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somnomania: wondering about tapering


somnomania

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Hello all. I'm mostly here because I have this question, and the only reason I'm really asking the internet community instead of my prescribing doctors is that 1) I have chronic insomnia and often am not awake during business hours and 2) I avoid phone calls whenever possible (the only manifestion of anxiety I ever have). Obviously if people here think I would be better off consulting my doctors, I will, but I've gotten this far without getting specific instructions from them.

 

Here's my problem: I build up a tolerance to the prescription meds I take to keep me asleep, over 1-2 months. You can see the meds in my signature as well, but they're amitriptyline and trazodone. Thusfar I've been using half doses to taper, and I generally do 2-3 days off the one and 2-3 days onto the other, when I make the switch. No negative effects at all from doing it that way, apart from the fact that the inadequate doses mean I get 4-6 nights of even worse sleep. Obviously I'd like to minimize the amount of poor sleep, so I'm wondering if I need to taper at all, or perhaps just taper off the one and then start the full dose of the other.

 

It's kind of funny, I'm a member on another forum, one that originates in the UK, where they still use amitriptyline as an antidepressant primarily, and for sleep as a secondary function. I see all these people there going "oh I had such a bad reaction to it" and "it gave me nightmares" and "I had to drop down to the next dosage because of the side effects", and they're all on 10-25mg of it. I take 150mg, and the only negatives of it that I've had have been that I do build up the tolerance to it, and that sometimes it just doesn't engage properly and I end up sleepless anyway.

Ehlers-Danlos Syndrome (hypermobile/type 3), fibromyalgia, depression, chronic insomnia. Sertraline (generic of Zoloft) 200mg/day for 10+ years. Currently alternating between amitriptyline (150mg) and trazodone (50mg) for the insomnia because I build up a tolerance to each of them after a month or so, at which point I switch to the one I'm not already taking.

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  • Moderator Emeritus

Hi somnomania , welcome to the site.    You've landed in the right place , but with your unique situation I'm

going to ask a few more questions , then ask the more experienced moderators to advise you.

 

Are you still taking sertraline 200mg a day?

 

How many years have you been taking trazodone and amitryptaline  for?  

 

Obviously your system hasn't been terribly successful if you still have insomnia. No one here will suggest you're

better off asking a doctor , because the advice they give will be flippant and uninformed and may not be in your best

interest.

 

Please click FOLLOW at the top right , and you'll receive an email each time someone posts here.

 

Best wishes ,  Fresh

1987-1997 pertofran , prothiaden , Prozac 1997-2002 Zoloft 2002-2004 effexor 2004-2010 Lexapro 40mg

2010-2012Cymbalta 120mg

Sept. 2012 -decreased 90mg in 6months. Care taken over by Dr Lucire in March 2013 , decreased last 30mg at 2mg per week over 3 months. July 21 , 2013- last dose of Cymbalta

Protracted withdrawal syndrome kicked in badly Jan.2014 Unrelenting akathisia until May 2014. Voluntary hosp. admission. Cocktail of Seroquel, Ativan and mirtazapine and I was well enough to go home after 14 days. Stopped all hosp. meds in next few months.

July 2014 felt v.depressed - couldn't stop crying. Started pristiq 50mg. Felt improvement within days and continued to improve, so stayed on 50mg for 8 months.

Began taper 28 Feb. 2015. Pristiq 50mg down to 45mg. Had one month of w/d symptoms. Started CES therapy in March. No w/d symptoms down to 30mg.

October 2015 , taking 25mg Pristiq. Capsules compounded with slow-release additive.

March 2016 , 21mg

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  • Administrator

Welcome, somnomania.

 

Do you sleep during the day? How long has that been going on?

 

Has anyone suggested to you that your sleep cycle has moved from night to day? Are you familiar with the concepts of "sleep hygiene"? See Important topics about symptoms, including sleep problems

 

What we see here is that going on and off neuroactive drugs can cause the nervous system to be sensitized so that the drugs no longer have the intended effect. It could be this applies to you.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Thanks for the replies.

 

@Fresh, yes, I'm still taking sertraline at that dose. The amitriptyline I've been taking for about three years, and the trazodone was introduced only about a year ago (I think; don't quote me on any of that, my memory isn't great). And I beg to disagree about doctors, but I also admit that I've been very lucky to find excellent doctors close to me, who actually listen to me. I wouldn't have gotten my EDS diagnosis without my rheumatologist.

 

@Altostrata, I sleep at all times. If you're interested, I was tracking my sleep/wake times through the fall (and I'm back to tracking them but haven't put them into anything like this). As you can see, the quantity of sleep and the times when I sleep are all over the place; the only pattern is that there IS no pattern. I did a sleep study several years ago, before the insomnia was this bad, and it found that the amount of time I spent in stage 1 sleep (dozing) and in stage 4 sleep (REM/deep sleep) were flipped from what they should have been. At this point, I doubt I would be able to do an out of the house sleep study. I need to discuss the option with my doctor of getting the equipment to do one at home. As for sleep hygiene, I've tried it. My insomnia is just too severe and affected by too many uncontrollable outside factors (noise, humidity, barometric pressure changes, etc.), and all most of the hygiene does is make me unhappy, and often deprive me of sleep. All I really do, and my therapist (who I'm very close to) agrees, is sleep when I feel like I can/when I need to. I take 6+ hour "naps". My record for hours slept in one sitting (and I wasn't even sick or anything at the time) is 19 hours. I can sleep 14 hours and go to sleep again five hours after I get up. There's no routine, no average, nothing. The times when I just don't feel like going to sleep, I don't, and I don't take my sleep meds those times because the trazodone especially makes me feel sick if I take it and then don't go to sleep. Those times, I usually tough it out through the day and end up going to sleep a little early for me (so before 3am), after being awake 24+ hours.

 

I'm settled in for the long haul with the insomnia; I'm not expecting it to ever be "cured", because the conditions I have that the insomnia stems from will never be cured, only managed (unless science comes up with something amazing in the future).

Ehlers-Danlos Syndrome (hypermobile/type 3), fibromyalgia, depression, chronic insomnia. Sertraline (generic of Zoloft) 200mg/day for 10+ years. Currently alternating between amitriptyline (150mg) and trazodone (50mg) for the insomnia because I build up a tolerance to each of them after a month or so, at which point I switch to the one I'm not already taking.

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  • 2 weeks later...

Did I scare everyone away with my ludicrous sleep patterns?  :P

Ehlers-Danlos Syndrome (hypermobile/type 3), fibromyalgia, depression, chronic insomnia. Sertraline (generic of Zoloft) 200mg/day for 10+ years. Currently alternating between amitriptyline (150mg) and trazodone (50mg) for the insomnia because I build up a tolerance to each of them after a month or so, at which point I switch to the one I'm not already taking.

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  • Moderator Emeritus

You seem to be very happy with your doctors , yet the drugs you are taking have serious adverse interactions , try putting them into the Interaction Checker at  www.drugs.com .

 

Major

amitriptyline  trazodone

 

Major

amitriptyline  sertraline

 

Major

trazodone  sertraline

 

 

I'd be inclined to  begin to taper sertraline , as that's the activating one that is likely causing the insomnia.

 

See  

Taking multiple psych drugs? Which drug to taper first?

 

See also

  

Why taper by 10% of my dosage?

and

Tips for tapering off Zoloft (sertraline)

 

You write:

"I'm settled in for the long haul with the insomnia; I'm not expecting it to ever be "cured", because the conditions I have that the insomnia stems from will never be cured, only managed (unless science comes up with something amazing in the future)."

 

If your attitude is one of total acceptance , you may never improve.

 

Once you appreciate that your drugs are your problem , and the insomnia / chronic sedation is a symptom , you can choose to see how much you can recover by minimizing the neuroactives.

1987-1997 pertofran , prothiaden , Prozac 1997-2002 Zoloft 2002-2004 effexor 2004-2010 Lexapro 40mg

2010-2012Cymbalta 120mg

Sept. 2012 -decreased 90mg in 6months. Care taken over by Dr Lucire in March 2013 , decreased last 30mg at 2mg per week over 3 months. July 21 , 2013- last dose of Cymbalta

Protracted withdrawal syndrome kicked in badly Jan.2014 Unrelenting akathisia until May 2014. Voluntary hosp. admission. Cocktail of Seroquel, Ativan and mirtazapine and I was well enough to go home after 14 days. Stopped all hosp. meds in next few months.

July 2014 felt v.depressed - couldn't stop crying. Started pristiq 50mg. Felt improvement within days and continued to improve, so stayed on 50mg for 8 months.

Began taper 28 Feb. 2015. Pristiq 50mg down to 45mg. Had one month of w/d symptoms. Started CES therapy in March. No w/d symptoms down to 30mg.

October 2015 , taking 25mg Pristiq. Capsules compounded with slow-release additive.

March 2016 , 21mg

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Given that two different doctors and a prescribing psychiatrist have all cleared and been made aware of the things I'm taking and how they interact, I'm inclined to trust them. Additionally, I don't take the amitriptyline and the trazodone at the same time, unless the interaction thing was just to cover the period of time while switching that they would both be present in my system. The major interactions for the sertraline and each of the other two are just for serotonin syndrome, which I'm aware of and don't have any symptoms of.

 

I've been on the sertraline for a very long time, and have not felt good the previous times I attempted to taper off of it. And I doubt that it's the cause of the insomnia; I have chronic pain from being hypermobile and also having fibromyalgia, which has been scientifically shown to have aberrant brain waves that keep deep sleep from occurring. Nothing will fix that except for medication. That's the only "total acceptance" that I have for my condition, which, as I said, is not something that can be cured or fixed, because Ehlers-Danlos Syndrome is a genetic condition that involves faulty collagen production in the body. Until someone finds a way to fix the mutated gene, I'm going to continue to have chronic pain and chronic fatigue. In the meantime, I'm managing those things with medication and routine chiropractor visits. I didn't come here because I want to get off the drugs; I came here wondering what sort of schedule I should be on when I need to switch from the one sleep med to the other. I do have a desire, at some point in the future, to perhaps try coming off the sertraline again, more slowly this time, but several other aspects of my life would need to change for me to be comfortable with that. If no one here can actually advise me about my initial question, then I'm through here, and I'll just pull it together and call my rheumatologist and ask him.

Ehlers-Danlos Syndrome (hypermobile/type 3), fibromyalgia, depression, chronic insomnia. Sertraline (generic of Zoloft) 200mg/day for 10+ years. Currently alternating between amitriptyline (150mg) and trazodone (50mg) for the insomnia because I build up a tolerance to each of them after a month or so, at which point I switch to the one I'm not already taking.

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  • Moderator Emeritus

We cannot advise you.

 

This site does not support your method of drug use.

" I didn't come here because I want to get off the drugs; I came here wondering what sort of schedule

I should be on when I need to switch from the one sleep med to the other."

 

This is a site for helping people come off antidepressants safely.

1987-1997 pertofran , prothiaden , Prozac 1997-2002 Zoloft 2002-2004 effexor 2004-2010 Lexapro 40mg

2010-2012Cymbalta 120mg

Sept. 2012 -decreased 90mg in 6months. Care taken over by Dr Lucire in March 2013 , decreased last 30mg at 2mg per week over 3 months. July 21 , 2013- last dose of Cymbalta

Protracted withdrawal syndrome kicked in badly Jan.2014 Unrelenting akathisia until May 2014. Voluntary hosp. admission. Cocktail of Seroquel, Ativan and mirtazapine and I was well enough to go home after 14 days. Stopped all hosp. meds in next few months.

July 2014 felt v.depressed - couldn't stop crying. Started pristiq 50mg. Felt improvement within days and continued to improve, so stayed on 50mg for 8 months.

Began taper 28 Feb. 2015. Pristiq 50mg down to 45mg. Had one month of w/d symptoms. Started CES therapy in March. No w/d symptoms down to 30mg.

October 2015 , taking 25mg Pristiq. Capsules compounded with slow-release additive.

March 2016 , 21mg

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Well, I guess I appreciate the effort, in that case. I would think the "surviving" part of the site name would cover discussion about how to safely remain on antidepressants when they're truly necessary, but apparently not. Perhaps that should be clarified in the Read This First subforum.

Ehlers-Danlos Syndrome (hypermobile/type 3), fibromyalgia, depression, chronic insomnia. Sertraline (generic of Zoloft) 200mg/day for 10+ years. Currently alternating between amitriptyline (150mg) and trazodone (50mg) for the insomnia because I build up a tolerance to each of them after a month or so, at which point I switch to the one I'm not already taking.

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  • Moderator Emeritus

I'm sorry you misunderstood the purpose of this site somomania, I can understand how the name could lead to some confusion. But this is actually explained in one of the topics in the Read This First subforum:

What will get you warned or banned

- Drug shopping or recommending drugs
This is a site for going off drugs. It is not a site for finding out what drug to take next, comparing drug cocktails, or recommending what drug to add. This could be dangerous. People could be hurt by your advice.
 
(We do not know of any drugs or drug combination that will fix withdrawal syndrome. Reinstatement of the original drug, often at a low dose, sometimes helps and sometimes does not.)
 
If you want to discuss your diagnoses and talk about adding to your drug cocktail, there are other support sites for this, such as http://depression.com or http://PatientsLikeMe.com.

 

I hope you're able to find the kind of advice you need, please come back in the future if you would like some help with tapering any of your medications safely.

I'm not a doctor.  My comments are not medical advise. These are my opinions based on my own experience and what I've learned. Please discuss your situation with a medical practitioner who has knowledge of tapering and withdrawal...if you are lucky enough to find one.

My Introduction Thread

Full Drug and Withdrawal History

Brief Summary

Several SSRIs for 13 years starting 1997 (for mild to moderate partly situational anxiety) Xanax PRN ~ Various other drugs over the years for side effects

2 month 'taper' off Lexapro 2010

Short acute withdrawal, followed by 2 -3 months of improvement then delayed protracted withdrawal

DX ADHD followed by several years of stimulants and other drugs trying to manage increasing symptoms

Failed reinstatement of Lexapro and trial of Prozac (became suicidal)

May 2013 Found SA, learned about withdrawal, stopped taking drugs...healing begins.

Protracted withdrawal, with a very sensitized nervous system, slowly recovering as time passes

Supplements which have helped: Vitamin C, Magnesium, Taurine

Bad reactions: Many supplements but mostly fish oil and Vitamin D

June 2016 - Started daily juicing, mostly vegetables and lots of greens.

Aug 2016 - Oct 2016 Best window ever, felt almost completely recovered

Oct 2016 -Symptoms returned - bad days and less bad days.

April 2018 - No windows, but significant improvement, it feels like permanent full recovery is close.

VIDEO: Where did the chemical imbalance theory come from?



VIDEO: How are psychiatric diagnoses made?



VIDEO: Why do psychiatric drugs have withdrawal syndromes?



VIDEO: Can psychiatric drugs cause long-lasting negative effects?

VIDEO: Dr. Claire Weekes

 

 

 

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