Sleeping tablets

[pete_uk]

I do struggle to get a good nights sleep here, even though I'm in a quiet, dark sideroom at the moment. (It's worse when on the ward). I'm just so inactive I don't seem to get sleepy unless I stay up very late, then I'm exhausted the next day when woken at 6ish for obs.

I have been requesting a sleeping tablet when I feel enough is enough, and really need a good night's sleep. Sorry - don't know the exact sort they are giving me. They seem to work well - especially if I'm fairly tired in the first place. However, I've been reluctant to take them too often because I don't want to become reliant. Am I worrying too much? Is getting more sleep more important? I'm worried that if I take them for several days in a row, I'll not be able to get to sleep without them after that.

Any thoughts?

[NYC Russ]

Difficult to say without knowing what sleeping medication they are giving you. Ask your nurse what it is and we will be able to see if what sort of long term effects it may have.

[richy77]

Pete - I wouldnt worry too much about taking sleeping pills as long as you intend to come off them soonish. I struggled with sleep during BEP due to the steriods I was on. I used sleeping pills for around a week each cycle and made sure I came off them inbetween. I'm not sure how correct this is, but my GP mentioned that they became additive after around 15 days. Sorry, dont know the exact ones I was on - used to different types during chemo.

Post the type you are perscribed and it might bring back memories!

[pete_uk]

They are giving me Zopiclone...

http://en.wikipedia.org/wiki/Zopiclone

Not recommended to use for more than 7 consecutive days. Well I don't want to get anywhere near dependency so think I will try to limit to just the odd day when I've had little or no sleep the previous night.

If I struggle with that approach I'll ask if they have anything milder.

Can anyone list anything they've had that has been effective, but might not lead to dependency so quickly?

[NYC Russ]

Ah, the infamous Z-drugs! I had a script for zolpidem which I have since stopped taking. It lost its efficacy after around day 21 (in a row) and while there was no "dependency" per se, there was a few days of "rebound insomnia" which was unpleasant.

Two potential alternatives which are OK to use long(er)-term: lorazepam (which I still use fairly frequently @ .5mg) and ramelteon (which might not be available in the UK) but claims not to have the Z-drugs' effects.

Below that, you've got "warm milk" option for a wholly natural remedy.

[richy77]

They are giving me Zopiclone...

Just checked with my wife and that is the 2nd type I was given. It worked really well for me and I managed not to be dependent on it after 5 days. It was the most effective for me and regularly gave me 6+ hrs.

[Fish]

In general, when meds are used to treat a specific condition under medical supervision, the risk of developing dependence is usually low. There are of course exceptions to this, particularly for patients who need high doses of narcotics for chronic pain.

It would be a great idea to discuss your concerns with your doctor.

Lorazepam is generally prescribed as an anti-anxiety drug, and might require higher prescribed doses to induce sleep, although sometimes just reducing anxiety levels allows a person to sleep better.

Again, why wait? You should feel free to discuss any concerns about meds, both prescription and OTC with your doctor.

Best wishes.

[Mrs Moggi]

The addiction rate with the newer drugs is still quite low, even if it's not zero if previously thought. If you post this concern again this time next month I might start to worry, otherwise I think you're likely to be fine.

[pete_uk]

Thanks for the replies. My main concern is with the rebound insomnia. As I am going to be in hospital for up to another 3 weeks solid, I'm pretty sure I can't take the zopiclone every day for that long. Even a few days in a row and I think it will make it hard for me to sleep naturally. I decided not to take it last night and couldn't sleep, which seems to support my concerns (think I'd had it 3 nights in a row previous to that).

I did mention it to the doctor this morning and she said she wouldn't not recommend me taking it, but I am nervous about doing so for anything other than the odd day or two. Maybe I will ask about lorazepam as a milder alternative.

[Karen]

Pete,
I went through a time where I was taking Ambien every night for almost a month. I had no rebound insomnia. When I travel I have a hard time sleeping, and find that the ativan or xanax are enough to get me off to sleep where I can usually stay for a good night. Sleep deprivationis not good for your immune system. Read this info and be more at ease....

http://www.medsafe.govt.nz/profs/PUarticles/3.htm

[NYC Russ]

Interesting article, although if my (admittedly bad) memory serves, more recent research on the z-drugs shows the incidence of withdrawal effects is higher than originally thought. (I'll see if I can find some support for that statement).

However, a few important things to remember. 3-4 weeks straight of sleeping pills of any kind, while not ideal, will not cause withdrawal effects in most people. For those who are susceptible, the recommended course is dose tapering (wish someone had told me that before I stopped the pills).

But, particularly while in treatment, sleep is so vital that I would argue it's worth dealing with a couple days of rebound insomnia later in order to ensure you sleep properly during active treatment. Sleep deprivation when you're not sick isn't pretty, so imagine the effects it has on your body now.

[pete_uk]

Hi Russ,

I'm torn between that approach (just take the thing every day until treatment's over) as I shouldn't hopefully be in hospital for more than 3 weeks for my last cycle, assuming no major complications) and just trying to avoid them completely.

On the last cycle I managed just taking one on odd days when I'd slept badly the previous night, but for some reason my baseline anxiety level seems to have gone up recently and I struggle to sleep at all if I haven't had the tablet. Of course now I'm thinking that, the effect reinforces itself psychologically!

Until I'm back in hospital I don't have any of the things, so the decision is out of my hands and I'll be going for the natural option of a hot chocolate with full fat milk.

[pete_uk]

Last night I tried a herbal sleeping aid (contains valerian, passiflora, wild lettuce, vervain and hop strobile). It seemed to help, although it could have just been exhaustion after several very bad nights. I think I was a little more relaxed and seemed to get to sleep more easily, but did still wake up multiple times for no obvious reason.

Must have got 4-5 hours sleep in total, which isn't too bad, so will stick with this stuff until I'm back in hospital.

[Fed]

Pete, just a little bit of a warning here. Make sure your doctors know about every single herbal supplement you take. There are many herbals out there that can suppress the effects of chemotherapy or worse, make it more toxic than it should be. Taking any kind of herbal supplement while on chemotherapy needs to be discussed with your oncologist.

[pete_uk]

Hi Fed,

Don't worry - when I'm back in hospital I plan to only be taking what the docs give me. Thanks for the warning though.

[JulieGL]

Hi Pete,

My husband took ambien for almost 2 1/2 weeks straight and did not seem to develop a dependency. It really helped him sleep, and I think that sleep is so important for helping a body get well. Just based on other over the counter stuff he has taken, Sominex works well...and, I have heard of lunesta being a sleep aid that does not lead to dependencies (doctor prescribed, I think, at least here in the states).

Best of luck-hope you get many good nights' rests ahead!

Julie

[pete_uk]

I'm taking the zopiclone every day whilst in hospital at the moment. I think this is the same as ambien or lunesta - not sure which, or similar anyway. It shouldn't be for more than a max of 3 weeks (hopefully a little less) and if I struggle when I get home I can take a half dose for a few days - hopefully that should wotk out ok.

I think I would struggle to get hardly any sleep without it at the moment so don't really feel like I have much choice, although I would prefer not to rely on such things.

[jdandordalton]

Ever since I was hospitalised for my first cycle of TIP, about three weeks ago, I've been taking a sleeping pill called Rhovane (zopiclone) every single day.

Yesterday, after 3 weeks of nightly usage, I tried to sleep without it and I was unable to. This might have been because I was dependant, or because I have so much anxiety. In any case, I took the pill at 1am and slept very well.

I decided that sleep is much too important to my recovery to not take the drug, and end up staying up all night worrying about my cancer. I'll worry about getting off the drug once I finish TIP, and the RNLPD... until then I'm going to enjoy falling asleep almost instantly after getting under the covers, and not lying in bed awake until the sun comes up, taking my Rhovane.