Insomnia: Melatonin + 5-HTP + Tryptophan

[Jeffster]

Hi all,

Has anyone tried taking all 3 of these together at bedtime? My insomnia has been bad since last December. My doctor started me on Trazodone in January, which does help me fall asleep but not stay asleep. I'll get maybe 3 hours sleep, then fragmented 20 - 40 minutes sleep periods until it feels like time to get up after around 8.5 hours of mask time. Daytime mental clarity can really suffer, but energy level can be quite high.

I read about Melatonin here, and a month ago added 3 mg of that at bedtime with the Trazodone. That seems to help me fall asleep as well but not stay asleep any longer, though I seem to remember more vivid dreams with it.

Two nights ago I added another OTC med, 100 mg 5-HTP. Way too early to say for sure if it is working, but it seemed to help.

Also two days ago I ordered online 1000 mg Tryptophan pills. So my big question is, when the Tryptophan arrives, will I be really overdoing to take all 3 OTC meds with the Trazodone:

50 mg Trazodone + 3 mg Melatonin + 100 mg 5-HTP + 1000 mg Tryptophan

Maybe better to just try the 50 mg Trazodone + 1000 mg Tryptophan

Any body have any experience combining these, or just have any advice at all? I do see there are B6 and Niacin amounts adding up in these OTC meds, plus my daily morning taken Centrum Silver multivitamin. I can elaborate in Q & A. I should post this now, because I had an even longer version that I accidentally deleted! I have some interruptions today.

Let me add, I believe that in the body this is the progression for these elements:

Tryptophan -> 5-HTP -> Serotonin -> Melatonin

So I could be taking supplements of 3 stages of the process, plus my Trazodone helps conserve Serotonin, all to help with this insomnia. Any one care to share experiences, or opinions? Too much?

[hbakar]

I am not sure about the interaction of the medications you are talking about, but the best way to find out would be talking to a pharmacist. YOu can stop by and call the wallgreens and cvs maybe? Are you doing anything else for your insomnia besides the medication? Do you engage to any kind of physical activity (I highly recommend that)? Are there specific things in your life bothering you? You should try to address the things that are bothering you. I also highly recommend the book called "good night insomnia" There are really useful tips in the book. You can also seek professional help from a therapist and that would also help you relax. I know it is easy to say, but those are the best things you can do in my opinion. Good luck.

[jules]

trazadone works on serotonin

all of that other stuff has serotonin involved - the 5HTP and tryptophane convert to serotonin then to melatonin (5HTP is one step closer is what I understood years ago)

STOP all the extra stuff until you get it okayed with your doctor

there is something really nasty called serotonin syndrome - Serotonin syndrome is a potentially life threatening drug reaction that causes the body to have too much serotonin, a chemical produced by nerve cells.


http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004531/

[Jeffster]

hbakar, yes, I do get some physical exercise, in outside daylight. You are so right in your recommendations. There are some extra stressful things going on, and i am working to handle them. I will look for that book, love the title!

jules, thanks for the warning about serotonin syndrome and the NIH doc. That makes me think, just try the tryptophan when it comes, and leave out the melatonin and 5-HTP, at least for the first trial. I have run some of this by my doctor, at least the melatonin part. I should update her on my 5-HTP trial, and pending tryptophan.

[jules]

you need to tell the doc all of that you take and let them decide

you are playing with fire

[robysue]

I am very sorry to hear that you've been fighting your insomnia monster since December. It is tough. Did the insomnia kick in shortly after you started on CPAP? Or have you always had serious insomnia?

I have no advice to offer you concerning the three medicines you are currently taking. You say the doc put you on Tryptophan back in January. You also say that you are getting about 8 1/2 hours of mask time each night. And you say that only the first three hours is not fragmented. 5 1/2 hours of severely fragmented sleep (sleeping in 20--40 minute long chunks) is super bad insomnia---particularly since you are already taking nightly prescription sleeping medication. Unfortunately almost all sleeping pills are designed to help you fall asleep more quickly and they do not seem to be particularly effective in helping you STAY asleep all night.

So the first question is: Have you seen the doc at all since then? Have you let the doc's office know that you are still dealing with SEVERE insomnia? Some sleeping pills can backfire for some patients---in other words, instead of helping the insomnia it is possible for a sleep medication to trigger rebound insomnia of some sort.

Second, I also think since the Tryptophan is prescription, you need to make sure that your sleep doctor knows (and approves) of your taking multiple meds. I'd also make sure the doc knows that the while the Tryptophan helps you fall asleep for about three hours, after that your sleep is highly fragmented and not at all "good".

Next, it may be that in addition to the sleep medications you are taking that you need to also do some CBT work to try to get your sleep cycles more consolidated. I would STRONGLY encourage you to call the sleep doc's office and ask if there are some CBT things you can do under their direction to help the insomnia and make the pills more effective. Back at the end of December when my own insomnia was at its worst, the PA put me on a "sleep restricted" schedule where I was only suppose to allow myself a maximum of six hours in bed for sleep every night. I was taking no sleep medication on a regular basis (my choice) during this. But by the end of a couple of months, the number of awakenings at night had dropped from 4--7 (in a six hour period) to 2 or 3 in a six hour period. Very recently they've started to drop to 1 or 2 per night on good nights.

Also: When you wake up at night, how long does it take you to get back to sleep? Are you anxiously watching the clock every time you wake up? Do you worry about how little sleep you are getting once you wake up at night? If these are problems, then you might want to get rid of the clock---put it somewhere where you cannot easily see it from your bed when you wake up at night.

Do you keep a sleep log? That can also help in identifying if there specific things that tend to wake you up and that you can work on solving. For me, I'd wake up with an uncomfortable fullness in my stomach (aerophagea) several times at night when my insomnia was at its worst. Yet another titration study was done and my pressure setting was able to be reduced, which took the edge off the aerophagia and reduced the number of wakes due to that.

And finally, how's your overall sleep hygiene? Sleeping medication works best when there are no serious problems with your sleep hygiene and improving it may help the sleeping pills work better.

[Jeffster]

you need to tell the doc all of that you take and let them decide

you are playing with fire

I will send my doctor an email with the updated info. There's a much longer story here. It will go as a reply to our recent email exchange where she explained to me why she canceled the referral I had asked for in my last office visit, and she initially granted, for me to meet with a sleep doctor and discuss my sleep apnea reports, and possible ways for me to improve my sleep results.

But I don't want to take my own thread too far off topic. So tell me more about the fire I am playing with, jules, or anyone else. Is it the serotonin syndrome, or more dangers?

[jules]

the serotonin thing

you didn't specify if you were on other meds - if you are on another antidepressant too (trazadone is one really but it is highly sedative so it is used as a sleeper) you need to be careful taking any of these 3 things you mentioned - melatonin, 5HTP, tryptophan as well as other herbals including St John's Wort - I don't know the complete list

I assume your doctor scripted the trazadone without knowing you would be taking any of these 3 OTC in the future.

I would also assume each of the OTC has a warning on it about not taking it with certain types of meds. Those are there for a reason.

[Jeffster]

robysue wrote, "I am very sorry to hear that you've been fighting your insomnia monster since December. It is tough. Did the insomnia kick in shortly after you started on CPAP? Or have you always had serious insomnia?"

I have been on CPAP for almost 9 years. I was also on Paxil 40 mg for most of those years. I weaned myself off the Paxil by August of last year to be done with the side effects. I remember feeling better, but then a few months later insomnia got worse. I have had sleep problems as far back as I can remember so I likely was suffering from sleep apnea as a child. Thanks for all your contributions here robysue!

[Otter]

Let me add, I believe that in the body this is the progression for these elements:

Tryptophan -> 5-HTP -> Serotonin -> Melatonin

So I could be taking supplements of 3 stages of the process, plus my Trazodone helps conserve Serotonin, all to help with this insomnia. Any one care to share experiences, or opinions? Too much?

The sequence above is correct. Melatonin also gets converted back to serotonin.

I have no experience with Trazodone, but my understanding is that it is a fairly weak serotonin reuptake inhibitor, and so is much less likely to cause seratonin syndrome than some of the other antidepressants. However, you really should keep your doctor in the loop as you experiment.

L-tryptophan and 5HTP can be treated as the same thing. I've read that 100mg of 5HTP is equivalent to 500mg of tryptophan. Some believe that tryptophan is safer than 5HTP because it has to go through one more process to become serotonin, but I talked about that today with a friend of mine who is a doctor with a great deal of experience with supplements, and she said no, 5HTP is regulated as well, so it really makes no difference as far as safety goes. Of course, everyone is different, and you obviously have a glitch or two in your system, so if you notice a difference in effectiveness, use whichever works best for you.

3mg of melatonin is probably way too much. Our bodies only make about 300 mcg of that hormone in 24 hours, and taking 10 times as much every night is likely to confuse your system even more than it is already. This happened to me a few years ago. Trust me, you don't want to go there.

If 250 mcg doen't make you sleepy, it's probably because you're so low on serotonin that your body is converting the melatonin back to serotonin. I'd concentrate on getting your serotonin levels up for now, and use much smaller doses of melatonin, 300mcg or less, when you need to adjust your circadian cycle. Even 100mcg should be enough to make you sleepy if you've got enough serotonin. Unfortuantely, smaller doses are hard to find, but you could get a pill cutter from the drugstore and cut the smallest tablet you can find into quarters. You can always take more if you need to, but if you take too much on a regular basis, your body might start fighting the melatonin. I'm not sure if this is actual melatonin resistance or the habit of converting it back to serotonin to try to keep balanced, but the end result for me was that melatonin supplements stopped working and my insomnia was worse than ever. So try to find the smallest effective dose, and don't use it all if you don't need it. Remember that if you're already sleepy, you've got plenty of melatonin, so taking more won't do anything useful.

Discuss with your doctor how to titrate the 5HTP and tryptophan. The usual suggestion is 500-1000mg of tryptophan or 100-200 mg of 5HTP as a starting point. Some people take much higher doses, but you need to find what works for you, and take the Trazodone into account. You could try increasing your dose every night or two until you start being sleepy, and then after a few days try lowering it to see if you still need that much. If you're used to doing things like this and you're desperate for sleep, you might go faster, but remember that though some is good, more may be a disaster. Measuring your serum serotonin at some point might be useful.

I don't think you have too much to worry about, but when it comes to drugs, I ask my doctor. I read too, of course, but it's silly to have a physician and not let him do his job. I'd also google serotonin syndrome and watch for the symptoms, just in case. If you're careful and you pay attention, you shouldn't get into too much trouble. Remember, though, when you start sleeping better, that will naturally bring your serotonin level up, so you're dealing with a moving target.

Good luck and let us know how it goes.

[napstress]

You are wise to pursue both conventional and alternative avenues for treating your insomnia—and to question how they might mix.

A Naturopathic Physician (NP) would know how the alternative OTC drugs would react with each other and with the prescription medications, as well as effective dosages. I doubt a PCP would even know what the alternative drugs are: mine sure doesn't. She didn't even know what homeopathy was! You might want to find a NP in the area. They have broad and deep training in both conventional and alternative medicine. Acupuncturists/herbalists often the big picture of both disciplines, in addition to a deep understanding of their own.

Good luck, and please let us know what you find out!

[robysue]

I have been on CPAP for almost 9 years. I was also on Paxil 40 mg for most of those years. I weaned myself off the Paxil by August of last year to be done with the side effects. I remember feeling better, but then a few months later insomnia got worse. I have had sleep problems as far back as I can remember so I likely was suffering from sleep apnea as a child. Thanks for all your contributions here robysue!

Ok, you've had long standing insomnia problems and likely have had apnea since your childhood.

Question: What's your sleep hygiene like? In other words, in addition to taking sleeping pills (on a nightly basis?) for the better part of 9 or 10 years, what is your sleep behavior like?

Do you do any of the following: Watch tv in bed? Surf the web in bed? Eat in bed? Read in bed? Text or chat on the phone in bed? Do you WATCH the CLOCK when you are in bed and cannot sleep?

What about the following: Do you have a bedtime ritual of any sort? Do you watch TV or web browse right up until the time you go to bed? Do you eat very close to bed time? Do you exercise at all? Do you exercise within a couple of hours of bedtime? Do you go to bed about the same time each night? Do you get up at around the same time every day---including weekends?

What about the following: Is your bed comfortable? Is your bedroom dark and cool enough for sleeping? Is your bedroom quiet enough for sleeping?

Answers to these questions MAY give you some NON-chemical things to start working on in your effort to tie up the insomnia beast.

[Jeffster]

jules wrote, "I assume your doctor scripted the trazadone without knowing you would be taking any of these 3 OTC in the future. " Good point. I have emailed her with my addition of two of them, and the plan to try the third when it gets here. I told her I'll leave out the melatonin and 5-HDT when I try the tryptophan.

Otter, thank you for for the good advice! As I mentioned above, I have sent email to my doctor telling her what I'm trying. Maybe tonight I'll try a test of leaving the melatonin out and see how my sleep goes with just taking the trazodone and 5-HDT. The trazodone has been helping me fall asleep for 6 months or so, but not stay asleep past the 3 to 4 hour point. It seems like the melatonin may be more for going to sleep, and less for staying asleep past the 4 hour mark.. Maybe either the 5-HTP, or the tryptophan when I finally try it, may help with giving me longer sleep?

napstress, yes, my PCP was not encouraging for the alternative meds because of quality control. But then she didn't want me to have the pharmaceuticals like Ambien either because they are supposed to be used for no longer than 7 days she said. So I wanted to try on my own some of the OTC things I've read about here. I will try to keep you all updated.

robysue, yes I think I do follow fairly good sleep hygiene. I likely need improvement since my insomnia is still bad. But the main problem is not falling asleep (the trazodone helps with that), but rather staying asleep (maybe the trazodone wears off after 3 or 4 hours?). When I wake up after 3 or 4 hours, I am in a comfortable position on my right side, usually having a dream. I'm not upset, just not asleep anymore.

[robysue]

robysue, yes I think I do follow fairly good sleep hygiene. I likely need improvement since my insomnia is still bad. But the main problem is not falling asleep (the trazodone helps with that), but rather staying asleep (maybe the trazodone wears off after 3 or 4 hours?). When I wake up after 3 or 4 hours, I am in a comfortable position on my right side, usually having a dream. I'm not upset, just not asleep anymore.

How long do you estimate that it takes you to fall back asleep once you are awake?

If you haven't fallen back asleep in, say, 20 or 30 minutes, are you still comfortable, not upset, and not worried? Do you continue to lie in bed for more than an hour before getting back to sleep?

And it IS worth asking the doctor who prescribed the trazodone how long it remains in your system and remains effective. Some of the newer sleep medications such as Ambien come in a "controlled release" formulation specifically for extending the amount of time there is a therapeutic level of the drug in your system. I haven't the foggiest idea of how long trazodone is supposed to last. I do know I was told by a PA in a sleep doctor's office that drugs like Ambien, Sonata, and Lunesta are all better at helping you GET to sleep than they are in helping you STAY asleep, and in fact that they are not really particularly effective at helping you STAY asleep in the first place.

Too much blue light before bedtime---as in TVs and computers---can disrupt sleep cycles in some people: And the problem is more with STAYING asleep than in GETTING to sleep. Before I successfully kicked my hubby's TV out of our bedroom many years ago, I'd regularly have no real problem falling asleep even when the TV was on. But I'd wake up two or three hours later and not be able to get back to sleep. After the tv was banished, I didn't have this problem any where near as often. So if you are watching TV or browsing the web right up to the time you call it a night and take the sleep meds and go to bed, you might want to try to build in 30--60 minutes of "blue light" free time between the end of the TV/web browsing and going to bed.

[Jeffster]

robysue said, "...you might want to try to build in 30--60 minutes of "blue light" free time between the end of the TV/web browsing and going to bed." Yes, it works out that way for me, about an hour off the computer and not looking at TV screen before lights out. Thanks again for all the good advice.

I do go easy on myself during the night time arousals, knowing that I need to relax to fall back to sleep. This works best for the first couple of them, then it gets harder with the later ones. I do look at the clock it aroused enough because in that state of mind I find it wakes me up more to wonder what time it rather than look and know, and I get to make mental notes about time between arousals, etc., which is better to know at that moment than lie there and wonder about.

Here's hoping that tryptophan, when it arrives, will work better for me. Does any one know, when is it best to take the tryptophan? Is it best to take it in the evening, like one or two hours before lights out?