OTC sleep med

[cortez356]

My CPAP therapy has been very good. My data results are great and I do have some energy. But I still do not sleep well. Often awake at 1 or 2 a.m. and stay awake for 2 or more hours. I tried the med that is actually Benadryl. It seems to work but I awake very groggy. I would prefer not to take any prescription drug. My BP and prostate problems prevent me from using some meds. Any good suggestions? Thanks


Bob

[Pugsy]

Some people report some success with Melatonin. It gave me bad vertigo. You would need to research it to see if it mixed well with your other conditions.

Any idea why you wake up? Pain? Just wake up? Trouble going to sleep and/or staying asleep?

What strength Benadryl? maybe try less dose or take it earlier so the grogginess is already gone?

[Slartybartfast]

Benadryl/diphenhydramine is great stuff. When I really can't sleep, 1/2 a tablet puts me out with no grogginess in the morning.

However, to prevent sleeplessness, I found that physical exercise during the day is the best way to ensure that I sleep well at night. So I make sure I walk for 45 minutes or so at lunch or after work. That does the trick for me.

Something that worked for me years ago when I was going through the Divorce from Hell and I couldn't sleep, was to get out of bed, go into the other room, sit in a chair and read. Usually within 45 minutes or so I would feel sleepy again and then go back to bed. Something about resetting my "getting into bed" routine seemed to work. You might give that a try.

[jbn3boys]

I was also going to suggest a smaller dose of Benadryl. If you get the tablets, they are pretty easy to cut. I use a pill splitter (pretty cheap, usually found near the pill boxes, etc). You could even do a quarter of a tablet--I think that's what my adult niece does.

I've also heard good things about Melatonin, but have never personally used it.

You could also research the posts by RobySue that deal with sleep hygiene. She has some great insight, as one who has struggled with insomnia, on how to treat it without medication of any kind (much like slartybartfast is talking about).

[jdm2857]

Unfortunately, antihistamines like Benadryl (diphenhydramine) negatively affect sleep architecture. That's why many sleep doctors prefer to prescribe Ambien (Zolpidem) for use during sleep studies. Ambien has a much lesser effect on sleep architecture.

Just hide your car keys before going to bed if you use Ambien.

[roster]

My CPAP therapy has been very good. My data results are great and I do have some energy. But I still do not sleep well. Often awake at 1 or 2 a.m. and stay awake for 2 or more hours. I tried the med that is actually Benadryl. It seems to work but I awake very groggy. I would prefer not to take any prescription drug. My BP and prostate problems prevent me from using some meds. Any good suggestions? Thanks


Bob

IMO there are no good OTC or prescription drugs for longterm treatment of insomnia. People report good results with various drugs, but often the drug is treating an underlying problem which was causing the insomnia.

I believe one should first practice excellent sleep hygiene (see Mayo Clinic website) for several weeks. If the insomnia still exists then the root cause of the insomnia should be researched.

Common root causes of insomnia among CPAP patients are suboptimal CPAP therapy; discomfort from CPAP; aerophagia or gastric insufflation; LPRD; GERD; anxiety; depression; and of course poor sleep hygiene.

If you are taking medications for hypertension or prostate enlargment, you should check whether insomnia is a possible side effect.

Good luck.

[robysue]

You could also research the posts by RobySue that deal with sleep hygiene. She has some great insight, as one who has struggled with insomnia, on how to treat it without medication of any kind (much like slartybartfast is talking about).

Thanks for the complement jbn3boys.

Two versions of the standard sleep hygiene rules can be found at http://www.mayoclinic.com/health/insomn ... e-remedies and http://www.umm.edu/sleep/sleep_hyg.htm

And some of the posts I've written as responses to other's threads about insomnia related isuses and using good sleep hygiene to fight insomnia include:

• viewtopic.php?f=1&t=60858&p=571545
  (first response of mine is on the first page)
  
  viewtopic.php?f=1&t=60958&p=571935
  (my response is on the first page)
  
  viewtopic.php?f=1&t=60835&p=570717
  (my response includes some of the rules that I regard as most important in dealing with insomnia and CPAP)
  
  viewtopic.php?f=1&t=60588&p=568843
  (includes an informal explanation of why Slartybartfast's sugestion of getting out of bed when you're not sleeping and doing something (pleasant, but quiet) in another room can work for many people.)
  
  viewtopic.php?f=1&t=60667&p=569264
  (my first response includes more information on some of the "important" rules of sleep hygiene.
  
  viewtopic.php?f=1&t=60207&p=565339

For posts about my own journey through dealing with severe CPAP-induced insomnia, see:

• viewtopic.php?f=1&t=58596&st=0&sk=t&sd=a
  (start of my own journey in using CBT and sleep restriction + good sleep hygiene to battle my CPAP-induced insomnia that decided to morph into a raging insomnia monster feeding on many non-CPAP issues as well)
  
  viewtopic.php?f=1&t=59163&p=556157
  (first update on CBT for the insomnia)
  
  viewtopic.php?f=1&t=59821&p=561489
  (second update on CBT for the insomnia and a post later down the thread includes my own history with pre-CPAP insomnia)
  
  viewtopic.php?f=1&t=60186&st=0&sk=t&sd=a
  (third update on the CBT for insomnia and my fourth sleep study results)
  
  viewtopic.php?f=1&t=60413&p=567280#p567280
  (fourth update on my CBT for insomnia)
  
  viewtopic/t60691/viewtopic.php?f=1&t=60 ... 27#p569127
  (fifth update on my CBt for insomnia)

[cortez356]

Thank you for the responses. My insomnia predates my CPAP therapy by at least 2 years. Tonight should not be difficult as I will be all night reading robysue's links!! Many thanks!



Bob

[chrisp]

Hi,
Tryptophan (The stuff thats in turkey), Valarian root, Vitamin D and 5 hta. Not all at once but some can be taken together. Tryptophan and Valarian root. Speriment, it can't hurt.

[avi123]

Thank you for the responses. My insomnia predates my CPAP therapy by at least 2 years. Tonight should not be difficult as I will be all night reading robysue's links!! Many thanks!



Bob

Bob,

There is no OTC medication, such as Tylenol PM, that could compete b/c of the hang overs.

The non benzo (Ambient, etc) and the benzo (Restoril, Valium, etc) drugs were made to help falling asleep with min hangovers. Why not use them as you use antibiotic when you need it? See my post below.

But you need to take low doses and sometime in the future be ready to withdraw.

[robysue]

The benzo (Ambient, etc) and non-benzo (Restoril, Valium, etc) drugs were made to help falling asleep with min hangovers. Why not use them as you use antibiotic when you need it?

But you need to take low doses and sometime in the future be ready to withdraw.

avi123: I don't believe your analogy between taking sleep meds for insomnia and using antibiotics to treat an infection is apt. Almost always, antibiotics are prescribed for very short periods of time for an acute infection and there is NO risk of developing a dependence on an antibiotic and there are NO withdrawal problems when the course of antibiotics is finished. [Even so, there is good evidence that antibiotics are over prescribed, often for conditions that the antibiotic will NOT actually help. And in that sense your analogy between sleeping pills and antibiotics does work.] Unlike antibiotics, sleeping medication is often prescribed (for short term use) but turns into a daily medication that is used long term---sometimes for years. Any sleeping medication does carry a risk of becoming dependent together with a real risk of rebound insomnia if/when the user decides to wean his/herself off the medication.

Now please understand: There is nothing a priori wrong with taking sleeping pills for fighting insomnia, but many people are NOT comfortable with the idea of medicating their way to sleep night after night after night. (I am not.) Even with the new drugs, there is a real risk of becoming dependent on the drugs and triggering perhaps severe rebound insmonia when trying to wean yourself of them. That's why it is so important to have a thorough chat with the person who prescribes the drugs about:

• (1) How you, the patient, will use them. Will you use them routinely every night for a given period of time? If so, how long? Or will you use them only intermittently? If so, what's the criteria for choosing to use them on a given night? For example, I reluctantly accepted my PA's advice about filling a prescription for sleeping pills and I now have a prescription for Sonata (switched from Ambien). But the PA and myself have agreed that for me the best way to use them is to prevent me from having two or more disasterous nights in a row. So the idea is that if I have a truly disasterous night on, say Monday night, I can take the Sonata on Tuesday night to make sure I don't have two disasters in a row. And I get to define the meaning of the word disasterous in the context of my insomnia. I've been lucky so far: I have not had to take sleeping pills for most of the time I've been doing the CBT work and I have NOT yet fallen into a pattern of taking something every other night. [For those of you who are interested: The switch to Sonata from Ambien was done because Sonata has a shorter half-life and hence should cause fewer problems with the morning grogginess that I had with the Ambien. Since being switched on 1/28, I've only had to use the Sonata one time---which was this week---due to some insomnia that may be related to a new migraine med.]
  
  (2) What strategy will be used to either prevent you from becoming dependent on the meds or wean you from the meds when you wish to quit taking them? This question is particularly important if you choose to take sleeping pills every night for a given period of time. Personally, I am NOT comfortable with the idea of taking a sleeping pill every night regardless of whether I think I may or may not be able to get to sleep in a timely fashion. But that's just me and my opinion of how I want to address my health needs. Other people make the opposite decision and have no problems taking sleeping pills on a consistent basis. And that's fine---as long as they know the consequences of nightly use of Ambien, Sonata, Lunesta, etc. And whether they will face potential problems should they later decide they want to wean themselves of the medication.

And even if a person decides to use sleeping medication to help battle long-term insomnia, it is still critically important to work on any sleep hygiene issues: Because unless you change the behavior patterns that feed the insomnia, it will return---possibly with a vengence---as soon as you decide to start weaning yourself off the meds.

[jdm2857]

The benzo (Ambient, etc) and non-benzo (Restoril, Valium, etc) drugs were made to help falling asleep with min hangovers.

You've got it backwards. Valium and Restoril are benzodiazepines; Ambien is not.

[avi123]

Ms. Butterfly (is robysue a name?), I am talking about this excerpt, for the conditions to take those pills, from Mayo Clinic:


Taking sleeping pills


If your best attempts to get a good night's sleep have failed, prescription sleeping pills may be an option. Use them safely.

■Get a medical evaluation. Before you take sleeping pills, see your doctor for a thorough exam. Often your doctor may be able to find specific causes for your insomnia. Your doctor also likely will recommend trying nondrug approaches, such as cognitive behavioral therapy. Sleeping on a regular schedule, exercising regularly, avoiding caffeine and daytime naps, and keeping stress in check also are likely to help.

■Never take a sleeping pill until you're going to bed. Sleeping pills can make you less aware of what you're doing, increasing the risk of dangerous situations. Wait to take your sleeping pill until you've completed all of your evening activities.

■Avoid alcohol. Never mix alcohol and sleeping pills. Alcohol increases the sedative effects of the pills. Even a small amount of alcohol combined with sleeping pills can make you feel dizzy, confused or faint. And, alcohol can actually cause insomnia.

■Quit carefully. When you're ready to stop taking sleeping pills, follow your doctor's instructions or the directions on the label. Some medications must be stopped gradually.

■Watch for side effects. If you feel sleepy or dizzy during the day, talk to your doctor about changing your dose or weaning off your pills.
If you continue to have trouble sleeping, ask your doctor for help.

Source: http://www.mayoclinic.com/health/sleeping-pills/SL00010

*******************************************

Since taking sleeping pills, even habit forming, in such cases as during OSA treatment is more important than NOT treating your OSA, I (and my wife who happened to be a retired pharmacist) regard it justifiable.

Tomorrow, I 'll add more cases in which habit forming Rx should be taken than not taken, regretfully. And I'll also add an opinion from my current Psychiatrist who put me on low dose of Xanax to try and let me withdraw from the small dose of Zolpidem that I still take when I place the mask on my face. So far it works ( with the tiny dose of Zolpidem) and helps me continue CPAPing, which is the top priority at this time. At the present time I MUST sleep well the 6 to 7 hours without questions or experimentations, even if I am a retiree and don't need to go to work.

[scrapper]

Avi123's last post and robysue's express two different viewpoints on the same subject.

What is right for one person, isn't necessary right for the next person........

There's no one right answer that you need to provide more research on tomorrow avi123.

[robysue]

Avi123's last post and robysue's express two different viewpoints on the same subject.

What is right for one person, isn't necessary right for the next person........

I agree 100% with this statement: In fact I have said more than once the decision to take sleeping pills is a personal decision. But I also believe that it is a decision that should not be taken lightly.

But I strongly believe that no-one should be talked into taking sleeping medication on a regular, possibly long-term basis if they are personally uncomfortable with doing so.

And the OP of this thread specifically said: I would prefer not to take any prescription drug. My BP and prostate problems prevent me from using some meds. Any good suggestions? Hence it seems disrespectful of the OP's sentiments to simply say "Take a prescription sleeping pill and don't worry about it; it's the same as taking an antibiotic."

I also strongly believe that for some people---such as avi123, the decision to take prescription sleeping pills is right for them. But I also believe that when one decides taking sleeping pills in an effort to adjust to xPAP is the correct path to take, it needs to be done in the context of trying to improve the overall sleep hygiene AND addressing the fundamental root causes of the insomnia---whether they are directly related to problems created by starting xCPAP therapy (such as those Rooster lists: suboptimal CPAP therapy; discomfort from CPAP; aerophagia or gastric insufflation;) or whether they are related to other medical problems problems (such as those Rooser lists: LPRD; GERD; anxiety; depression among others). Without working on improving the sleep hygiene and taking care of the other root causes of the insomnia, the sleeping pills may mask the insomnia, but the fundamental problem triggering the insomnia remains and may (and probably will) raise its head at a future time---particularly if the person taking the sleeping pills eventually does decide they no longer want to take them on a regular basis.

So to avi123 in particular: You are comfortable with your decision to take the small dose of Zolpidem (generic Ambien) and the Xanax to allow you to tolerate CPAPing and to help you sleep. You also appear to be keenly aware of the potential for long term dependence on such drugs. And you have a legitimate feeling that in your case the benefits of the medication outweigh the risks. In my humble opinion, you appear to have made the decision to take sleeping medication for the long term in an intelligent, thoughtful manner. And you've made the right choice for you.

I too have taken much time to weigh my own decisions about sleeping medication. I decidedly do not wish to take them long term and do not wish to run the risk of becoming dependent on them since there are many addictive tendencies in my family. I am quite sensitive to many medications---including sleeping pills. Putting the mask on at night has not been the problem: I have no anxiety issues. What triggered the CPAP-induced insomnia was sensory overload and aerophagia. In spite of the insomnia, I have 100% compliance right from day 1 and objectively highly effective therapy in terms of AHI. And at this point, with the help of my excellent PA, the CPAP issues that initially triggered the insomnia have been positively address and have been largely eliminated; but the insomnia remains. And so for me, the risks outweigh the benefits for anything but the absolute minimum use of sleeping pills to avoid two or more *disastrous* nights in a row. And that's why the insomnia solution that is right for me is heavy duty CBT supplemented by a very reluctant use of sleeping pills at a very infrequent frequency.

And yes, robysue is my name, or more precisely a family nickname.