Tuesday, August 05, 2008

I. Can't. Sleep.


So what are the options for drifting off to blissful slumber? Well, aside from the standard holistic, behavioral, and natural advice (chamomile tea--tastes great, especially with a splash of fat-free vanilla soymilk and Splenda, but doesn't really help me sleep; keeping to a bedtime routine--yes, I take a few minutes to wind down, I even had a gentle pre-bed yoga routine for a while, but nada; warm milk, which has a fair amount of tryptophan--the amino acid that, through a series of magical steps, gets converted to serotonin--has yielded nothing but a need to brush my teeth again, and anyway I hates the milk)...there are, of course, drugs. Pharmaceutical options. Better living through chemistry. And while I'm generally not in favor of getting all "Strom-Thurmond-at-an-historically-black-sorority-reunion" excited about unnecessary medications, a good night's sleep is the foundation of solid mental and physical health. So for a chronic insomniac these aren't, strictly speaking, unnecessary.

Technically, drugs that put you to sleep are called "hypnotics," from Hypnos, God of sleep. Sedatives, which may be the same drugs as hypnotics but at a reduced dose, just...um...chill you out a little. An example from my medicine cabinet: 0.25 mg of Ativan is a sedative. 0.5 mg of Ativan is a hypnotic. And 1.0 mg of Ativan means you could run me over with a truck on the 50-yard line at the SuperBowl and I wouldn't even roll over.

Option 1. Antihistamines. They help with allergies too, but beware that as a class, they will dry out your mucous membranes. Including that one, girls. These are H-1 (or nonselective) antagonists; H-2 antagonists are the drugs you take when you have acid reflux problems. Cool, eh?

There's diphenhydramine, or good ol'-fashioned Benadryl. Knocks me out better than some of the prescription sleep meds I've tried, to be honest, and without weird hangover effects. When I had my colonoscopy/esophogastroduodenoscopy (say that five times fast) done in February, I had an 'anxiolytic' dose of Benadryl before they wheeled me back to the procedure room. I was already feeling pretty good about life (though wondering why the room was revolving, and why they'd installed a strobe light in the hall) by the time I got hit with the Versed and whatever else it was they gave me. 50 mg of IV Benadryl, when you're barely knocking on 100 lbs, will do that to a person. And it should go without saying, but however this appears, it's not medical advice, OK? Also, while I'm not giving you advice, for Moses' sake don't mix any of these with alcohol, unless you don't have any appointments for the next few, you know, days. Or, depending on which drug, how much, and how much EtOH, if you don't have any more appointments, ever.

There's doxylamine succinate, which is actually sold just as a sleep aid (as opposed to an anti-allergy preparation). It's the stuff in NyQuil (or Unisom) that puts you to sleep. There's some evidence it's even more sedating than phenobarbital, for Goddess' sake. It's also used to combat morning sickness, which brings up the interesting point that a lot of antihistamine antiallergy/antipruritics are pretty potent antinausea/antiemetic agents as well. (In case you were wondering, antipruritic means it makes stuff not itch, pruritis being the 50-buck word for "itching." Interesting fact: the pretty schmancy-sounding "pruritis ani," which has been Latinized and doctored out of all recognizability, is a way for doctors to record that you have an itchy anus, without having to write the dreadfully unsophisticated "itchy butthole" in your records. Your insurance company reads those, y'know. Now aren't you thankful for Latin?)

Option 2. Benzodiazepines.
Oh joy. These can be short-acting (meaning you're out pretty quickly), or long-acting (meaning it takes a while to kick in, but has staying power)--finding the right balance between the two means that intermediate-acting ones are the best...Getting to sleep quickly enough but sleeping through the night; sleeping through the night without being so hung-over you plow into pedestrians like someone doing Human Bowling on a Japanese game show the next day.
Actually, benzos aren't recommended for long-term management of insomnia; they're a little bit addictive. Mostly people take them for sleep if they have an acute condition, or if they have an anxiety disorder and have panic attacks at night and just happen to discover--lo and behold--that they can actually freaking sleep if they take them. Purely hypothetically. By the way, some benzodiazepines are super-duper effective, if short-acting, anticonvulsants. They really are the little pills that do everything! (And they ARE little, as anyone can tell you who's ever dropped a bottle on the floor when they were having a panic attack and their hands were shaking so badly they could hardly even unscrew the STUPID child-proof cap...what sadist decided to make an anxious person solve the physical equivalent of a New York Times Crossword to get to their drugs?...well, man, good luck finding those babies before they're ground into the carpet).

Option 3. Barbiturates and Opioids.
No one uses these for treating insomnia anymore. I put it here so I could list more options. I'm so ashamed. They're too addictive, and in the case of barbiturates, there's too great a chance for accidental (or, considering that insomnia is a prominent feature of many mental illnesses, intentional) overdose.

Option 4. The Other Stuff.
Zolpidem, or Ambien, works to make GABA (gamma amino butyric acid) work better as an inhibitory neurotransmitter...but it BINDS to benzodiazepine receptors. Cheaters. As a bonus, some people report sleep-walking, sleep-eating, and sleep-sex-having. If I'm going to be noshing on Cheezits and doing the horizontal tango, I want to be awake to enjoy it. Anyway, I've tried Ambien and the next morning I felt like I'd been hit by a truck. And not the Cheezits-and-orgasms truck. A bad truck.
Zaleplon, or Sonata, is pretty much the same thing as Ambien but in different clothes (and their ads have a moth in them!).
Ramelteon, ie Rozerem, has Abe Lincoln and his beaver (or is it a woodchuck?) sidekick shilling for it. It is a novel hypnotic, though; it's a melatonin receptor agonist. Melatonin binds to recpetors in certain parts of your brain (especially a part called the "suprachiasmatic nucleus," which is closely associated with your 'internal clock') and basically tells you it's time to turn in for the night. Remember your aunt from Boulder who swore by melatonin supplements at bedtime? This is the same thing, only standardized and much more expensive.

Hope this treatise hasn't been a hypnotic in itself. Hopefully I'll still have time to just learn cool things that interest me once I start school. Or maybe I'll just have to get my happy ass interested in whatever it is I happen to be studying. Somehow I think that's more likely.


Tracy Crowe Jones said...

Have you tried Seroquel or Clonapin? They both work for me. Also, a couple of Xanax is a good alternative.

Grossnickle said...

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Clerk said...

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