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 Post subject: Out of control insomnia
PostPosted: Wed Nov 23, 2011 12:16 am 
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I helped my dad do a really slow taper off suboxone and he was very active and comfortable the entire time. His only challenge was insomnia and so went on a low dose of 10mg amitriptelene the last 3 mos. He took his last subox dose on oct. 8th and 10 days later his insomnia started getting worse and a month out he stopped taking his flexural and amitriptelene CT without telling anyone.

Now he's at day 16 of virtually no sleep, I'm not exaggerating he looks really bad and I'm scared. He's been to three different dr's and all they did was put him on: nortriptelene 25mg and it didn't put him to sleep, clonodine and same results, zamaflex and voltaren for pain. He is adamant not to go back to anything that will cause dependence, but I'm fearing that going day after day with little naps that amount to 1-2 hrs sleep a day that he's fading fast. Benadryl and melatonin won't work, or even pot cookies.

Can anyone help advise? I'm so drried about him. Lori

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Lori writing on behalf of my dad

Previously taking Hydrocodone 10's (3-4 per day) then switched to methadone for about 5 mos. Cut down a bit, then dr. switched him to suboxone. Done with suboxone on oct. 8, 2011 after @6 mos.


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PostPosted: Wed Nov 23, 2011 2:43 am 
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It seems a really difficult situation for you and your father. His commitment to staying off narcotics including Suboxone is really admirable too, and IMO it's something that should be supported.

It sounds like he's in pain to some degree. While insomnia is a symptom of PAWS, in my experience it doesn't get this severe. If the insomnia was related to the buprenorphine withdrawals, it really should be getting better, not worse over time.

Is it possible he's still going through some kind of pain, and that's what's preventing him getting decent sleep? He sounds really resilient, and determined. But that combination of medications would knock most people flat, so there must be something that's stopping him from being comfortable in bed.

Are you finding he's edgy / racy when he's awake? Is he keeping active? What non-medical ways have you experimented with? The best thing I've found is being active, walking / jogging / bike riding, physical labor etc. A nice bath / shower before bed, reading a book, a meditation / relaxation CD to listen to in bed etc. Also cutting out all caffeine and marijuana is a must, I can't stress that enough. Marijuana, while making people drowsy, actually messes with sleep cycles, and people wake up much less rested if they go to sleep stoned.


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PostPosted: Wed Nov 23, 2011 7:32 am 
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So he's only been off sub for about a month now? I don't think the sleep difficulties a month away from sub is that unusual. Most people get some kind of a sleep aid and often are still taking it a month out.

Has he tried Trazodone? It's an older, atypical antidepressant that's almost primarily used off-label these days for sleep. It's NOT addictive and it works quite well. I've used it for a while now and I'm pretty sure a few others on this site have too.

Going without sleep for this long can really mess with someone. He needs to get some sleep. I hope he's willing to try something, if not Trazodone then maybe something else another member will come along and suggest.

Good luck. Let us know how he's doing.

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PostPosted: Wed Nov 23, 2011 8:58 am 
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Tear and Hat,
Thanks so much for your thoughts, I am going to try to get him in to see our pain mgmt. dr. asap and will ask about Trazadone and i was wondering about Cymbalta or Wellbutrin as another alternative. What do you think about Ambien? I know he needs to try one at a time, just want to leave with more than one possibility as this dr. is not participating with my dads insurance.

Dad is very jittery, nervous, depressed and no exercise at all. He can barely walk at this point. I know how important a positive mind set is as i have been through an awful withdrawal myself. Just can't get him to that happy place, he's a "glass half empty" kind of guy. Not used to being out of control and so he feels hopeless.

He did go on opiates for pain issue due to knee replacement and i believe he has extensive muscle damage from long term statin use, which he's off now. Will keep you posted and thanks loads for your concern.

Lori

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Lori writing on behalf of my dad

Previously taking Hydrocodone 10's (3-4 per day) then switched to methadone for about 5 mos. Cut down a bit, then dr. switched him to suboxone. Done with suboxone on oct. 8, 2011 after @6 mos.


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PostPosted: Wed Nov 23, 2011 9:01 am 
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Ambien is a good sleep med, but I believe it is habit-forming. It also metabolizes (or something like that) as a benzo. I used to take Ambien and it worked great, but I recall getting used to it quickly and having to up my dose faster than I was comfortable doing. In my non-professional opinion, I'd try the Trazodone before Ambien, if only because it's habit-forming.

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-I'm only responsible for what I say, not for what you understand.


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 Post subject: out of control Insomnia
PostPosted: Wed Nov 23, 2011 9:23 am 
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Ok Hat, will avoid ambien, thanks

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Lori writing on behalf of my dad

Previously taking Hydrocodone 10's (3-4 per day) then switched to methadone for about 5 mos. Cut down a bit, then dr. switched him to suboxone. Done with suboxone on oct. 8, 2011 after @6 mos.


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PostPosted: Wed Nov 23, 2011 10:33 am 
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Make sure you get the okay from your doc re medication changes. There's a lot of potential interactions with the meds he's already on, which would likely limit what medications he can take.

Hat's right about the merits of avoiding benzos.

Is he doing any kind of physiotherapy / mild exercise to assist with the muscle growth? It may be worth seeing a physio at least once, and learn some appropriate exercises to assist healing.

Huge injuries can be really hard for us men, as we all want to be strong and in control. It can really dent the pride. It's really important to have hope for recovery. What's the prognosis on the leg?


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 Post subject: Out of control insomnia
PostPosted: Wed Nov 23, 2011 11:26 am 
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Tear & Hat,
Right now he's tapering down off clonoidine because it really increased his leg pain. So about 4mg every 10 hrs. He didn't stay on any of the other meds I mentioned earlier because they either increased his pain or didn't help the insomnia and he felt that they increased his jitters/nervousness. I do have the list of meds he's taken per his gp, to take along today. Appt is in one hour and he's sleeping, wow I can't wake him??????

I know about bentos, came off them myself not too long ago,, rough drug very rough. Worst 9 mos. ever. Oh to answer a earlier suggestion, we are also taking him to a naturopath as well.

No more pot and I'll take his coffee away, not having much but I agree 0 is best. I think his leg pain prognosis is pretty grim, he's been to probably a dozen drs trying to alleviate it. I'll check physio out, tks

Lori

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Lori writing on behalf of my dad

Previously taking Hydrocodone 10's (3-4 per day) then switched to methadone for about 5 mos. Cut down a bit, then dr. switched him to suboxone. Done with suboxone on oct. 8, 2011 after @6 mos.


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 Post subject: out of control Insomnia
PostPosted: Fri Nov 25, 2011 8:24 pm 
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Well we went to the dr. Friday and left with a script for seroquel. Dad took 100mg at 8pm, he didn't get sleepy and became more jittery/nervous than usual. I sent a text to doc and he suggested amitriptelene. So dad took 75mg of amitriptelene and after all this he only slept an hour or 2 at the most.

You won't believe what happened last night though.....he didn't take any seroquel or amitriptelene. After almost 3 weeks of just cat naps he slept almost a normal nights sleep, whoo hoooo!!

I'm not sure how any of it happened but i sure am glad to get a break through. Thanks for your encouragement :) Lori

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Lori writing on behalf of my dad

Previously taking Hydrocodone 10's (3-4 per day) then switched to methadone for about 5 mos. Cut down a bit, then dr. switched him to suboxone. Done with suboxone on oct. 8, 2011 after @6 mos.


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 Post subject: out of control Insomnia
PostPosted: Thu Dec 08, 2011 2:08 pm 
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Back again, seroquel didn't work and dr. wont return phone calls to me. Dad just doesn't want to pay big bucks to go in each time and leave with a script that costs him a lot of $$ and doesn't end up working anyhow. I talked briefly to an addictions dr. who spoke at my church last sunday and this is what he wrote me:

"I am limited to 100 suboxone patients, and I have a waiting list which is full. Once dependent on opioids, most people have a permanent biological change to the brain and opiate receptors. That means the body is never happy without SOME type of opiate in the system to bind to the receptors. Therefore suboxone may help a lot of the problems you describe.

The problem is finding a doctor whose waiting list isn't full. Some who have openings are those who charge a lot of cash for it and don't take insurance. Still, if you find one who will take you for insurance or a reasonable charge, it may be worth the wait. In my almost 4 years of prescribing suboxone, I have only one or 2 who have been able to get off it and stay off it for the reasons I mentioned.

It is NOT "just in the head". Good luck. Maybe you could print my e-mail and show it to the MD who prescribes suboxone. Good luck."

So after having digested the above information dad and i are thinking of putting him back on a very small amount of opiate. My question is this: I have hydrocodone 10's, what if i crush some up and add to water, and give a very small amount? I was thinking 5mg in 10ml of water and then give him say 1ml of this mixture using a syringe (orally of course) before bed only. We want to try the smallest possible amount that might do the trick.

I did email the above mentioned dr. back, but so far no reply. Possibly the information that he offered is as far as he's willing to go without dad being an actual patient.

If need be i can get dad some suboxone if you think for any reason that it's better than hydrocodone. I am so tired of being my dad's doc, that's what it feels like here. I can't find him one that seems competent, they're all guessing at doseages and I'm not tooting my horn here but feel like i know more from this site than they do.

Lori

_________________
Lori writing on behalf of my dad

Previously taking Hydrocodone 10's (3-4 per day) then switched to methadone for about 5 mos. Cut down a bit, then dr. switched him to suboxone. Done with suboxone on oct. 8, 2011 after @6 mos.


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PostPosted: Thu Dec 08, 2011 2:56 pm 
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I can tell you this, Dr. Junig has written about the opiate receptors of addicts and says different. Dr Junig has stated that once all opiates are removed, the opiate receptors return to normal. They are NOT permanently damaged. In fact they were never damaged to begin with. Addicts have more opiate receptors than non-addicts is the way I understand it, and when we remove the opiates once and for all, the "extra" receptors eventually go away (for lack of a more scientific term).

I'll try to find his posts where he discusses that, and perhaps you can search for it as well. It is likely on is Suboxone TalkZone Blog (link at the top of the page).

I'm so sorry to hear your father still isn't getting any sleep. I'm not surprised the Seroquel didn't help. It's powerful, but it's not a freakin' sleep med! (Sorry, I hate hearing when doctors give people that med for sleep.) Hell, at this point, I'd take the damn Ambien! That man needs some sleep already!!!

I would really do some research on your own on opiate receptors of addicts before putting your father back on opiates, especially full opiate agonists. That just never ends well.

I wish I had something more to offer you. I'm so sorry this is still going on.

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-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

-I'm only responsible for what I say, not for what you understand.


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 Post subject: out of control Insomnia
PostPosted: Thu Dec 08, 2011 3:55 pm 
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Hat,
Ok I can surely understand another point of view on the opiate receptors. What helps is that i was told by many dr.s that i'd never get off and stay off benzo's and i did. I think it depends on one's determination and doing the work on finding better ways of coping instead of using drugs that don't work for us anymore. Not including those who they do work for, no need to stop using opiates or benzo's if they work well for you.

You told me previously about Trazadone and i let the dr. talk me into seroquel, I'm trying to get trazadone for dad. What is a logical doseage so I know that they haven't over or under medicated him? I just don't trust their judgement at this point, do you mind giving me som kind of a range?

_________________
Lori writing on behalf of my dad

Previously taking Hydrocodone 10's (3-4 per day) then switched to methadone for about 5 mos. Cut down a bit, then dr. switched him to suboxone. Done with suboxone on oct. 8, 2011 after @6 mos.


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PostPosted: Thu Dec 08, 2011 4:23 pm 
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Trazodone doses range from 50 mg up to 400 mg, as per my understanding. I'm no doctor, but I think 100 is an average starting dose, but sometimes as low as 50 or as high as 150.

I just hope the poor man can sleep sometime! How much sleep is he averaging per day/night? How is he functioning? How's his mood? I just feel so terrible for him. UGH.

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-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

-I'm only responsible for what I say, not for what you understand.


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 Post subject: out of control Insomnia
PostPosted: Thu Dec 08, 2011 4:49 pm 
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Hat,
Dad's sleep avg. was 4.26 for october, 1.87 for November, and so far this months avg. = 3hrs. I know it's better than november but still awful for a man of 73yrs.

I did some research while waiting for your reply and i see suboxone is a partial agonist, so if we can get the trazadone and it doesn't work then do i understand correctly that suboxone would be a better opiate choice than hydrocodone? And while i'm on this topic what do you think of methadone?

Correct me if i'm wrong but would the preferred order of drugs to try be: trazadone, ambien, suboxone, hydrocodone?

_________________
Lori writing on behalf of my dad

Previously taking Hydrocodone 10's (3-4 per day) then switched to methadone for about 5 mos. Cut down a bit, then dr. switched him to suboxone. Done with suboxone on oct. 8, 2011 after @6 mos.


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PostPosted: Thu Dec 08, 2011 5:26 pm 
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I'm so not qualified to make any recommendations like that. But it's my utterly unprofessional opinion that he ought to get something to sleep before going back on any opiate, be it partial or full. I'm partial to trazodone because it works for me, but other people have better luck with completely different sleep meds.

I'm sure there's others here that have plenty to say, too. I'm just one person.

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-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

-I'm only responsible for what I say, not for what you understand.


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PostPosted: Thu Dec 08, 2011 5:44 pm 
Lori, I understand what he is going through, at least to a degree.

I have PTSD and was an insomniac even before that..

When I went to detox the first time, I was detoxed off benzos. After a year of many sleepless nights (and about 6 months into stopping dope for real and being on Sub), the doc decided it was healthier for me to take a sleeping pill then to sleep so poorly (this doc also drug tests, so he knows I tell the truth).

I think that we are scared into believing that because we are addicted to opiates we will abuse anything. I never abuse my sleeping pill, but I don't think benzos are any fun. I take 15 mg of temazepam every night, and I feel better because of it. I get a few extra every month (from the doc) so if I really need to sleep that night, I can take two. That is so I will never have to increase my nightly dose. If it stops working, I will stop taking it.

If he can take a little bit of a benzo and fall asleep, well..why not? As long as he doesn't abuse them..and it doesn't seem like he wants to. If he doesn't want to be on something that causes dependence, he can take it only every couple of days. Better than not sleeping at all, ever. A good nights sleep (even if it is benzo assisted) actually reduced my cravings a lot.

The reason I suggest benzos is because none of the non narcotics ever worked for me for more than a couple weeks. Once I got used to them, they no longer worked. Also, if he is diabetic, he should NOT take Seroquel. No good for the blood sugar.

Good luck!!


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 Post subject: out of control Insomnia
PostPosted: Sat Dec 10, 2011 8:39 am 
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Hat,
Well I'm amazed here! Out of the blue dad slept 8 hrs. on Thursday night, not sure how last night went but i'm hoping ok as i haven't received his usual "i didn't sleep worth a darn last night text" This looks hopefull, he felt so good yesterday that he was out and about all day long.

We had tried to get Trazadone on thursday and it looked like it was going to happen and then didn't. I told him that I guess it wasn't meant to be. I'm feeling a bit more hopefull now, will keep you posted.

much thanks, Lori

_________________
Lori writing on behalf of my dad

Previously taking Hydrocodone 10's (3-4 per day) then switched to methadone for about 5 mos. Cut down a bit, then dr. switched him to suboxone. Done with suboxone on oct. 8, 2011 after @6 mos.


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 Post subject: out of control Insomnia
PostPosted: Sat Dec 10, 2011 8:45 am 
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Hat & Ironic
Well I'm amazed here! Out of the blue dad slept 8 hrs. on Thursday night, not sure how last night went but i'm hoping ok as i haven't received his usual "i didn't sleep worth a darn last night text" This looks hopefull, he felt so good yesterday that he was out and about all day long, which we haven't seen in a long long time.

I just can't see him on a benzo, i suffered an awful winter and spring tapering off that class of drugs. If i had slept great while on them i'd agree but what started out great eventually led to really poor sleep. Dad's had a really rough 1 1/2 months but my taper off benzo hell lasted from dec-may. i never could have done it if i had anyone to take care of besides myself. Anyhow everyone is different i agree.

We had tried to get Trazadone on thursday and it looked like it was going to happen and then didn't. I told him that I guess it wasn't meant to be. If it ever gets called in we'll fill it and keep it on hand just in case, like insurance. I'm feeling a bit more hopefull now, will keep you posted.

much thanks, Lori

_________________
Lori writing on behalf of my dad

Previously taking Hydrocodone 10's (3-4 per day) then switched to methadone for about 5 mos. Cut down a bit, then dr. switched him to suboxone. Done with suboxone on oct. 8, 2011 after @6 mos.


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PostPosted: Sat Dec 10, 2011 9:25 am 
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You've mentioned a couple of times now that your father has had a real turnaround for a night. It may be worthwhile figuring out how often it's happening. Before you resort to him getting back on opioids, consider filling a table of how many hours your father is sleeping every night. If you can afford to wait, see if you can get some weeks tabled. You could even get fancy and make a graph. It may really help to see if your fathers condition is improving on its own.

I've got a mood disorder, and the times I've filled in mood graphs it's been really helpful. I wonder if it can help for insomnia.

Just say his insomnia is related to early recovery off opioids. Like hatmaker was saying - those symptoms actually improve over time as the brain re-adapts to living without opioids. I get the feeling, from what I saw in rehab etc (I'm no doctor) that people who are older can take longer to recover with these things.

Also, the residents who were coming off methadone, a similar long acting opioid, often didn't get a proper sleep for 1-2 months. But they survived, and they returned to normal.

I am being prescribed Seroquel at the moment because of insomnia related to my liver treatment. It is an anti-psychotic, but doctors often prescribe it as a sleep-aid as it's sedating, and it works for about 8 hours. I only need 25mg to get me sleeping. If your father isn't knocked out by 100mg, that's a beastly insomnia. To put it in perspective, on the street they call Seroquel "Rhino stoppers".

Another thing similar to Trazadone is Doxepin / Deptran. I saw it used in a detox, and those given it were pretty much out 24/7, only to get up occasionally and stuff their faces and drink all the milk. Of course run it past the doc, as those meds can do weird things to some people's hearts.


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 Post subject: out of control Insomnia
PostPosted: Sat Dec 10, 2011 9:47 am 
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tear,
I do keep a calender of dad's sleep and yes it is slowly improving. I for sure won't give him the opiate at this point at the rate of improvement that he's on just in general this month. Even though he feels at times that he can't continue like this any longer, it is improving slowly. I think just knowing that the suboxone is a possibility as "insurance" as well keeps him going. He wants to keep going without it at this point.

I was thinking as well that his age is making this even harder. I have another friend who is taking 8mg a day of suboxone and he is thinking that he'd like to taper down. He said that he's heard that neurontin/gabapentin is a good drug to help the taper to go smoother, any thoughts on this? Not thinking of my dad, seperate issue here. He wants me to help him and i don't know anything about the drug.

_________________
Lori writing on behalf of my dad

Previously taking Hydrocodone 10's (3-4 per day) then switched to methadone for about 5 mos. Cut down a bit, then dr. switched him to suboxone. Done with suboxone on oct. 8, 2011 after @6 mos.


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