Prescription Sleep Medication

October 12, 2015 10:30 AM

I'm a lifelong insomniac. After years of fighting it with "sleep hygiene" and melatonin and all sorts of other supposed remedies that never worked, I finally went to the doctor and got a Trazodone prescription. I took it every night with excellent, side effect-free results for about six years. I recently had to stop the Trazodone, however, because it interferes with another much more important medication that I absolutely must take every day. My sleep is, predictably, terrible again. It's been two months and I know I have to ask my doctor for something else.

I know you are not my doctor. I don't want doctor-like advice. I'm in treatment for breast cancer and see doctors very frequently and I trust them, but I've also learned through the experience of having cancer that other patients are often a better, or at least complementary, source of information than a single physician, no matter how good he or she is.

What I would like are stories of personal experience with other sleep medications so I can go into my appointment with an informed viewpoint about which option(s) might be best for me. I would love it if there's another low-dose, side effectless medication with no tolerance buildup over time that I can take every night and sleep like a normal person. I get the feeling that is probably not the case, though.

Can you tell me about the prescription meds you take for sleep? How well do they work? How often can you take them? Do you feel tired or hungover the next day? Are there any other weird side effects you can share?

(And just to get it off the table: I can't take Benadryl or other OTC meds containing diphenhydramine (Tylenol PM, etc.) either. And I do have a Xanax prescription that puts me to sleep semi-reliably but I try not to take it more than once a week because I don't want to build a tolerance. And also, I understand that the drugs you take may not be appropriate for me because of my cancer treatment and/or other medications I am taking. Filtering those out is what my doctor is for, I'm just looking for personal experiences here.)

posted by something something to Health & Fitness (25 answers total)

Valerian works really well for me, as does a meditation practice called Relaxation Response.
posted by TenaciousB at 10:57 AM on October 12, 2015

Response by poster: I should have said but thought the question was getting too long: I currently already take melatonin, although I'm not sure why because it's not effective at all, and valerian has not worked either. Believe me, I have tried every possible thing for sleep that is not a prescription medication before throwing in the towel and going to the doctor.
posted by something something at 11:01 AM on October 12, 2015 [1 favorite]

Best answer: I have a sleep disorder called alpha wave intrusion that was discovered during a sleep study. I have been taking Lunesta 3mg since the drug first came out, 12-15 years. I do have to go off it once a year to reset my body but have never experienced any withdrawal symptoms other than the expected rebound insomnia. I feel refreshed when I wake after a good 7 hours of sleep. I consider it a miracle drug.
posted by cairnoflore at 11:02 AM on October 12, 2015 [2 favorites]

I wanted to add that I tried melatonin, valerian, teas, trazadone, ambien, ambiencr, and restaril. None of them work like Lunesta.
posted by cairnoflore at 11:08 AM on October 12, 2015

Best answer: Lunesta is the only one that works for me. I take the 3mg but I read recently that the recommended dosage has changed. Ideally, you would take a 1mg and then add a 2 mg if you aren't out in an hour. Or, just take a 2 mg. I do get a slight hangover on the 3 mg but it isn't bad. I take it for a few nights in a row to re-set my system and can sometimes go without for a month at a time. I have to get at least 30 minutes of exercise in during the day, as well as a good bit of sunlight, or sleep just isn't going to happen on its own. I also avoid caffeine after lunch, unless I'm taking an lunesta, and then I enjoy the hell out of an afternoon cup of tea.

When I'm not using the Lunesta, I try to have a bowl of oatmeal around 8:00 pm with walnuts in it, no sugar. Walnuts are supposed to help you sleep and the oatmeal keeps me from waking up hungry at 3:00 am (I'm hypoglycemic). I have this with 2 cups (2 bags each cup) of Yogi Bedtime Tea, which makes me nice and drowsy. I also have to keep to a pretty regimented sleep plan. Awake and asleep at the same times every day, even weekends. No sleeping in, ever, but naps are allowed. No reading or watching television in my bedroom. And I stop taking phone calls at 9:00pm sharp, which helps me with winding down.

I built up a resistance to melatonin many years ago and haven't tried it since. I have no desire to try it again as it can mess with your hormones. I hate Ambien with a passion. It works for 3 hours and then makes me feel like going on a killing spree until it leaves my system. I can't take benadryl or tylenol either. Xanax and Valium do bad things to me.
posted by myselfasme at 11:13 AM on October 12, 2015

Best answer: Can you take Unisom sleeptabs? Many people overlook these because most Unisom products are made with diphenhydramine, but the sleeptab ingredient is doxylamine succinate, which you may have more success with. It works for me much more reliably than diphenhydramine does.
posted by srrh at 11:17 AM on October 12, 2015 [2 favorites]

Best answer: I've spoken about this before, but the prescription medication I currently take for sleep is clonidine. It's primary/original use was to control blood pressure, but it's now used for a lot of other things (ADHD, anxiety, alcohol/drug withdrawal, etc). Treating sleep disorders is one of it's off label uses.

Anyway: I've taken it every night for going on 6 years now. I started taking .2 mg in combination with 100 mg Seroquel (ugh, would never recommend seroquel), but I went off seroquel about 4 years ago, and went up to .3 mg. I haven't noticed any reduction in the efficacy despite taking it nightly. It has no addictive potential. The one major side effect (well it was it's original intended effect) is that it can lower blood pressure, so if you already have low blood pressure, that is something to watch out for.

It's not the kind of medication that will completely knock you out. It helps relax my body enough that I can drift off to sleep very easily. I still have to combine this with good sleep hygiene. It's the kind of thing where I can definitely fight the effects if I want to, but it works very well. I usually take it about an hour before I want to go to sleep.

I have never felt hungover from it, ever. I also occasionally take a single (.1 mg) pill for anxiety, especially when I'm flying since I tend to get sort of anxious on flights. (Or at least I used to. Now I've gotten to the point where I can often sleep on planes without taking it.)

Of course, YMMV, but as long as you don't have any medical conditions or other meds that would be contraindicated, I would really encourage you to give this a shot. I was a lifelong insomniac (also a perpetual night owl), and this has been life changing for me.

I've also tried:

Ambien: worked pretty well, but I abused it like crazy because at that point I was an active alcoholic, and now that I'm 4+ years sober I wouldn't want to risk it. Also, not something that is usually recommended for daily use.

Seroquel: It knocked me out to the point where I literally couldn't stay awake, but it also left me hung over. Oh, and starving. SO HUNGRY. No matter how full I was when I took it, an hour later I'd be raiding the fridge and wanting to eat everything in sight. It's one known side effect, among many others. I would not recommend taking it unless you need it for another condition (like psychosis).

Trazadone: Worked okay sometimes; not very effective. Also had an interaction with an asthma med I took.

The only other med I've had good luck with is an over the counter antihistamine similar to benadryl/diphenhydramine. It's called doxylamine succinate; you can usually find it sold under the brand name Unisom. It's also the sedative ingredient in some Nyquil preparations. It's a less powerful antihistamine compared to benadryl, but a better sedative. However, it is not something that should be taken regularly. When I did take it nightly for a couple months, I went from taking 25 mg to 200 mg in that two month period since I quickly become habituated to the dose. Also, ugh rebound insomnia. (I started taking it to get off Ambien.) I still occasionally take it; for example, when I recently travelled internationally, but it's a once in a while kind of thing.

tl;dr: Clonidine has made a huge difference for my sleep problems. I would definitely recommend asking your doctor about it.

(On preview, I see srrh just mentioned doxylamine as well, so I guess I'm seconding that recommendation.)
posted by litera scripta manet at 11:19 AM on October 12, 2015 [4 favorites]

Best answer: Ambien (zolpidem) does not have tolerance effects. It has worked very well for me for years. It has dramatic side effects in some people, so you should know to watch for those.

I had one dose of Trazodone, once, and will never again - I was groggy the next morning and nearly fell during a PT session, which could have been very, very bad for my freshly bolted-together spine. Its half-life is 10-12 hours. The half-life of Ambien is 2-3 hours, which is why it comes in a controlled-release (CR) formulation.

This is just my anecdata. Best wishes for good sleep.
posted by Dashy at 11:21 AM on October 12, 2015

Sleep apnea can present very differently in women than in men. Have you had a sleep study? One of the ways that sleep apnea can present for women is a perception of insomnia (also restless leg and a bunch of other stuff you don't often see for men). Women with sleep apnea also don't often fit the "overweight, snoring" profile that you see in men.

So, yeah, have a sleep study and see what they say. Even if its not apnea per se, they may be able to pinpoint something else that is interfering with your sleep.
posted by anastasiav at 11:22 AM on October 12, 2015 [2 favorites]

Oh, and I know this doesn't directly answer your question, but I just want to mention that in combination with the clonidine, I've had very good results controlling light exposure. I do use white light in the morning, which is the much more well known technique, but actually the main thing that has helped is using blue light blocking orange goggles, an orange bulb, and a few other things. I only came up with this routine over the last 4 months or so, but it's been very helpful in combatting my strong night owl tendencies. Here's a much more detailed answer including amazon links to all the stuff I use. All the night time orange light assorted materials are very cheap. If you wanted to start out with one thing, I would recommend the goggles, which should cost under $10.
posted by litera scripta manet at 11:27 AM on October 12, 2015 [3 favorites]

Best answer: Currently taking Lunesta. Works pretty well, although it does leave me groggy until about midday the next day. But doctors tell me drugs tend to stay in my system longer than they do in most people's, and based on previous experiences I expect that effect tp get better over time.

I have to have something for sleep every night or it just desn;t happen. Here's what I've tried, with the various benefits and side effects:

Ambien: Works well with little to no side effects, but loses effect over time.
Lunesta: Works pretty well, loses effect over time, can cause next-day grogginess
Benadryl: Have to take huge does before it has any effect, debilitating grogginess all next day that never wears off
Triazolam: Little to no effect even at higher dose
Temazepam: Little to no effect even at high dose
Rozerem: Little to no effect even at high dose
Melatonin: Little to no effect even at high dose
Seroquel: Deep sleep for eighteen hours at a time on minimum, skyrocketing blood glucose

That's the sum total of anything any doctor has been willing to give me.
posted by The Underpants Monster at 11:36 AM on October 12, 2015

The only prescription med I've tried is zopiclone, and I hated it; it made me dull and loopy and didn't actually help me feel rested. I'm wary of hypnotics in general because of these findings.

Non-antihistamine OTC options: I've tried low-dose melatonin, used as a chronobiotic (0.5 mg, 8 hours before target sleep time, with the aim of shifting half an hour forward every few days); found it too difficult to comply, wasn't able to be consistent. My preference (for non-antihistamine options) is to use either 1) a standardized valerian root extract, courtesy of my local health foods store (it's a German brand, I think) or 2) Suntheanine (TM) (the brand name is important; it's the standardized version of L-Theanine used in studies like this one), about an hour before I want to sleep.
posted by cotton dress sock at 11:37 AM on October 12, 2015

Yeah, the Doxylamine Succinate version of Unisom is nothing like the diphenhydramine versions (that wikipedia article is actually really interesting, I hadn't read it before - apparently it's more sedating than barbiturates, and it's sometimes prescribed for morning sickness). It's worth discussing with your doctors and pharmacist.

Melatonin isn't a soporific, for however much it is marketed as one. Some people have receptive enough melatonin receptors to use it like one, but that's not what it's for.

Clonidine was the only thing my mother liked besides Halcyon, but her doctor finally stopped giving her that (to everyone's relief), but Clonidine's a problem if you have low blood pressure, so she had to stop using it.

Valerian is probably not a good idea if you're on chemo, since most of the studies about its toxicity are all over the map and it seems to be iffy on the liver, which in your case is probably under a lot of strain already.
posted by Lyn Never at 11:55 AM on October 12, 2015

Best answer: I like Ambien when I am really struggling with sleep. I am usually okay with good sleep hygiene but not when I am traveling and not when I have other messy things going on in my life. I take it before bed (5 mg, they are 10 mg pills but the dosage for women should be lower so I take half) and I am zonked out most of the time within 30-45 minutes. It doesn't seem, for me, to last that long and I often feel this sort of "washed ashore" awake feeling after about 4-5 hours as if the sleepy medicine suddenly washes out of my body but usually then it's the middle of the night and I can go back to sleep decently at that point. I am lucky and have zero side effects from it that I know of.
posted by jessamyn at 12:09 PM on October 12, 2015

I used to take mirtazapine for depression, and it also worked powerfully for sleep. I didn't have a sleepless night the whole three years I took it, and would usually fall asleep within half an hour of taking it.

There's definitely a hangover/adjustment period (I slept for maybe fourteen hours a day the first few weeks I took it), but this does ease off to the point where you can be functional in the morning and not really notice it. I only noticed it myself when I was tapering the dose by taking it every other day some years later and realised I felt marginally clearer on mornings when I hadn't taken it the night before.

It can be appetite stimulating, but I didn't find the effects of that as bad as with seroquel (which made me sleep but was also zombie hell).
posted by terretu at 12:38 PM on October 12, 2015

Best answer: I've been taking Ambien CR daily since 2008 with no side effects and no decrease in effectiveness. Best sleep ever, highly recommended.
posted by bile and syntax at 3:02 PM on October 12, 2015

Best answer: I've been taking Ambien and now it's generic Zolipdem for years. I haven't built up a tolerance, it seems just as effective as it's always been. But, beware, the Ambien walrus is real. Don't take it if you're not planning on going to sleep right away. Items will show up at you door that you don't remember ordering. Also, the generic is super cheap, less than $20 for a 3 month supply at Costco with no insurance.
posted by Grumpy old geek at 3:07 PM on October 12, 2015

Best answer: I take generic Ambien, and have zero next-day grogginess.

As a FYI, Merck is offering free 10-day vouchers for a new drug, Belsomra- might be worth discussing with your doctor.
posted by invisible ink at 3:38 PM on October 12, 2015

You must needs take hydroxyzine. I too occasionally take klonopin and trazodone if i need to get to sleep in 15 minutes. But hydroxyzine (similar but older to benadryl) 2 hours before bed makes me incredibly sleepy with no grogginess if I'm out 8 hours. I couldn't do without it.
posted by kinoeye at 3:48 PM on October 12, 2015

Aha! That new drug from Merck is out. I know some backstory from a professional point, but here's a really good article about it from The New Yorker.
posted by Dashy at 4:01 PM on October 12, 2015

Best answer: Ambien is really great if you enjoy hallucinations that the walls are breathing, authoring nonsensical ramblings in Microsoft Word and making very strange purchases on the Internet that you later don't remember.
posted by killdevil at 6:07 PM on October 12, 2015

I was prescribed baclofen because I have muscle spasm issues as well as insomnia. It works well for me and seems like a really natural kind of sleepiness. I have no hangover from it in the morning, but my doctor was actually surprised about that, so ymmv. I've been taking it for more than a year and it works as well as ever, with no tolerance effect.
posted by Tandem Affinity at 7:53 PM on October 12, 2015

Best answer: I use the muscle relaxer Flexeril as a sleep aid. I have inflammatory arthritis, and it's a common sleep aid for us because our pain tends to worsen at night. I take a low dose: 10 mg. higher doses leave me hung over. I've been taking it for years with no tolerance or side effects.
posted by hydropsyche at 5:34 AM on October 13, 2015

Best answer: I took Ambien for 5 or 6 years. I definitely got memory "brown outs" where I would have difficulty remembering the next day what I did 30 minutes after taking it, but it never resulted in unusual and bizarre behavior. I do have friends who did some strange things after taking it so it's definitely a YMMV kinda thing. I never experienced any side effects other than some drowsiness the next day.

My current sleep doctor switched me onto benzodiazepines. I was super worried about the addictive aspect of them, but once I found a dose that worked I haven't felt the need to take more. I take it about as often as I took Ambien-- 5-7 days a week, skipping doses when I've had a drink in the evening. Xanax made me extremely drowsy and kind of depressed, so I switched to taking Ativan which has worked well for me. I do miss the "lights out" effect of Ambien; with Ativan I have to be more mindful in terms of making sure I get into bed within an hour of taking it because otherwise I don't feel the urgent need to go to sleep that Ambien induced and that I completely lack when not on medication. Same side effects as Ambien.
posted by fox problems at 5:43 AM on October 13, 2015

Response by poster: Thank you all for your responses! This is exactly what I was hoping for. Good old metafilter.

hydropsyche, you are my special hero because I have a comical amount of Flexeril left over from a back injury a few years ago and had forgotten about it completely. It will totally get me through until I see my doctor in a couple of weeks.
posted by something something at 2:39 PM on October 13, 2015