Experiences - SWIM is worried about taking QUETIAPINE (Seroquel) for insomnia.

[Smitty2]

SWIM was not sure if he should post this here or in the Antipsychotics forum, but it looks like this one gets more traffic and this post is also about general insomnia and everything SWIM has tried to help with it. SWIM will try to keep the history concise here, but basically he has suffered from very bad insomnia for a long time now, first noticing it in college when he realized his roommate would pass out in 10 mins while SWIM would be up for 2-4 hours before falling asleep. SWIM mainly has problems falling asleep and then once he is out he will usually sleep ok, but falling asleep does not come easy and often takes 4 hours of tossing and turning to achieve. SWIM believes that this is mainly due to his ADD and Anxiety disorders, he just cannot shut his mind off and for whatever reason once SWIM is laying down to sleep it becomes the time for all of his thoughts to race and keep him awake all night. SWIM is also recovering from an addiction to Opiates which he turned to mainly because they alleviated all of SWIMs Anxiety and finally let him sleep well. Of course this didn’t last long and turned into a full addiction which lasted for about a year. SWIM is now 4 mouths clean.
SWIM has been seeing a Doctor for almost two years now and listed below is all of the medications he has tried that he can recall from memory. SWIM rated these on a 1-5 scale based on effectiveness, only a few of them have worked well, the main issue being that most of these drugs make SWIM physically tired and make him want to sleep, but they do not turn off the racing thoughts in his head so SWIM finds himself in a worse position, which means he wants to be able to sleep even more because he is exhausted but his minds still will not let him. Most of these SWIM was prescribed to for about a month long period where he tried it and then determined that it was not very effective, the exception being lorazepam, which SWIM has been prescribed to for over a year. This is one of the only medications that has worked for SWIM, as well as any other Benzos. But of course tolerance built after a while, it became less effective and SWIM began to abuse them and took around 4mg a day as well as whatever other Benzos he could get. Once SWIM stopped Opiates he also made the choice to stop Benzos as well and is now almost at the end of his taper and down to .5mg just at night.
So this brings SWIM to his current dilemma, his Doctors have more or less tried everything out there including many meds that are used “off-label” for insomnia and since SWIM now has a history of addiction, he can no longer take the only class of medication that has ever helped him with this problem, which is of course Benzos. So does SWIM just suffer and never get any relief or is there anything left that will work, well yes there is and that medication is Quetiapine. Last appointment SWIMs doctor went though the list of everything we have tried and this was one of the only things left, SWIM has tried this stuff before in small doses of 15-25mg and it worked almost too well, after about an hour he could not do anything except fall asleep. BUT SWIM does not like the idea of using a heavy duty antipsychotic prescribed for schizophrenia and bipolar to get him to sleep. SWIM would rather be taking a small dose of Ativan at night instead, but that is out of the picture. SWIM would also love to try Zolpidem (Ambien) as that is one of the other only things he has yet to try and believes that it would work perfectly and be less dangerous than taking an antipsychotic med. But SWIMs doctor will not give that to him either as it has a high potential for abuse I guess. So SWIM is pretty much screwed, when he really, really needs to sleep he will give in and take a Seroquel and it works great, but SWIM is so worried about taking a drug like this frequently, granted it is give in doses up to 400-600 mg which makes SWIMs look small, but he still thinks it is not a good idea. What do you SWIMMERs think, is anyone else forced to choose between not getting a night’s sleep and taking a potentially dangerous antipsychotic? For now SWIM is trying to only take it when he absolutely has too, meaning he has not gotten more than 6 hours of sleep for the past 3 nights.

5-HTP – 1 (useless)
Benzodiazepines – 5 (LORAZEPAM, ALPRAZOLAM, CLONAZEPAM, DIAZEPAM) (The best, makes SWIM physically tired, makes both his mind and body calm down and relax)
CLONIDINE (Catapres) – 3 (This stuff is sometimes fairly decent in .02-.04, but it mainly just makes SWIM very physically tired which does not mean sleep)
Doxepin (Sinquan) – 2 (Similar to Trazodone but weaker)
Diphenhydramine (Tylenol PM, Unisom) – 2 (sometimes helps, but only in really high doses which make SWIM unable to get up in the morning)
Exercise – 3 (Can be very helpful in tiring the body, but not always the mind, although it no doubt relieves some tension)

GABAPENTIN (Neurontin) – 2 (Not very effective, made SWIM feel dizzy at any dose that would slightly help)
Melatonin – 1 (seems to be useless unless combined with other meds)
QUETIAPINE (Seroquel) – 5 (extremely effective, scary in this sense, makes SWIM so tired and heavy he has to pass out no matter how busy his brain is)
TRAZODONE (Desyrel) – 3 (worked ok, high doses could knock SWIM out, but made it even harder to get up in the mornings then only getting 2 hours of sleep)
Valerian Root – 1 (useless)

[doingdadope]

swims feels for yah man, swim used to take 4mg of clonazapam a day and 30 mg of Zolpidem a night for sleep, eventually these doses stopped working so swim got off of them which was to say unpleasant. But seroquel is basically lobotomy in pill form although it does get the job done and is easy to get a script for but is it really worth permently altering your brain chemistry ??

btw seroquel in lower doses acts only on certain recepters while the higher doses start having antiphyscotic effects rather than drowsinesses. So lower doses = more drowsiness.

[Kindred S0ul]

i feel ya, swim takes 600mg of seraquel and 10 mg zaleplon (sonata) and 2 mg of zany at night. swim has had insomnia for almost 6 years. the seraquel knocks him out while the sonata and zany keep him asleep. been on it for years and the nasty side effects in the morning go away after a while but ya def need to find whats best but thats whats best for swim.

[Pachanoid]

SWIM was prescribed Seroquel once, and had a similar reaction. He didn't want to take an antipsychotic and was wary of the side effects.

However, at the time, SWIM was desperate for sleep, so he gave in to Quetiapine.

He has to say it worked very well for what SWIM was looking for. Basically, a bang on the head and a full night's sleep. Not the best sleep or the most relaxing, but better than the depression and insomnia SWIM was going through that's for sure.

[violentcheetah]

SWIM can relate to every med named. Good luck. SWIMS only downfall with seroquel is its one of the quickest tolerances every experienced. So beware. Also SWIM liked how quickly it took effect.

[staples]

First of all, I am a little surprised how closely SWIY's experiences with certain medications mirror my own. Specifically 5-HTP, Benzos, Diphenhydramine, Mealtonin, Trazadone, and Valerian Root. The only differences I can see are that I would rate diphenhydramine a 1 and note that I experience some irritating discomfort, and I would probably rate benzos a 4 and note that while lorazepam helped me sleep, it caused next-day drowsiness, and clonazepam didn't do anything for me. Furthermore, I relate fully with the college roommate experience (where I was amazed that my roommate could fall asleep so fast because until that point, I didn't know it was abnormal to have so much trouble sleeping), and the anxiety and attention disorders. I suspect that the similarities do not end there, so I will offer my experiences for SWIY's consideration.

It may be important to note differences, though: I've found that exercise doesn't seem to affect sleepiness, and I've never been prescribed to or have otherwise tried the other options listed. I also do not have the same "addictive personality," that is, I've never experienced particularly wanting to take my lorazepam, let alone a habit of taking it. I've also never experienced such compulsions with opiates. While I will say that while taking (prescribed, of course) hydrocodone, I did feel like sleep onset occurred more naturally/correctly, but I don't think of hydrocodone as a remedy for insomnia.

Before I get to my experiences, I have a few questions for SWIY:
Admittedly I am not terribly familiar with antipsychotic medications, so I may simply be ignorant of some common knowledge. However, I do know that it isn't uncommon to prescribe such medications for insomnia characterized exactly how SWIY describes it (i.e, racing thoughts, mind won't shut down). So my question is: why is SWIY convinced that quetiapine is dangerous, or at least moreso than other medications? It isn't entirely obvious from the original post, but it seems to me that SWIY is more weary of the title "antipsychotic" than anything, so I might suggest SWIY refer to it as a "neuroleptic" instead.

You mentioned SWIY's anxiety and ADD. Is SWIY being treated for those, or is SWIY taking any other medications?

Finally, I think SWIY's doctor should reconsider the nonbenzodiazepine z-drugs. To my knowledge, although there has been some research which indicates the z-drugs (or, at least zolpidem) may cause more dependence than originally thought, they are still considered much less habit-forming than the benzos. In fact, at higher doses, the z-drugs lose their specific GABA receptor affinity and act more like benzos, which may be the cause for the increased reports of dependence--people were taking more than they should (more on that in a second).

As for me, I've been being treated for insomnia for over 3.5 years now. In addition to what I've already mentioned, I've been given Mirtazapine (Remeron), which either gave me migraines (I may be confusing Remeron with Effexor/Venlafaxine) or it actually worsened sleep and did not address symptoms of depression (I recently saw a research paper about comorbid insomnia which suggested that it is better to treat insomnia separately from comorbid symptoms, anyway). Various SSRIs intended to help with sleep as well, but usually they made it worse, or also messed with appetite and attentiveness.

The two z-drugs I've been prescribed to are Eszopiclone (Lunesta) and Zolpidem (Ambien). Eszopiclone didn't work until my doctor increased me to three times the starting dose, but even then it didn't work that well and gave me nightmares.

I was actually prescribed to Zolpidem first of any medication for insomnia, and it worked for about 2 months. I switched another medication during that time and Zolpidem seemed less effective, which prompted trying other treatments. After I found unsatisfactory results with the other medications, I was no longer on the medication which seemed to affect Zolpidem's effectiveness, and I've been prescribed to Zolpidem ever since.

Zolpidem works best for me, but it doesn't always work. I suspect that many people who have been prescribed to zolpidem long-term experience this hit-or-miss nature and falsely believe that their tolerance has dramatically risen. Clearly this belief makes self-medication seem obvious, and that is where I think most people go wrong, and why I believe research has been identifying higher-than-expected rates of dependence on Zolpidem.

But Zolpidem's problem isn't tolerance. It works like a charm one night, and works like a placebo the next, but it may then work flawlessly on the third night--something you wouldn't expect if tolerance were the issue. I think many problems with Zolpidem could have been avoided if people refused to deviate from their doctor's instruction. Nobody should expect a perfect night of sleep every night. Something I have noticed is that some generics for Ambien seem to work more often than others for me. Specifically, Mylan Pharmeceutical's Zolpidem seems to work better than Dr. Reddy's Zolpidem.

Maybe I'm a little strange in that it doesn't really bother me to miss a night or two of sleep. Sure I might feel miserable by the second or third night, but I feel more miserable if I waste all of that time complaining about being miserable. Instead I try to remain productive, get something done with my extra time.

Something I've thought a lot about is the idea of needing a medication to sleep, and if that constitutes dependence. Not many people want to see themselves as needing a medication, which implies an immanent threat of withdrawal as well as perhaps relying on uncertain things like health insurance and job security. But if taken as prescribed, the termination of Zolpidem may cause rebound insomnia typically for a night or two. So what's so bad about needing Zolpidem to sleep? As of right now I have health insurance and can afford it and I can afford to see both a therapist and a psychiatrist to make sure nothing is going awfully wrong. I don't mind skipping a dose every now and then to see if I can sleep on my own or to purposely stay up all night. I don't mind when I can't sleep even after taking Zolpidem. I'd say I need it to sleep, but I wouldn't say it will always let me sleep, or that I'm dependent.

So again, if SWIY is only concerned about quetiapine being typically used to treat schizophrenia, then I think SWIY may want to rethink about that. Otherwise, I would recommend trying Zolpidem. If SWIY's doctor happens to be convinced the Zolpidem is dangerous and habit-forming, SWIY should probably talk to another doctor if possible.

Reputation Comments on this post:

	helpful, ionformative post, including your experiences
	Thanks for sharing this.

[missparkles]

Swim isn't being funny when she says this but she knows from her own experience that junkies, even when clean, still look for drugs to solve all and any problems. Even sleep problems.
Swim is currently looking at everything that helps her sleep as she also suffers from insomnia.
She has tried benzo's but eventually just built up a tolerance and they stopped working. The next step up would have been stronger drugs, possibly illegal ones. So she's looking for something that will help her sleep too. She knows, as an ex junkie, drugs are not the answer.
What has made it easier is getting into a routine every night. She goes to bed at the same time, and gets up at the same time, even if she hasn't slept well. Laying off alcohol and coffee in the evening also helps. Don't exercise late at night this will keep swiy awake.
Swiy might want to ask his doctor about Melatonin. It's produced naturally by the body when it gets dark, (don't ask how) and it's what puts swiy to sleep. Supplements of Melatonin have been known to help regulate an out of sync body clock and promote sleep. Swim listens to audio books, it's like being told a bedtime story, it just relaxes swim and she eventually sleeps.
At the end of the day swiy will sleep when his body needs it. Just don't stress over it, that will make it worse.
Take care.

Reputation Comments on this post:

good to mention non-drug tricks to help improve sleep

[staples]

Originally Posted by missparkles

What has made it easier is getting into a routine every night. She goes to bed at the same time, and gets up at the same time, even if she hasn't slept well. Laying off alcohol and coffee in the evening also helps. Don't exercise late at night this will keep swiy awake.
Swiy might want to ask his doctor about Melatonin. It's produced naturally by the body when it gets dark, (don't ask how) and it's what puts swiy to sleep. Supplements of Melatonin have been known to help regulate an out of sync body clock and promote sleep. Swim listens to audio books, it's like being told a bedtime story, it just relaxes swim and she eventually sleeps.
At the end of the day swiy will sleep when his body needs it. Just don't stress over it, that will make it worse.
Take care.

This is good advice and I meant to mention sleep hygiene. To the OP, if your doctor did not address sleep hygiene first, you should certainly address it yourself and probably look into seeing a different doctor.

Regarding melatonin, the OP claims that melatonin only seemed effective when used in combination with other medications, which is my experience as well. However, I have heard that it makes a world of difference for some people, and I've also heard that some companies were caught selling melatonin supplements that didn't actually contain melatonin, so be weary of that.

Regarding how the body knows when to release melatonin: a group of neurons in the hypothalamus called the suprachiasmatic nucleus learns about daylight information from the retina, and influences the release of melatonin from the pineal gland. If you're interested, some more information can be found here.

[el burgo]

Swim does not agree that seroquel should be prescribed for off label uses such as insomnia at all. Swim is on 100mg a day and swims dosage is being increased (swim prescribed for mania etc). Swim thinks seroquel prescribed off label will case more harm than good!
Works well for swim though!
regards

[missparkles]

Doctors seem to be prescribing anti psychotics more and more lately, the sedative effect (without the addictive potential) is seen as an effective sleep aid.
Perhaps all doctors should be given a dose of largactil (chlorpromazine hydrochloride) just 25mg, before they prescribe it? They would certainly think twice before prescribing it again...that's for sure.
Sparkles believes no addict who is experiencing PAWS should ever be given anti psychotics. In fact she will go as far as to say she believes no one, who isn't experiencing a psychotic break, uncontrollable mania or extreme agitation (due to a diagnosed mental disturbance) should ever be prescribed these drugs.
There are so many drugs now that have sedating side effects, using anti psychotics seems quite punishing. Perhaps that's the idea when they're given to ex addicts...who knows?
Like putting a straight jacket on someone who isn't insane. Bad analogy perhaps, but you get the meaning.
Take care.
Sparkles.

[el burgo]

Sparkles
Great analogy - hits home

[benzoknowledge]

swim says he takes 300mg a night(no self-incrimanation its prescribed, jeesh) well any way swim has a tolerance so high to all the benzodiazepines, and opiates... so ive been taking seroquel for a long time, after awhile you will not notice the side effects....it can take up to 2 months for it to take full effect(anti-psychotic) and for the nasty side effects to ware off......i have no side effects to it.....I ACTUALLY ENJOY IT its so strong it knocks swim stupid( A GOOD THING) swim smokes a doobie and takes .5MG CLONAZEPAM WITH IT......NO SIDE EFFECTS AT ALL BENZOS TAKE AWAY THE INTENSE FEELINGS OF QUETIAPINE....its THE ONLY DRUG THAT WILL MAKE ME SLEEP.....xanax ativan phenobarbital butabarbital valium halcion....all that will get swim buzzed but not sleepy....and seroquel does not PERMANently change brain chemistry...actually the past few months have been more productive cause i can sleep easily....so dont knock seroquel (its not for everyone hence prescription antipsychotic) it may work for swim and swiy but not for *** JUST REMEMBER ASK UR DOC FOR KLONOPIN TO COUNTER ACT THE SEROQUEL...THE DOC GAVE SWIM KLONOPIN FOR THE SIDE EFFECTS OF SEROQUEL