Review Prescription Sleep Aids

Use this section to discuss your experiences with prescription drugs, iron injections, and other medical interventions that involve the introduction of a drug or medicine into the body. Discuss side effects, successes, failures, published research, information about drug trials, and information about new medications being developed.

Important: Posts and information in this section are based on personal experiences and recommendations; they should not be considered a substitute for the advice of a healthcare provider.
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Rustsmith
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Joined: Sat Sep 28, 2013 9:31 pm
Location: Colorado Springs, Colorado

Review Prescription Sleep Aids

Post by Rustsmith »

Although I have had urge-to-move issues for many years and was trying to get a neurologist that I used to see to diagnose those issues, it was the insomnia side of my RLS/WED that drove me to a sleep neurologist where I finally received my diagnosis and initial treatment for anything other than an inability to get a good night sleep. So, through the years I have tried and now failed to successfully use just about every prescription sleep aid available. I therefore thought that a review of the strengths and weaknesses of each would be useful to others.

1. Benzodiazepines - These are the older class of sleep medications that include products such as Xanax, Klonopin and Valium. They are intended to help you get to sleep and stay asleep because they have a long half life. This means that the drug is still in your body when you get up the next morning, so you still stay groggy or sleepy and can have difficulty functioning. Although these drugs have been used for extended periods, they are also known to cause dependence, which simply means that you must use them in order to get any sleep after a while. My personal experience - they did not help me fall asleep. My RLS was stronger, so this meant that I was literally bouncing off the walls like a drunk as I would stumble around the house trying to address the urge-to-move side of RLS. These were all very such short term experiments for me.
2. Ambien (zolpidem) - This is the first of the "Z" drugs and is the best known. It was the favorite of many doctors for quite a while because it appeared to have minimal side effects, especially when compared to the benzo's that most doctors had been prescribing for years. Then, problems began to appear in the form of actions an individual would take while asleep. These not only involved sleep walking and sleep sex, but also sleep driving and other activities outside the house. I heard about a suspected death of a woman in Singapore who climbed over the balcony of her hotel room while on Ambien. This became such a problem that the FDA has mandated smaller dose pills that are especially targeted at women. This was done in an attempt to reduce the side effects. Ambien is also not approved for extended use. My personal experience - While I was traveling by myself, I woke one morning after taking Ambien and went downstairs to get some breakfast. The next thing that I remember was walking back down the hall to my hotel room. I could tell that I had eaten breakfast, but had no idea what I had consumed nor how I got back to the floor where my room was located. That was the last time it took Ambien. Other than that incident, Ambien was effectively treated my RLS-insomnia.
3. Lunesata (eszopiclone) - This is the next "Z" drug. It is supposed to have a lower incidence of sleep activity side effects than Ambien and has FDA approval for extended use. It is also reported to leave a metallic taste in your mouth when you get up in the morning. There are also warnings that you should have 8 hrs for sleep because that is how long it will take to wear off. My personal experience - Lunesta was effective against my RLS most of the time. Those times where it was not effective, the Lunesta did not seem to cause any of the problems (like the benzo's did). I could even concentrate on work during the early morning if it failed.
4. Sonata (zaleplon) - This is the newest of the "Z" drugs. It has the shortest half life, which means that unlike Ambien and Lunesta, you can take it if you wake up in the middle of the night. My personal experience - I have only tried to use it one, during one of my sleep tests. I had one dose at 10P and another around 2A. Neither had any effect on me. I might as well have been taking placebo's.
5. Rozerem (zaleplon) - This is a relatively new drug that works on the melatonin side of the sleep chemistry rather than trying to depress the action of the central nervous system like the benzo's and the Z drugs. It is supposed to be stronger than simply taking melatonin and should have minimal side effects (compared to the others). My personal experience - I took Rozerem for 12 days. At first it seemed to be helping me get a few more hours of sleep each night. That benefit then seemed to decline until one night I suddenly woke in a panic about an hour after going to sleep. My RLS urges were at full strength and I HAD to get out of the bedroom. My wife finally caught up to me as I was hanging onto the shower stall in our bathroom. Since I NEVER have panic attacks or even get upset, we knew that this was an extended effect of the Rozerem. Hallucinations, changed behavior, anxiety and agitation are all reported side effects, so scratch another one off my list.
6. Belsomra (suvorexant) - This is the newest sleep aid on the market. There are advertisements for it on television by Merck, but the ads never actually say the name of the product. As I have posted previously in this forum, Belsomra is so expensive that my insurance company refused to cover it. Since I had a prescription, I was able to get 10 pills as a trial offer. The first one that I took allowed me to sleep about an hour longer than normal, but I was very groggy when I got up and the fog did not completely go away until about 12 hrs after I took the pill. I have tried a second dose and it also caused some grogginess the next morning, but not for quite as long. At this point, I have not had another opportunity with a "free" morning where I could afford to try a third experiment. I should also mention that my doctor stated that Belsomra has not yet been evaluated for the treatment of insomnia in RLS patients. I understood this to include informal evaluations in addition to formal research studies.

Price -
The benzo's have been around for a long time, are readily available and are mostly generics at this point. So they are the least expensive. Unfortunately, the also have the greatest potential for abuse.
Ambien is now available as a generic, so it is not as expensive
Lunesta has also recently become available as a generic, although here, even the generic is not cheap.
Sonata and Rozerem are still under patent protection in the US, so these are quite a bit more expensive. My insurance company requires special reviews in order to justify getting these products
Belsomra - the price is through the roof expensive. Even if it is highly effective, I doubt that I will ever get more than the one 10 day trial supply.

So, my situation - I am still looking and have not gotten more than 3 to 4 hrs of sleep in almost a year, which interesting enough coincides with when I started using the Neupro patch and mostly regained control of the urge-to-move side of my RLS.
Steve

https://www.mayoclinicproceedings.org/a ... 0/fulltext
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

Orrel
Posts: 101
Joined: Sun Jun 15, 2014 12:23 am

Re: Review Prescription Sleep Aids

Post by Orrel »

Steve: I am not quite sure from your posting why you do not still take Lunesta as it seems the
least problematic of all the options.

Rustsmith
Moderator
Posts: 6476
Joined: Sat Sep 28, 2013 9:31 pm
Location: Colorado Springs, Colorado

Re: Review Prescription Sleep Aids

Post by Rustsmith »

It was not effective all of the time, so my doctor and I were hoping that one of the newer drugs would be more effective for me. However, that does not appear to be the case.

And, as I described in this note: http://bb.rls.org/viewtopic.php?f=21&t=9297

I am quite probably looking at changing from the use of the Neupro dopamine patch to treat my urge-to-move symptoms to an opiate in the next month or so. That will once again shake up the situation and I will have to re-figure out what I need at that time.

Lunesta also requires a review by my insurance company, which they have always granted but requires some time to process. So getting a one month supply of Lunesta at this point seems a bit pointless. I will save my stash and only use them on the days when I really need to be fresh the next day.
Steve

https://www.mayoclinicproceedings.org/a ... 0/fulltext
Opinions presented by Discussion Board Moderators are personal in nature and do not, in any way, represent the opinion of the RLS Foundation, and are not medical advice.

debbluebird
Posts: 2386
Joined: Mon May 21, 2012 3:27 pm

Re: Review Prescription Sleep Aids

Post by debbluebird »

I know that when I was put on Mirapex, my sleep time was cut in half. After I got off and finally adjusted, my sleep returned to what it was. At the time I thought it was menopause. I had no clue. It was like that for about 20 years. So happy to be sleeping longer again.
I've been taking Methadone for four years now. It's not perfect, but it is so much better. I still have nights when my legs start, but usually I'm able to get it to go away, by turning on my side. I take another pill. Then I can only stay on a side for an hour, by then the legs have settled down and I can sleep on my back again. It's my hips that keep me from staying on my sides. I used to sleep on my sides all the time. I wish I could return to that position. I take the Methadone two to three times a night, 5 mg. each.
Good luck.

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