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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Long Term Insomnia

hello
I've experienced long term insomnia and have tried a number of treatment options, from medications(benzos and even seroquel) to sleep studies. I currently see an addiction psychiatrist(though, I am not an addict, so I see her for general psychiatry) I am considering other medications that are less frequently prescribed due to potential side effects(that I am well read on; I am a neuropharmacology Ph.D candidate) but I am interested in A) the best way to address this with my physician, and B) How realistic might such request be? I am speaking of medications that are schedule II controlled substances for the most part.
Tue, 8 Sep 2015
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Psychiatrist 's  Response
As a psychiatrist my suggestion for a long term problem of insomnia is to get to the root cause of the problem, which is the best way to deal with insomnia.
If you say that you have had a fair trial of medications, then i assume that the usual medications have failed to show response, which leaves us with the only option of using alternative molecules, i.e. the schedule ii drugs.

It is common for us to prescribe these molecules in patients not responding to usual treatment options. The up-side being that they are highly efficacious and help to cater to accompanying symptoms if any (anxiety, mood changes, etc).
The flip-side however is their property of tolerance, wherein higher doses might be required after prolonged use. This difficulty is usually managed by using the medication for a fixed duration followed by gradual tapering and some lifestyle modifications.

So if i am in your situation, having being aware of the pros and cons, i would opt for the other medication under supervision of the treating psychiatrist and discuss with him/her about the long-term plan.

I hope this addresses your concern. Happy to help if any more queries.
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Suggest Treatment For Long Term Insomnia

As a psychiatrist my suggestion for a long term problem of insomnia is to get to the root cause of the problem, which is the best way to deal with insomnia. If you say that you have had a fair trial of medications, then i assume that the usual medications have failed to show response, which leaves us with the only option of using alternative molecules, i.e. the schedule ii drugs. It is common for us to prescribe these molecules in patients not responding to usual treatment options. The up-side being that they are highly efficacious and help to cater to accompanying symptoms if any (anxiety, mood changes, etc). The flip-side however is their property of tolerance, wherein higher doses might be required after prolonged use. This difficulty is usually managed by using the medication for a fixed duration followed by gradual tapering and some lifestyle modifications. So if i am in your situation, having being aware of the pros and cons, i would opt for the other medication under supervision of the treating psychiatrist and discuss with him/her about the long-term plan. I hope this addresses your concern. Happy to help if any more queries.