Any luck with sleep aides?

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I hate getting into bed early, knowing I have to wake up early, only to waste the next 2-3 (sometimes more) hours laying in bed and thinking about crap then getting angry that I'm still awake. I've tried tylenol PM and it worked but it left me very groggy the next morning. I know this will be important for the long hours of residency so I'm wondering if you guys have any sleep aide suggestions that don't leave you feeling groggy.

Originally Posted by SchroedingrsCat

I hate getting into bed early, knowing I have to wake up early, only to waste the next 2-3 (sometimes more) hours laying in bed and thinking about crap then getting angry that I'm still awake. I've tried tylenol PM and it worked but it left me very groggy the next morning. I know this will be important for the long hours of residency so I'm wondering if you guys have any sleep aide suggestions that don't leave you feeling groggy.

Try sleep hygiene first --
get up and go to bed at the same time daily.
Only use your bed for sleep and sex
Limit caffeine after 2pm (stays in your system for 12h)
Develop a sleep ritual
Get sunlight in the morning, and make your bedroom dark, quiet, comfortable.
Don't watch TV/computers/video games within 1-2 h of sleep (light and stimulation can keep you up)
If you don't fall asleep within 20minutes, get up and do something BORING
Only sleep when sleepy. That might mean sleep restricting yourself for a day to get yourself on schedule.
If you have an alarm clock next to your bed, turn it around. Reading requires you to be fully awake (even the #'s on a clock), and the frustration of knowing the time only worsens insomnia.

Sleep aids work temporarily, but use daily always runs risk of tolerance, escalation, and worsening insomnia. From benadryl (in tyl PM) to benzo's to z-hypnotics.

Pass this on to your patients

Run at around 6pm a mile or two, I run w Golan audio so I can justify to myself running at prime study time. When u get home shower and eat. Sit and study with chamomile tea for another two hours, and half hour before u want to be asleep take melatonin pills. The combo works great.

read histology

5-HTP works for me but I get intense dreams.

there's a huge thread on this somewhere.

but yeah...melatonin works pretty well for most people. you don't build a tolerance to it. A dose of around 0.3 - 1mg is most effective.

Originally Posted by betsywetsy

Nice. I was thinking the exact same thing lol. Has always worked for me!

Originally Posted by nitemagi

Try sleep hygiene first --
get up and go to bed at the same time daily.
Only use your bed for sleep and sex
Limit caffeine after 2pm (stays in your system for 12h)
Develop a sleep ritual
Get sunlight in the morning, and make your bedroom dark, quiet, comfortable.
Don't watch TV/computers/video games within 1-2 h of sleep (light and stimulation can keep you up)
If you don't fall asleep within 20minutes, get up and do something BORING
Only sleep when sleepy. That might mean sleep restricting yourself for a day to get yourself on schedule.
If you have an alarm clock next to your bed, turn it around. Reading requires you to be fully awake (even the #'s on a clock), and the frustration of knowing the time only worsens insomnia.

Sleep aids work temporarily, but use daily always runs risk of tolerance, escalation, and worsening insomnia. From benadryl (in tyl PM) to benzo's to z-hypnotics.

Pass this on to your patients

First, this...and not just as attending suck-up, but coming from a life-long insomniac, strict adherence to sleep hygiene (and you have to be strict about it) gets me about 60% there.

For me, AND ONLY FOR ME PERSONALLY, NOT MEDICAL ADVICE, my list of increasing measures:
-hygiene as above
-800mg magnesium (cannot emphasize how awesome this has worked for me)
-melatonin
-diphenhydramine (dirt cheap, and I am not fond of using it chronically, but dang it, it really helps)
-the demon Zolpidem (hate the stuff, hate the psychoactive effects, but can mean the difference between functioning in life and not)

Really, really focusing on the sleep hygiene has gotten me a good amount of mileage (again, only when I got very serious about applying it fully and consistently). My goal is to keep at it and get as close to 100% drug-free sleep as possible.

^ This post, and the post that was quoted.

I had big insomnia problems in college; sometimes I would sleep like 4-5 hours in a 72 hour period (I know, get used to it for residency blah blah), and I eventually got a prescription for zolpidem which gave me the glorious gift of sleep. With it I also saw my ceiling turn into ocean waves and generally freaked my girlfriend out by acting so weird, so it wasn't ideal.

Now in medical school, my schedule is much more regulated and my sleep hygiene has gotten much better. I rarely have major sleep problems now, although I don't think I get the wonderful deep sleep a lot of people seem to get.

An ounce of Glenmorangie does it for me.

Ambien works really well for me. I'm scared to use it often though.

Originally Posted by SchroedingrsCat

I hate getting into bed early, knowing I have to wake up early, only to waste the next 2-3 (sometimes more) hours laying in bed and thinking about crap then getting angry that I'm still awake. I've tried tylenol PM and it worked but it left me very groggy the next morning. I know this will be important for the long hours of residency so I'm wondering if you guys have any sleep aide suggestions that don't leave you feeling groggy.

Caffinate to stay awake during the day (this will be particularly useful thrid year).

If you're still high on caffeine, you gotta come down some how. I recommend whiskey.

Then you realize you are becomining dependent on alcohol for sleep. You think to yourself that while this is not a CAGE criteria, it might not be the best for you. So you switch to some trazzies (trazodone for people who don't speak the lingo).

Don't do benadryl. It just makes you groggy and hung over the next morning. It works, being the "PM" ingredient in anything that says PM. It makes your drowsy, thats all.

If you need a short burst of sleep, Vicodin does a good job, but those are hard to come by unless you have a resident friend who doesn't mind crowding their DEA# with some slightly sketchy scripts.

Ultimately, you could try the Benzos, both straight up benzos and the BZ1s like Lunesta. They get you groggy, cause sleep walking, have horrendous dependence issues, and you get the same effect with a shot of liqour. While drinking every night may be frowned upon socially, being a wackadoo who needs a benzo every night is way worse.

Oh, and sleep hygeine (i.e. dont do caffeine to go up then whiskey to come down)

Originally Posted by OveractiveBrain

Caffinate to stay awake during the day (this will be particularly useful thrid year).

If you're still high on caffeine, you gotta come down some how. I recommend whiskey.

Then you realize you are becomining dependent on alcohol for sleep. You think to yourself that while this is not a CAGE criteria, it might not be the best for you. So you switch to some trazzies (trazodone for people who don't speak the lingo).

Don't do benadryl. It just makes you groggy and hung over the next morning. It works, being the "PM" ingredient in anything that says PM. It makes your drowsy, thats all.

If you need a short burst of sleep, Vicodin does a good job, but those are hard to come by unless you have a resident friend who doesn't mind crowding their DEA# with some slightly sketchy scripts.

Ultimately, you could try the Benzos, both straight up benzos and the BZ1s like Lunesta. They get you groggy, cause sleep walking, have horrendous dependence issues, and you get the same effect with a shot of liqour. While drinking every night may be frowned upon socially, being a wackadoo who needs a benzo every night is way worse.

Oh, and sleep hygeine (i.e. dont do caffeine to go up then whiskey to come down)

Oh, also, dont do Cocaine.

I have not taken my zolpidem for four nights...my wife mentioned this morning that I did not snore all night, and was much less "restless."

We all know what those symptoms point to (especially in a obese adult male with an 18" neck and HTN). I've dodged the polysomnogram thus far (pure denial on my part, as I know CPAP will be close behind). If chronic zolp use is actually behind my those issues (I'm dropping weight too, alas) that would be a sweet thing to learn, as the Mg is really making my sleep better.

Insomnia sucks, whining about it sucks more. I feel like a fibro patient when I hear myself saying "waaah, I can't function without my Ambien, waaah."

I've had terrible nightmares with Benedryl.

zolpidem

I was always against taking drugs, etc for sleep but as a few people have mentioned, Melatonin does the job quite nicely and definitely no addictive effects or any side effects. Only used it a couple of times in the past month, but it definitely helps when I'm too anxious and it's keeping me up.

Yah zolpidem really works for me. THe problem is getting my PMD to continue to prescribe it long term.

Z drugs and benzos = no good IMO. I have taken a benzo a few times to sleep, woke up groggy even after a solid 8-9 hours uninterrupted. I know they both interfere with sleep architecture, not sure to what extent, however. Maybe Dr. Rack can comment.

Zolpidem is my absolute fav. I fall asleep so fast and wake up refreshed.

My personal combo is 100mg 5-HTP + 6mg melatonin. If I know that I really need to get to sleep and I'm not even a little tired, I'll add 25mg diphenhydramine.

Used to have a magnesium/zinc supplement, too, but I ran out and haven't bought more

Originally Posted by MediCynical

My personal combo is 100mg 5-HTP + 6mg melatonin. If I know that I really need to get to sleep and I'm not even a little tired, I'll add 25mg diphenhydramine.

Used to have a magnesium/zinc supplement, too, but I ran out and haven't bought more

Yah sometimes I pop a M&M

kidding

Originally Posted by OveractiveBrain

Caffinate to stay awake during the day (this will be particularly useful thrid year).

If you're still high on caffeine, you gotta come down some how. I recommend whiskey.

Then you realize you are becomining dependent on alcohol for sleep. You think to yourself that while this is not a CAGE criteria, it might not be the best for you. So you switch to some trazzies (trazodone for people who don't speak the lingo).

No joke, I had that EXACT same thought about alcohol the other day. I drink pretty unhealthy amounts of caffeine during the day, but try to stop ~6-7 hours before sleep time. During test weeks I was drinking~two beers a night, or 2-3 shots of jack,jim, or bulliet with non-caffeinated coke. Then it dawned on me, this is probably what alcoholics do.

So, I'll stop during alcohol for a few weeks, then I'll start back up during the next test week.... I can stop it, I'm not an alky, right?!?

Also, I think I am a slow metabolizer of benadryl. If I even take half a pill, it knocks me the eff out. I am talking about being nearly comatose and needing~12-13 hours of sleep for it to wear off. My girlfriend can eat two and wake up just fine, doesn't faze her at all. So, I can't use that.

Melatonin for me didn't really work. However, someone told me you have to build it up in your system and I didn't really do that. So try taking it every night and maybe after awhile it will work?

Originally Posted by FunnyCurrent

Yah zolpidem really works for me. THe problem is getting my PMD to continue to prescribe it long term.

.... It's an abused drug, no wonder. I sometimes volunteer at our addiction clinic. normally a guy or two in there (out of ~15) abusing zolpidem. They have all kinds of trouble, lack of a sleep schedule really messes with them when coming down.....

Sleep hygiene for the win.

Originally Posted by cbrons

Z drugs and benzos = no good IMO. I have taken a benzo a few times to sleep, woke up groggy even after a solid 8-9 hours uninterrupted. I know they both interfere with sleep architecture, not sure to what extent, however. Maybe Dr. Rack can comment.

Dr. Rack can hopefully back me up on this, but benzos depress slow wave sleep and decrease the quality of sleep.

Rozerem is probably the least "addictive", followed by Sonata. They are also on the weaker side of sleep aids.

Melatonin has a powerful placebo effect and studies suggest it is effective when taken approximately 6 hours before the desired bedtime to "reset" your sleep cycle. Taking it right before bed is scientifically useless.

The finding that melatonin had an effect on sleep onset latency, but not on sleep efficiency, in people with primary sleep disorders supports the hypothesis that melatonin exerts its effects on this population by acting as a phase re-setter rather than as a hypnotic.

http://www.ahrq.gov/clinic/epcsums/melatsum.htm

Originally Posted by painmd87

Dr. Rack can hopefully back me up on this, but benzos depress slow wave sleep and decrease the quality of sleep.

Rozerem is probably the least "addictive", followed by Sonata. They are also on the weaker side of sleep aids.

Melatonin has a powerful placebo effect and studies suggest it is effective when taken approximately 6 hours before the desired bedtime to "reset" your sleep cycle. Taking it right before bed is scientifically useless.


http://www.ahrq.gov/clinic/epcsums/melatsum.htm

More than that, though, I worry about the long-term effects of protracted benzodiazepine usage especially for people who take it nightly. Tolerance develops pretty quick and the eventual withdrawal from even moderate doses can be a really awful experience according to everything I've read. Still I find it amazing that primary care physicians will prescribe an mg of Ativan or half an mg of Xanax at the drop of the hat to someone with insomnia.

Originally Posted by MediCynical

My personal combo is 100mg 5-HTP + 6mg melatonin. If I know that I really need to get to sleep and I'm not even a little tired, I'll add 25mg diphenhydramine.

Used to have a magnesium/zinc supplement, too, but I ran out and haven't bought more

I've had to separate the magnesium from the zinc...turns out the zinc was stimulative for me. The Mg (for me) has proved to be excellent.

Originally Posted by cbrons

More than that, though, I worry about the long-term effects of protracted benzodiazepine usage especially for people who take it nightly. Tolerance develops pretty quick and the eventual withdrawal from even moderate doses can be a really awful experience according to everything I've read. Still I find it amazing that primary care physicians will prescribe an mg of Ativan or half an mg of Xanax at the drop of the hat to someone with insomnia.

I concur. I think those drugs have a role in very short-term usage, if nothing else than to relieve the stress around not being able to fall asleep. The analogy with treatment of chronic pain is apparent to me; small, limited use of low-dose opioids may seem ok as a very temporary bridge to better measures, but all too easily become long-term crutches.