Gridley

Gridley

143 posts in this topic

A couple of questions about insomnia.   Ten days after I completed the switch of Lexapro from bedtime to morning (Nov. 8), the number of hours I was  sleeping started out great, with 7 1/2 and 8 hour nights predominating.  Since November 14, though, the hours I'm able to sleep has been diminishing, down to three to five hours a night.  Can anyone offer an explanation?  Nothing has changed in my regimen.

 

Hi, Gridley.

 

Can you give us a timeline of your drugs and symptoms such as listed in this post? - Keep notes on paper about your drug dosages and daily symptom pattern

 

It may help to see your drugs and symptoms in context. Not sure if there's anything that can be done (such as shifting a higher portion of your daily benzo to a night dose), but it's good to check and see. 

 

Also, are you using any supplements? Please list those, as well.

 

Some members find melatonin to be helpful:

 

Melatonin for Sleep

 

And some other information on insomnia:

 

Sleep problems - That Awful Withdrawal Insomnia

 

Insomnia during withdrawal is very, very common and many of us are struggling with it, but hopefully you'll find some useful information in these links.

 

Share this post


Link to post

Thanks, Scallywag and Shep.  I'll put together a list of drugs, supplements and symptoms beginning after my last list.  By the way, I took a low dose of Enorphos last night (100mg) at bedtime and got the best night's sleep in quite a while! More than eight hours!  I'll keep it up and monitor my reactions.

I feel much better this a.m.

Share this post


Link to post

Drugs dosages, supplements and symptoms, including amount of sleep, following shift from bedtime to morning of 20 mg Lexapro.  Purpose is to see if there is an explanation why immediately after the shift my sleep was good, 7-8 hours a night, but diminished subsequently.

 

Nov. 8 (day 10 after switch of Lexapro to morning)  10:00-5:30  7 1/2 hours sleep the night before (somewhat interrupted)

I try to have my schedule of drugs and supplements is the same every day.  For following days.  For clarity, for the following days I won't list timing of drugs and supplements unless there has been a change.  

7:00 am  .5 mg Lorazepam, theanine, Natural Balance Happy Camper on empty stomach

10:00 am   20 mg Lexapro on full stomach

Supplements after breakfast: Omega fish oil, vitamin E , vitamin D3, VSL3DS probiotic, zinc, fo-ti, vitamins B12

Feeling good and in good mood.

Omega oil after lunch

2:00 pm    .5mg Lorazepam plus theanine on empty stomach

10:00 pm  .5 mg Lorazepam, 25 mg Imipramine, 100 mg magnesium on empty stomach

 

Nov 9   8 hours sleep the night before (10 pm - 1:30 am, 1:30 am - 6:30 am)

I took my afternoon .5 mg Lorazepam 45 minutes late at 2:45.

Went into village, no anxiety.

 

Nov. 10   7 1/2 hours sleep the night before (10 am - 3 am, 3 - 5:30 am)

Awoke with some anxiety

12:00  anxiety after light exercise

I took my bedtime .5 mg Lorazepam and 25 mg Imipramine on full stomach)

 

Nov. 11  7 1/4 hours sleep the night before (8:45 pm - 2 am, 2 - 4 am)

Awoke very anxious, anxious all morning, a bit less in pm.

Took Lexapro 20 minutes late at 10:20 am

 

Nov. 12  8 hours sleep the night before (10:15 pm to 6 am)

Stayed at home, did nothing, no anxiety all day.  Around 6:30 pm I got hiccups, which kept me up all night.

 

Nov. 13   0 hours sleep due to hiccups

Anxious most of morning.

Added 100 mg magnesium in morning.  Diarrhoea.

Eliminated vitamin B12 

Coming down with sore throat

Only moderate anxiety

 

Nov. 14   4 3/4 hours sleep (10:15 pm - 3 am)

Added 1000 mg vitamin C and echinacea/goldenseal for sore throat

Calm, peaceful day.  Some diarrhoea from vitamin C

 

Nov. 15  4 1/4 hours sleep the night before (10:15-2:30)

Sick with cold.  Continue vitamin C and echinacea

Not much anxiety

 

November 16  Good night's sleep, perhaps due to being sick.  I didn't write down how many hours.

Continue vitamin C and echinacea.

 

Nov. 17   7 hours sleep the night before (10:15 pm - 5 am)

No anxiety

Took Lexapro 4 hours late, at 2 pm

 

Nov. 18   3 1/2 hours sleep the night before (11 - 2:30)

Took pm  .5 mg Lorazepam 1 hour late, at 3:00

Ate some gluten and dairy at both lunch and dinner (had eliminated these 2 months ago)

 

Nov. 19  4 1/2 hours sleep the night before (9:30 - 2 am)

Anxiety in am, calm in pm

Feeling better, stop vitamin C and echinacea

 

Nov. 20  5 3/4 hours sleep the night before (9:45 - 4 am)

Peaceful day, little anxiety

 

It seems that the increased insomnia followed the following events: my getting no sleep one night due to hiccups, taking my Lexapro at 2 pm instead of 10 am (arguing that it is an activated), possibly my adding vitamin C and echinacea, and eating gluten and dairy one day.

 

As of Nov. 21, I started taking Enerphos Phosphoserine for insomnia and will report how that works after a few more nights.

 

Any thoughts or suggestions would be appreciated.

Share this post


Link to post

I can't see any patterns yet. What is Enerphos Phosphoserine ?  I've never heard of it and I know about most insomnia remedies.  <_<

Share this post


Link to post

Neesby brand Enerphos is the reformulation of the old Neesby Seriphos phosphatidyl serine (PS).  I believe is came out this year, and I'm not sure if the old Neesby Seriphos is still available.  There is a lot of discussion on the Internet about the new product, some saying it doesn't work for their insomnia, some saying it does.

Share this post


Link to post

Thanks.  I think Enerphos is the new kid on the block, similar but not exactly the same.

Share this post


Link to post

Hi, Gridley.

 

It's probably good you eliminated the B12 vitamins, as they can be stimulating. My concern is you're making too many changes with supplements at one time - eliminating B12 and now adding a new supplement, Enerphos. 

 

Just having a cold can rev up symptoms like insomnia, so please be careful trying to fix everything at once. 

 

When you're dealing with 3 drugs and multiple supplements, it can get very difficult to tell what is coming from what. Add in a cold, and your CNS is getting slammed in yet another direction. 

 

Two questions for you:

 

1.  On November 8, you took your night drugs and supplements on an "empty stomach", but on November 10, you wrote you took them on a "full stomach". Do you see a difference in how you are absorbing them as far as your sleep goes? 

 

2.  Do you have trouble falling asleep, staying asleep, or both? 

 

Share this post


Link to post

Hi, Shep,

 

You're right--I need to hold off on my "tinkering."  

 

1. I have noticed that my absorption of Lorazepam is less on a full stomach, so now I take care to wait around two hours after dinner for my bedtime Lorazepam.

 

2.  I don't have trouble falling asleep but do have trouble staying asleep.

 

Thanks.

 

Gridley

Share this post


Link to post

Thanks, Gridley. That's helpful information.

 

I also used to take my benzo on an empty stomach and found it worked better.

 

I was going to suggest moving more of your daily benzo dose toward evening if you were having trouble "falling" asleep, but since it's the "staying" asleep part that's the problem, that wouldn't help, since Lorazepam's half life is so short.

 

Hopefully, getting off the B12 will help and do let us know how you sleep with the Enerphos. 

 

I wish I had a magic cure for the "staying" asleep part myself, as this has been a problem that I've lived through. But it does get better in time. 

 

Also, when you're stable enough to start decreasing the Lexapro, that may help with your sleep, too. 

Share this post


Link to post

Many thanks, Shep.

Share this post


Link to post

I've had success in lessening insomnia with Enerphos (a refined version of Seriphos phosphatidyl serine by Neesby), which I've been taking for ten nights now.  My problem is not in falling asleep but rather staying asleep and getting back to sleep.  

 

I take 100 mg at bedtime.  Some nights I sleep several hours, wake in the middle of the night, then drift back to sleep with no difficulty. Other nights, I have more difficulty falling back to sleep but have found that if I get up and walk a few gentle laps around the house (at 2 am, 4 am, whatever), I'm able to fall back to sleep for another 3 or so hours. As to why this works I have no idea.   I've been averaging around 7 to 7 1/2 hours sleep per night, generally awakening once during the night.  This is a big improvement over the 4-5 hours I'd been getting previously.  It would be great to sleep without waking, but I'm very happy with the results I've gotten.

 

The instructions say to take it on an empty stomach and I found that to be a good idea.  One night I took my 100 mg Enerphos directly after dinner on a full stomach and after awakening at 1:00 am couldn't get back to sleep.  Now I wait 3 full hours after dinner before taking Enerphos.  Per Alto's suggestion I take it with an Omega oil capsule.

Share this post


Link to post

I started taking Enerphos Phosphoserine on November 23, 100 mg at bedtime for insomnia.  I wasn't able to get back to sleep when I woke in the middle of the night, so on December 7, I split the dose, taking 50 mg at bedtime and the other 50 mg when I woke.  This has helped a good bit, and I am able to get back to sleep for another three or so hours.

 

I think I am stable enough to begin my Lexapro taper and am ready start, but don't want to make too many changes at once on top of the Enerphos addition and dosage change.  Should I wait before beginning the Lexapro taper?

Share this post


Link to post

It's good you are approaching this so cautiously.

 

You've been on the same dose of Enerphos for 17 days, and the dose time-change was 3 days. It can take a minimum of 4 days to a week for changes to register in the central nervous system, so you're very close to that. 

 

Are you having any other symptoms or was insomnia your main one? 

 

Do you have a plan for your Lexapro taper yet? Are you doing the general 10% taper or have you thought about a micro taper? 

 

If you aren't troubled by other symptoms and your insomnia is resolved, yes, it sounds like you're in a really great place to start your taper very soon. 

Share this post


Link to post

Shep,

 

My only other symptom is moderate anxiety, usually worse in the morning or when I go into the village or am in a social situation. Some days the anxiety is brief, other days it can go on for a while.   I generally get relief from the .5 mg Lorazepam I take 3X daily, along with the yoga pose lying on my back with my feet on the wall, and also meditation.  I can't say I'm not troubled by the anxiety but it is within tolerable levels, especially with the relief I'm often able to obtain.  I don't know if I can say the insomnia is resolved, but it is certainly better, with the Enerphos working 4 of the last 5 nights.

 

My plan was to do a general 10% taper, though I'm open to a micro-taper, which I would guess to be 5% and maybe holding longer.  Any thoughts you have would be appreciated.   I'm not able to get liquid Lexapro here, but I do have a Gemini gram scale that I've been using to measure my doses of Imipramine and Enerphos.  I plan to cut little pieces off the 20 mg Lexapro and weigh them until I get the correct percentage reduction.  I'll keep the spare powder in a pill bottle.  

 

I plan to follow Alto's post about tapering Lexapro.  

If you find withdrawal symptoms from a 10% decrease to be too difficult, after 3-4 weeks decrease by a smaller amount.

My understanding is that if the withdrawal symptom are too difficult, don't updose (too many changes) but rather wait until I stabilise.  Then I would likely decrease the next time by 5% instead of 10%.

 

As an exception to the general don't-updose rule,  I recall reading a post by Alto saying that if after 3-4 days the withdrawal symptoms are too difficult, I might updose a small amount.  I don't remember where I read this.  Do you recall this?

 

Thanks.

Share this post


Link to post
As an exception to the general don't-updose rule,  I recall reading a post by Alto saying that if after 3-4 days the withdrawal symptoms are too difficult, I might updose a small amount.  I don't remember where I read this.  Do you recall this?

 

 

I think I know what you're talking about. I recall the below two posts in a conversation between Alto and Jemima: 

 

http://survivingantidepressants.org/index.php?/topic/1024-why-taper-by-10-of-my-dosage/?p=33258

 

http://survivingantidepressants.org/index.php?/topic/1024-why-taper-by-10-of-my-dosage/?p=33260

 

This is from the thread Why taper by 10% of my dosage?

 

There really isn't a "general no-updose rule," but the hope is that if you go slowly enough, you won't need to updose. But if you do, that's okay.

 

The key is going slow enough that if there is a bump in the road, it can be more easily managed. 

 

Share this post


Link to post

I am a week into my dosage change from 100mg Enerphos to a split dose of 50mg X 2, which generally gains me about 3 hours additional sleep.  However, on December 9, 3 days into my dosage change, I started waking most mornings with depression, which I haven't felt in a very long time, certainly long before I began the Imipramine taper a year ago.  The depression fades by mid-morning.  I don't know whether the depression is a side-effect of the Ererphos.  If so, at this point it's worth it to get the sleep.

 

My question is this: I do want to begin my 10% taper of Lexapro tomorrow.  is the appearance of this new symptom any reason not to proceed as planned?

Share this post


Link to post

It's best to delay starting a taper until your symptoms have been stable for several weeks. That way you're more likely to be dealing with the sole factor of the dose decrease in Lexapro rather than a combination of things.  One factor at a time(OFAT) is how we have to do it because the research is so lacking.

Share this post


Link to post

Many thanks.

Share this post


Link to post

As Scallywag suggested, I will let my symptoms become stable for several weeks before beginning my Lexapro taper.  As it is, the depression I mentioned has abated and I'm guessing came from Imipramine withdrawal or else some situational cause, rather than any reaction to Enerphos.  

 

I have now been taking the Enerphos Phosphoserine for one month for insomnia, with definite benefit.  Since Enerphos is a new product, I've had rely on Internet sources dealing with the predecessor PS, Seriphos, and several recommend a three-month course and then stopping, which is my plan.  That will be in two more months.  Does the one-factor-at-time (OFAT) rule mean that I would have to wait until I'm off the Enerphos (plus a week for my CST to stabilize) before I can start my Lexapro taper?  

Share this post


Link to post

Are you planning to taper the Enerphos Phosphoserine or stop it "cold-turkey"?

Share this post


Link to post

I didn't know.  Would you recommend a taper?

Share this post


Link to post

G. As it's a natural supplement and you have had success with it, I would keep on with it as you taper the Lexapro. If it's helping you sleep , that's a huge advantage.

Share this post


Link to post

I've read further on Seriphos, and other sources indicate that three months is the minimum, not maximum (which is nine months), so I'm going to continue with the Enerphos.  Thanks for the suggestion.

Share this post


Link to post

Hi Gridley--  in a PM you asked me about the Brassmonkey Slide Method and I sent you a long reply.  With your permission I'm reposting that reply here for your records and so other members, who may be interested, can see it.

 

Hi Gridley-- Welcome to SA.  I'm very glad you find my experience helpful and upbeat. I've found that a positive attitude is very important to getting through everything that WD will throw at you, not just for me but I've seen in in others too.  I've also seen that the Brassmonkey Slide Method makes things a lot easier on people.  The whole idea behind it is to sneak up on the symptoms caused by a drop by spreading them over several weeks, instead of having them happen all at once. That's the main advantage of the Slide over the standard 10% drop.  It also makes a person feel like they're being more active in their taper instead of just drop and hold, drop and hold.

 

There are several ways to work the math. First the method you used, figure the total drop and divide it by 4 which works well. Then you can also calculate each dose by multiplying.  Starting with your previous dose the first week you multiply it by 0.975.  The second week by 0.95. The third week by 0.925 and the fourth week by 0.9.  So using the example of starting with 18mg you'd get 18 x 0.975 = 17.55, 18 x 0.95 = 17.1, 18 x 0.925 = 16.65, and 19 x .9 = 16.2. Rounding is either up or down which ever is closest, but doesn't happen that much.

 

I just kept track of each weeks dose as a list on a piece of paper, nothing fancy. I tracked both the mg weight and the actual weight of the dose.  Because of the pills containing fillers they weigh a lot more ( mgpw mg pill weight) than the weight of the active ingredient (mgai) which is the weight we always talk about.  You need to keep track of both. Also because of the difference in weights it is possible to get very accurate measurements using just a scale.  I use the Gemini-20 myself.

 

Yes, it will take longer to use this method compared to the 10% x 4 week recommended taper. However, it's much gentler on your system which will lead to greater success.  The 10% x 4 week method is a baseline minimum and in many cases too fast for most people.  It's much better to go slowly, because if a person starts having problems from the symptoms catching up with them from going too fast it can be very painful to get things stabilized again, and can actually take a longer time in the long run.

 

It takes a while to get ones head around the length of time it will take, especially when you get to the lower doses.  Then it seems like it's taking forever to make any progress, but it eventually happens.  As you noticed I'm just about finished with my taper.  It;s taken just about 5.5 years, I can't believe how fast its gone.  The act of tapering becomes a part of ones life with a long term goal.  As long as there is progress towards that goal, that's all that matters.  It will eventually happen.  As the taper progresses your symptoms should improve.  So by next year you should be feeling noticeably better than you are now, and each year will show more improvement.

Share this post


Link to post

Hi, all,

 

I believe I'm now stabilized enough to begin my Escitalopram taper.  My symptoms have been stable for several weeks.  The anxiety is tolerable and not constant.  I have occasional moderate depression that lifts after a while.  The insomnia is much better with the Enerphos, and I have been getting 7-8 hours sleep per night since I began taking a split 50 mg dose on December 7.

 

I plan to use the Brassmonkey Slide Method for my taper (2 1/2% reduction per week for four weeks, with a two week hold before the next drop).  I'll be calculating my dosages with a Gemini scale.

 

Any comments, suggestions or well-wishes are welcome.

Share this post


Link to post

This sounds great, Gridley, so no suggestions because I think you've got it covered.

 

I will send well wishes, though.  :)

 

And thanks for letting us know how you're doing with the Enerphos. I'm really glad it's helping. 

 

Please keep us updated as you commence the Brassmonkey Slide. 

Share this post


Link to post

I need some help please.

 

Two days ago, I started my 2 1/2% per week 4-week then hold for 2 weeks Brassmonkey Slide Taper of 20 mg escitalopram with a .5mg drop to 19.5.  Since then I have experienced a marked increase in anxiety and a return of the insomnia, going from 6-8 hours sleep to 3-4.  I was surprised that such a tiny drop would have such pronounced effect, but I am new at this.

 

I was forewarned.  Wellness wrote on this thread, "Regarding escitalopram, it has been shown to increase GABA (in rats, poor things), so it is GABAergic as benzodiazepine.  If it helps with anxiety, you can bet that you will get rebound anxiety from coming off it."

 

Brassmonkey wrote this about symptoms on his 6-week slide taper:

 

For me, I found that things eventually settled into a pattern of symptoms showing up on day 2 or 3 and had generally stabilized by day 6 or 7.  The further into each slide the longer it took for them to subside.  Almost always I would return to WDnormal by the middle of the 6th week, frequently during the 5th week.  The first part of my taper was so symptomatic it's hard to recall any pattern.  I do remember feeling slightly better at the end of the 6 weeks then at the beginning. It was more of a "push through until I find stability" sort of time.

 

On the regular 4-week 10% taper, I've read that if after 3-4 days your symptoms haven't stabilized, you can updose or if after 3-4 weeks you haven't stabilized, you can wait to stabilize then make your next drop smaller.  But in my case, with such a small drop, that doesn't seem to apply.  Brassmonkey seems to have predicted this happening when he said symptoms show up on day 2 or 3.  

 

What do I do?  Stay the course and "push through until I find stability"?  I'm feeling a little daunted at the idea of two years of this but most of you have gone much, much longer.

Share this post


Link to post

You're off to a good start Gridley.  The beginning is always rough as your body tries to figure out what is happening to it. Tapering isn't going to be pain free, it is pain managed.  There will be some symptoms hit a few days after the drop.  They'll stick around for a few days and then settle out.  After a few drops there may be a pattern start to show so you can predict somewhat how you will react.  Updosing is not a good idea, the more you change the dose the less stable your system becomes and the harder the taper will be.  Just hold on and ride it out, things will settle out. Don't think about how long the taper will last, just work on managing the symptoms you have now.  Your entire taper will not be this uncomfortable, as the doses decrease the symptoms will change.  Some will get better, some may get worse, but overall your WDnormal baseline will improve and you will feel better the longer you're at it.

 

Like I said, you're off to a good start, now it's just a matter of letting time and nature do their healing.

Share this post


Link to post

Thanks, Brassmonkey, for the encouraging words.  Very helpful.  

Share this post


Link to post

Gridley -- one small addition to brassmonkey's brilliant post: Don't let the calendar or your plan override what your body is telling you. If you get rough symptoms with a 2.5% per week reduction in the slide, make the next reduction smaller.

Share this post


Link to post

Thanks, Scallywag.  The insomnia was better last night, so I think my body is adapting.

 

I do have a stressor coming up--my sister-in-law just went into hospice and we'll be having to fly back to the States for the funeral.   She's not old.  It's very sad.

Share this post


Link to post

I went to post an update in my Introductions thread but found I was at the bottom of page 2 and I don't know how to get to page 3 so I can post.  Help, please.

Edited by scallywag
merged

Share this post


Link to post

I'm entering week 6 of my Brassmonkey slide taper off 20 mg escitalopram, now at 18 mg.  I'm doing well.  If anything, the anxiety and insomnia have lessened with the reduction of the activating escitalopram.  Good call, Alto and Shep!  One more week of holding at 18 mg and then another 2.5% cut.

Share this post


Link to post

I went to post an update in my Introductions thread but found I was at the bottom of page 2 and I don't know how to get to page 3 so I can post.  Help, please.

Just reply the way you normally would. The forum software will either add your post to the bottom of page 2 or create a page 3 and place your post there.

 

To move to different pages in your intro, there are navigation tools just below your topic title and below the last post on a page. The "tools" are clickable links. Here's a screen capture from another topic:

 

z2da8edq58qaqe46g.jpg

Share this post


Link to post

Great update, Gridley. I'm glad you are doing so well on the Brassmonkey slide.  :)

Share this post


Link to post

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now