Wow I have never done Acupuncture at all. It sounds like you benefited from it a little. That is some progress

Clozapine (Clozaril) has fewer of those issues and, loxapine (Loxitane) is one of the very early not widely used non-classical AP's. Both are associated with lesser EPS and Movement disorder incidence. That can include akathisia which, if it presents in someone who already cannot sleep... eeks.

Clozapine and loxapine are both new generation but not universally considered atypicals - there is controversy. some say yes, some say no - it depends whom you ask, what you read, and which country you're in. i have seen loxapine called "paratypical" in one place. In any event both drugs are overall safer than the classical APs. Chemically, both are dibenzazepines like olanzapine (Zyprexa) and quetiapine (Seroquel), but they are both of different sub-classes, have significant structural differences, and were developed earlier on.

I took loxapine 10mg qHS for about a year and then PRN to help with sleep. I personally had no side effects.

So i guess what i'm saying is, if it were me at risk for diabetes and couldn't sleep, before gobbling haloperidol, i'd opt for clozapine or loxapine for a short term treatment... but the situation is complicated by the deal with the Klonopin. Everything considered, i would want to see your friend under medical supervision, whatever she is going to take, and i would want a doctor involved in that decision also, who should be of course made aware of her genetic diabetes risk.

Just wanted to include this excerpt from The Asthon Manual regarding insomnia........

Insomnia, nightmares, sleep disturbance. The sleep engendered by benzodiazepines, though it may seem refreshing at first, is not a normal sleep. Benzodiazepines inhibit both dreaming sleep (rapid eye movement sleep, REMS) and deep sleep (slow wave sleep, SWS). The extra sleep time that benzodiazepines provide is spent mainly in light sleep, termed Stage 2 sleep. REM and SWS are the two most important stages of sleep and are essential to health. Sleep deprivation studies show that any deficit is quickly made up by a rebound to above normal levels as soon as circumstances permit.

In regular benzodiazepine users REMS and SWS tend to return to pre-drug levels (because of tolerance) but the initial deficit remains. On withdrawal, even after years of benzodiazepine use, there is a marked rebound increase in REMS which also becomes more intense. As a result, dreams become more vivid, nightmares may occur and cause frequent awakenings during the night. This is a normal reaction to benzodiazepine withdrawal and, though unpleasant, it is a sign that recovery is beginning to take place. When the deficit of REMS is made up, usually after about 4-6 weeks, the nightmares become less frequent and gradually fade away.

Return of SWS seems to take longer after withdrawal, probably because anxiety levels are high, the brain is overactive and it is hard to relax completely. Subjects may have difficulty in getting off to sleep and may experience "restless legs syndrome", sudden muscle jerks (myoclonus) just as they are dropping off or be jolted suddenly by a hallucination of a loud bang (hypnagogic hallucination) which wakes them up again. These disturbances may also last for several weeks, sometimes months.

However, all these symptoms do settle in time. The need for sleep is so powerful that normal sleep will eventually reassert itself. Meanwhile, attention to sleep hygiene measures including avoiding tea, coffee, other stimulants or alcohol near bedtime, relaxation tapes, anxiety management techniques and physical exercise may be helpful. Taking all or most of the dose of benzodiazepine at night during the reduction period may also help. Occasionally another drug might be indicated (see section on adjuvant drugs, below).

The previous post on antipsychotics was regarding the question of whether haldol would knock you out, Mickey.

But now, on to another thing..... following on from Bizi's notes from the Ashton manual...

Not all benzo's are created equal.

While all benzodiazepines have some degree of anxiolytic, sedative, and anticonvulsive properties, each has a unique profile... some are used more as sedatives/hypnotics, others more as anxiolytics.

Klonopin is an anxiolytic and in a pinch useful for status epilepticus (diazepam is usually used).

Klonopin or other anxiolytics are sometimes given for insomnia is secondary to anxiety.

Normally, for primary or "true" insomnia, hypnotic benzo's are given. one example is Dalmane. This one is not often given because its major metabolite has a very long half-life (up to 100 hours), such that the effects are seen best on the second or third night of administration.

it is not terribly potent, on the benzo scale, but as it has a different profile (more hypnotic vs anxiolytic) attempts should not be made to substitute it for an anxiolytic ... say... Klonopin.

Also, in this particular situation with 10mg Klonopin not "working" the receptors may have reached saturation such that the Klonopin is being discarded. if that is the case, another benzo of any sort will likely be ineffective, as the same receptors are in play for all benzo's (BZD binding sites on GABA receptors). The other risk, if the Klonopin is indeed active, is that the hypnotic effect be magnified... to an unknown extent... the two drugs will compete for binding, and i've no idea which one has greatest affinity.

Furthermore, there may be enzymatic induction in the liver, or transport issues interfering with the Klonopin's action in the body. There may be conditions by which its absorption is being blocked. we do not know what is going on. So tossing in new meds, be it atypical or paratypical APs, or hypnotic benzo is rather a scary prospect outside of a hospital context where any emergency can be handled promptly.

Emergencies could include severe cardiorespiratory depression, tachycardia, bradycardia, or even seizures, depending what is going on with these meds.

at worst, if there is to be no hospital going, no drug should be added without full medical consultation.

~ waves ~ praying for your safety.

I did some research on dalmane,
looks like it is effective for insomnia but only several times a week, NOT Daily due to extremely high tolerance level.
check in when you can mickey
bizi

Weird as it will sound but have you tried amtrypilline.

It might be something that would work.

Donna

can have clearance issues, esp in the elderly.

It is not used much anymore for this reason.

I received this note on email today:

bizi

Thanks for all of the information. I have been having connectivity problems with my internet, so I have not been able to check in on a regular basis. At any rate, I have been on dalmane and pretty much didn't do anything. I trust my doctor and I do believe she is aware of everything mentioned in this thread. She has to take into consideration that Im not just an insomniac, but Im Bipolar I, I have OCD, PTSD, Panic Disorder, and possibly borderline personality.

Right now I am sleeping well with the increase in trazedone and Im hoping it lasts. I wake up probably about once or twice, but Im not waking up in a panic. And I am able to get back to sleep, so in 13 more days I get to see my doctor and I'll bring up some of the issues from this thread.

Thanks to everyone for taking the time....

Hi, I just got off the phone with my doctor and i was getting some ambien from her and now she wants me to stop taking it. I have explanined that this isnt a good time because my husband has left i am in so much stress. When i go to bed my mind runs 100 mph i cant sleep i have been 4 days with only maybe 2 hours of sleep total. My body is exhausted but my mind wont give up. is there help or do i just go to another doctor and see what they can do. There is times when i feel like i cant breath, i have taken over the counter sleep aids and they make my legs crawl. i am desperate for some advice. i have nobody to talk to.