Trazodone, a Tryptophan alternative for sleep for APOE4/4 on SSRI?

[Brian4]

Stavia and Frank,

I very much appreciate the words of caution. I do have access to people who could do this carefully, so I'll be OK.

But I'm not quite there yet. I've either tried (without success) or -- on grounds of risk of harm, or near certainty of development of tolerance -- ruled out nearly everything.

But I want to see whether the LDN improves my health in some way that improves my sleep. If that fails, then I will start getting set up for the propofol infusions. There's nothing else to try....

Sleeping shouldn't be this hard!

Yeah, that's a thought I've had a lot over the years (especially when lying awake in bed).

Brian

[Stavia]

why would compounded melatonin have a different result for sleep than mass produced melatonin? More doses for slower titration? Less additives?

placebo?

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[Stavia]

Stavia and Frank,

I very much appreciate the words of caution. I do have access to people who could do this carefully, so I'll be OK.

But I'm not quite there yet. I've either tried (without success) or -- on grounds of risk of harm, or near certainty of development of tolerance -- ruled out nearly everything.

But I want to see whether the LDN improves my health in some way that improves my sleep. If that fails, then I will start getting set up for the propofol infusions. There's nothing else to try....

Sleeping shouldn't be this hard!

Yeah, that's a thought I've had a lot over the years (especially when lying awake in bed).

Brian

I understand Brian. If I were considering it - I'd only be happy if the administrator is a doctor or paramedic who can ensure an adequate airway and circulatory support until it wears off if I have an unexpected reaction. The trial you quoted isnt big enough to show possible known serious side effects such as arrythmias, apnoea and adverse circulatory effects.

[TheBrain]

why would compounded melatonin have a different result for sleep than mass produced melatonin? More doses for slower titration? Less additives?

The pharmacist said that it was about quality and that you're getting the dose you're expecting to get. But I, too, have wondered about placebo. But wouldn't placebo wear off after a while? I'm sure there are some brands of melatonin that are low quality and you wouldn't get what you're expecting. (Remember the news story about retail brands of supplements not containing the active ingredients listed on the label or the correct dose?) However, I would be shocked if high-quality brands would be guilty of such fraud.

My doctor's nurse and the pharmacist aren't working today, but I'll inquire further next week.

The titrating process could probably be done with OTC melatonin. I'm using a combination of 5 mg and 10 mg capsules as I titrating upward.

[TheBrain]

.Alysson my friend I feel so bad that you can not get to the bottom of this. You work so hard and have made so many positive steps in your quest for better health. Just out of curiosity can you take naps during the day? I mean if you allow yourself the time, do you fall asleep during daylight hours? I was always afraid to sleep during the day, because then I was told you will never sleep at night. Finally in desperation (like Brian referred to, because it gets you to that point) I said the hell with it and if I was at home just let myself pass out on a lounge chair. Because if I went into bed the anxiety of sleep would hit just like at night. However, by doing this and getting some sleep during the day I reduced some of the fear of not sleeping at night.

That helped a lot because I went to bed and told myself ok if I don't sleep now, I will sleep later in the day. Lucky I was doing medical consulting at the time and worked from home, so I could get away with that. When I went back to teaching health and anatomy at my college, I did not have that option (as much) and remember telling myself during lectures that I can't go on being exhausted much longer. Luckily I had some very low dose Ativan on hand from my wife's doc, and that helped to break the cycle. I took a very small dose every other night for a week and got back on a sleep pattern. I truly feel for you guys and anybody else that has sleep issues, they truly suck to say it mildly.

Did you guys read the study MARC posted, very interesting and might relieve a tiny bit of anxiety about sleep because if you don't get 8 hours of sleep, no big deal? But like you guys go through 3, 4, 5 is not 6 and 1/2 to 7 hours either. Good luck guys, I truly hope you can find the missing link.

Frank

I'm sorry to hear you've had your own experience with insomnia. Thank goodness you found your way out of it relatively quickly and without getting addicted to anything.

When I was a little girl, I loved my naps. When I became an adult, I stopped being able to nap, but it was not an issue for a long while because I slept just fine. But then it became an isssue starting with my first bout of insomnia at age 39. Recently, within the last year, I've been able to nap on occasion, but I have to be utterly exhausted. Yesterday, I couldn't nap. My nervous system is, by default, in a hyperaoused state. I'm one of those hypervigilant people who doesn't feel safe due to childhood trauma. I've done a ton of inner work, but I still haven't gotten past that yet. The pattern is embedded in my nervous system. However, as the evening wears on, I can sometimes fall asleep on my recliner before bed while listening to a guided relaxation audio or meditating. I've slept as long as three hours on my recliner, and I'm okay with that. I count that as sleep.

Yes, I read about the study Marc posted. As an adult, I've always felt best on 8 hours of sound sleep, though, so I don't know that to think.

I recently found out through stool testing that I have no measurable amount of bifidobacteria in my gut. I'm suspicious of my longstanding gut dysbiosis as a contributing factor for my insomnia and other issues.

[Brian4]

Stavia, thanks, yes, the people who would set up this for me (again, I'm not there yet, by any means) are aware of the very serious risks. (The friend who told me about this has done a lot of research, and wants to try it himself.)

Frank, a belated expression of sympathy for what you went through: just because someone has solved a sleep problem doesn't make it less serious, or less life-altering. It must have been horrible to try to negotiate such heavy professional responsibilities with a schedule that didn't permit the relief of a powernap in the middle of the day. (I've actually said no to several jobs/projects precisely because they wouldn't permit me a time window for a siesta – not that my attempts to nap always succeed....)


I also want to express appreciation for the sympathy expressed here. Having a chronic sleep problem is life-altering. In my case, some of the reactions of people around me, even if well intended, miss the mark. For me, insomnia has absolutely nothing whatsoever to do with psychological stress. It's just some GABA or orexin or whatever receptors that don't work right. This goes back generations. So to be at parties or whatever and have well-meaning people insist I need to meditate or relax or try yoga... just makes it worse. Again: these are well-meaning attempts to help, but they miss the mark so widely that one feels isolated. A hug (which I'm getting here, virtually), is far more helpful.

Brian

[TheBrain]

I also want to express appreciation for the sympathy expressed here. Having a chronic sleep problem is life-altering. In my case, some of the reactions of people around me, even if well intended, miss the mark. For me, insomnia has absolutely nothing whatsoever to do with psychological stress. It's just some GABA or orexin or whatever receptors that don't work right. This goes back generations. So to be at parties or whatever and have well-meaning people insist I need to meditate or relax or try yoga... just makes it worse. Again: these are well-meaning attempts to help, but they miss the mark so widely that one feels isolated. A hug (which I'm getting here, virtually), is far more helpful.

Brian, what do you think of Belsomra? Given all the approaches you've tried and those you decided not to try, I imagine you've explored this medication, which works on orexin receptors. I've got about 10 pills left of a 30-day supply, and I think I'm done with it. I can't take it more than every 5-7 days because it otherwise becomes ineffective. If I space them out, I can sleep 7-8 hours, but I don't feel well rested. The last time I took it, I felt almost ill the next day. And it's quite expensive: $365 for thirty 10-mg pills! But I'm wondering if it's riskier than I've thought.

In my case, as I've said, past trauma plays a big role in my insomnia. But I wanted to clarify that trauma isn't just about psychological stress. Trauma actually changes the brain's structures and the body's response to stressors. It increases one's risk of CVD, AD, autoimmune disease, addiction, etc. However, my father suffered from terrible insomnia for decades before he died. As far as I know, he did not experience childhood trauma, although he used to say that if his mother hadn't been his mother, he wouldn't have had a relationship with her; she wasn't a nice person. So maybe she was emotionally abusive; I'll probably never know. But I do believe genetics play a role in insomnia and in some cases, like yours, can be the #1 cause of it. In my case, I believe genetics is a factor, but my trauma history and all of its consequences triggered the insomnia.

I know what you mean about those well-meaning attempts to help.

[Brian4]

Alysson, I looked into Belsomra closely, but finally decided that the effective dose for me would be so high that I wouldn't like the side-effects. Plus, people in my family (likely with similar genes) tried it and it didn't work (unless they used a high dose, and then the side-effects were horrible).

You raise a good point about trauma being more than psychological. Some two or so years ago I think Susan (or was it Circ?) had an excellent post about epigenetic effects of psychological trauma.

I had a crazy adolescence, that, in many ways could be considered traumatic, so it's perfectly possible that is also playing a role in my insomnia.

As you say, sleep should not be this hard.