apace41: tapering Zoloft / sertraline

[bromor]

Hi Andy. How has your sleep schedule been? My naturopath doc posted a YouTube video on insomnia & you came to mind. Before I started treatment & even in the beginning of it, I had terrible insomnia & 3 am wake up calls. Changing my diet & using those supplements really helped me. I still have to be very careful ~ especially in my tapering. If I get too confident and taper too much/too fast, I definitely get the nighttime surges & wake up issues. Anyway, I know you really want to steer clear of melatonin & kavinace ~ and I totally get that! Just wanted to check in on you. Take care.

[apace41]

Thanks so much for checking in, Bromor!

 

My sleep has been improved over the past week to 10 days.  Not back to normal but much better.  Most nights I'm getting to bed around 11 and waking at 12:30, back to bed until about 3 and then back again until about 5:45 when I get up.  It's kind of interrupted but I've had decreasing amounts of cortisol awakenings where you can't get back to sleep because your mind is racing.  I have not (thankfully) returned to that early state where I was unable to sleep at all the entire night.  I've been able to do this without specific supplementation (melatonin, kavinace, etc.) or a prescription that I had been given for hydroxyzine when I explained the situation to my primary care.

 

I don't want to say I'm over it, but I've seen some real improvement.

 

Thanks again,

 

Andy

[PoetJester]

Hey Andy,

 

I was just reading parts of your thread and it reminded me of one of my cold turkey withdrawal periods in 2005.  I had gone ct off of Zoloft and zyprexa, and after a wretched few days on my hands and knees vomiting all over my apt, got better, but developed  the same alternating day sleep pattern that you are describing.  I would go a full day without sleep and then get a solid 8 hrs the next night.  I kind of did alright for about 6 months but in the back of my mind I knew it wasn't too good to be missing sleep entirely every other day.  After 6 months though, I crashed and had a mental breakdown.  A few months later I ended up in a group home and back on the pills.   I finally cold turkeyed again in feb 2014 and am now one of your fellow Insomniacs or possibly InZombiacs with fragmented sleep that is not terribly restorative and cognitive and memory problems.   Anyways,  I hope your sleep continues to improve.   

 

Derek (PoetJester)

[apace41]

Thanks for checking in, Derek.  I appreciate your story and sorry you had to go there.  Hopefully, I can get this straightened out without having the breakdown since I didn't do the cold turkey.  

 

I may have posted too soon about about the improvement.  Last two days have been pretty bad.  Friday night reintroduced my CPAP to see how I would do and I got 5 hours straight from 12-5.  Woke with a cortisol surge for the first time in a while, however, which was concerning.

 

Saturday night I felt increasing anxiety heading toward bedtime.  Had a lot of anxiety and didn't feel like I would fall asleep but finally did and slept from 2-6 but woke with more anxiety and had a fair amount all day Sunday.  

 

Last night fell asleep at 11 and woke at 2 and have been up pretty much since then.  Had a lot of waves of anxiety and dizzy sensations all night.  Had a couple of moments with eyes closed of feeling like I was falling.  All pretty disturbing and coming on the heels of doing better even more so.

 

Not sure if there's something I've done that is causing this or if it is just the natural ebb and flow of the CNS readjusting to coming off the medicine.  

 

• As I've stated, I finished the switch to all liquid on the Sertraline two weeks ago and perhaps i'm still adjusting to that?  
• I had an increased amount of sugar last week -- wondering if that could have been a trigger?
• I had more wheat last week than I have in a while -- gluten sensitivity?
• Hurt my back two weeks ago and it is lingering so I took some curcumin, although it didn't seem to impact the sleep on the first couple of days and I've taken it before without seeing any problems

It's only been two days and they weren't "no sleep" days -- just limited and not great sleep days -- so it's premature to get too concerned about it I suppose, but it is very disconcerting in the aftermath of what I thought was improvement and moving back toward baseline at least from a sleep perspective.

 

Any thoughts welcome.

 

Best,

 

Andy

[bubble]

Hello Andy,

 

I'm sorry you are still struggling. I seem to be in the same boat although with a slightly different pattern: I have no problem falling asleep. I literally pass out after a few minutes of listening to some sleeping meditation and then can believe my eyes when I wake up and see that only one hour has passed. But I just think we have to stay positive and keep calm and stubbornly wait it out.

 

​I remember when you were discussing whether to resume taper after a 5 month hold and despite still feeling symptomatic. When I look at your signature there have been quite a few ups and downs. It seems your CNS is quite sensitised and reacts strongly to any changes and there were quite a few of those... When we are sensitised it seems that any cuts regardless of how small they are destabilise us even further. I can't see it from your signature when you actually started taking 24 mg. It seems you will just have to wait as long as you stabilise. Sweets, gluten and curcumin might have played a role but for me jumping around in doses would be the main culprit.

 

 In my case I know I have sinned against my CNS and I know I have to accept that it will take it as long as it takes to bounce back. Secondary fear of things getting even worse and being dysfunctional for a long period of time is probably the worst. ​But it is also an opportunity for practicing acceptance and giving myself time and space to feel as unwell as I need to while knowing it will pass. I don't see there is anything I can do except good self-care, holding, avoiding stress of any kind, patience and patience.

 

I'm sorry that I can't be more helpful and I hope things start improving soon. Alto always says that people can manage on little sleep for long and I find this very comforting now. The most difficult think to do is to do nothing...

[apace41]

Bubble,

 

Thanks so much for your post.  Came at a great time and reinforced some important things.

 

I'm sorry you are still struggling. I seem to be in the same boat although with a slightly different pattern: I have no problem falling asleep. I literally pass out after a few minutes of listening to some sleeping meditation and then can believe my eyes when I wake up and see that only one hour has passed. But I just think we have to stay positive and keep calm and stubbornly wait it out.

 

We are not that different in this regard, Bubble.  I had the same thing last night and most nights (didn't mention it) where I got to bed and wake up between 1 and 1.5 hours later thinking "it must be morning" and then seeing the clock.  I am able to roll over and go back to sleep most of the time when that happens.  When I have the second "awakening" usually around 2:00 to 3:00, the past week to 10 days I was able to go back to sleep until 5 or 6 but last night I was unable to fall back and had a much higher cortisol sensation all night when I tried to go back.

 

I remember when you were discussing whether to resume taper after a 5 month hold and despite still feeling symptomatic. When I look at your signature there have been quite a few ups and downs. It seems your CNS is quite sensitised and reacts strongly to any changes and there were quite a few of those... When we are sensitised it seems that any cuts regardless of how small they are destabilise us even further. I can't see it from your signature when you actually started taking 24 mg. It seems you will just have to wait as long as you stabilise. Sweets, gluten and curcumin might have played a role but for me jumping around in doses would be the main culprit.

 

THIS is where you provide that valuable reminder.  I continue to find myself in some senses in denial that my nervous system is now a casualty of the SSRI wars.  I want to believe that I am not that sensitive since I really wasn't until very recently.  Alas, things have changed and I need to baby myself and be more consistent in this regard.  I think I thought the jumping around that resulted from my measurement error was going to be "no big deal" (as did many others who posted), however, it seems that it, in conjunction with other issues of stress in my life, have laid me low when it comes to my bounce back ability.  You are right -- I need to just hold, hold, hold and hope to stabilize soon.  Once I do, I will hold some more as I won't taper until I've been stable for a good while.

 

In my case I know I have sinned against my CNS and I know I have to accept that it will take it as long as it takes to bounce back. Secondary fear of things getting even worse and being dysfunctional for a long period of time is probably the worst. ​But it is also an opportunity for practicing acceptance and giving myself time and space to feel as unwell as I need to while knowing it will pass. I don't see there is anything I can do except good self-care, holding, avoiding stress of any kind, patience and patience.

 

YES and YES!  Forgive me for I, too, have sinned, Bubble (this from a Jewish guy no less).  I will say "5 Our Prozacs" and "6 Hail Paxils" but I'm guessing that won't get it done.  (Hope I didn't offend anyone -- just a little levity on little sleep.)  The secondary fear is really at the root of so much of the problem.  It's easy to spiral into catastrophic thinking. 

 

The notion of acceptance is so tough for me to be honest.  I'm trying to work on it but I must say it is one of the bigger challenges I've ever faced.  I preach a lot of that on this board but sometimes it is in the "those who can't do, teach" category.  Focusing on that is a big new initiative for me so your reminder is very timely.

 

I'm sorry that I can't be more helpful and I hope things start improving soon. Alto always says that people can manage on little sleep for long and I find this very comforting now. The most difficult think to do is to do nothing...

 

To the contrary, very helpful, Bubble.  Even if the content weren't as valuable as it is, the fact that you came here and showed me your compassion is touching.

 

As I said, this at least is a few hours so it's not like the 4 day "shutout" I pitched a few weeks back.  If I can survive that... this is far less.

 

Thank you,

 

Andy

[Shep]

Andy, you mention sensitivity to sugar and possibly gluten. Do you think your CNS has become even more sensitive now? If so, it may be time to re-evaluate your supplements again.

 

Sorry, I know I'm one who harps on this, but I do think it's important.  

 

 

 

 

Last night fell asleep at 11 and woke at 2 and have been up pretty much since then.  Had a lot of waves of anxiety and dizzy sensations all night.  Had a couple of moments with eyes closed of feeling like I was falling.  All pretty disturbing and coming on the heels of doing better even more so.

 

 

Your comment here is what stood out -  "eyes closed of feeling like I was falling".  This happened to me after coming off benzos and z-drugs. Every time I went to bed and closed my eyes I felt like I was spinning in my head. I don't have near the problems that a lot of people talked about with vertigo on the benzo forums, but "the feeling of falling with eyes closed" seemed specific to benzos in my own case. 

 

I'm still wondering if you're having a benzo wave that's exasperated by the other factors that you and Bubble have discussed.

 

Please be particularly careful with Valerian, as it can cause dizziness as a side effect and if your CNS is indeed becoming more sensitive, extra caution is in order.

 

This is from the Valerian thread: 

 

Common Side Effects

Valerian may cause headaches. Valerian has been reported to cause gastrointestinal upset. Dizziness, headaches and itchiness are other common side effects, according to the Office of Dietary Supplements (ODS). Medline Plus reports that excitability, uneasiness and unsteadiness are other commonly reported valerian side effects.

 

http://survivingantidepressants.org/index.php?/topic/599-valerian-root/

 

 

 

If the valerian is no longer effective for sleep, perhaps this will be something to consider eliminating to shelter your CNS from any side effects. 

 

Wish I had better answers for all of this, but if it is benzo and GABA related, this may help. 

 

 

[apace41]

Thanks for weighing in, Shep.  Some responses below.  Your further input appreciated.

 

Andy, you mention sensitivity to sugar and possibly gluten. Do you think your CNS has become even more sensitive now? If so, it may be time to re-evaluate your supplements again.

 

Sorry, I know I'm one who harps on this, but I do think it's important.  

 

Yes, I've considered that my CNS is more sensitive and think that is definitely an issue.  I've been hesitant to come off any supplements because I was fearful of making any changes, either adding or decreasing, to what has been a reasonably longer term set of supplements.  I think adding the Curcumin was a bad idea and have cut that out.  What are your thoughts on decreasing others that I've been on for a while?

 

Your comment here is what stood out -  "eyes closed of feeling like I was falling".  This happened to me after coming off benzos and z-drugs. Every time I went to bed and closed my eyes I felt like I was spinning in my head. I don't have near the problems that a lot of people talked about with vertigo on the benzo forums, but "the feeling of falling with eyes closed" seemed specific to benzos in my own case. 

 

I'm still wondering if you're having a benzo wave that's exasperated by the other factors that you and Bubble have discussed.

 

Very helpful, Shep.  Could be that this is a benzo issue rearing it's head 18 months later.  I always wondered what the overlap might be in terms of symptoms.  Not sure there's much I can do about it other than ride it out.

 

Please be particularly careful with Valerian, as it can cause dizziness as a side effect and if your CNS is indeed becoming more sensitive, extra caution is in order.

 

If the valerian is no longer effective for sleep, perhaps this will be something to consider eliminating to shelter your CNS from any side effects.

 

This is one of those cases where I was fearful of discontinuing the supplement.  I took it during the benzo withdrawal and have just stayed on it so I've been on Valerian for 3.5 years or so.  I worry that getting off will trigger more symptoms and further destabilize the CNS.  Thoughts?

 

Wish I had better answers for all of this, but if it is benzo and GABA related, this may help. 

 

I appreciate the thoughts and this is very helpful.  The problem with ALL of this stuff is there are no clear answers to much of it.

 

Andy

[Shep]

 

 

This is one of those cases where I was fearful of discontinuing the supplement.  I took it during the benzo withdrawal and have just stayed on it so I've been on Valerian for 3.5 years or so.  I worry that getting off will trigger more symptoms and further destabilize the CNS.  Thoughts?

 

 

I think you're being very smart here when it comes to further destabilization. 

 

How are you getting the Valerian - through tea or from a pill? 

 

Maybe a gentle 10% reduction to start off with. 

[apace41]

I get it through a pill, Shep.  It has a dense amount of valerian root in the capsule.  I assume it can be opened and/or weighed.

 

Not sure I've ever seen a protocol for tapering Valerian.

 

Thanks,

 

Andy

[bromor]

Great info in the responses. ~ seems I've rejoined the insomnia & 3 am cortisol wake up calls. (At least the past few days) Bubbles reminder of how sensitive our CNS are was greatly needed for me. Hate to hear, Andy, that the issues haven't resolved for you. On valerian ~ would you need to taper? If so, you could use the valerian essential oil (I use young living) & make your own capsules, gradually reducing? Just a thought.

[apace41]

Great info in the responses. ~ seems I've rejoined the insomnia & 3 am cortisol wake up calls. (At least the past few days) Bubbles reminder of how sensitive our CNS are was greatly needed for me. Hate to hear, Andy, that the issues haven't resolved for you. On valerian ~ would you need to taper? If so, you could use the valerian essential oil (I use young living) & make your own capsules, gradually reducing? Just a thought.

 

Sorry to hear you have rejoined the club you don't want to be a member of. 

 

I am thinking that the safest approach would be to taper Valerian but I'd love to hear any thoughts from people.  I would also assume that the taper could be a lot faster than a 10% a month taper.  The essential oils approach is interesting, Bromor.  I was thinking I would take my capsules and weigh them  fully loaded, open the capsule and dump out the percentage to reduce, and then close it back up and take it in the reduced amount.

 

I haven't looked at the capsules so I don't know how much of a challenge that will be.  Will scout it out and report back once I do.

 

Hope you can sleep tonight.

 

Best,

 

Andy

[brassmonkey]

Hey Andy-- Valerian acts on the GABA receptors in a manner similar to benzos. If you've been taking it for three plus years there is a good chance that there's a tolerance WD effect happening, one of the symptoms being insomnia.  Also having been on it that long I would suggest a benzo style taper to get off.  With your system being sensitized there is no need to shock it with a CT.

 

You should be able to open the capsules and divide the powder.  Keep in mind that the powder can be sticky and hard to work with, and it STINKS.

[apace41]

Also having been on it that long I would suggest a benzo style taper to get off.  With your system being sensitized there is no need to shock it with a CT.

 

You should be able to open the capsules and divide the powder.  Keep in mind that the powder can be sticky and hard to work with, and it STINKS.

 

That was my thought, Tom, but you don't think I need to do a 10% taper do you?

 

I was planning to do 10% to see if it had any adverse effect and then go a little faster, like 15-20% a month.

 

Thanks for you input and any further thoughts.

 

Best,

 

Andy

[brassmonkey]

I'm not really up on the benzo protocols, but I seem to remember something about 10% every two weeks being a workable plan.  The SERT loading is probably similar to ssris so I would guess that a more aggressive approach in the beginning and then more conservative lower down would work.  This is more benzoesque than true benzo so there should be some wiggle room.

 

I was reading Bromers thread and had some thoughts for "he who teaches".  CBT, AAF, and DARE are all different approaches to the same thing and are somewhat dependent on the personality of the practitioner for their success. In the end they're all about establishing acceptance of the situation by taking control of it.  The acceptance only comes after the control has been established, second nature and then relinquished. It's a fluid process that, like wd, has to be allowed to run its course as it's worked through, and can take its time. Not quite sure where I'm going here, but wanted to throw it out there.

[apace41]

Well, I am officially back in the throes of the full-on insomnia.  Didn't sleep much if at all last night.  Every time I felt like I was getting close to nodding off I got hit with a wave of anxiety and, even though I did a decent job of not allowing it to escalate into higher levels of fear, it was enough to keep me from getting any real sleep.  Very tiring and challenging.  I had, at Shep's wise counsel, taken the past 4 Wednesdays as "work at home" days and was set to return to the office for this Wednesday.  I think I will need to discuss extending that another week or two because this Wednesday is probably a good one to be at home for.  I think that even though i've done a good job to date of getting through most of the insomnia without a sleep aid, I probably will take something tonight in order to get some level of sleep.  Don't want to but am feeling like my hand is being forced.  Of course, I may feel differently by tonight.

 

On the positive side, I found the Valerian capsule easier to work with than I feared and was able to taper 10% by weight of one capsule fairly easily and will do so again and for the foreseeable future.

 

More fun from your friends at "Psych Med Withdrawal" -- the gift that keeps on giving.

 

Best,

 

Andy

[Shep]

Sorry to hear you're in the "full-on insomnia" camp now, Andy. I'm just now getting out of it, so I know how bad it feels.

 

Do you think the 10% decrease in Valerian made it worse or do you think you were heading in that direction regardless?

 

This may get more complicated adding in another sleep aid, so please look toward the most benign ones out there, especially since they usually only help you "get" to sleep but may not help with the "staying" asleep part caused by cortisol and adrenaline surges, sudden drops in blood sugar, etc.  Melatonin got me out of a real "crisis" state because I was so sleep deprived I was experiencing dangerous suicidal thoughts. By the time it turned paradoxical, I had re-grouped enough to continue on without it. So it's really a difficult give-and-take until you find your way out of this wave. It's good you're taking more Wednesdays at home. This may provide enough of a light to guide you through without needing too many additional remedies. 

 

Sending healing vibes your way. 

[apace41]

Thanks for checking in, Shep.

 

Do you think the 10% decrease in Valerian made it worse or do you think you were heading in that direction regardless?

 

I find it hard to imagine that the first day of reducing the Valerian by only 10% would be enough to cause any additional issues.  I think that was going to happen in any event.  It was building.

 

 

This may get more complicated adding in another sleep aid, so please look toward the most benign ones out there, especially since they usually only help you "get" to sleep but may not help with the "staying" asleep part caused by cortisol and adrenaline surges, sudden drops in blood sugar, etc.

 

Understood.  I don't intend to "go on" another sleep aid -- just use one on a Tuesday night (knowing I'm home on Wednesday) so that I can try to break the cycle.  This seemed to work the last time so I'm hoping it does again.  I hear you on the "getting" v. "staying" asleep.

 

   It's good you're taking more Wednesdays at home. This may provide enough of a light to guide you through without needing too many additional remedies. 

 

Yes.  Thanks again for the suggestion.  I remain in your debt.

 

Best,

 

Andy

[Sertramean]

Keep going Andy, the sleep will gradually resolve in time. It's a horrible place to be and it's very frustrating but it's only temporary. You're tapering the right way so blips like this won't last too long. Just get up and watch some footy if it all gets too much!

 

All the best mate.

[apace41]

Keep going Andy, the sleep will gradually resolve in time. It's a horrible place to be and it's very frustrating but it's only temporary. You're tapering the right way so blips like this won't last too long.

 

Thanks, Sert.  I'm hoping you are right.  When you are in it it's hard to see the forest for the trees.

 

Just get up and watch some footy if it all gets too much!

 

ALWAYS a good solution!

 

Best,

 

Andy

[bromor]

I sure was hoping to find you had slept! A few thoughts ~ eat a high protein snack before bed, that'll help with your blood sugar levels/cortisol. I've even eaten a spoonful of natural peanut butter (without added sugar). ~ this was recommended by a natural pharmacist.

I'm sure by now you know I tend towards the natural side of things......last night I diffused the EO blend of peace & calming right by my bed. Helps to relax & I was pleasantly surprised to only be up once (at midnight) & then when my alarm went off.

 

Would you consider kavinace as a sleep aid?

[apace41]

I sure was hoping to find you had slept! A few thoughts ~ eat a high protein snack before bed, that'll help with your blood sugar levels/cortisol. I've even eaten a spoonful of natural peanut butter (without added sugar). ~ this was recommended by a natural pharmacist.

I'm sure by now you know I tend towards the natural side of things......last night I diffused the EO blend of peace & calming right by my bed. Helps to relax & I was pleasantly surprised to only be up once (at midnight) & then when my alarm went off.

 

Would you consider kavinace as a sleep aid?

 

Thanks so much, Bromor!  Glad to know you were thinking of me. 

 

The protein snack is a good idea.  I just heard that today and you posted it to me at the same time so it must be a good idea.

 

I use a little lavender shea butter sometimes but not essential oils. Glad it worked for you.

 

Not sure on the kavinace although my opthamologist also recommended it highly.  At 3 in the morning I'd probably do just about anything for a few ZZZZs. Keeping all options open. 

 

Best,

 

 

Andy

[apace41]

Update on the sleep front:

 

• Took a hydroxyzine last night and slept from 12-7 with one wakening for the bathroom
• Felt pretty good for a while this morning after that sleep albeit a little groggy -- could have gone back to sleep for a little bit but have to work
• Good feeling wore off by around 11 or so and I have some inner anxiety but not horrible

It was good to break the cycle and get some sleep.

 

Not sure what tonight will bring. 

 

Best,

 

Andy

[Altostrata]

Good to hear you got some sleep.

 

bromor suggestion of protein before bed is a good one. I used to drink undenatured whey protein before bed. When your blood sugar drops, adrenaline is released -- this could be adding to your wakefulness.

 

How long has it been since you took melatonin? How much were you taking before? Even 0.25mg might help.

 

The magic ingredient in Kavinace is phenibut, a gray-market drug related to benzos that can cause dependency and needs to be tapered. Up to you if you want to experiment.

[apace41]

Good to hear you got some sleep.

 

Thanks, Alto.  That was Tuesday.  Last night not as good.    Given its antihistamine nature, I'm trying to limit use of the hydroxyzine to "only when desperate." 

 

bromor suggestion of protein before bed is a good one. I used to drink undenatured whey protein before bed. When your blood sugar drops, adrenaline is released -- this could be adding to your wakefulness.

 

I did that both Tuesday and Wednesday with a scoop of peanut butter.  I thought it worked on Tuesday but when I didn't sleep on Wednesday...

 

How long has it been since you took melatonin? How much were you taking before? Even 0.25mg might help.

 

I hadn't taken anything in at least 3 weeks.  I took melatonin 2x -- first time I slept -- second time I didn't (felt kind of paradoxical).  Last night at some point when I was feeling anxious about not sleeping and work coming to greet me I took a 3mg pill (dissolvable) and took a bite out of the corner (tried to approximate .5mg or so).  No change in status. 

 

 The magic ingredient in Kavinace is phenibut, a gray-market drug related to benzos that can cause dependency and needs to be tapered. Up to you if you want to experiment.

 

Yes.  I've done my research on Phenibut and I've shied away to date.  I've considered trying it because if I had that one night a week and hydroxyzine one night a week, I could get enough sleep to carry the bad nights in between.  Very hesitant though because it feels kind of "unknown."

 

I'm having a hard time stabilizing.  I can only imagine it is the result of trying to cut from 25mg and accidentally increasing (bad math on conversion to liquid), then reducing back to 25mg and then cutting further once the mistake was corrected.  Now, I'm at 24mg all liquid and more symptomatic than I've been in the past (dp/dr, anxiety, insomnia, general shakiness).  I suppose it's probably a matter of time and consistency and keeping the CNS calm, but it's hard not to think things like "did switching to liquid cause this?"

 

It's also hard to assess anything because the entire last month has seen symptoms that may well be exacerbated by the insomnia.  It's hard not to react to those symptoms, but they may not be as "real" as they seem if and when sleep returns.

 

Frustrating because the switch to liquid was supposed to make things easier and it feels like it hasn't.  Probably just coincidence of timing as opposed to causation, but still frustrating.

 

Best,

 

Andy

[Altostrata]

Can you take part of a solid sertraline tablet and part liquid?

 

Trader Joe's has good sublingual 0.5mg melatonin. I buy Source Naturals sublingual 1mg tablets on the Web and cut them in half.

[apace41]

Can you take part of a solid sertraline tablet and part liquid?

 

If you recall, Alto, we worked out a transition from part tablet part liquid over a 3 week period, increasing the liquid and decreasing the tablet.

 

Are you suggesting I go back to part liquid part tablet to see if that helps?

[Altostrata]

Did the quality of your sleep decrease, increase, or stay the same when you made the transition to all-liquid?

[apace41]

Did the quality of your sleep decrease, increase, or stay the same when you made the transition to all-liquid?

 

On April 9 I was doing 1/2 dose on pill and 1/2 dose liquid.  I raised the issue at the time of the liquid/tablet because I was in the throes of 3 straight sleepless nights. With your guidance, I switched over to all liquid over the next two weeks as I reduced the tablet and increased the liquid.  My sleep was better over that two week period albeit rather choppy varying between up every other night with a decent night's sleep on the nights I slept and other periods of 5-6 hours of broken sleep with pee breaks inbetween.  I was on all liquid for several weeks before this latest bout of full on insomnia hit.

 

With regard to other symptoms, I've felt like I've been backsliding over the past several weeks, but it's very hard to parse out what is the result of withdrawal (i.e., the liquid v. the tablet) and what is the result of poor sleep.  Not sure what steps to take next, if any.  Just looking to stabilize so I can hold for a couple of months and right the ship.

 

Best,

 

Andy

[apace41]

Further update on the sleep situation:

 

Tried taking Kavinace (contains phenibut) last night as I would love to have something I could take every so often as needed instead of Hydroxyzine.  Mixed results.

 

Got into bed around 10:30 to read and thought I was getting tired.  Tried to sleep and was unsuccessful for the most part until around 1:30.  Got up and took my book into the other room and read for a bit longer.  Somewhere in the 2-2:30 range I fell asleep and slept until 6:15 or so.  Got around 4 hours.  Not clear if the supplement helped or if the exhaustion kicked in. 

 

I had HORRIBLE nocturia during the night but only while I was awake.  I went to the bathroom and as soon as I lay down again, I felt like I had to go again.  When I fell asleep I didn't have to get up and I have had no problems during the day.

 

Weird, weird, weird.

 

Best,

 

Andy

[Altostrata]

What time of day do you take sertraline? Any symptoms for several hours afterward?

 

Are you using the CPAP regularly?

[apace41]

What time of day do you take sertraline? Any symptoms for several hours afterward?

 

I have taken my dose of Sertraline, from the beginning, in the morning just before breakfast.  It's never varied.  Symptoms do not seem to be directly related to taking the Sertraline, however, I confess to not having studied that closely.  I take the med, have breakfast and then get in the car to drive to work.  From the time I take it until the time my workday starts is about 1.5 hours.  That is not typically high-stress time and while I don't notice a huge improvement, I also am usually not highly symptomatic.  I have had some times when I've had anxiety on the drive but that's not usual.

 

 

Are you using the CPAP regularly?

 

NO.  For the past month, since the sleeplessness first hit, I have been largely unable to use the CPAP.  The sense of having a mask on coupled with the anxiety/cortisol surge has made that difficult.  Last week, on Friday, after a couple of weeks of sleep improvement, I used the CPAP for the first time and was able to sleep 5 hours with it.  However, I woke with anxiety for the first time in a while.  That night I had more insomnia and stopped using it and have not used it since.  Anticipating the next logical question, I did not take careful notes to be able to determine if I was noticeably better after the CPAP usage.  It was a Saturday so it would ordinarily be lower stress and "better" in any event.  I do recall I did some gardening and that was okay.

 

Thanks, Alto.

 

Andy

[Altostrata]

Andy, I don't know what's going on. Could be your apnea is getting in the way, or you are having a paradoxical reaction from something you're taking to sleep.

 

It sounds to me like the sertraline is not causing the activation at night.

 

You might reduce the valerian again to see if that's involved. Or, split the dose of the sertraline, moving some later in the day. Maybe its influence will change whatever's causing the alerting at night.

[apace41]

Andy, I don't know what's going on. Could be your apnea is getting in the way, or you are having a paradoxical reaction from something you're taking to sleep.

 

Possible, but it started before I stopped using the machine.  In other words, I had a couple of bad days (but not complete non-sleep days) prior to the full-on insomnia.  It was only after the few bad days that I wound up stopping CPAP.  The only thing I was taking for sleep was the Valerian before any of this hit.  I take a couple of other things at that time, including Verapamil, a calcium channel blocker I take to prevent cluster headaches (which rival withdrawal and insomnia and are called "suicide" headaches).  I've considered the possibility of that being the source but I've taken that for 15 or more years without problem so the likelihood is remote. 

 

It sounds to me like the sertraline is not causing the activation at night.

 

I agree that it is not apparently the "direct" cause of the insomnia.  I've been wondering if I'm having some adverse reaction to it (A) generally or (B )fully in liquid form that might have triggered increased withdrawal the symptoms of which include insomnia?  Also not likely but I'm grasping at some straws.

 

You might reduce the valerian again to see if that's involved. Or, split the dose of the sertraline, moving some later in the day.

 

I just reduced the Valerian Monday by 10%.  Would you think going to 20% tonight would be okay or would you suggest waiting a few more days to make sure the 10% is not an issue?

 

I might try splitting the Sertraline into 2/3 in the AM and 1/3 at dinner time to see how that goes.  It's probably worth trying just to see if it changes anything. 

 

The hard part is figuring out whether what I'm feeling (other than sleep) is a function of withdrawal or simply lack of quality sleep.  Very confusing.

 

Thanks again,

 

Andy

[nz11]

Hi Andy

Sorry to read of your ongoing sleep issues.

Just to change the subject i note you have mentioned klonopin as being 20 times more potent than valium.

I too have mentioned this in posts. My source document for this is from Laurie Oakleys book 'Crazy and it was'  Laurie says it but doesnt give a reference. I was just wondering if there was a more official source for this that you know of.

[apace41]

Thanks, NZ.  Did much better last night.

 

Here is a link that shows equivalence of all benzos.

 

http://www.benzo.org.uk/bzequiv.htm

 

Hope that helps.

 

Best,

 

Andy