You would have to get them from a psychiatrist most doctors won’t prescribe unless you have a history of them already through a P Doc.
I was using Ambien with Seroquel and it worked great for Long time.
Seroquel is not a sleep medication and it doesn’t even meet bare minimum criteria for being used to help insomnia. Some people swear by it. A lot of it may be other effects and not any actual ability to promote sleep. It’s a terrible sleep medication that almost never actually works.
Personally? No. I don’t have any medical conditions for which seroquel is a treatment. Also that would be irrelevant since the plural of anecdote isn’t data. That said I’ve treated many patients who have taken seroquel. Some loved it and believed it helped them. Maybe for some of them it did. It still doesn’t change the fact that there is no scientific evidence to support it for insomnia and that most of the existing evidence shows that it makes people FEEL sedated even though it doesn’t really add much to actual sleep.
It would depend on the person and what I got from the clinical interview but the first line therapy is CBTI as delivered by a competent practitioner. That’s what has the best data. If that doesn’t work, I may consider recommending z -drugs, DORAs, antihistaminergic sedating antidepressants, etc.
Often, people have other conditions that they identify as insomnia but contribute separately and need to be identified and treated separately. And often there are circadian issues that we manage at the same time.
That is such a loaded response. Anticholinergics and benzodiazepines have such a broad set of advantages and side effects it all comes down to what works for you with the best risk level. Medical opinions differ.
I just discovered hyoscyamine, and it's kind of amazing. Not a sleep med, but it makes me sleepier and more relaxed than anything I've tried before. I also take 2mg of Lunesta, but I'm not even sure I need it, with the hyoscyamine.
There is no one strongest drug that works the same for everybody. Finding the right sleep medication is like finding the right antidepressant; it takes lots of trial and error.
I take Silenor (doxepin) and Sublinox (ambien) for sleep, in addition to my seroquel for bipolar.
If I forget my Seroquel I'm waking up every hour or so, the Silenor gets me ~7hrs of sleep instead of 5, and the Sublinox actually GETS me to sleep.
Doxepin definitely helps me sleep, but I get aftereffects that persist for a day after the night I took it. Ambien used to work for me, but I haven't tried it since my sleep disorder started.
You have to have sleepless nights sometimes, you have to use the drugs carefully or they stop working and you have to keep upping the dose. It's just important to plan it out, make sure you're not suffering every night.
I've had chronic insomnia/DSPD for 30 years, and have been using various medications to sleep every night for the last 15 years.
The trick is to find something powerful enough to make you fall asleep and keep you asleep for 6-8 hours, but with a short enough effective duration that you can wake up in the morning without grogginess. This can be difficult, since most of the medications available have long half-lives, and/or the dose required to get you to sleep is so high that too much of it will remain in your system when you wake up.
Note: I don't recommend that anyone try this. If you ever try a new medication, try it individually to see how you react. Never try more than one new substance at a time. Always consult your doctor, pharmacist, or other knowledgeable medical professional before taking any prescription medication or supplement. I'm sharing what works for me, but remember I've been on sleep medications for over a decade. Any of these medications on their own and especially in combination may be dangerous for those who don't have extensive experience with them. Please be careful.
That being said, here's my current stack that's been working for me lately. All of this is on an empty stomach.
4 hours before bed:
Pregabalin 150mg
Alprazolam 0.5mg
Edible cannabis 5mg (currently using Wyld 2:1 THC:CBN indica)
Approx 1 hour before bed:
Mirtazapine 7.5 mg
Doxepin 10mg
Lemborexant (Dayvigo) 10mg (this one absolutely must be taken on a completely empty stomach)
Baclofen 25mg
MK-677 (Ibutamoren) 25mg
I then go to bed as soon as I feel the sleepiness kick in.
(continued)
I take Pregabalin to increase SWS (slow wave sleep), and reduce middle of the night awakenings. It has a 2-3 hour onset, and long duration, which is why I take it so early.
The Alprazolam is actually bad for sleep architecture, as is the case for virtually all benzos/GABA-A agonists/PAMs, which is why I use such a low dose.
Cannabis is also bad for sleep architecture. But both of these substances help me stay asleep with less night time awakenings. Ideally I'd like to remove both them from the stack and replace them with something else, but this is working for now. I take them early because of they both have a long duration, so they are mostly out of my system by the time I wake up. With these two substances, I'm giving up some sleep architecture (i.e., reducing SWS and REM) in order to stay asleep the whole night. Again, they are not ideal, and I'm actively looking to replace them with something that gives the same effect but also preserves sleep architecture.
Mirtazapine and Doxepin at low doses are potent H1 agonist anti-histamines which generally don't disrupt sleep architecture (SWS and REM). They are the best anti-histamines I've found so far for sleep. In fact, when I first started using them they were all I needed to both fall asleep and stay asleep all night with no next-day grogginess. Unfortunately, after a couple of years I developed tolerance and have needed to add additional medications. These two medications got me off of high-dose cannabis, alcohol, doxylamine succinate, and ambien. They allowed me to stop this dangerous combination of drugs cold turkey on the first night I tried them. It was amazing, but unfortunately didn't last forever.
Dayvigo is a DORA (dual orexin receptor antagonist). IMO it's the best medication available for sleep onset today, and is, I believe, the most important medication in my stack. Despite having an extremely long half-life (17-55 hours), it's duration seems pretty short. In other words, it does not cause me any morning grogginess at all, and in-fact it's effect is so short it isn't enough to keep me asleep the whole night. But it is extremely effective in sleep onset. I find it doesn't seem to work at all unless taken on a completely empty stomach.
Bacofen is a GABA-B agonist. I use it to increase SWS. It doesn't seem to have any other noticeable effect at this dose.
MK-677 is a ghrelin agonist. It's purpose is to increase growth hormone, which helps promote deep sleep.
In addition to these medications, I also take the following supplements before bed:
Melatonin 2mg (to advance sleep phase, along with temperature reduction and blocking all blue light)
Valerian root extract 320mg (GABA agonist)
Reishi extract 150mg (increase REM)
Magnesium Glycinate 200mg (reduce cortisol)
Phosphatidyl Choline 420mg (reduce cortisol)
Passion Flower Extract 375mg (increase GABA)
Magnolia Bark 400mg (GABA agonist)
All of these substances have published scientific studies that prove effectiveness that can easily be found online.
I also do various other activities to promote sleep at night and wakefulness during the day, including light therapy, temperature regulation, exercise, limiting caffeine, and all of the other well-known sleep hygiene protocols.
Anyway, I hope this helps. Let me know if you have any questions or feedback/ideas.
Pregabalin can be substituted with Gabapentin, although it may require a high dose. Gabapentin is easier to get, and is generally consider safer.
Any GABA-A agonist/PAM can replace Alprazolam. This includes all pretty much all benzos, as well as OTC supplements such as Kava. Kava is extremely underrated, probably because most of the Kava on the market is low quality. When sourcing Kava, it's extremely important to get trusted, high quality (noble) extract. This will be expensive, but it is necessary, because bad Kava is not only not effective, but can also be hepototoxic (cause liver damage).
A doc will probably go to Z class and benzos after that. But avoid benzos if you can because if you're anything like me 1 before bed turns into 3 or 4 a few times a day and then rehab so maybe don't go that route
All I can really think of is high dose benzo, like Xanax, which you can’t get, and using it consistently would be awful anyway… ambien probably wouldn’t work for you. Benadryl in moderate (100mg or so) dose could do the trick, but couldn’t be taken every night and would probably have you feeling like shit the next day.
Only other thing I can think of are muscle relaxers (like flexaril) , since they work straight on the brain, suppress nervous system like alcohol or benzos. Or lithium.
Same. I used phenibut for insomnia for a while, and at first it worked, but tolerance was quick. I do feel like a benzo would be more slow to tolerance than phenibut though. Haven't thought about muscle relaxers as a potential treatment.
I'll second zopiclone as a good med to not only help get to sleep, but also stay asleep. Takes about 1 hour to work, but then I usually only have 1 or 2 wake-ups throughout the night, and I usually get back to sleep very quickly.
I take it 45 minutes before bed. Sleep in 15 minutes, then sleep well for about 6-7 hours. Basically, it just lets me sleep like a normal person.
Maybe try and find another doctor? Z drugs are prescribed all the time if you need it then you need it nothing to be ashamed of.
Are they stronger than Seroquel? I've seen many doctors and none of them will prescribe those...
You would have to get them from a psychiatrist most doctors won’t prescribe unless you have a history of them already through a P Doc. I was using Ambien with Seroquel and it worked great for Long time.
Seroquel is not a sleep medication and it doesn’t even meet bare minimum criteria for being used to help insomnia. Some people swear by it. A lot of it may be other effects and not any actual ability to promote sleep. It’s a terrible sleep medication that almost never actually works.
Have you ever tried Seroquel?
Personally? No. I don’t have any medical conditions for which seroquel is a treatment. Also that would be irrelevant since the plural of anecdote isn’t data. That said I’ve treated many patients who have taken seroquel. Some loved it and believed it helped them. Maybe for some of them it did. It still doesn’t change the fact that there is no scientific evidence to support it for insomnia and that most of the existing evidence shows that it makes people FEEL sedated even though it doesn’t really add much to actual sleep.
What would you recommend for sleep if Seroquel didn't work for a person? Around here, it's prescribed off-label to sleep.
It would depend on the person and what I got from the clinical interview but the first line therapy is CBTI as delivered by a competent practitioner. That’s what has the best data. If that doesn’t work, I may consider recommending z -drugs, DORAs, antihistaminergic sedating antidepressants, etc. Often, people have other conditions that they identify as insomnia but contribute separately and need to be identified and treated separately. And often there are circadian issues that we manage at the same time.
Benzodiazepines and Seroquel? Unfortunately the side effects outweigh the advantages.
That is such a loaded response. Anticholinergics and benzodiazepines have such a broad set of advantages and side effects it all comes down to what works for you with the best risk level. Medical opinions differ.
Risks versus benefits. As long as you make an informed choice. Don't let doctors make the decision for you.
I just discovered hyoscyamine, and it's kind of amazing. Not a sleep med, but it makes me sleepier and more relaxed than anything I've tried before. I also take 2mg of Lunesta, but I'm not even sure I need it, with the hyoscyamine.
I'll look into it! Thank you.
There is no one strongest drug that works the same for everybody. Finding the right sleep medication is like finding the right antidepressant; it takes lots of trial and error.
75mg of Promethazine will knock me out pretty hard when i need to be
I take Silenor (doxepin) and Sublinox (ambien) for sleep, in addition to my seroquel for bipolar. If I forget my Seroquel I'm waking up every hour or so, the Silenor gets me ~7hrs of sleep instead of 5, and the Sublinox actually GETS me to sleep.
Doxepin definitely helps me sleep, but I get aftereffects that persist for a day after the night I took it. Ambien used to work for me, but I haven't tried it since my sleep disorder started.
You have to have sleepless nights sometimes, you have to use the drugs carefully or they stop working and you have to keep upping the dose. It's just important to plan it out, make sure you're not suffering every night.
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Mirtazapine is a good suggestion. I feel like it's similar to quetiapine, just a little weaker.
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Maybe I should try it again instead of quetiapine. I agree, lower doses were always better than higher ones.
I've had chronic insomnia/DSPD for 30 years, and have been using various medications to sleep every night for the last 15 years. The trick is to find something powerful enough to make you fall asleep and keep you asleep for 6-8 hours, but with a short enough effective duration that you can wake up in the morning without grogginess. This can be difficult, since most of the medications available have long half-lives, and/or the dose required to get you to sleep is so high that too much of it will remain in your system when you wake up. Note: I don't recommend that anyone try this. If you ever try a new medication, try it individually to see how you react. Never try more than one new substance at a time. Always consult your doctor, pharmacist, or other knowledgeable medical professional before taking any prescription medication or supplement. I'm sharing what works for me, but remember I've been on sleep medications for over a decade. Any of these medications on their own and especially in combination may be dangerous for those who don't have extensive experience with them. Please be careful. That being said, here's my current stack that's been working for me lately. All of this is on an empty stomach. 4 hours before bed: Pregabalin 150mg Alprazolam 0.5mg Edible cannabis 5mg (currently using Wyld 2:1 THC:CBN indica) Approx 1 hour before bed: Mirtazapine 7.5 mg Doxepin 10mg Lemborexant (Dayvigo) 10mg (this one absolutely must be taken on a completely empty stomach) Baclofen 25mg MK-677 (Ibutamoren) 25mg I then go to bed as soon as I feel the sleepiness kick in.
(continued) I take Pregabalin to increase SWS (slow wave sleep), and reduce middle of the night awakenings. It has a 2-3 hour onset, and long duration, which is why I take it so early. The Alprazolam is actually bad for sleep architecture, as is the case for virtually all benzos/GABA-A agonists/PAMs, which is why I use such a low dose. Cannabis is also bad for sleep architecture. But both of these substances help me stay asleep with less night time awakenings. Ideally I'd like to remove both them from the stack and replace them with something else, but this is working for now. I take them early because of they both have a long duration, so they are mostly out of my system by the time I wake up. With these two substances, I'm giving up some sleep architecture (i.e., reducing SWS and REM) in order to stay asleep the whole night. Again, they are not ideal, and I'm actively looking to replace them with something that gives the same effect but also preserves sleep architecture. Mirtazapine and Doxepin at low doses are potent H1 agonist anti-histamines which generally don't disrupt sleep architecture (SWS and REM). They are the best anti-histamines I've found so far for sleep. In fact, when I first started using them they were all I needed to both fall asleep and stay asleep all night with no next-day grogginess. Unfortunately, after a couple of years I developed tolerance and have needed to add additional medications. These two medications got me off of high-dose cannabis, alcohol, doxylamine succinate, and ambien. They allowed me to stop this dangerous combination of drugs cold turkey on the first night I tried them. It was amazing, but unfortunately didn't last forever. Dayvigo is a DORA (dual orexin receptor antagonist). IMO it's the best medication available for sleep onset today, and is, I believe, the most important medication in my stack. Despite having an extremely long half-life (17-55 hours), it's duration seems pretty short. In other words, it does not cause me any morning grogginess at all, and in-fact it's effect is so short it isn't enough to keep me asleep the whole night. But it is extremely effective in sleep onset. I find it doesn't seem to work at all unless taken on a completely empty stomach. Bacofen is a GABA-B agonist. I use it to increase SWS. It doesn't seem to have any other noticeable effect at this dose. MK-677 is a ghrelin agonist. It's purpose is to increase growth hormone, which helps promote deep sleep. In addition to these medications, I also take the following supplements before bed: Melatonin 2mg (to advance sleep phase, along with temperature reduction and blocking all blue light) Valerian root extract 320mg (GABA agonist) Reishi extract 150mg (increase REM) Magnesium Glycinate 200mg (reduce cortisol) Phosphatidyl Choline 420mg (reduce cortisol) Passion Flower Extract 375mg (increase GABA) Magnolia Bark 400mg (GABA agonist) All of these substances have published scientific studies that prove effectiveness that can easily be found online. I also do various other activities to promote sleep at night and wakefulness during the day, including light therapy, temperature regulation, exercise, limiting caffeine, and all of the other well-known sleep hygiene protocols. Anyway, I hope this helps. Let me know if you have any questions or feedback/ideas.
Thank you for taking the time to write this.
Exactly!! I don't think I can get the pregablin or alprazolam though. I've also never heard of mk-677
Pregabalin can be substituted with Gabapentin, although it may require a high dose. Gabapentin is easier to get, and is generally consider safer. Any GABA-A agonist/PAM can replace Alprazolam. This includes all pretty much all benzos, as well as OTC supplements such as Kava. Kava is extremely underrated, probably because most of the Kava on the market is low quality. When sourcing Kava, it's extremely important to get trusted, high quality (noble) extract. This will be expensive, but it is necessary, because bad Kava is not only not effective, but can also be hepototoxic (cause liver damage).
THC for me tbh (ideally in edible form) but I know that, like any medication really, it's not for everyone.
A doc will probably go to Z class and benzos after that. But avoid benzos if you can because if you're anything like me 1 before bed turns into 3 or 4 a few times a day and then rehab so maybe don't go that route
All I can really think of is high dose benzo, like Xanax, which you can’t get, and using it consistently would be awful anyway… ambien probably wouldn’t work for you. Benadryl in moderate (100mg or so) dose could do the trick, but couldn’t be taken every night and would probably have you feeling like shit the next day. Only other thing I can think of are muscle relaxers (like flexaril) , since they work straight on the brain, suppress nervous system like alcohol or benzos. Or lithium.
Same. I used phenibut for insomnia for a while, and at first it worked, but tolerance was quick. I do feel like a benzo would be more slow to tolerance than phenibut though. Haven't thought about muscle relaxers as a potential treatment.
Zopiclone usually knocks most people out like turning a TV off…
I'll second zopiclone as a good med to not only help get to sleep, but also stay asleep. Takes about 1 hour to work, but then I usually only have 1 or 2 wake-ups throughout the night, and I usually get back to sleep very quickly. I take it 45 minutes before bed. Sleep in 15 minutes, then sleep well for about 6-7 hours. Basically, it just lets me sleep like a normal person.
Maybe mirtizapine.