Lunesta and Ambien CR

zombie76 · Post by **zombie76** » Tue Dec 23, 2008 6:40 am

My neurologist put me on Ambien CR for sleep about 2 months ago. Funny thing is..it didn't have an effect on me. It didn't knock me out (although I never have problems falling asleep) and I still occasionally woke up during the night will no weird feelings.
My regular doctor said he can't believe it so now I am on Lunesta 2MG. I've been on it a week and feel a little better (my issue is RLS and PLMs) but don't feel like it is having much result.

Anyone else out there unaffected by these meds?

My main complaint is extreme daytime fatigue. Anyone had good results with something else?
I've been on Lyrica which slightly improved the pain but did not improve quality of sleep. Augmented on Mirapex and Requip so they didn't help. Was on Provigil for a while but didn't have any good or bad result with it minus the cost.

thanks

Neco · Post by **Neco** » Tue Dec 23, 2008 6:53 am

Ambien and Lunesta are junk... They work for a small minority of people usually in conjunction with another medication like you have tried already.. they don't do anything to actually diminish the RLS sensations or PLMD movements while you sleep. They are hypnotic medications, that basically put you under and make you fall alseep. They don't work on me either.

Having failed Requip and Mirapex, and suffering from extreme fatigue, you need to lobby your doc for more aggressive treatments. And make sure he absolutely knows you are suffering from this fatigue and are not getting symptomatic relief.

The Mayo Algorithm says at this point opiates are an acceptable solution to look at. As are certain benzodiazapene medications.. Klonopin is commonly prescribed, and may helped with your PLMD but not so much with RLS sensations.. It will just knock you out, but you could suffer drowsiness the next day.

Opiates should take care of the RLS if your dose is sufficient, but won't help the PLMD... I suspect I have PLMD but am not diagnosed.. However I take methadone for my severe RLS, pretty much the same with meds as you are. However Methadone is a last resort medication and I am also a recovering addict, so it made more sense for me to be on it than other weaker opiates I was having problems controlling my use of.

Tylenol #3 w/codeine, Hydrocodone (Vicodin), and Oxycodone are common opiates for treating RLS.. Ultram (tramadol )is technically an opiate, but is not a controlled substance, except for in the state of Kentucky.

These are all medications you could try, but personally I would steer clear of Oxycodone unless you absolutely need it. Here is a link to the Mayo Clinic Algorithm for RLS, which outlines the recommendation for opiates and qualifications for reaching that conclusion.

Adobe PDF
http://www.mayoclinicproceedings.com/pd ... 907Crc.pdf

HTML Text
http://www.mayoclinicproceedings.com/in ... =1698&UID=

Print this out and show it to your doctor, hopefully he will welcome the information. I reccomend starting with either Hydrocodone (Vicodn) or Tramadol (Ultram)

When you show your doctor, make sure you highlight with a marker specifically Figure 3. Outlining Refractory RLS (this is what I have) so he pays special attention to it. It's possible this may be what you have as well.

Highlight section 13 below that as well, describing opiod treatments.. I need to print this out too as this is an updated document and now includes methadone in the litterature as well as tramadol. Initially these were not listed as far as I can remember. Sure my doc would be interested to see the changes

Post by **ViewsAskew** » Tue Dec 23, 2008 8:49 am

Lunesta and Ambien are not considered first line RLS drugs, to my knowledge. They help some of us sleep in conjunction with other drugs that stop the RLS sensations or the PLM movements. But alone, they will only help a small minority of us, I am guessing.

Having augmented, my guess is that your doc is trying anything he or she can to avoid getting into the pain med territory. But, that's not necessarily a good choice, from my perspective. I WISH that none of us needed to take them, but the fact is they work and they shouldn't be withheld after trying the other main options...which you have done.

Zach included some helpful links. I hope they help you.

Aiken · Post by **Aiken** » Tue Dec 23, 2008 10:54 am

Ambient and Lunesta are really just drugs that make it easier for an insomniac to get over the hump into sleep. They certainly won't help physical problems like RLS or PLMD. Even if they do knock you out, they're supposed to wear off during sleep, since they're only meant to get you to sleep, not to keep you asleep. For us, with physical sensations either waking us, or keeping us from getting back to sleep when we wake periodically, they are wholly inadequate.

Back when I was a mere insomniac, I used a drug in the same class, called Sonata. Ambien made me nauseated if I took it for more than two days, and Lunesta made my breakfast taste terrible. Side effects aside, at first all three worked well enough as far as knocking me out, but after a very short time I'd get used to them. Though I would apparently act very strange, and had a very strong urge to go online and say peculiar things to people I knew on the net (think drunk dialing), I didn't really get knocked out anymore. No matter what the literature says, I really don't think they're meant for chronic problems.

zombie76 · Post by **zombie76** » Tue Dec 23, 2008 3:56 pm

Great info, thanks.
I guess I have been going about this the wrong way. We originally tried to get the RLS symptoms to go away but had augmentation so I haven't been taking anything to specifically treat the RLS since. It's generally uncomfortable and doesn't get to a high level of pain too often so I've been trying to deal with it. If it wasn't interrupting my sleep then I'd be fine as is.
The doctor wanted to try to knock me out to see if at least I could get some refreshed sleep but it hasn't worked so far. I never have problems falling asleep and most of the time sleep through the night uninterrupted but it is not quality sleep because of the movements.

It sounds like I need to go back to the doc and have another discussion.

thanks

Neco · Post by **Neco** » Tue Dec 23, 2008 4:18 pm

Definitely, and remember to print out, highlight important stuff about your symptoms, and take it with your.. MAKE them look at it if you have to.

If your doc wants to try knocking you out, you could try going with a benzo.

Even stuff like Valium or Xanax which doesn't really knock you out, has had minor success with some patients and helped control their RLS.

But it does look like opiates or benzos are gonna be your only choices for effective treatment that provides genuine relief.

SquirmingSusan · Post by **SquirmingSusan** » Fri Dec 26, 2008 6:26 am

Zombie, I've been taking Lunesta for a couple years, with mixed results. For a while I talked the doctor into prescribing 2x2mg tablets a night. I'd take one, and then a couple hours later, I'd take the other one. That worked most nights. Now I take a 3mg tablet most nights. Some nights it works great, some nights not at all. Taking it with high fat foods blocks absorption, though, and sometimes I just like to nosh a little at bedtime. (OK, who am I kidding! I like to nosh a lot at bedtime.

) Usually I also take a Sleep MD, and when that starts to make me a little sleepy, then I take the Lunesta.

I took Ambien several years ago, and it had absolutely no effect. Then I tried it again, when I was taking Requip, and I had hallucinations. When I finally lay down and went to sleep, I had the best night's sleep ever. I'm tempted to try it again, or maybe alternate with Lunesta.

The only sleep medicine that has helped me consistently to get to sleep is Unisom, but that makes the legs kick like mad.

About a year ago, I had light general anesthesia, and I felt more rested afterward than I had for years. Now if I could only hire an anesthesiologist every night to knock me out...

I also have the extreme daytime fatigue, and it really bites. I take Provigil and it helps me halfway function, but it doesn't help me feel rested.

Here's a thought - some people have popped in here and said that they are taking Ritalin or other ADD meds for their RLS. It helps with the daytime fatigue, and it also helps the RLS. Maybe you could ask the doctor about that?

Post by **Polar Bear** » Fri Dec 26, 2008 7:08 pm

Hi Zombie, I use Ambien .5mg. as a sleep aid.
No, it doesn't ease the rls, I rely on Requip/codeine for that. But the Ambien has certainly given me a better sleep pattern (of sorts) albeit it a medicated sleep pattern.

zombie76 · Post by **zombie76** » Tue Dec 30, 2008 6:42 pm

I tried taking the 2MG Lunesta with one, 7.5/350 Hydro/APAP for a couple of nights but it didn't make a difference.
Last night I tried 3MG of Lunesta and I can't seem to wake up today.

So, I go back to the doc on Friday and will talk about Ritalin and the other suggestions.

thanks, Shane

zombie76 · Post by **zombie76** » Sun Jan 04, 2009 5:56 am

Went to the doc again yesterday. Told him that Lunesta wasn't doing much, if anything. Asked him about Ritalin and he pretty much moved past it. I asked him about it as a last resort and he said it might help but he wanted to treat the cause not the effect. I appreciate that but it might be what I have to do in order to function.

He suggested Sonata to try and if that doesn't work then looking at Neurontin. Of course, I've read the stories on the boards about it so I don't know if that is an option I'll consider. I'm still curious about the Ritalin and may push for it.

Hey gave me a 7 day trial of Sonata and after 1 night I'll rate it as 'useless'. Same as Lunesta and Ambien...I fell asleep fine and woke up the next morning feeling unrefreshed.

Post by **ViewsAskew** » Sun Jan 04, 2009 9:05 am

Did he say why he's pushing medications that don't really treat the cause????

The cause of your sleep problems isn't insomnia, unless I've missed something...so how can a non-hypnotic sleep med help? None of these meds are included as first line defense for RLS or PLMs.

In a way, I agree with him - you do want to treat the cause. So, his idea of Neurontin is closer to the mark. It is a first line med used for RLS.

If it were me, I'd want to see a list of meds used for RLS treatment and I'd want to ask him about those. The algorithm (see the Managing RLS sticky in the New to RLS section) would be helpful; I personally like the two books aimed at treating RLS - Clinical Management of Restless Legs Syndrome by Hening, et. al. and Restless Legs Syndrome by Buchfurer, et. al. They can both be taken to the doctor and you can ask dumb questions. "Huh, doc, I'm confused. This book doesn't mention Sonata for treating RLS. Please help me understand how it will help me?"

They are also great for ensuring that the doc is doing things that are consistent with commonly accepted treatment of RLS.

Neco · Post by **Neco** » Sun Jan 04, 2009 12:39 pm

Personally I wouldn't push for Ritalin.. Aside from the fact it is as tightly controller as opiates, if not more than opiates, it really is a hit and miss. It may do nothing for you, and I've seen few people who say it helps their RLS. Usually its people with ADHD who make a fleeting observation who notice it and post that it works.

It won't be the answer for daytime fatigue either. It'll just turn you into an amphetamine repository.

Frankly I'm not sure what your doctor means by treat the cause not the symptoms. Not even sure if he's clear about -what- he is supposed to be treating. If he wants to treat the cause not the symptoms, then why is he not using more aggressive first and second tier drugs used to control RLS?

That statemet alone doesn't even apply to RLS. In most cases you CAN'T treat the cause - because no one knows what it is! So you HAVE to treat the symptoms, or else the patient is going to keep suffering needlessly. If it were me I'd probably be past the point where I snapped and told this doctor I was sick of being his guinea pig.

I dunno.

I am pretty surprised that 7.5mmg of Hydrocodone didn't help, even just a little.. But taking it with Lunesta I don't think someone would be able to tell. They'd be so foggy usually, and even with sleep aids, if you don't get enough sleep they can leave you unrefreshed in the morning as well.

zombie76 · Post by **zombie76** » Tue Jan 06, 2009 5:25 am

I have the book by Hening.

I guess the point of prescribing Ambien, Lunesta and now Sonata was not to cure insomnia (which I don't have) but to get me to a deeper state of sleep or restorative sleep. I guess common sense says that is sound logic but it hasn't worked.

So, if I'm following Figure 10.3 from the Hening book is says that step 1 is an agonist....
Tried Mirapex and Requip and augmented

Step 2 would be another agonist, anticonvulsant or medium strength opiod
Tried Lyrica with no major results

Would Gapabentin (Neurontin) possibly yield better results than Lyrica?

Thanks again for the replies.

SquirmingSusan · Post by **SquirmingSusan** » Tue Jan 06, 2009 6:15 am

It's possible that Gabapentin might yield better results than Lyrica. It seems like some people have better luck with Lyrica, and others have better luck with gabapentin. It seems like it's a matter of if you can handle the doses that relieve your RLS without too many side effects. There are many other anticonvulsants that can be used as well, but those 2 are the most commonly used for RLS.

If you augmented on both Mirapex and Requip, then it's a bad idea to try another dopamine agonist.

Post by **ViewsAskew** » Tue Jan 06, 2009 6:16 am

Not necessarily, but most docs would want you to try gabapentin first. Very few docs are going to jump to #4 - opioids. Many would pick a combo of a benzo with gabapentin or some such.

The problem, to me, is that we still don't know how RLS manifests - what route does it take? How does the lack of dopamine or iron result in these odd sensations? Etc. So, we're throwing medicines at it that make logical sense based on one component of it.

But, none of them are really for RLS. So, we play this game. Some work for some people, but not others. The doctors try to pick the order in which they try them on you based on either how well they work (trying a dopamine agonist first) or in order of how little they affect you (Sonata instead of a benzo).

If you are lucky, you find results in the first few you try. If you're not so lucky, you try five, ten, fifteen until you hit the magic one. I think I tried about 8 or 9. And, while my RLS is mostly under control, I'd give up what I take in a heartbeat if I could have energy and cognitive function back.