Should I updose? Your help would be much appreciated

Hello everyone, I have been on Diazepam since August 2020 (so for 10 months). In December last year I started tapering by dropping 0.5mg every 2 weeks - I started out on 8mg and I am now down to 2.5mg. Everything was going fine until I got hit with terrible insomnia about a week after dropping to 2.5mg. When I dropped to 2.5mg I also went from two doses per day to only one dose per day and I stupidly kept the morning dose and not the night dose. Do you think I should updose back to 3mg to try and stabilise and reduce the insomnia? Or should I stick it out on 2.5mg? Last night I moved my dosage to night time and it didn't help much. Thanks so much

 

Hey Nicjk,

It sounds like you tapered a little too quickly, but how else to know until we try? Insomnia is a common side-effect of rapid tapering. Diazepam's beautifully long half-life has a dark side, in that it's possible to create a momentum of reductions before realizing the full effects; recovering from this momentum, I understand, can sometimes take a few weeks.

 

Even a week with "terrible insomnia" is really rough. Days and days of difficult nights (I've had my share) can feel like they will never end. You could updose, and since you've come so far in your taper, it was probably necessary to take a break from tapering at some point along the way and just let your nerves recover.

 

A suggestion of mine would be to updose to 3mg and give it a week to see improvements. I believe it takes about this long for an increase in diazepam to reach it's full therapeutic potential. In the meantime, I suggest using sleep hygiene, relaxation exercises, and naps (if possible) to try to give your body the healing benefits of sleep. I use a liquid melatonin (available at Whole Foods and others) and I dose 0.5mg every night at 8pm to help me keep a sleep rhythm; this may help, if you haven't already had a bad reaction to low-dose melatonin.

 

Specifically because you're on diazepam, specifically because you've been cutting steadily for 10 months, and specifically because you're experiencing "terrible insomnia", is why I suggest this moderate updose and to lean on other strategies to keep this updose minimal.

 

Sleep will return! You could hold at 2.5mg and I believe you would recover within the month, but it sounds like your system was ready for a break and 0.5mg more won't set you back very much. Once you see improvements after the updose and other efforts, I suggest taking a break from tapering for a few weeks or so to rest and restore. You may also need smaller reductions from this point forward.

 

I hope this helps! May the sandman bless you again soon. 

Fwiw.. I second what Slownsteady posted..

 

Your doing great Nicjk..

We got the Sandman a bit tied up here in Aust. atm, but we will pass him on asap..

 

A lot of good info here for low doses, when your ready..

 

http://www.benzobuddies.org/forum/index.php?topic=151673.0#top

 

 

Hi slownsteady,

 

Thank you so much for your response! It makes a lot of sense that my insomnia has been caused by a "momentum of reductions" as you mentioned. Very well said.

 

I have been a little scared of updosing incase it causes more issues, as I have been on 2.5mg for 15 days now. Is there a recommended safe period when it comes to updosing? E.g. within 3 weeks. Last night I had a slightly better night which is encouraging - so I am considering sticking it out at 2.5mg.

 

Once I have stabilised do you think it would be ok to continue cutting by 0.5mg if I hold my dosages for a month instead of 2 weeks?

 

Wishing you all the best

 

Nicole

 

Hey Nicjk,

It sounds like you tapered a little too quickly, but how else to know until we try? Insomnia is a common side-effect of rapid tapering. Diazepam's beautifully long half-life has a dark side, in that it's possible to create a momentum of reductions before realizing the full effects; recovering from this momentum, I understand, can sometimes take a few weeks.

 

Even a week with "terrible insomnia" is really rough. Days and days of difficult nights (I've had my share) can feel like they will never end. You could updose, and since you've come so far in your taper, it was probably necessary to take a break from tapering at some point along the way and just let your nerves recover.

 

A suggestion of mine would be to updose to 3mg and give it a week to see improvements. I believe it takes about this long for an increase in diazepam to reach it's full therapeutic potential. In the meantime, I suggest using sleep hygiene, relaxation exercises, and naps (if possible) to try to give your body the healing benefits of sleep. I use a liquid melatonin (available at Whole Foods and others) and I dose 0.5mg every night at 8pm to help me keep a sleep rhythm; this may help, if you haven't already had a bad reaction to low-dose melatonin.

 

Specifically because you're on diazepam, specifically because you've been cutting steadily for 10 months, and specifically because you're experiencing "terrible insomnia", is why I suggest this moderate updose and to lean on other strategies to keep this updose minimal.

 

Sleep will return! You could hold at 2.5mg and I believe you would recover within the month, but it sounds like your system was ready for a break and 0.5mg more won't set you back very much. Once you see improvements after the updose and other efforts, I suggest taking a break from tapering for a few weeks or so to rest and restore. You may also need smaller reductions from this point forward.

 

I hope this helps! May the sandman bless you again soon. 

Hi Cantfly,

 

Are you also of the opinion that I should updose? I am really nervous about the decision.

 

Nice to come across a fellow Aussie

 

I will take a look at the link you posted

 

Big thanks!

 

Fwiw.. I second what Slownsteady posted..

 

Your doing great Nicjk..

We got the Sandman a bit tied up here in Aust. atm, but we will pass him on asap..

 

A lot of good info here for low doses, when your ready..

 

http://www.benzobuddies.org/forum/index.php?topic=151673.0#top

 

Hi slownsteady,

 

Thank you so much for your response! It makes a lot of sense that my insomnia has been caused by a "momentum of reductions" as you mentioned. Very well said.

 

I have been a little scared of updosing incase it causes more issues, as I have been on 2.5mg for 15 days now. Is there a recommended safe period when it comes to updosing? E.g. within 3 weeks. Last night I had a slightly better night which is encouraging - so I am considering sticking it out at 2.5mg.

 

Once I have stabilised do you think it would be ok to continue cutting by 0.5mg if I hold my dosages for a month instead of 2 weeks?

 

Wishing you all the best

 

Nicole

 

Hi Nicole,

I'm glad to hear you had a better nights rest. If you want to stick it out at 2.5mg, I agree that this is perhaps ideal, especially if you can see regular improvements.

 

Maybe your sense of "terrible insomnia" is a bad night or two; it's fortunate if that's all you've experienced. I would updose myself my sleep was significantly impaired and not improving within a week or so. I think the risks of updosing once or twice in a taper is very small, especially if it's a "learned from mistake", and does not become a habit.

 

To my knowledge, there's no point in time at which you couldn't updose. In my mind it's not about the time since you cut, it's about how badly your body is struggling to repair the changes, and the updose would be based on how quickly seems appropriate to respond to the severity of symptoms.

 

Withdrawal is an overload of neurological repair; if that overload becomes untenable and isn't improving within the week, I consider an updose, stabilization, and a more gradual rate of reduction; this is because I prioritize functionality in my taper. The danger I see of holding at an un-sustainably low dose is cascading failures; lack of sleep impairing judgement, which impairs dosing, which impairs digestion, or similar. Fortunately, it doesn't sound like you're having this problem right now.

 

I am assuming you're trying to stick with dry cutting your 2mg tablets. Unfortunately, I do not suggest taking 0.5mg reductions going forward, even with longer hold times. It's entirely up to you, but the severity of symptoms will be based on the half-life of the medicine, not the time you planned afterwards to recover.

 

Would you be willing to fuss with a cheap milligram scale? They're $20-50 on Amazon. If so, I suggest taking 0.25mg reductions every two-weeks; we can help you work out the pill weight math. There isn't a good reason in my mind to DMT a diazepam script (though I'm sure some do), but two 0.25mg reductions per month will likely cause much less WD symptoms than one 0.5mg reduction per month.

 

Alternatively we could work out a way to dissolve your 1/4 tablet (0.5mg), in a tiny bit of alcohol and dilute heavily with water and divide the volume in half, and this would also achieve a 0.25mg reduction with a little kitchen mixing every two days. No electronics or fancy liquid measuring equipment required; no medicine wasted either.

 

For either of these tapering options it might be good to start a thread in the Titration Board; myself and others would be happy to help guide you to find a solution that works for you.

 

What would you like to do going forward?

Hi Cantfly,

 

Are you also of the opinion that I should updose? I am really nervous about the decision.

 

Nice to come across a fellow Aussie

 

I will take a look at the link you posted

 

Big thanks!

 

Fwiw.. I second what Slownsteady posted..

 

Your doing great Nicjk..

We got the Sandman a bit tied up here in Aust. atm, but we will pass him on asap..

 

A lot of good info here for low doses, when your ready..

 

http://www.benzobuddies.org/forum/index.php?topic=151673.0#top

 

your call, but I get the feeling you dont need to.. Again, in line with SS, holding as things would appear ideal..

-fwiw, I pill split to 0.25v just with a pill splitter and Antinex brand (bigger pill than some, and dont crumble)..

low dose tapering can become more about learning and following your personal symptom profile as it unfolds than schedules and timeframes, and you will get there..

 

 

Hi Slownsteady,

 

I am so pleased to say that I had an even better night's sleep last night. My insomnia was pretty rough for 7 nights - I was waking up wide awake between 12:00am and 1:00am and then tossing and turning for the rest of the morning, but over the last two nights I have woken up once and gone back to sleep. And I didn't have that "wide awake" feeling when I woke up. So looks like I'm definitely sticking with the 2.5mg.

 

I think your advice to cut down by 0.25mg per fortnight is very good advice. I have decided I'd like to dry cut and I've started a thread on the titration board: http://www.benzobuddies.org/forum/index.php?topic=256941.0

 

I have a question. I only had a very small amount of 5mg tablets left when I realised I needed to hold on 2.5mg (due to the insomnia). The 5mg Valpam brand tablets crumble really easily when you cut them so with my next 7 days worth I didn't want to risk "over trimming" them and ruining them so my next 7 days worth weighed 0.01g more than the prior pills. Would this be counted as an updose? I have taken 2 of the slightly higher weighing pills so far.

 

Thanks again for all of your help.

 

- Nic

 

Hi slownsteady,

 

Thank you so much for your response! It makes a lot of sense that my insomnia has been caused by a "momentum of reductions" as you mentioned. Very well said.

 

I have been a little scared of updosing incase it causes more issues, as I have been on 2.5mg for 15 days now. Is there a recommended safe period when it comes to updosing? E.g. within 3 weeks. Last night I had a slightly better night which is encouraging - so I am considering sticking it out at 2.5mg.

 

Once I have stabilised do you think it would be ok to continue cutting by 0.5mg if I hold my dosages for a month instead of 2 weeks?

 

Wishing you all the best

 

Nicole

 

Hi Nicole,

I'm glad to hear you had a better nights rest. If you want to stick it out at 2.5mg, I agree that this is perhaps ideal, especially if you can see regular improvements.

 

Maybe your sense of "terrible insomnia" is a bad night or two; it's fortunate if that's all you've experienced. I would updose myself my sleep was significantly impaired and not improving within a week or so. I think the risks of updosing once or twice in a taper is very small, especially if it's a "learned from mistake", and does not become a habit.

 

To my knowledge, there's no point in time at which you couldn't updose. In my mind it's not about the time since you cut, it's about how badly your body is struggling to repair the changes, and the updose would be based on how quickly seems appropriate to respond to the severity of symptoms.

 

Withdrawal is an overload of neurological repair; if that overload becomes untenable and isn't improving within the week, I consider an updose, stabilization, and a more gradual rate of reduction; this is because I prioritize functionality in my taper. The danger I see of holding at an un-sustainably low dose is cascading failures; lack of sleep impairing judgement, which impairs dosing, which impairs digestion, or similar. Fortunately, it doesn't sound like you're having this problem right now.

 

I am assuming you're trying to stick with dry cutting your 2mg tablets. Unfortunately, I do not suggest taking 0.5mg reductions going forward, even with longer hold times. It's entirely up to you, but the severity of symptoms will be based on the half-life of the medicine, not the time you planned afterwards to recover.

 

Would you be willing to fuss with a cheap milligram scale? They're $20-50 on Amazon. If so, I suggest taking 0.25mg reductions every two-weeks; we can help you work out the pill weight math. There isn't a good reason in my mind to DMT a diazepam script (though I'm sure some do), but two 0.25mg reductions per month will likely cause much less WD symptoms than one 0.5mg reduction per month.

 

Alternatively we could work out a way to dissolve your 1/4 tablet (0.5mg), in a tiny bit of alcohol and dilute heavily with water and divide the volume in half, and this would also achieve a 0.25mg reduction with a little kitchen mixing every two days. No electronics or fancy liquid measuring equipment required; no medicine wasted either.

 

For either of these tapering options it might be good to start a thread in the Titration Board; myself and others would be happy to help guide you to find a solution that works for you.

 

What would you like to do going forward?

Hi Slownsteady,

 

I am so pleased to say that I had an even better night's sleep last night. My insomnia was pretty rough for 7 nights - I was waking up wide awake between 12:00am and 1:00am and then tossing and turning for the rest of the morning, but over the last two nights I have woken up once and gone back to sleep. And I didn't have that "wide awake" feeling when I woke up. So looks like I'm definitely sticking with the 2.5mg.

 

I think your advice to cut down by 0.25mg per fortnight is very good advice. I have decided I'd like to dry cut and I've started a thread on the titration board: http://www.benzobuddies.org/forum/index.php?topic=256941.0

 

I have a question. I only had a very small amount of 5mg tablets left when I realised I needed to hold on 2.5mg (due to the insomnia). The 5mg Valpam brand tablets crumble really easily when you cut them so with my next 7 days worth I didn't want to risk "over trimming" them and ruining them so my next 7 days worth weighed 0.01g more than the prior pills. Would this be counted as an updose? I have taken 2 of the slightly higher weighing pills so far.

 

Thanks again for all of your help.

 

- Nic

 

Oh, so it seems like you've been dry cutting already with a scale! Then I totally understand wanting to stick with that method. I guessed wrong when I thought you had 2mg tablets. At some point soon 2mg tablets might be easier to use, if your prescriber is accommodating.

 

I don't understand exactly what you mean about your recent tablet doses, but yes, if you took more than half the 5mg tablet in pill weight, and you were previously taking half the 5mg tablet as your dose, you updosed. You haven't told me your pill weights or anything, but maybe you already know how to work out exactly what milligrams you're at presently with your extra hundredth of a gram of pill weight added on. Maybe that hundredth of a gram of pill weight is what you cut next, when you're feeling good enough, and get back to 2.5mg for a couple weeks or so.

 

Do you have a metal nail file? That might be a way to avoid crumbles; I personally have a metal nail file for this purpose and I've never used it so I'm sorry I can't be more insightful. My scale sits lonely and dejected. I titrate a small liquid dose and I cut tablets for the rest.

 

I hope you enjoy some deep sleep and a few weeks of rest and recover from all your steady cutting. Congrats for getting this far! 

Hi Slownsteady,

 

My full 5mg pill usually weighs 0.18g and when I first went down to 2.5mg from 3mg my "half" pills weighed 0.10g (so not exactly half). When I realised I needed to stay on 2.5mg after the insomnia saga I quickly cut another weeks worth of "halves" and because I didn't want to risk cutting too much off them (I only had 7 pills left) I cut them down to 0.11g which I have taken for the last couple of nights. I am really worried that I have caused issues by updosing by 0.01g. Do you think I should trim the remainder of my pills down to 0.10g? I am speaking to my psychiatrist today and he will prescribe me a new batch of 5mg and 2mg pills.

 

Thanks for the tip about the metal file! I will invest in one

 

Many thanks,

 

Nic

 

Hi Slownsteady,

 

I am so pleased to say that I had an even better night's sleep last night. My insomnia was pretty rough for 7 nights - I was waking up wide awake between 12:00am and 1:00am and then tossing and turning for the rest of the morning, but over the last two nights I have woken up once and gone back to sleep. And I didn't have that "wide awake" feeling when I woke up. So looks like I'm definitely sticking with the 2.5mg.

 

I think your advice to cut down by 0.25mg per fortnight is very good advice. I have decided I'd like to dry cut and I've started a thread on the titration board: http://www.benzobuddies.org/forum/index.php?topic=256941.0

 

I have a question. I only had a very small amount of 5mg tablets left when I realised I needed to hold on 2.5mg (due to the insomnia). The 5mg Valpam brand tablets crumble really easily when you cut them so with my next 7 days worth I didn't want to risk "over trimming" them and ruining them so my next 7 days worth weighed 0.01g more than the prior pills. Would this be counted as an updose? I have taken 2 of the slightly higher weighing pills so far.

 

Thanks again for all of your help.

 

- Nic

 

Oh, so it seems like you've been dry cutting already with a scale! Then I totally understand wanting to stick with that method. I guessed wrong when I thought you had 2mg tablets. At some point soon 2mg tablets might be easier to use, if your prescriber is accommodating.

 

I don't understand exactly what you mean about your recent tablet doses, but yes, if you took more than half the 5mg tablet in pill weight, and you were previously taking half the 5mg tablet as your dose, you updosed. You haven't told me your pill weights or anything, but maybe you already know how to work out exactly what milligrams you're at presently with your extra hundredth of a gram of pill weight added on. Maybe that hundredth of a gram of pill weight is what you cut next, when you're feeling good enough, and get back to 2.5mg for a couple weeks or so.

 

Do you have a metal nail file? That might be a way to avoid crumbles; I personally have a metal nail file for this purpose and I've never used it so I'm sorry I can't be more insightful. My scale sits lonely and dejected. I titrate a small liquid dose and I cut tablets for the rest.

 

I hope you enjoy some deep sleep and a few weeks of rest and recover from all your steady cutting. Congrats for getting this far! 

Hi Slownsteady,

 

Just an update. I decided to trim the remainder of my 5mg halves to 0.10g (seeing as I only took 0.11g for 2 days) and while I was doing so I realised that the scale fluctuated between 0.10g and 0.11g when weighing the pill pieces anyway. I might start using a 0.001g scale when cutting the remainder of my 5mg pills so that I'm even more accurate.

 

I spoke to my psychiatrist yesterday and told him that after I stabilise I would like to cut and weigh my pills to remove 0.25mg per fortnight. He said that he didn't want me to cut and weigh because I blame myself whenever errors happen and make a mountain out of a mole hill (this is true), so he is switching me to liquid Diazepam after 4 weeks on 2.5mg. I have edited my post on the titration board and I'm happy for us to continue our conversation there: http://www.benzobuddies.org/forum/index.php?topic=256941.0

 

Many thanks,

 

Nic

 

 

Hi Slownsteady,

 

I am so pleased to say that I had an even better night's sleep last night. My insomnia was pretty rough for 7 nights - I was waking up wide awake between 12:00am and 1:00am and then tossing and turning for the rest of the morning, but over the last two nights I have woken up once and gone back to sleep. And I didn't have that "wide awake" feeling when I woke up. So looks like I'm definitely sticking with the 2.5mg.

 

I think your advice to cut down by 0.25mg per fortnight is very good advice. I have decided I'd like to dry cut and I've started a thread on the titration board: http://www.benzobuddies.org/forum/index.php?topic=256941.0

 

I have a question. I only had a very small amount of 5mg tablets left when I realised I needed to hold on 2.5mg (due to the insomnia). The 5mg Valpam brand tablets crumble really easily when you cut them so with my next 7 days worth I didn't want to risk "over trimming" them and ruining them so my next 7 days worth weighed 0.01g more than the prior pills. Would this be counted as an updose? I have taken 2 of the slightly higher weighing pills so far.

 

Thanks again for all of your help.

 

- Nic

 

Oh, so it seems like you've been dry cutting already with a scale! Then I totally understand wanting to stick with that method. I guessed wrong when I thought you had 2mg tablets. At some point soon 2mg tablets might be easier to use, if your prescriber is accommodating.

 

I don't understand exactly what you mean about your recent tablet doses, but yes, if you took more than half the 5mg tablet in pill weight, and you were previously taking half the 5mg tablet as your dose, you updosed. You haven't told me your pill weights or anything, but maybe you already know how to work out exactly what milligrams you're at presently with your extra hundredth of a gram of pill weight added on. Maybe that hundredth of a gram of pill weight is what you cut next, when you're feeling good enough, and get back to 2.5mg for a couple weeks or so.

 

Do you have a metal nail file? That might be a way to avoid crumbles; I personally have a metal nail file for this purpose and I've never used it so I'm sorry I can't be more insightful. My scale sits lonely and dejected. I titrate a small liquid dose and I cut tablets for the rest.

 

I hope you enjoy some deep sleep and a few weeks of rest and recover from all your steady cutting. Congrats for getting this far! 

Hey Nic,

I see you've started a new thread and are looking into switching to liquid. I just wanted to share with you the results I came up about your previous doses, if this is at all helpful for you...

 

If your 5mg tablets weight 0.18g, you were actually at 2.77mg with your 0.1g tablets, and you were at 3.05mg with 0.11g tablets.

 

I did this math by dividing the tablet potency by the weight.

5 / 0.18g = 27.7...

 

This says that there are 27.77mg of medicine in every 1 gram of pill weight. Then I multiplied this by the pill weight you are using. For example...

 

0.1g * 27.7 = 2.77mg of diazepam in 0.1g of pill weight

0.11 * 27.7 = 3.05mg

I hope this helps. 

Hi Slownsteady,

 

Thank you - that is very helpful. I am terrible at maths so I definitely needed those calculations.

 

Do you think it's likely that I've caused any issues by taking 3.05mg for a couple of nights and then going back to 2.77mg which I had previously been on for 15 days? I'm thinking that because of the long half life I'm not likely to experience any issues. What are your thoughts?

 

- Nic

 

Hey Nic,

I see you've started a new thread and are looking into switching to liquid. I just wanted to share with you the results I came up about your previous doses, if this is at all helpful for you...

 

If your 5mg tablets weight 0.18g, you were actually at 2.77mg with your 0.1g tablets, and you were at 3.05mg with 0.11g tablets.

 

I did this math by dividing the tablet potency by the weight.

5 / 0.18g = 27.7...

 

This says that there are 27.77mg of medicine in every 1 gram of pill weight. Then I multiplied this by the pill weight you are using. For example...

 

0.1g * 27.7 = 2.77mg of diazepam in 0.1g of pill weight

0.11 * 27.7 = 3.05mg

I hope this helps. 

Hi Slownsteady,

 

Thank you - that is very helpful. I am terrible at maths so I definitely needed those calculations.

 

Do you think it's likely that I've caused any issues by taking 3.05mg for a couple of nights and then going back to 2.77mg which I had previously been on for 15 days? I'm thinking that because of the long half life I'm not likely to experience any issues. What are your thoughts?

 

- Nic

 

Nic,

I suspect it won't be much of a bump in the road, especially if you hold off on cutting for a bit. What do you think about taking a break from cutting for few weeks?

 

I think you've certainly earned a break with your continuous 10 months of cutting.

2.77mg is a far cry from 8mg! Great job!

 

 

Sorry to jump on but wondered if anyone can advise.

Dropped from 12 to 10mg on diazepam and cant seem to stabilise. 4th week now.

Was put on 3mg lorazapam June 2020. Up and down. Cross over to 20mg in January.

Any help or advice appreciated! X

 

Sorry to jump on but wondered if anyone can advise.

Dropped from 12 to 10mg on diazepam and cant seem to stabilise. 4th week now.

Was put on 3mg lorazapam June 2020. Up and down. Cross over to 20mg in January.

Any help or advice appreciated! X

Hi Miss piggy, sorry that you have not had a response to your post.I would start a new thread, and ask for Mod help for your questions.