my life to one.

[[Mi...]]

Hi John,

 

I'm having severe insomnia as well.  Get maybe 2 hours sleep then toss, turn, sweat, racing thoughts....yuck.  I updosed once before because of this, and I found it actually made me worse and I had to start tapering all over again.  For me, it was not worth it.

Like you, I would give anything for a solid 5 hours sleep.  5 Hours is all I'm asking for...doesn't seem like a huge request, butu for those of us who are sleep deprived, it would be a miracle.

I hope you find something (without relying on benzos,etc.) that works for you.  Let me know if you do!

Might be worth trying LOTN's suggestion of the supplements she takes.  I'm just too afraid to put anything else into my body!

I hope you can get some sleep soon.

Missy xo

[[an...]]

John:

 

I have had insomnia for quite a long time now, and I would certainly not take any risks with the meds to help sleep.  I've been down that road and it ain't pretty!  I have to use caution with any natural things, too, but you may have success with them.  I treat everything, including supplements and natural remedies, as meds, too, because you can certainly have reactions to them as well.  I wish you the best in your sleep.  You're just off a little over a week.  It takes our bodies a while to adjust. 

 

And Missy - I noticed your insomnia problem and the fact that you say you toss, turn, sweat and have racing thoughts.  I have been asking people in my blog about the racing thoughts and if that's part of the w/d process.  I'm dying to hear from anyone who has experienced these intensifying as they got lower in their dosage.  If you have an opportunity, could you stop by my blog and let me know your experience with the racing/obsessive thoughts?  Sorry to be a pest but I need some reassurance.  (It's under Depression - Feeling down and need encouragement - for Anx Girl).

 

Thanks,

 

Jan

[[...]]

Thanks all for your time, suggestions, and comments.  In addition to the suggestions made here I have a few from my alternative doc regarding non-prescription supplements that I can try.  I slept a little last night so feel a bit better today.  The pattern seems to be two nights without much sleep at all followed by one night of minimal sleep.  I guess the body gets tired enough to force sleep by night three.  I think this problem is thyroid related and not benzo related but there could be some overlap.  If it proves to be thyroid its going to take some time to sort out so I'm in for a potentially long ride with this thing.

 

Missy - your experience is very similar to mine except I don't have the racing mental thing.  I never thought I'd be grateful for five hours of sleep but right now I'd pay dearly for that !  I sure hope your symptoms let up soon.  I feel for you.

 

I think you are all right that prescription meds are likely a dead end and I shouldn't tempt fate to go that route.  I'm just going to try the non-rx alternatives and see what happens.

 

John

 

[[...]]

Hey all.  I'm now not sleeping at all and am at day three with no more than an hour of daydream-like "sleep." I know you all say to tough it out but I can't function in this state.  When I first posted this I was getting 2-4 hours and I could deal with that but now that I'm not sleeping at all its a differnt beast. How do/did you live without sleep ?  I'm keenly aware of the dangers but I'm now very tempted to to take the restoril my doc said she'd give me, at least for one night.  I know ... one night leads to another but I think my fear of benzos can keep me from doing that.  I just don't see how I can go on without any sleep.  Maybe some of you can do this but I just don't see how I can.  I'm so messed up now I'm barely able to type this.  I'm going to go lay down now and try to get a little rest (but I know I won't sleep).  Thanks for listening.

 

John

 

[[Pa...]]

I can tell you're at your wits end, I'm so sorry.  Of course, this is your decision and we'll support you whatever you decide.  As I said in an earliar post to you, I would vote for 1 night of Ambien (a drug which I loathe and fear) over Temazepam.  Ambien is prescribed for sleep, the Temazepam is not, the sleep is a side benefit.  Maybe you just need to break this cycle, perhaps one night will be all it will take.

 

Whatever you decide, I know you'll be cautious.

 

 

[[...]]

Thanks Pam.  I just got up from "resting" and am still rummy.  Didn't help much.  Actually, temazepam (restoril) is prescribed for sleep; all the medical sites list it as for sleep.  Anyway, it still has all the bad juju that any of the sleep meds have.  I went ahead and had the rx filled and will go get it presently.  I'm really torn about this but I just can't face another sleepless night.  Given how I feel now I can't imagine how another night would leave me.  I think I'm just going to have to take one tonight so as to get caught up enough to make it.  I'll have to resist any temptation to use it again unless I really have to.  I'm going to see an endocrinologist next week and hopefully he'll be able to pinpoint my problem and direct me to a real solution.  I certainly hope so.

 

Thanks for supporting me.  I know its not what your intuition says to do.

 

John

 

[[la...]]

You must be quite pooped.  I've been there, too.

 

Okay, my first question is:  What obligations do you have during the day?  Are you forced to work, drive, etc?  If not, I would suggest perhaps continuing to wait out the insomnia dragon.  However, if you must hold a job, drive a vehicle, etc and your livelihood and/or life are in jeopardy due to insomnia, then YES you must break the cycle a little.

 

If you use a med such as Ambien, break the lowest dose tablet in half.  If you are good and tired, that should be enough to push you over the edge.  Go LOW DOSE on this.  Higher doses can actually worsen insomnia.

 

Don't get into a thing where you're trying to throw as much drugs as necessary at it to force sleep.  That's what Michael Jackson did, 'ya know.

 

Let me ask about your sleep hygiene:  Are you getting some good cardiovascular exercise every day?  And have you eliminated caffeine, nicotine, and alcohol from your diet?  And have you eliminated OTC meds?  If not, please try that.

 

Do you have a peaceful bedtime routine, incorporating grandma's remedies like a bubble bath and warm milk?  If not, try that, too.

 

Finally, and this is important -- don't take your thoughts too seriously while you're sleep deprived.  Know that you will be incline to catastrophize things and think in desperate terms.  When those thoughts come, don't act on them.  Just let them pass.

 

One way or another, this will break.  Honest. 

[[Pa...]]

You must be quite pooped.  I've been there, too.

 

Okay, my first question is:  What obligations do you have during the day?  Are you forced to work, drive, etc?  If not, I would suggest perhaps continuing to wait out the insomnia dragon.  However, if you must hold a job, drive a vehicle, etc and your livelihood and/or life are in jeopardy due to insomnia, then YES you must break the cycle a little.

 

If you use a med such as Ambien, break the lowest dose tablet in half.  If you are good and tired, that should be enough to push you over the edge.  Go LOW DOSE on this.  Higher doses can actually worsen insomnia.

 

Don't get into a thing where you're trying to throw as much drugs as necessary at it to force sleep.  That's what Michael Jackson did, 'ya know.

 

Let me ask about your sleep hygiene:  Are you getting some good cardiovascular exercise every day?  And have you eliminated caffeine, nicotine, and alcohol from your diet?  And have you eliminated OTC meds?  If not, please try that.

 

Do you have a peaceful bedtime routine, incorporating grandma's remedies like a bubble bath and warm milk?  If not, try that, too.

 

Finally, and this is important -- don't take your thoughts too seriously while you're sleep deprived.  Know that you will be incline to catastrophize things and think in desperate terms.  When those thoughts come, don't act on them.  Just let them pass.

 

One way or another, this will break.  Honest.   

 

Is she good or is she good?

[[...]]

Hi Lady.  Thanks so much for your response and concern.  I'll try and answer your questions.

 

I got the rx (restoril) and took 30mg last night.  It worked wonderfully and today I feel so much better.  I am very aware, though, of the risks and will not take any unless I have had two or three nights in a row without any sleep.  Its a rock/hard place kind of thing as I just can't function after two days without sleep.  I know already how easy I build a tolerance and I'm definitely not one to over-do any medications.  If anything, I tend not to take anything I don't absolutely have to have and then only the smallest dosage that works.

 

I have an as-yet undiagnosed (have endocrinologist appt. next week) medical problem possibly related to arthritis so my insomnia isn't the result of anxiety, obsessive thoughts, bad sleep hygeine, etc.  We do all the right stuff and have a hot tub that we use almost every night. I tried all the OTC/alternative stuff one after the other but none worked so my choices were sleep med or no sleep.  I'm not taking any OTC stuff now and eliminated alcohol several months ago (although I might consider a glass of wine socially if the opportunity presented itself).  I researched ambien & lunesta (as well as restoril) and decided the restoril had the fewest dangers.  It was what my doc recommended and I trust her judgement so I went with it.  All of them are "rolling the dice" one way or another.

 

As far as toughing it out, I don't understand how folks say they just tough it out without sleep.  Yesterday I was so out of it and miserable after three nights I can't even imagine continuing and getting even worse.  I did and will tough out several nights in a row but that's all I can tolerate.

 

Luckily I am retired so I don't have many of the obligations you mention.  However, I am not without some obligations and also want to be able to do the volunteer work, hobbies, and other activities that make my life enjoyable and meaningful.  I wouldn't be able to do much of anything if I was like I was yesterday all the time.

 

Thanks again for your advice and for listening.  Sometimes I just need a sympathetic ear.  I'm going to repeat the warnings you, Pamster, and others have posted to myself every day.

 

John

 

 

 

[[Js...]]

Hi John, sorry to hear that the insomnia won't let up. I took Restoril for about a month before the Klonopin was prescribed. I found that it knocked me right out but I would only get about 5 hours of sleep out of it before I was back wide awake. I'm glad to hear that it's working well for you. I can commiserate on the need to sleep, that was the one of the main reasons that I ended up on this stuff, I had to function in that I am far from retiring and couldn't lose my job ( still can't for that matter)

 

Goof luck John, be careful w/ the Restoril (it's a benzo too) and I hope you get to enjoy the weekend,

 

Jim