I think a need a rotation of hypnotics to fully withdraw from clonazepam

For reference, see my introduction.

 

I understand that many people don't want to take 'extra' drugs and that not taking additional medication is usually preferred.

 

But I have to be realistic.

 

I could get through the taper if I could deal with the insomnia. Lack of sleep is torture. My insomnia is not anxiety-induced.

 

So I may want to try a rotation of hypnotics (not the same one every night) to finish my taper.

 

Some suggestions are mentioned in 'http://www.benzo.org.uk/ashunfi.htm''.

'Major symptoms were treated where possible. For insomnia a rotation of hypnotics was used, a different hypnotic being given each night. The hypnotics included: promethazine (75-100mg), dichloralphenazone (1.3-1.95g), chlormethiazole (two capsules, 384mg base) and butobarbitone (100-200mg).'

 

Good luck getting those prescribed, most of those are probably not even on the market anymore !

 

Modern hypnotics are benzodiazepines and drugs that act like benzodiazepines, the z-drugs.

Sedating antihistamines are not the miracle drugs that they often are claimed to be. I do have a high tolerance to antihistamines. I could use one in a rotation, but not for every night.

While I don't have much experience with antipsychotics and antidepressants for sleep, what little experience I have with those drugs is not good.

 

So, are there any options ?

Liberty,

 

You might want to read the posts in the Insomnia Forum to get some ideas about how to help with sleep.  Some people are toughing it out, some take otc meds, some use sleep hygiene, some are taking prescription meds.

 

I am taking Amitriptyline for sleep while tapering.  It's an old AD. I am currently at 50 mg.  My doc thinks I may have to go up to 100 mg.  His instructions were to take 25 mg the 1st week, 50 mg the 2nd week, etc. until I reached 100 mg.  Of course he said if I sleep at a lower dose to stop there.  He told me it might take 2 to 4 weeks to start working but others have told me it starts to work for them the first night. I haven't had any side effects yet.  I was on Amitriptyline many years ago for sleep and the only side effect I had was dry mouth but usually only when I was nervous.

 

I also have idiopathic insomnia.  I saw a sleep doctor and his suggestion was to go back on the Amitriptyline which my pcp agreed with. So far it has worked well for me.

 

Pacey

Liberty,

I haven't experimented with rotating hypnotics. I have chronic insomnia caused by the anti-depressant I'm on, which is why I got put on temazepam (I was already on Klonopin), and now Seroquel.

 

I will say that I have taken promethazine before as an anti-nausea med for migraines. I didn't used it on a regular basis. My Rx was for 25 mg, and I had to cut it in half. It really knocked me out and gave me the best sleep I'd ever had, easily topping a benzo. 25 mg made me too groggy the next day (but I was already on a long list of CNS depressants), so if you are considering that med, I would start with a slow dose and work up. The promethazine acts on the anti-histamine receptors. I've used Benadryl for insomnia, which has done nothing for me, but the promethazine has really helped when I've used it sporadically. However, I don't have experience using it on a regular basis.

 

I was on Ambien (a Z-drug) for many years. It works for awhile, but you have to taper from that (although the tapering isn't as hard as a benzo, and the major side effect is rebound insomnia, which can last for several weeks).

 

Good luck and good sleep,

Marie

Pacey, thank you.

 

I did read everything or near everything. Without much luck.

 

The very mild stuff like valerian, anxiolytic herbs is either too weak or anxiolytic. And my insomnia is not caused by anxiety.

 

Sleep restriction ? My issue is not getting enough sleep. I don't want to restrict the amount of sleep I get even further. And to be honest, I don't think I have the strength. With luck I can 'survive' on 4 hours of quality sleep.

That's bad enough.

 

It's awful that your doc put you on 6 mg of clonazepam for sleep ! Of course I don't know the specifics of your situation, but clonazepam is an anti-epilepsy drug. Meaning, of all the different actions a benzo can have (anxiolytic, muscle relaxant, anticonvulsant, hypnotic) clonazepam's main action is anticonvulsant.

Especially effective for absence seizures and myoclonic seizures. I can't be sure, but it may exacerbate other kinds of seizures. It's a nasty drug. Not good to develop full tolerance to its anticonvulsive effects !

 

Amitriptyline. I did try that once, a long time ago. While it did help me fall asleep I got a nasty rebound in the morning.

What many people don't know is that clonazepam has a not so minor action on serotonin (I could provide links, but what's the point). And amitriptyline inhibits the reuptake of serotonin and norepinephrine. So I don't care much for that interaction.

Perhaps it might have worked for me if I had started that drug at the beginning of my taper. At this point I don't think it's such a good idea.

It's a versatile drug btw. At very low doses it acts mostly as a potent antihistamine. What exactly it does depends on the dose.

 

I'm glad it works for you.

inkerbelle,

 

It has been my experience that while I am in withdrawal from clonazepam the hypnotic benzodiazepines (like temazepam) and the z-drugs don't work for me.

Clonazepam is just too powerful.

 

I have taken promethazine. For me, it's not potent at all. If I wanted to sleep on that I'd have to take a high dose. And it just wouldn't work if taken daily.

 

Btw, my experience with melatonin is that it either doesn't work or I get dependent on it real quick.

 

Liberty,

 

The otc meds didn't work for me either. Also like you I wouldn't use sleep restriction.

 

Yes I should have never been put on Clonazepam for sleep.  It taught me a lesson though to not take any med without researching it.

 

I hope you find something that works for you.

 

Pacey

 

 

No one has experience with (or knowledge of) a rotation of hypnotics to withdraw from a benzodiazepine ?

Liberty,

 

You might try posting on another Forum - you might get more responses.  If it were me I would try these two Forums:  Withdrawal & Recovery Support and/or Other Medications.

 

Pacey

 

Liberty,

 

You might try posting on another Forum - you might get more responses.  If it were me I would try these two Forums:  Withdrawal & Recovery Support and/or Other Medications.

 

Pacey

 

 

Thank you.

You're welcome. 

Liberty,

 

I answered your other post.

 

I, too have insomnia more than anxiety.

 

I am no Doctor, so you will need to talk with him / her about it.

 

Here are a few sleepers- Seroquel, Trazadone, Doxepin, Depakote, Rozerem, Remeron... so on.

I know how it feels to get no sleep, but your body eventually and naturally goes to sleep.

I have tried Melatonin.. it did not work for me, but could you.

 

 

And I would NOT suggest Ambien or any other Z drug.

I hope you find peace with sleep, I know it can be hard, but there are plenty of techniques without using medications or supplements, tonics, herbs, whatever...

 

Set a regular bedtime. Go to bed at the same time every night. Choose a time when you normally feel tired, so that you don’t toss and turn. Try not to break this routine on weekends when it may be tempting to stay up late. If you want to change your bedtime, help your body adjust by making the change in small daily increments, such as 15 minutes earlier or later each day.

Wake up at the same time every day. If you’re getting enough sleep, you should wake up naturally without an alarm. If you need an alarm clock to wake up on time, you may need to set an earlier bedtime. As with your bedtime, try to maintain your regular wake–time even on weekends.

Nap to make up for lost sleep. If you need to make up for a few lost hours, opt for a daytime nap rather than sleeping late. This strategy allows you to pay off your sleep debt without disturbing your natural sleep–wake rhythm, which often backfires in insomnia and throws you off for days.

Be smart about napping. While taking a nap can be a great way to recharge, especially for older adults, it can make insomnia worse. If insomnia is a problem for you, consider eliminating napping. If you must nap, do it in the early afternoon, and limit it to thirty minutes.

Fight after–dinner drowsiness. If you find yourself getting sleepy way before your bedtime, get off the couch and do something mildly stimulating to avoid falling asleep, such as washing the dishes, calling a friend, or getting clothes ready for the next day. If you give in to the drowsiness, you may wake up later in the night and have trouble getting back to sleep.

 

Increase light exposure during the day

Remove your sunglasses in the morning and let light onto your face.

Spend more time outside during daylight. Try to take your work breaks outside in sunlight, exercise outside, or walk your dog during the day instead of at night.

Let as much light into your home/workspace as possible. Keep curtains and blinds open during the day, move your desk closer to the window.

If necessary, use a light therapy box. A light therapy box can simulate sunshine and can be especially useful during short winter days when there’s limited daylight.

 

Boost melatonin production at night

Turn off your television and computer. Many people use the television to fall asleep or relax at the end of the day. Not only does the light suppress melatonin production, but television can actually stimulate the mind, rather than relaxing it. Try listening to music or audio books instead, or practicing relaxation exercises. If your favorite TV show is on late at night, record it for viewing earlier in the day.

Don’t read from a backlit device at night (such as an iPad). If you use a portable electronic device to read, use an eReader that is not backlit, i.e. one that requires an additional light source such as a bedside lamp.

Change your light bulbs. Avoid bright lights before bed, use low-wattage bulbs instead.

When it’s time to sleep, make sure the room is dark. The darker it is, the better you’ll sleep. Cover electrical displays, use heavy curtains or shades to block light from windows, or try an eye mask to cover your eyes.

Use a flashlight to go to the bathroom at night. As long as it’s safe to do so, keep the light to a minimum so it will be easier to go back to sleep.

 

Make your bedroom more sleep friendly

 

Keep noise down. If you can’t avoid or eliminate noise from barking dogs, loud neighbors, city traffic, or other people in your household, try masking it with a fan, recordings of soothing sounds, or white noise. You can buy a special sound machine or generate your own white noise by setting your radio between stations. Earplugs may also help.

Keep your room cool. The temperature of your bedroom also affects sleep. Most people sleep best in a slightly cool room (around 65° F or 18° C) with adequate ventilation. A bedroom that is too hot or too cold can interfere with quality sleep.

Make sure your bed is comfortable. You should have enough room to stretch and turn comfortably. If you often wake up with a sore back or an aching neck, you may need to invest in a new mattress or a try a different pillow.  Experiment with different levels of mattress firmness, foam or egg crate toppers, and pillows that provide more support.

 

How to sleep better tip 4: Eat right and get regular exercise

Your daytime eating and exercise habits play a role in how well you sleep. It’s particularly important to watch what you put in your body in the hours leading up to your bedtime.

 

Stay away from big meals at night. Try to make dinnertime earlier in the evening, and avoid heavy, rich foods within two hours of bed. Fatty foods take a lot of work for your stomach to digest and may keep you up. Also be cautious when it comes to spicy or acidic foods in the evening, as they can cause stomach trouble and heartburn.

Avoid alcohol before bed. Many people think that a nightcap before bed will help them sleep. While it may make you fall asleep faster, alcohol reduces your sleep quality, waking you up later in the night. To avoid this effect, so stay away from alcohol in the hours before bed.

Cut down on caffeine. You might be surprised to know that caffeine can cause sleep problems up to ten to twelve hours after drinking it! Consider eliminating caffeine after lunch or cutting back your overall intake.

Avoid drinking too many liquids in the evening. Drinking lots of water, juice, tea, or other fluids may result in frequent bathroom trips throughout the night. Caffeinated drinks, which act as diuretics, only make things worse.

Quit smoking. Smoking causes sleep troubles in numerous ways. Nicotine is a stimulant, which disrupts sleep. Additionally, smokers actually experience nicotine withdrawal as the night progresses, making it hard to sleep.

 

Deep breathing. Close your eyes—and try taking deep, slow breaths—making each breath even deeper than the last.

Progressive muscle relaxation. Starting at your toes, tense all the muscles as tightly as you can, then completely relax. Work your way up from your feet to the top of your head.

Visualizing a peaceful, restful place. Close your eyes and imagine a place or activity that is calming and peaceful for you. Concentrate on how relaxed this place or activity makes you feel.

 

Stay out of your head. The key to getting back to sleep is continuing to cue your body for sleep, so remain in bed in a relaxed position. Hard as it may be, try not to stress over the fact that you’re awake or your inability to fall asleep again, because that very stress and anxiety encourages your body to stay awake. A good way to stay out of your head is to focus on the feelings and sensations in your body.

Make relaxation your goal, not sleep. If you are finding it hard to fall back asleep, try a relaxation technique such as visualization, deep breathing, or meditation, which can be done without even getting out of bed. Remind yourself that although they’re not a replacement for sleep, rest and relaxation still help rejuvenate your body.

Do a quiet, non-stimulating activity. If you’ve been awake for more than 15 minutes, try getting out of bed and doing a quiet, non-stimulating activity, such as reading a book. Keep the lights dim so as not to cue your body clock that it’s time to wake up. Also avoid screens of any kind—computers, TV, cell phones, iPads—as the type of light they emit is stimulating to the brain. A light snack or herbal tea might help relax you, but be careful not to eat so much that your body begins to expect a meal at that time of the day.

Postpone worrying and brainstorming. If you wake during the night feeling anxious about something, make a brief note of it on paper and postpone worrying about it until the next day when you are fresh and it will be easier to resolve. Similarly, if a brainstorm or great idea is keeping you awake, make a note of it on paper and fall back to sleep knowing you’ll be much more productive and creative after a good night’s rest.

 

From How to sleep better

 

 

 

 

 

Mod*

Edit: BTW I take Doxepin. 8 hours sleep today, but that is what works for me.

Seroquel, Trazadone, Doxepin, Depakote, Rozerem, Remeron.

 

Seroquel at low doses acts mostly as an antihistamine. For me, it did NOTHING.

 

Trazodone is a weak antidepressant. Popular in the USA, but where I live they don't prescribe that for insomnia.

The local counterpart is Amitriptyline.

 

Doxepin is also an antidepressant. Not prescribed/available in this country.

 

Depakote is an anticonvulsant. I can see why it would work for sleep, but it seems overkill.

Hypothetically I might be able to jump from clonazepam to an anticonvulsant, but that's a different issue.

 

Rozerem is a variation on melatonin.

 

Remeron is a sedating antidepressant. Most of the sedation probably comes from its effect on the antihistamine receptors.

 

Thanks for the suggestions, but I'm looking for something that's more selective for sleep. 'hypnotics'

 

Seroquel, Trazadone, Doxepin, Depakote, Rozerem, Remeron.

 

Seroquel at low doses acts mostly as an antihistamine. For me, it did NOTHING.

 

Trazodone is a weak antidepressant. Popular in the USA, but where I live they don't prescribe that for insomnia.

The local counterpart is Amitriptyline.

 

Doxepin is also an antidepressant. Not prescribed/available in this country.

 

Depakote is an anticonvulsant. I can see why it would work for sleep, but it seems overkill.

Hypothetically I might be able to jump from clonazepam to an anticonvulsant, but that's a different issue.

 

Rozerem is a variation on melatonin.

 

Remeron is a sedating antidepressant. Most of the sedation probably comes from its effect on the antihistamine receptors.

 

Thanks for the suggestions, but I'm looking for something that's more selective for sleep. 'hypnotics'

 

 

Oh, well then I don't know.

I know of no Hypnotic to get rid of withdrawal.

 

Good luck.

 

 

Please don't take this the wrong way.

 

'I know of no Hypnotic to get rid of withdrawal.'

The issue is not getting rid of the withdrawal, but dealing with severe insomnia.

 

The drugs you mentioned are antipsychotics (although at low doses Seroquel is mostly an antihistamine) and antidepressants, with the exception of Depakote (anticonvulsant) and Rozerem (which is not available locally).

 

I'm just really against the use of antidepressants and antipsychotics for sleep. They are not hypnotics. When they are prescribed for sleep, they are prescribed for their side effects. My very limited experience with these drugs for insomnia is not good.

They did get rid of almost all of the older hypnotics, antidepressants and antipsychotics for sleep are often promoted. Lyrica as a 'safe' alternative for GAD ...

It's the classic 'newer is better' paradigm.

 

Anyway, if someone has some suggestions ...

 

So I may want to try a rotation of hypnotics (not the same one every night) to finish my taper.

 

Modern hypnotics are benzodiazepines and drugs that act like benzodiazepines, the z-drugs.

 

 

My benzo-wise physician says that phenobarbital has a place in benzo withdrawal related insomnia in certain cases.  He went on to say that he only uses pheno in approximately 2 to 3 patients per year and those patients do "very well".  What that means is anyone's guess.  Best wishes to you in your journey.  Laurie