Does anyone know of any good sleep aids (other than illegal drugs or a sledgehammer to my head) that will not leave me feeling hung over the next morning? Thanks folks!:smack:
have you tried melatonin? I’m giving it a trial at the moment and so far it seems to work
A small amount of whiskey works for me. Not enough for a buzz, just 2 fingers or so.
Melatonin hasn’t been found to be terribly effective for many folks.
Most insomnia treatment programs emphasize sleep hygiene, cognitive behavioral therapy, and if that isn’t helping, only then do they recommend use of drugs. And then only for short term.
If drugs are used, Zolpidem is one of the most widely used agents. Particularly the short-acting form, for treatment of sleep-onset insomnia. If the problem is staying asleep rather than falling asleep, then it’s hard to avoid the longer acting agents, which tend to give the hangovers.
Other agents can be prescribed, their track record is mixed.
I really push sleep hygiene, relaxation techniques, and exercise at a suitable time well before sleep.
Ambien.
I just think I’m not meant to enjoy sleep. I’ve been prescribed everything under the sun to treat my insomnia and nothing works. Ive been on Ambien, Seroquel, Klonopin, Trazodone and more. And I’ve definitely tried EVERYTHING otc. Melatonin had a mildly beneficial effect for the first week, then nothing. “Sleep hygiene”?! Please. I could recite that shit in my sleep. If only I slept. 
Sominex.
For those who live with other people who stay up late, then walk around and make noises during the night, a sleep aid may be at times be a necessity.
Note:
Ambien is Zolpidem.
And they are both very scary drugs - read, read, ask, read more, ask more.
Then get Lunesta - a different class of drug (yes, I know Zolpidem is also not a benzodiazepine), and, for me, a much sweeter sleep - complete with dreams and everything. I even got back to sleep after awaking early!
I have been on one sleeper or another since 2000 - before that it was Vodka and diphenhydramine (antihistamine sold as OTC sleeper).
If you want to stick with OTC (STRONGLY RECOMMENDED - HAVING TO BEG A MD FOR PERMISSION TO SLEEP IS HUMILIATING) - try the Unisom Gel-Caps - the gel caps are also just diphenhydramine, but are faster acting.
UNDER NO CIRCUMSTANCES TAKE TRIAZOLAM FOR MORE THAN 2 WEEKS! It causes brain damage and death. I know. I took 1.5 pills for over 2 years.
Last time I ever took a MD’s word on drug safety.
You strike me as being— if I may be so bold as to observe— not entirely dead, per se.
I’m thinking there’s not much walking around at night for QtM’s patients…
I use Power to Sleep PM made by Irwin Naturals, but as with most sleep aids if I take it every night, it doesn’t work as effectively. The capsules are too large for my preference, but I still buy it anyway, as it works great.
Pacing, maybe.
I think it was someone on this board who recommended time-release melatonin, for those of us whose problem is staying asleep rather than falling asleep. It works most of the time for me (in combination with Benadryl, because I have allergies anyway). If someone would just make extended-release Benadryl, I’d be a happy camper!
I tried extended-release Ambien…very briefly. You know how the label warns to leave at least 7 hours for sleep? Well, for me it was more like 12. The alarm went off after 9 hours, and I was so groggy I could barely make it across the hall to the bathroom. I had to call in to work. Not long after, the recommended dosage for women was cut in half.
Making sure you have lots of light during the day (even just a few wide spectrum bulbs in your lamps helps) and dim lights as the evening sets in. Exposure to Room Light before Bedtime Suppresses Melatonin Onset and Shortens Melatonin Duration in Humans - PMC
Some people wear orange sunglasses or goggles if they have to work with lights on or lighted screens (laptop, ipad, tv, smartphone, etc.) at night, which is believed to increase your body’s own production of melatonin by blocking the blue spectrum of light. You need blue light during the day, and a lack of it is linked to increased rates of depression, but too much at night seems to decrease melatonin and sleep. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831986/pdf/ehp-118-a22.pdf Amber lenses to block blue light and improve sleep: a randomized trial - PubMed Wearing them in the morning helps night-shift workers get better sleep during their “night”, which is of course the world’s day. Wearing blue-blockers in the morning could improve sleep of workers on a permanent night schedule: a pilot study - PubMed
There are many herbs traditionally used to promote and improve sleep. Chamomile is probably the most famous, and makes a pretty nice tasting infusion (“tea”). I can’t use it much myself, as I have an unusually sensitive reaction to it where just a single cup of fairly strong chamomile infusion knocks me out like a klonopin, but for most people it just helps them relax and fall asleep easier. Others include valerian, passionflower, skullcap, lavender, kava kava, catnip and hops. I leave you to further research each, along with their risks and drug interactions.
Benadryl is the exact antihistamine which is diphenhydramine - look around under both antihistamine and OTC sleep aids for your extended release version.
A quick google (first page) seems to indicate that extended-release antihisramines use drugs other than diphenhydramine as a base.
Might be worth an experiment.
Without knowing more details, it’s hard to make more than a very generalized recommendation. Is your problem difficulty falling asleep, staying asleep, or both? Is your complaint that you can’t sleep, or that your sleep doesn’t seem to be fully recuperative, leaving you feeling overly tired the next day? Is the problem intermittent or continuous? Have you noted any accompanying effects (ie waking up with a sore throat, an acid taste in the back of your mouth/throat, a partner complaining of snoring, snorting, or odd breathing sounds)? The differential for persistent insomnia is pretty big, so nailing down what’s causing the problem is important.
True, though it arguably has the best (albeit low quality) evidence going for it in specific sub-populations, including children with ADHD (where it beats out everything, including zolpidem) and the elderly (whose sleep tends to fragment which may be a result of age-related reductions in the production of melatonin).
I second all of the above, with the caveat that while widely used, Zolpidem’s evidence of benefit is modest, at best. According to one meta-analysis, found here, a mean difference in sleep latency of 22 minutes was found between z-drugs and placebo control groups utilizing objective measurement by polysomnography, and only 7 minutes difference between the groups when looking at subjective sleep latency, with the data suggesting greater benefit in younger individuals, women, the specific use of zolpidem, and higher doses, though you have to keep in mind that with higher doses come more side effects. It also found that the placebo effect component contributed about half of the total drug effect in objectively measured sleep latency (mean decrease in sleep latency of about 42 minutes, 22 minutes from drug effect, 20 minutes from placebo effect components). Another meta-analysis, found here, looked at response in elderly patients and found improvements in total sleep time on any sedative-hypnotic of about 25 minutes versus placebo and about 34 minutes when benzodiazepines specifically were compared with placebo, while also finding a Number Needed to Treat value of 13 and a Number Needed to Harm value of 6 for sedative-hypnotics versus placebo, though caution in interpretation is necessary when directly comparing the two since the NNT value was derived from 4 studies, while the NNH value was derived from 16. Other studies have found the use of sedative-hypnotic agents in the elderly, be they benzodiazepine or z-drug, significantly increases the risk of motor vehicle accidents, falls, fractures, and utilization of emergency department services, and are associated with a greater risk of developing Alzheimer’s, compared to those not on sedative-hypnotics. Finally, several studies have found an association with sedative-hypnotic use and increases in mortality, including this one by Kripke et al, and this newer one by Weich et al. Before anyone panics, remember these are associations/correlations, not definitive proof that sedative-hypnotics increase your risk of death or cancer, though the data does seem to be trending in that direction.
Sometimes a useful tool, particularly for very short-term, intermittent use, but other times can actually contribute more harm than benefit.
Diphenhydramine, the active ingredient in Sominex, like most of the first generation H1 Inverse Agonists, tends to knock you out, but leaves you with a next morning “hangover” effect, as well as increasing time spent in the lighter phases of sleep (Stages 1 and 2) while decreasing the amount of time in the stage of sleep (deprecated from Stages 3 and 4 to just 3 now, per Principles of Neurology) considered to be the most recuperative, with chronic use. Like Ambien (Zolpidem), occasional intermittent use is probably not a problem, but chronic use might actually make things worse.
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Eszopiclone (Lunesta) is a different chemical structure, but like the other Z-drugs (Zolpidem, Zaleplon), binds to the same receptor site on the GABA-A complex (termed the BZ-1 site, which is more specifically an interface pocket between an alpha-1 subunit and a gamma-2 subunit of certain types of GABA-A complexes) to mitigate it’s sedative-hypnotic effects, though it is argued to be less selective for this site than Zolpidem is and acts more like a benzodiazepine (in that it has greater alpha-2 and alpha-3 activity), even though structurally it is not a benzodiazepine.
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While I’m perfectly content to echo not using Triazolam for more than 2 weeks (I generally recommend this for all benzodiazepines and z-drugs, though specific cases might allow for longer term usage), cite for brain damage/death at FDA-labelled doses? Triazolam, of all of the oral benzodiazepines, is the most prone to wearing off in the middle of the night, resulting in a rebound insomnia, but I know of no studies showing at 0.125mg or 0.25mg that it causes brain damage.
Roughly 1 in 3 women put on 12.5mg CR Zolpidem will experience next day impairment (and 1 in 4 men), according to the literature which prompted the FDA to change the recommended dosage. Women, for reasons we’re still working out, tend to clear the drug more slowly than men do, though those differences seem to even out in the elderly (with both men and women showing slower drug clearance). If you’ve ever read the medication guide which should be provided with each fill of the drug, it states that the FDA actually recommends against driving at all the day following the use of Ambien CR, though you can probably guess how often that advice is heeded. I make it a point to make sure any patient on Zolpidem CR is told this at least once (and document it), when I counsel on the drug.
I’ll happily second recommendations to limit exposure to high-intensity blue light in the hours leading up to bedtime. If you must use a computer close to bedtime, I recommend considering using a program called f.lux, which can tone down blue light from computer screens at night time (or you can invert it and do so during the daytime for us night shift workers). Is this a hard science, it definitely works recommendation? No, but I’ve had good anecdotal success with it, installing light-blocking curtains in my bedroom, etc.
Valerian is probably not a great option in those individuals on hepatotoxic agents or with a history of liver disease, though, just FYI. Another option would be the use of L-Theanine (found in highest concentration in green tea, though a synthetic form is commercially available), though strictly speaking, it does NOT act as a hypnotic. Small, low-quality studies have demonstrated it to have a relaxing effect, and one study in children with ADHD demonstrated improvement in sleep quality (time in bed spent actually asleep) but not sleep latency, wake after sleep onset, or total sleep duration. Personally, my own bedtime regimen consists of 3-6mg melatonin in combination with 400mg L-Theanine a couple of hours before I want to sleep, along with the use of light blocking curtains (I work night shift), Philips Hue lights set to a color temperature of 2483k, and f.lux for my computer screens. Occasionally, if I need to induce sleep faster, I use really low dose mirtazapine (1/8 to 1/4 of a 7.5mg tablet at my psychiatrists order/recommendation) as at low nanomolar concentrations, mirtazapine functions almost exclusively as an H1 Blocker without the anticholinergic or Serotonin Transporter or Norepinephrine Transporter blocking effects.
Oh, and thanks for those links. I haven’t read them yet, but I enjoy reading medical literature a great deal.
Absolutely. And I don’t recommend hops to alcoholics in recovery. I don’t know if it’s psychosomatic or biochemical, but I’ve seen too many relapses shortly after people starting taking hops to assume it’s a coincidence. Other warnings, contraindications and interactions can be found with a little research. WebMD has some good, if conservative, herb articles for that.
And any herb with potentially sedating effects should be used very carefully, if at all, if one is also taking drugs with sedating effects. These things don’t always add up like you’d expect; sometimes the additive effect is nearly exponential.
Problem, of course, is that green tea is also chock full of caffeine and theobromine, and jitters and peeing all night are not conducive to good rest. 
Much as I love my herbals, this is one time when the synthetic is probably better than getting it from the source.
You’re welcome. Full disclosure: I’m too busy with work stuff tonight to have vetted them real closely. I just google grabbed. 
While I suppose it depends on how one defines psychosomatic, it’s probably “both” and “neither”. Addictions are heavily reliant on memories/behaviors formed/favored by operant and classical conditioning, and there seems to be a growing appreciation in addiction literature for interoceptive stimuli and their ability to trigger (or fail to trigger) adaptive tolerance, cravings, and so on. Given the role hops plays in the formation of many alcoholic beverages, it’s not surprising (at least to me) that supplementation with a hops product could trigger those same interoceptive cues and result in relapse.
QFT.
In the context of the current discussion, absolutely. That being said, 200-400mg of L-Theanine along with 100-200mg of Caffeine is an interesting (albeit imperfect) stack versus the Caffeine alone, as far as concentration goes. I still prefer, much though I hate having to rely on a schedule II drug, Vyvanse, but in a pinch, Caffeine/Theanine is better than nothing for ADHD.
I’m ok with that. The more I read, the better I get at picking out bad studies from good ones, and what makes a study a good one versus a bad one. I’m probably nowhere near Qadgop or Dseid levels, yet, but I’m slowly getting better the more I read, which is all I can ask of myself. 
Cute, but I’m speaking for those of us who need more than hygiene.