Is there a role for Xyrem in refractory insomnia?

[Manicsleep]

---

Members don't see this ad.

Um, no.

Is this a real question?

Anyone who did this must have very little exposure to substance abusing populations. And is well on their way to a medical board ding.

It had to be a joke.
You can make an excuse and say you are treating the pain or something else which is in turn leading to secondary insomnia.

 

[nitemagi]

It had to be a joke.
You can make an excuse and say you are treating the pain or something else which is in turn leading to secondary insomnia.

I already see enough people who are escalating their own doses of seroquel to the 6-800mg range chasing insomnia and tolerance to antihistamine effects. The last thing I need is to step into chasing insomnia AND pain with ever-increasing doses of meds, especially controlled substances.

Coincidentally, the Arch Int Med has an editorial related to this (overuse of chronic opioids, particularly in chronic pain), from some UCSF internists:
http://archinte.ama-assn.org/cgi/content/extract/171/16/1426?etoc

 

[BobA]

What's the dose of melatonin? Consider going above max on this before adding Xyrem.

Also, a sleep study can pick up all kinds of things besides OSA. For instance, one could get a sense of how accurate his self reports of only sleeping x hrs/night are.

Did you ever mention CBT-I? That's the gold-standard according to the guidelines: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576317/

 

[nitemagi]

What's the dose of melatonin? Consider going above max on this before adding Xyrem.

Also, a sleep study can pick up all kinds of things besides OSA. For instance, one could get a sense of how accurate his self reports of only sleeping x hrs/night are.

Did you ever mention CBT-I? That's the gold-standard according to the guidelines: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576317/

Be cautious though of abuse of melatonin. Runs risk of bleeding problems, especially at higher doses. Had a guy taking 45+ mg/day (over 10x recommended dose).

 

[ghost dog]

I already see enough people who are escalating their own doses of seroquel to the 6-800mg range chasing insomnia and tolerance to antihistamine effects. The last thing I need is to step into chasing insomnia AND pain with ever-increasing doses of meds, especially controlled substances.

Coincidentally, the Arch Int Med has an editorial related to this (overuse of chronic opioids, particularly in chronic pain), from some UCSF internists:
http://archinte.ama-assn.org/cgi/content/extract/171/16/1426?etoc

Couldn't agree more.

A mood disorder is a risk factor for misuse / abuse of opioids (potent modulator of mood).

Opioids are a very poor choice for hypnotics; chronic use? Nooooooo.

But then again, I'm very much against chronic benzo use.

 

[ghost dog]

This (elderly) patient reports on average 3 hours of sleep in 24 hours, with difficult onset and fragmentation. They do in fact have MDD (with anxiety) which is in partial remission. Notably their mood and anxiety symptoms are the best they've been in decades. Aside from the (chronic) insomnia, only mild mood and anxiety symptoms persist.

I would be worried about all the same sort of issues associated with a trial of benzos in regards to scripting Xyrem and the elderly - falls, head trauma / related hip fractures.

This sounds risky - both medically and medicolegally (i.e. insomnia is not an approved indication for Xyrem).

If something untoward happens, there could be trouble.

 

[Majesty]

Maybe you should turf it to a sleep specialist. Doesn't look like things are going well. Or even a psychiatrist who is more comfortable with sleep and sees it as part of day-to-day practice.

I got a warning for this post. Apparently its inflammatory to advise someone to consult sleep medicine when they have no interest in the subject, believe they have tried everything and the patient continues to suffer.

 

[Technotronic]

🙂

I am on probationary status.
I have asked them how to deactivate my account.
I have gone back and deleted most of my posts.

Someone is on a power trip. Someone doesn't realize I don't care. I am not going to be nasty. I just want out with permanent removal.

 

[BobA]

Be cautious though of abuse of melatonin. Runs risk of bleeding problems, especially at higher doses. Had a guy taking 45+ mg/day (over 10x recommended dose).

Abusing Melatonin? I thought they had better sh%t in Cali.

Seriously, though - That's wild. I'm just saying compared to Xyrem, 12mg of melatonin might be preferable.

 

[Majesty]

🙂

I am on probationary status.
I have asked them how to deactivate my account.
I have gone back and deleted most of my posts.

Someone is on a power trip. Someone doesn't realize I don't care. I am not going to be nasty. I just want out with permanent removal.

Lemme grab manic and have him exorcised. That should take you off the forum.

 

[billypilgrim37]

A long time ago I wondered if Majesty and Manic were the same, but Majesty sorta disappeared. Technotronic never really said anything of consequence, so I never really cared.

At least we don't think Manic was Wall Street!

 

[nitemagi]

Abusing Melatonin? I thought they had better sh%t in Cali.

Seriously, though - That's wild. I'm just saying compared to Xyrem, 12mg of melatonin might be preferable.

It's a funny subpopulation - patients that want "natural" drugs, but don't really know anything about therapeutic indexes or windows, safety parameters, or side effects. So they use (and abuse) what they want when they want. In this case it was melatonin. If 1 doesn't work well enough or long enough, maybe 10 will...

Had another guy that hired farmers to grow his own herbal supplies and would make his own "tinctures." A mix of 4 or 5 different herbals, and he was a mess of an anxiety case when he walked in the door.

 

[firedoor]

A long time ago I wondered if Majesty and Manic were the same, but Majesty sorta disappeared. Technotronic never really said anything of consequence, so I never really cared.

At least we don't think Manic was Wallstreet!

I also suspect that Manicsleep is Majesty (we already know that Manic is technotronic). The same derogatory tone with an axe to grind with me on any sleep-related issues, presumably because I commented that sleep disorders (and I mean primary sleep disorders such as narcolepsy) should not be included in the DSM-5 (not that psychiatrists shouldn't treat sleep problems, but that's besides the point). That really sent Manic~Majesty~technotronic into a tizzy.

 

[pingouin]

This thread is going nowhere fast. Closing.