Do Nortriptyline, Melatonin And Ambien Help Treat Sleep Disorder?

Posted on Mon, 28 Dec 2015

Question: For many years I took Lunesta and then started in Ambien for sleep. The Doctors on this site advised this could be harmful, so I stopped taking them. But, I continue to have sleep problems and now I take 10mg of Melatonin and it does help me to sleep, albeit not without waking several times throughout the night. I also take 10mg of Nortriptyline at night. Any advise?

Answered by Dr. Dr. Chintan Solanki (1 hour later)

Brief Answer:
amitryptiline or quetiapine can help,follow sleep hygiene,provide more info

Detailed Answer:
Hello,

Thanks for writing to us.

Considering your history I recommend amytriptiline or quetiapine for sleep. Discuss these options with your treating doctor.

Try to follow some measures called 'sleep hygiene' which would help in sleep. You can find the same in below link.

sleepfoundation.org/ask-the-expert/sleep-hygiene

Drinking a cup of warm milk before going to bed helps in 30-40% of patients and they do not need medicines as per my clinical experience.

I also need some more information.

You are suffering from insomnia (sleep disturbance) since long.

Insomnia (sleep disturbance) is of two types:

1. Primary: There is problem of only sleep disturbance and no other physical or psychological problem is there. In this case treatment for sleep problem is needed.

2. Secondary: There is some underlying physical or psychological problem which is responsible for sleep disturbance. In this main treatment is done for underlying problem.

- Which type of insomnia there in your case?

- Is there difficulty in sleep onset, fragmentation of sleep or early morning awakening?

- What was the schedule (timing) and duration of sleep before the problem started? How much reduction in sleep from previous?

- Do you have any stress in life (it can be social, economical, relationship, study/work or emotional)?

- Do you have any physical illness?

- Any day time sleepiness is there?

Hope I have answered your query, I will be happy to help further.
Regards,
Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Chintan Solanki (6 hours later)

Dr XXXXXXX thanks for your response. Back in 2005 I had hip replacement and had to sleep on my back. Never slept on my back and therefore I needed a sleep aid. I took Lunesta for nearly 7 years and Ambien for about 6 months. I try to stop the hypnotic medication and started Melatonin. I have a problem getting to sleep and really have no physical illness other than IBS, which did cause sleep problems until I started taking Pamelor at night and Zoloft in the morning. I own a business and Always have some stress. I am allergic to dairy, therefore I can't drink milk at night.

Answered by Dr. Dr. Chintan Solanki (2 hours later)

Brief Answer:
amitryptiline is good option, adding benzo would help

Detailed Answer:
Hi,

Thanks for information.

You are already on pamelor (nortryptiline) - a medicine from tricyclic group- which helps in pain and sleep. But at 10 mg it is not likely much helpful. I recommend amitryptiline (elavil) instead of that. It gives more and good sedation than nortryptiline.

If your cognition (memory) is good until now adding frug from benzodiazepine group like ativan (lorazepam) or klonopin (clonazepam) at night also helps in sleep.

Other options are quetiapine (seroquel) and trazodone.

You can change medication after consulting your doctor and discussing above recommendations.

Hope this answer will help.

Take care.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar