Questions about different sleep aids
March 8, 2020 9:41 PM   Subscribe

I have tried almost everything for insomnia, but have questions about the only 3 remaining things I haven't: valerian root, Gabapentin, and Ambien. Assume no interactions or contraindications.

My insomnia is a side effect of one of the cancer treatments I am on.

Please do not suggest any of the following, in brackets - I have tried them in all safe doses and either A) found them to be not effective for me or B) effective but caused serious negative side effects/reactions. [CBD and THC in all conceivable forms, Melatonin, Benadryl, Trazodone, Seroquel, benzos like Ativan, assorted SSRIs, Remeron, good "sleep hygiene," yoga, acupuncture, white noise machines, blackout curtains/sleep masks, different types of meditation, breathwork, different types of talk therapy].

I am curious to try Valerian root supplements, but want to know if there is a specific type/brand that doesn't taste horrible, and if it is more homeopathy woo vs actually evidence based, when taken for insomnia?

I am curious to try Gabapentin, but not sure if a doctor can/would prescribe this off label (ie not for seizures, which I don't have), and also wondering about possible side effects people here have experienced?

I'm curious to try Ambien, because both my mom and sister have had good experiences with it (effective and no SEs). But there seems to be A LOT of stigma around this one - in terms of addiction potential as well as people doing dangerous things on it - so I'd like to know if it's even likely a doctor would allow me to take it long term? What if it's the only thing that works?

I'm not looking for a temporary "reset" but something for every night, as I will be on my particular cancer med for the next 7 years.
posted by CancerSucks to Health & Fitness (33 answers total) 4 users marked this as a favorite
Gabapentin is also often prescribed for neuropathy, if that helps. I have friends who found that it affected memory and cognition. In my relatively short term use I didn’t have such a problem, but boy howdy that is not a pill you want to take in the morning by mistake.
posted by praemunire at 9:50 PM on March 8, 2020

Valerian Root has worked well for me. Key to take it at least 30+ mins before desires bedtime. Many (15?) years ago I took it in something called “Alluna”, which contained other things like hops, and it was fantastic (would address my jetlag issues so quickly) but at some point I could no longer find it. Plenty of other formulations out there. IIRC, the smell of Alluna wasn’t bad at all. I’ve taken others since then which do smell bad, but taste isn’t a problem, no unpleasant burp taste/smell, etc.

Glad you’re avoiding remeron. The 9 months I was on that, were some of the worst of my life. It’s the devil’s drug.

Getting a sleep study & CPAP machine saved my life. Worth checking out.
posted by armoir from antproof case at 9:54 PM on March 8, 2020 [1 favorite]

It looks like there is credible (but small) research to suggest that gabapentin really can help with sleep
Treatment effects of gabapentin for primary insomnia
and this one which suggests that it is better for sleep than trazodone in receiving alcoholics.

Given that there is research to support your request, I think many doctors would be willing to consider it.

I have a family member who takes gabapentin for nerve pain. She found that she was very sensitive to the dosage level - too high created some bad side effects, stepping it back made it good for her. So that is something to pay attention to if you give it a trial.
posted by metahawk at 9:58 PM on March 8, 2020

My medical oncologist prescribed me Ambien during treatment. Worth a shot.
posted by purpleclover at 10:15 PM on March 8, 2020

I take gabapentin for nerve pain and have had no ill effects at all. I take 300 mg, 3 times a day. I briefly took it 4 times a day, for a total of 1200 mg per day. That didn't help me any more than the 900 mg/day, but I had no side effects, either.
posted by NotLost at 10:24 PM on March 8, 2020

It's pretty impossible to predict what doctors will do. Ambien has some well documented weird side effects (I used to take it some and thought it was great until one time when I woke up, had a conversation with my mother, called her later in the day, wondered why she was acting weird until she said "do you not remember that we talked earlier today?" which I 100% did not) but I knew someone whose doctor just kept giving it to her, I think maybe for years. I will say it knocks you out good. I used to take one and half an hour later I needed to be near the bed. (Years later aforementioned mother figured out she was having whole days she couldn't remember after taking Ambien so really it is a weird drug and one I would be circumspect about it but then maybe you're one of the people who won't have weird side effects.)

I found Valerian comparable to tap water in its sedative properties, and I think having taken benzos may make this even more pronounced.
posted by less of course at 10:31 PM on March 8, 2020

It's certainly worth a try for Gabapentin, which in my circles is not terribly hard to get prescribed for a range of issues but anecdata suggests it's not a powerhouse for insomnia unless pain is a significant factor. Ambien is worth a test scrip, but I recommend having someone there, if you normally don't, as for some people it doesn't really make you terribly sleepy, it just gives you amnesia as you go about some weird middle-of-the-night shit - for the most part it's benign, but you may want to make your computer(s)/devices offline and hard to get online, hide your car keys, and make it hard to get out the door.

You don't mention doxylamine succinate, the non-benadryl version of Unisom (and every drugstore has a store brand version), which is the only thing that has ever consistently worked for me and I have also tried everything on your list. Also I had no idea this was still being prescribed, I thought there'd been some uproar in the early 90s, but my mother's cardiologist just gave her a scrip for Halcion which is the only thing that's ever worked for her. My understanding is that it has many of the same side effect risks as Ambien plus possible anxiety/paranoia issues but it's something to ask about if nothing else works.

I've never taken a valerian that didn't give me painfully nasty belches, but it's been a while since I tried it. Valerian can be hard on the liver, which might be a concern depending on your chemo. I don't think I ever found it any more effective than taking magnesium and B-complex around bedtime (which I still often do, at least magnesium for restless legs) for a bit of a chill-out effect.
posted by Lyn Never at 10:35 PM on March 8, 2020

I've taken Ambien for years with no side effects. Which is strange for me, as I used to sleepwalk, and always have thrashed at night (Ive recently found that a weighted blanket is really helping on that front), I expected to have problems with Ambien. But none. Two different docs had no problems with it.

I've needed to take gabapentin for some periods of time. Every time, I had to rediscover that even the smallest dose (100 mg once a day! I think I'd be dead on the dose above!) built up to serious fatigue that landed me in an eval for autoimmune disease. Nope, it was the gabapentin. I just can't take that one. Similarly bad experience with trazadone.

Every human body is a little different. Try both and see what works, go from there once you've had some sleep. Because sleep deprivation is literally torture, but I don't need to tell you that. Best wishes for some good sleep.
posted by Dashy at 10:57 PM on March 8, 2020

It's a long shot, but doxylamine succinate?
posted by aramaic at 11:21 PM on March 8, 2020 [1 favorite]

At least in my experience gabapentin is pretty liberally prescribed by physicians, it's concidered a safe alternative to opioid pain relief and is also prescribed for mental health conditions. I was in a significant dose for anxiety for awhile (I think I took 300mg, 4 times a day? Something like that) but I didn't sleep on it. I don't think asking will hurt. I think physians would be way more likely to perscribe gabapentin than ambien. Ultimately for my wouldn't sleep phase, 400mg of seroquel was my solution, then trazadone, then eventually nothing. And those didn't work for you.
I've never taken valarian to help you out there.
posted by AlexiaSky at 11:55 PM on March 8, 2020

I was going to suggest doxylamine succinate as well. Whenever I find myself taking a nighttime cold medicine that contains it, I sleep like a rock and have pretty awesome dreams. I've never tried it on its own—I generally sleep OK, and am leery of recreational antihistamines—but it's the active ingredient in many OTC sleep aids.
posted by mumkin at 12:03 AM on March 9, 2020 [2 favorites]

you may want to have a look at pregabalin as an option or alternative to gabapentin as it's a kind of updated / preferred compound in the same family.

generally works fairly well for insomnia / sleep disorders / anxiety. anecdata suggests it might be helpful. best of luck.
posted by soi-disant at 1:17 AM on March 9, 2020

I have been where you are right now. It's extremely frustrating when you seemingly try everything and nothing works.

If AT ALL possible, see a sleep specialist. They are not all about sleep apnea. In fact, I'd recommend you specifically find a neurologist who is a board certified sleep specialist. There are root causes that can be fixed with appropriate diagnosis, which will require a sleep study.

Do you have trouble falling asleep or staying asleep or both? There are different purposes for different medications. Falling asleep because you are worrying or your thoughts are racing? That's truthfully a job for anxiety approaches. Are you waking up a million times and it doesn't seem like you can get through a night without waking up? Different issue. You can have both problems, too.

Regarding gabapentin, I was prescribed that along the way, and I'd say it's worth a shot depending on your particular diagnosis. For my specific issue it wasn't what I landed on, but that's because my sleep disorder is a bit more serious than gabapentin can handle.

Good luck.
posted by Stewriffic at 4:03 AM on March 9, 2020 [2 favorites]

Adding, because I somehow overlooked that it's a side effect of cancer medicine. I still recommend seeing a sleep specialist neurologist. There are more medical options than you have listed, and they can look to see what your brain is doing overnight in order to find the appropriate class of medication. You can also look to medications that help you be more wakeful during the day (not just stimulants--think nuvigil). I'm so sorry.
posted by Stewriffic at 4:07 AM on March 9, 2020 [2 favorites]

I’ve taken Ambien every night for five years. I have no appreciable side effects. My doctor is also an insomniac who takes it every night and he had to convince me it would be fine - and it is fine. It’s definitely worth a try.
posted by something something at 5:36 AM on March 9, 2020 [1 favorite]

Chronic insomniac here. I tried Valerian last year, and two days on a very low dose immediately affected my liver (it turned my poops totally white!). I am a youngish, healthy adult whose liver tests always come back within healthy parameters, and I’ve been able to take liver-stressing medications without side effects, but valerian was a total no-go.

I take magnesium in the evening, and it works reasonably well for me - specifically, 400mg magnesium glycinate, to reduce the laxative effect associated with magnesium. It’s not a magical difference, but it does measurably improve my sleep.
posted by wind_up_horse at 6:05 AM on March 9, 2020 [1 favorite]

I haven't had any trouble getting prescriptions for gabapentin or Ambien for sleep. I didn't find Ambien effective and it made me kinda depressed. Gabapentin works better for me than anything else with no obvious side effects. (My main issue is staying asleep, not falling asleep, and other drugs really don't tend to be good for that. There is an extended release version of Ambien though.)

Another one you can try is amitryptiline. It left me a zombie, but friends have sworn by it.
posted by metasarah at 6:06 AM on March 9, 2020 [1 favorite]

Magnesium supplements are the only thing that consistently help me fall asleep.

I've been testing Valerian via Celestial Seasonings Sleepytime Tea. It tastes good and seems to make me slightly relaxed, but doesn't do a lot to help me sleep.
posted by belladonna at 6:18 AM on March 9, 2020

Hey, I hope this isn't a stupid question... you said Benadryl. Do you mean Diphenhydramine? That did not work well for me but Doxylamine Succinate does. They're sold side by side and generally really only unisom is Doxy. I only ask because you might have missed it and it really helped me. It along with Benadryl have had questions about their long term effects and alzheimers though. (I'm 36 and not sleeping sometimes is way worse on my life ATM than worrying about that in many years and the data was very tenuous when I looked at it but didn't want to avoid mentioning it.)
posted by OnTheLastCastle at 6:58 AM on March 9, 2020 [1 favorite]

A note on doxy since so many of us are recommending it: I'm a large person and I only take a half, or a third if I'm really lucky with a pill splitter. A whole one makes it so I have trouble walking when I get up for my 3am pee. So start small if you decide to try it, but don't give up on it if a third or half aren't super effective, just test a higher dose on a night you don't have to be anywhere early.
posted by Lyn Never at 8:29 AM on March 9, 2020 [1 favorite]

Ambien isn't approved for long-term use, or at least that's what my doctor told me. Personally, I had a negative experience with it trying it short term (I didn't fall asleep, and instead sort of hallucinated).
posted by pinochiette at 10:26 AM on March 9, 2020

I take gabapentin for insomnia. I've seen no side effects and it definitely helps, although it's not a magic cure - I still have some sleepless nights. Since you say you've taken remeron, I can give you a comparison: remeron puts me right out and I've never had trouble falling asleep after I take it, but it makes me very groggy in the morning, while gabapentin helps me fall asleep and especially stay asleep, but I don't notice any lingering effects in the morning.

Good luck - insomnia sucks!
posted by Ragged Richard at 10:27 AM on March 9, 2020

IANAD. I take gabapentin for anxiety, at a reasonably high dose, throughout the day. My experience is that there were ~2 weeks or so after I started where there were pretty intense cognitive side effects and reduced motor control. Probably still some reduced memory function but not enough to matter. I would guess it would not be very hard to get an MD in the US to write a script, as it tends to be low risk AFAIK. It definitely helps my sleep. One thing I don't think has been mentioned is that gabapentin has a pretty short half life, ~4 hrs, so if you take it at bedtime it'll likely be mostly cleared from your body when you rouse.

Good luck, do consider a sleep study as suggested.
posted by PMdixon at 10:33 AM on March 9, 2020

I take gabapentin as part of my sleep cocktail, but I take five other drugs with it. For me, there's zero chance it'd get me to sleep on its own, but it helps knock down the pain a little so the other drugs can work. Tried Ambien and had a paradoxical reaction to it, as I do to the benzos as well, but I know I'm in the minority on that.

My long list of things I've tried is here; you might find something you've not tried yet on it. The reason I take multiple things is that this is the approach the specialist for my chronic illness favors - his experience is that monotherapy for insomnia tends to fail and polypharmacy tends to remain stable in the longer term.
posted by jocelmeow at 10:38 AM on March 9, 2020

Ambien isn't approved for long-term use, or at least that's what my doctor told me.

Yeah, no judgement against anyone on this thread, but remember that until recently there were some doctors who prescribing opioids at like 100x the average rate. So not every doctor is on the same page when it comes to how dangerous various medications are.

I will say that my doctor, who is generally of the mind that people are adults who control their bodies, gave me a stronger "this stuff will ruin your life" speech when he prescribed me Ambien verses than he did for any pain medication.
posted by sideshow at 10:41 AM on March 9, 2020 [2 favorites]

I don't have the references handy, but we found sufficient evidence that a combination of valerian extract and hops that we wrote a couple Canadian NNHPD applications and received NPNs for them. We even had to convince Health Canada to specify the amounts of 'presumed active ingredient' (its not required).

If you buy products, look for ones that claim/ state the actual amounts of valerenic acid and humulene/ a-humulene/ a-caryophyllene.
posted by porpoise at 11:19 AM on March 9, 2020 [1 favorite]

I too take gabapentin--mine for restless leg syndrome. I was really skeptical about it at first, because I'd heard about rebound, but I haven't experienced that, although I did increase my dosage a year and a half ago. I still have the occasional night where my racing mind refuses to let me sleep, but it's made a world of difference. I haven't yet encountered a medical professional who didn't see its value for off-label use and was willing to prescribe it. I will say the increased dose means I often have trouble really waking up and wanting to get out of bed in the morning, but see how one pill at night works for you. Not everyone gets as groggy as I do; I've battled insomnia my whole life for various reasons and this has been most effective so far.

I live alone, so I'm terrified of things like ambien--if I started driving at night or cooking, there's no one to stop me from crashing my car or burning the damn house down. I have a friend who regularly takes it when she's having problems, and has never had one of those episodes, but she also lives with someone, so...

Though I did used to take valerian and still have a lot of it lying around I really should get rid of. It wasn't super reliable for me, was my main issue, and didn't really overcome my super-stressed-out brain cascades, but if I was calm enough, it worked. Considering what you're up again, it's hard to say. It tastes terrible in tincture form, but I hate all tinctures so I'm not the most reliable there. You can get pills from some brands, they seemed to me to be equally effective. I didn't have a problem with it interacting with any of my meds at the time, unlike a number of other herbal remedies I'd tried for various things.
posted by kitten kaboodle at 1:06 PM on March 9, 2020

I sleep badly and I have a variety of things I take which include ambien. I also take gabapentin for (unrelated) post-herpetic neuralgia after having shingles. My two experiences.

1. For many people gabapentin is great for sleep, and for others not so much. I do find it has a measurable effect on my anxiety (being chiller) and a little on my memory (being a little spacier and have a harder time remembering things but not in a really bad/scary way. I experienced very minor weight gain, I think honestly from not being anxious all the time. I am on 1200mg and the usual dosage is anywhere from 200-1800, it's really all over the place. Only mentioning this because if 200 mg doesn't work, talk with your doctor about trying a little more. When I did stop taking it, I had to taper off of it and had some rebound effects so be careful. I have had friends who have gotten it prescribed specifically for sleep issues surrounding menopause, so I think it's often prescribed like this.I have zero other side effects from it. My sister takes it in higher dosages for epilepsy and has slightly more memory side effects.

2. Ambien. I consider this the "big guns" in my arsenal and I have a doctor who is very much not into prescribing it so I get a small amount of it every month and try not to use it. For me, when it works, it's like a hammer to the head in terms of just being knockout drops. I do not have any of the side effects (sleep eating, walking, driving, whatever) and I wake up in the morning feeling basically fine. The big deal is you need to give yourself eight hours for it (like if you're someone who sleeps in short bursts it's not for you) but it doesn't keep me from, say, getting up to pee in the middle of the night. Very occasionally it will flat out not work which I always find alarming but I think just sometimes happens. I usually take it when I have to get up at some early time in the morning and I'm afraid otherwise insomnia will mean I don't get to sleep early enough.

I should also mention that I don't drink. Ambien + alcohol is very strongly not recommended.
posted by jessamyn at 4:09 PM on March 9, 2020

Ambien is a hyonotic. While you may feel like you slept wonderfully, you may simply not remember that you tossed and turned all night.

I took Ambien off and on for years. I eventually started having side effects.....sleep eating, attempting to drive, telephone conversations I didn't was frightening. I no longer take Ambien.
posted by SassyMcSassin at 9:26 AM on March 10, 2020

My partner's entire family are insomniacs and don't sleep very well. His dad uses Ambien, and the side effects can be pretty serious.

My partner was recently prescribed Gabapentin but didn't like being on it - the side effects were pretty intense and he felt like he was going through a fog the entire time.

Tea at night - mixture of chamomile, valerian root, and peppermint - has also been very effective, as has been turning off screens for the last hour before bed.
posted by Drowsy Philosopher at 12:05 PM on March 10, 2020

I have battled insomnia since my early teens. Tried so many OTC options that would work in the short term but my body always got used to them.

My work stress increased a lot about nine months ago and I finally asked my GP for a sleep aid. He told me that a low dose of Ambien should be fine. My doctor specifically told me that many problems occur with Ambien because people try to stay awake after it has kicked in.

I take 5mg. I only take it when I know I am ready to get in bed within the next 20-30 minutes. I have had vodka and wine in the early evening when I take it with no side effects. I sleep great, I can wake up to use the restroom and go right back to sleep, and I wake up with no grogginess. I only take it on work nights and sleep fine on the weekends.
posted by narancia at 12:18 PM on March 10, 2020 [1 favorite]

I take valerian for insomnia. when I've stopped it sort of takes a while to really work once I start again, like about two weeks. It's more effective when I take it with melatonin (which I understand you may not be able to do). It's very gentle for me, but I sleep better than without.

I like the smell and don't mind the taste. I buy it from Mountain Rose Herbs and take thirty drops in a couple swallows of water. It's an herbal remedy -not homeopathic. Studies haven't discovered the mode of action, are inconclusive, or mildy positive. You can look for some and see what you think. It works for me, but it's not like taking a valium as some sources suggest.
posted by oneirodynia at 11:33 PM on March 11, 2020

I took valerian for a couple of years and it's a nice, gentle sleep aid. It won't knock you out like a z-drug but if taken every night it does help. In my experience it also takes the edge off of muscle pain. (I'd still be taking it, but it gives me strange dreams.) There have been some positive studies for valerian, though there seem to be dose standardization problems etc.

I second oneirodynia's recommendation: Mountain Rose Herbs makes very good herbals. If you're outside of the US, the Orange Naturals tincture is also good; that's the one I've used. The grain alcohol-based tinctures don't taste too terrible.

(If valerian helps and you're interested in other herbs, some good ones for sleep include lemon balm, hops, damiana, and combinations thereof. I've used them all to good effect, either as a tincture or brewing the dry herb as a tea. Lemon balm tastes considerably better than valerian.)
posted by fire, water, earth, air at 7:58 PM on March 15, 2020

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