What put a frown on your face today?

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Re: What put a frown on your face today?

Unread postby René » 12 January 2021, 12:31

Our plane from Dulles to Heathrow this morning felt like we were on a really bumpy road for a while. I normally love turbulence, with the sudden drops and everything, but this was just annoying. No sudden drops or jumps, no euphoria, just an annoying sort of vibration.

#NotMyTurbulence :oface:
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Re: What put a frown on your face today?

Unread postby OutsideIn » 12 January 2021, 13:13

René wrote:Doxepin, 0.5 to 6 mg before bed (licensed in the US in 3 or 6 mg but I find 0.5 is enough; brand names include Silenor) (possibly combined with melatonin). It's safe and effective long-term. The degree to which this medication is underutilised is baffling. So many people suffering needlessly. :(

Anyway, ask your doctor if low-dose doxepin for insomnia is right for you (if you live in the US)! Or get it regardless like I do. :P

I’ve already tried it. I don’t recall the dose. It didn’t work for me. I have been on every sleeping pill available. I have taking every off-label option also, including anti-anxiety, antidepressants, and anticonvulsants. Nothing works on me. They hand out pills over here like candy because it’s cheaper than trying to find the real problem.

I have multiple causes for insomnia. I have an underlying condition, the name of which I can never remember, that makes my sleep schedule nearly impossible to control. I would be fine if I were rich and could sleep whenever I wanted. I also have a thyroid condition and even some nutritional problems. It all makes trying to manage my insomnia feel like trying to balance on the edge of a razor.

I could write a book on my problems with insomnia. It would be a very boring book. Possibly it could be used to treat insomnia.
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Re: What put a frown on your face today?

Unread postby René » 12 January 2021, 13:40

OutsideIn wrote:
René wrote:Doxepin, 0.5 to 6 mg before bed (licensed in the US in 3 or 6 mg but I find 0.5 is enough; brand names include Silenor) (possibly combined with melatonin). It's safe and effective long-term. The degree to which this medication is underutilised is baffling. So many people suffering needlessly. :(

Anyway, ask your doctor if low-dose doxepin for insomnia is right for you (if you live in the US)! Or get it regardless like I do. :P

I’ve already tried it. I don’t recall the dose. It didn’t work for me.

Oh, this is a totally different drug at different dosages. The doses I'm talking about are two orders of magnitude smaller than those normally used to treat e.g. anxiety and depression and, historically (and still to this day by some ill-informed doctors), insomnia.

At high/traditional doses, it is NOT an effective insomnia medication. At low doses, it is. (Doesn't mean it'll work for everyone, of course. But the dosage is an absolutely crucial detail.)
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Re: What put a frown on your face today?

Unread postby OutsideIn » 12 January 2021, 23:20

René wrote:Oh, this is a totally different drug at different dosages. The doses I'm talking about are two orders of magnitude smaller than those normally used to treat e.g. anxiety and depression and, historically (and still to this day by some ill-informed doctors), insomnia.

At high/traditional doses, it is NOT an effective insomnia medication. At low doses, it is. (Doesn't mean it'll work for everyone, of course. But the dosage is an absolutely crucial detail.)

That is the way I took most of the off-label drugs. It wasn’t at the dose used to treat the common problem, like depression. It was usually at a much lower dose. Even at low doses, some of them gave me bad side effects. None of them worked. At most, they would make me drowsy. Drowsiness wasn’t my problem. It was that my brain doesn’t properly regulate my sleep cycle. This has been going on for about 14 years.
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Re: What put a frown on your face today?

Unread postby OutsideIn » 12 January 2021, 23:28

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Re: What put a frown on your face today?

Unread postby erti » 12 January 2021, 23:44

René wrote:
OutsideIn wrote:
René wrote:Doxepin, 0.5 to 6 mg before bed (licensed in the US in 3 or 6 mg but I find 0.5 is enough; brand names include Silenor) (possibly combined with melatonin). It's safe and effective long-term. The degree to which this medication is underutilised is baffling. So many people suffering needlessly. :(

Anyway, ask your doctor if low-dose doxepin for insomnia is right for you (if you live in the US)! Or get it regardless like I do. :P

I’ve already tried it. I don’t recall the dose. It didn’t work for me.

Oh, this is a totally different drug at different dosages. The doses I'm talking about are two orders of magnitude smaller than those normally used to treat e.g. anxiety and depression and, historically (and still to this day by some ill-informed doctors), insomnia.

At high/traditional doses, it is NOT an effective insomnia medication. At low doses, it is. (Doesn't mean it'll work for everyone, of course. But the dosage is an absolutely crucial detail.)


Like seroquel for sleep is low dosage like 25mg to 200mg. dosage of 200 or higher is an antipsychotic... or can it be a mood stabilizer as well?
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Re: What put a frown on your face today?

Unread postby Severelius » 13 January 2021, 13:29

Talking to my mum on the phone.
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Re: What put a frown on your face today?

Unread postby René » 13 January 2021, 14:48

OutsideIn wrote:
René wrote:Oh, this is a totally different drug at different dosages. The doses I'm talking about are two orders of magnitude smaller than those normally used to treat e.g. anxiety and depression and, historically (and still to this day by some ill-informed doctors), insomnia.

At high/traditional doses, it is NOT an effective insomnia medication. At low doses, it is. (Doesn't mean it'll work for everyone, of course. But the dosage is an absolutely crucial detail.)

That is the way I took most of the off-label drugs. It wasn’t at the dose used to treat the common problem, like depression. It was usually at a much lower dose. Even at low doses, some of them gave me bad side effects. None of them worked. At most, they would make me drowsy. Drowsiness wasn’t my problem. It was that my brain doesn’t properly regulate my sleep cycle. This has been going on for about 14 years.

I don't think you understand. Doxepin doses for depression are like 75-300 mg/day. For many many years and even today, it would have been common for a doctor to think that 25 mg is a very low dose that would work off-label as a sleep aid along the lines you described. But it wouldn't work very well and would cause side effects, including anticholinergic effects.

I'm talking about doses another 4-50 times lower than that: 0.5 to 6 mg/day. At these doses, side effects are similar to placebo (with even somnolence/sedation occurring in less than 5% of patients, and no daytime sedation, increased appetite or weight gain seen), while it is much more effective for problems like you describe than at higher doses (at which it actually can be sedating), which are much more likely to have been what you've been given before.

Many more people have been prescribed far-too-high off-label doses of this drug for insomnia than have received the FDA-approved doses for insomnia of 3 and 6 mg/day under the Silenor brand name.

erti wrote:Like seroquel for sleep is low dosage like 25mg to 200mg. dosage of 200 or higher is an antipsychotic... or can it be a mood stabilizer as well?

Antipsychotics like quetiapine (or Seroquel for you branded Americans :P) typically have mood-stabilising properties in patients with bipolar disorder but, even though they are sedating, they are completely inappropriate for use as sleep aids.
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Re: What put a frown on your face today?

Unread postby erti » 13 January 2021, 16:41

René wrote:Antipsychotics like quetiapine (or Seroquel for you branded Americans :P) typically have mood-stabilising properties in patients with bipolar disorder but, even though they are sedating, they are completely inappropriate for use as sleep aids.


I’ve known a few people who take it mainly for sleep but it maybe the last resort meds.. otherwise they use melatonin or trazodone or I even heard Benadryl but not for long term use.
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Re: What put a frown on your face today?

Unread postby René » 13 January 2021, 19:01

erti wrote:
René wrote:Antipsychotics like quetiapine (or Seroquel for you branded Americans :P) typically have mood-stabilising properties in patients with bipolar disorder but, even though they are sedating, they are completely inappropriate for use as sleep aids.

I’ve known a few people who take it mainly for sleep but it maybe the last resort meds.. otherwise they use melatonin or trazodone or I even heard Benadryl but not for long term use.

There should certainly be better alternatives for people knocking themselves out with side-effect-laden antipsychotics, anticholinergics and antidepressants.

Diphenhydramine (Benadryl) leads to rapid tolerance (if it even works to begin with) and is associated with increased risk of developing Alzheimer's disease (two properties it shares with benzos, which obviously also should not be used for chronic insomnia, or arguably any insomnia).

Melatonin is another one where the dosage is crucial, but what works varies wildly per person. Some seem to need 0.1 mg and no more, some 0.3, 0.5, 1, 3, 6 mg or even more. This can also change over time in one person. And it should ideally be taken at the same time every day to help regulate the sleep-wake cycle, not just when acutely having trouble sleeping.
Taking too much can actually make it harder or impossible to sleep.
Way too many people write it off as "not working" for them even when they only tried one dosage one time.

And of course it may take a combination of different substances. I would not give up before at least properly experimenting with melatonin as described above in combination with low-dose doxepin, theanine and a good lemon-balm extract.

As a last resort, I would be thinking more of something like cannabis than antipsychotics. :P
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Re: What put a frown on your face today?

Unread postby erti » 13 January 2021, 19:22

René wrote:There should certainly be better alternatives for people knocking themselves out with side-effect-laden antipsychotics, anticholinergics and antidepressants.

Diphenhydramine (Benadryl) leads to rapid tolerance (if it even works to begin with) and is associated with increased risk of developing Alzheimer's disease (two properties it shares with benzos, which obviously also should not be used for chronic insomnia, or arguably any insomnia).

Melatonin is another one where the dosage is crucial, but what works varies wildly per person. Some seem to need 0.1 mg and no more, some 0.3, 0.5, 1, 3, 6 mg or even more. This can also change over time in one person. And it should ideally be taken at the same time every day to help regulate the sleep-wake cycle, not just when acutely having trouble sleeping.
Taking too much can actually make it harder or impossible to sleep.
Way too many people write it off as "not working" for them even when they only tried one dosage one time.

And of course it may take a combination of different substances. I would not give up before at least properly experimenting with melatonin as described above in combination with low-dose doxepin, theanine and a good lemon-balm extract.

As a last resort, I would be thinking more of something like cannabis than antipsychotics. :P


Well cannabis here isn’t available here for sleep... there’s only a few things in my state where you can get a medical marijuana card... like PTSD.

As many hospitals stays I’ve met a lot of people who talk about using seroquel to help them sleep... but yeah... it’s a last resort.
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Re: What put a frown on your face today?

Unread postby OutsideIn » 13 January 2021, 22:57

René wrote:I don't think you understand. Doxepin doses for depression are like 75-300 mg/day. For many many years and even today, it would have been common for a doctor to think that 25 mg is a very low dose that would work off-label as a sleep aid along the lines you described. But it wouldn't work very well and would cause side effects, including anticholinergic effects.

I'm talking about doses another 4-50 times lower than that: 0.5 to 6 mg/day. At these doses, side effects are similar to placebo (with even somnolence/sedation occurring in less than 5% of patients, and no daytime sedation, increased appetite or weight gain seen), while it is much more effective for problems like you describe than at higher doses (at which it actually can be sedating), which are much more likely to have been what you've been given before.

Many more people have been prescribed far-too-high off-label doses of this drug for insomnia than have received the FDA-approved doses for insomnia of 3 and 6 mg/day under the Silenor brand name.


I do understand. I just don't remember all of the details because it was spread out over many years and it was with multiple doctors. To the best of my recollection, the first doctor (GP) gave me off-label doxepin at the lowest dose. A few years ago, a different doctor (sleep specialist) gave me brand name Silenor. Neither was sufficient to make me sleep more than I was without any medication.

René wrote:Antipsychotics like quetiapine (or Seroquel for you branded Americans :P) typically have mood-stabilising properties in patients with bipolar disorder but, even though they are sedating, they are completely inappropriate for use as sleep aids.

I took Seroquel too, during the first major issue. I was very sick, and insomnia was only one of my many problems. I was sick for YEARS, and I had to try anything I could to sleep. I always believed that my insomnia was preventing me from recovering. Desperate times call for desperate measures.

In any case, anyone experiencing chronic insomnia should see a doctor, preferably a specialist, to rule out serious conditions like sleep apnea. I would also encourage people to look into the possibility of multiple causes for their insomnia, and even look at things like diet. My worst insomnia, where I sometimes went multiple days without sleep, was caused by not getting enough magnesium. I am not joking when I say that a quarter of a cup of pumpkin seeds has given me more relief than any drug I have ever taken.
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Re: What put a frown on your face today?

Unread postby René » 14 January 2021, 00:31

OutsideIn wrote:
René wrote:I don't think you understand. Doxepin doses for depression are like 75-300 mg/day. For many many years and even today, it would have been common for a doctor to think that 25 mg is a very low dose that would work off-label as a sleep aid along the lines you described. But it wouldn't work very well and would cause side effects, including anticholinergic effects.

I'm talking about doses another 4-50 times lower than that: 0.5 to 6 mg/day. At these doses, side effects are similar to placebo (with even somnolence/sedation occurring in less than 5% of patients, and no daytime sedation, increased appetite or weight gain seen), while it is much more effective for problems like you describe than at higher doses (at which it actually can be sedating), which are much more likely to have been what you've been given before.

Many more people have been prescribed far-too-high off-label doses of this drug for insomnia than have received the FDA-approved doses for insomnia of 3 and 6 mg/day under the Silenor brand name.

I do understand. I just don't remember all of the details because it was spread out over many years and it was with multiple doctors. To the best of my recollection, the first doctor (GP) gave me off-label doxepin at the lowest dose. A few years ago, a different doctor (sleep specialist) gave me brand name Silenor. Neither was sufficient to make me sleep more than I was without any medication.

Well, that clears things up! Thanks :P

Have you tried combinations of different things?

I would at least experiment with Silenor + theanine + lemon balm + melatonin at all the different dosages, all for a decent while, before giving up hope. Maybe adding in CBD and/or a variety of strains of full-on cannabis as well (even if illegal, based on how terrible your situation sounds).

:hug:
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Re: What put a frown on your face today?

Unread postby OutsideIn » 14 January 2021, 03:15

René wrote:Well, that clears things up! Thanks :P

Have you tried combinations of different things?

I would at least experiment with Silenor + theanine + lemon balm + melatonin at all the different dosages, all for a decent while, before giving up hope. Maybe adding in CBD and/or a variety of strains of full-on cannabis as well (even if illegal, based on how terrible your situation sounds).

:hug:

It has been quite the saga. A few of my stories are even a little funny, but I won’t bore you with that right now.

My sleep specialist had me try a few different things, including some combinations. Melatonin helped a little bit. He had me take a specific type from a specific brand. I think it was 10mg. It only had an affect for a little while. I think I adapted to it. I think it is good for fixing a bad sleep schedule, but it isn’t good long term.

I have a lot more control over it now than I used to. I think that first major problem I had broke the part of my brain that controls sleep. I was always an odd sleeper, mostly being a night owl, but that issue was like kicking me off of a cliff. I’ve accepted it.
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Re: What put a frown on your face today?

Unread postby René » 14 January 2021, 03:28

OutsideIn wrote:My sleep specialist had me try a few different things, including some combinations. Melatonin helped a little bit. He had me take a specific type from a specific brand. I think it was 10mg. It only had an affect for a little while. I think I adapted to it. I think it is good for fixing a bad sleep schedule, but it isn’t good long term.

My experience has been that if it stops working for you, the dose needs to be changed, either up or down, and the only way to find out which is by experimenting. :D

I've taken 1 mg, 3 mg, 6 mg, 10 mg, 12 mg at different points in my life over the past 14 years or so. I'm currently on 12 mg, partly for its anti-GORD (or GERD for you Americans) effect and putative general pro-health (e.g. cancer-prevention) effects.
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Re: What put a frown on your face today?

Unread postby OutsideIn » 14 January 2021, 11:46

René wrote:My experience has been that if it stops working for you, the dose needs to be changed, either up or down, and the only way to find out which is by experimenting. :D

I've taken 1 mg, 3 mg, 6 mg, 10 mg, 12 mg at different points in my life over the past 14 years or so. I'm currently on 12 mg, partly for its anti-GORD (or GERD for you Americans) effect and putative general pro-health (e.g. cancer-prevention) effects.

Thanks! I may try it again in the future. :D
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Re: What put a frown on your face today?

Unread postby OutsideIn » 14 January 2021, 12:30

I woke up this morning convinced it was Friday. It is going to be a very disappointing day. :(
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Re: What put a frown on your face today?

Unread postby René » 14 January 2021, 13:57

OutsideIn wrote:I woke up this morning convinced it was Friday. It is going to be a very disappointing day. :(

Yeah, that feeling sucks. Conversely, I sometimes find myself suddenly on a Friday afternoon or Saturday morning without realising and it's like yaaaaay :D
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Re: What put a frown on your face today?

Unread postby rogonandi » Yesterday, 19:16

We’re going back to stage one lockdown so I have a feeling that I’m probably going to be laid off of work until it’s over. :(
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