Dr Jacob Teitelbaum MD
Q: What are some sleeping aids for fibromyalgia?
A: You can try these in the order listed or as you prefer based on your history. **ADJUST DOSE AS NEEDED TO GET 7-9 HOURS OF SOLID SLEEP WITHOUT WAKING OR HANGOVER. No going to the bathroom if you wake up unless you still have to go 5 minutes later. Mixing low doses of several treatments is more likely to help you sleep without a hangover than a high dose of 1 medication. You can take up to the maximum dose of all checked off treatments simultaneously. Do not drive if you have next day sedation (adjust your treatment to avoid this). If you’re not sleeping 7-8 hours a night without waking on the checked off treatments, do not wait until your next appointment to let us know or contact your physician! Ambien, Klonopin, Xanax and Soma are considered potentially addictive. If you have next day sedation, try taking the medications (except the Ambien) a few hours before bedtime. The antidepressants (e.g., Prozac/Paxil) can improve sleep a lot after 6 weeks. #126 and 127 can also help sleep. TAKING YOUR MAGNESIUM AND/OR CALCIUM AT NIGHT ALSO CAN HELP SLEEP. YOU CAN TRY THE NATURAL PRODUCTS IN COMBINATION FIRST TO SEE IF THEY GIVE YOU 8 HOURS OF SLEEP A NIGHT. ADD THEM IN THIS ORDER #24, 28, 33, 26, 32, 36B, 44A. Use 36C if pain keeps you up and #29 is also helpful and is non-prescription.
22.* Ambien (Rx, zolpidem) – 10 mg- _ to 1_ at bedtime. If you tend to wake during the night, leave an extra _ to 1 tablet at bedside and you can take it as needed to help you sleep through the night.
23.* Desyrel (Rx, trazodone) – 50 mg – _ to 6 at bedtime. Although sedating, it can be used (50-250mg at a time) for anxiety. Do not take over 450mg a day (or 150mg a day if on other antidepressants).
24. Revitalizing Sleep Formula (by Enzymatic Therapies and PhytoPharmica) – Valerian 200mg, Passion Flower 90mg, L-Theanine 50mg, Hops 30mg, Piscidia 12mg and Wild Lettuce 28mg. Take 2-4 capsules each night 30 to 90 minutes before bedtime. Can also be used during the day for anxiety. Do not take more than 4 capsules a day. If Valerian energizes you (occurs in 5-10% of people) use the other components.
25. Passion Flower (Passiflora) – 100 to 200mg at night. This is also good for anxiety during the day. In the sleep formula (#24).
26. Delta Wave Sleep Inducing CD/Tape. This helps with no side effects Play to fall asleep and if you wake
during the night. They can be played throughout the night if desired (order from 800-333-5287 for our web site at http://www.endfatigue.com). You can use either of the CD’s.
27.* Klonopin (Rx, clonazepam) – _ mg – begin slowly and work your way up as sedation allows. Take _ tablet at bedtime increasing up to 6 tablets at bedtime as needed. Can be very effective for sleep, pain and Restless Leg Syndrome. Klonopin may be addictive.
28. Melatonin – _ mg – 1mg at bedtime (available at health food stores). If you feel wide awake at bedtime, try 5mg at 3 to 5 hours before bedtime. Don’t use a higher dose unless you find it more effective (.5mg is usually as effective as 5mg and may be safer).
29. Doxylamine (Unisom For Sleep) – 25 mg at night (an antihistamine).
30. Soma (Rx, carisprodol) – _ to 1 at bedtime. This is very good if pain is severe. Soma may be addictive.
31. Flexeril (Rx, cyclobenzaprine) – 10 mg- _ to 2 at bedtime. Muscle relaxant – can cause dry mouth.
31A. Sonata (Rx) 10mg – Take 1-2 capsules during the night if you wake after 3AM. Effect only last 3-4 hours.
32. Kava Kava – 30% extract – 250mg capsules -1 to 3 capsules at night (if a rash develops add a B-complex
50mg at night – and stop/decrease the dose/frequency of use. If the rash persists, see your family doctor). Do not use if you have liver inflammation. May rarely cause liver inflammation.
33. 5 HTP (5 Hydroxytryptophan) – 200 to 400mg at night. Naturally stimulates Serotonin. Don’t take over 250mg a day if you are on Prozac, Paxil, Zoloft, Desyrel or Celexa. Can help with pain and weight loss at 300mg a day for at least 3 months.
34A. Remeron (Rx, mirtazapine) – 15mg – 1 to 3 tablets at bedtime (especially helpful if you feel like you’re “hibernating” during the day).
34B. Elavil (Rx, amitriptyline) – 10 mg- _ to 5 tablets at bedtime. May cause weight gain or dry mouth. Good for nerve pain and vulvadynia.
34C. Doxepin (Rx, Sinequan) – 5-10mg, 1-3 capsules at bedtime or Doxepin liquid 10mg/cc. If lower dose is needed you can start with 1-3 drops at night. A powerful antihistamine.
35. Xanax (Rx, alprazolam) – _ mg – _ to 4 tablets at bedtime. This is short- acting and gives a good 3 to 5 hours sleep with less hangover in the morning. Xanax may be addictive.
36A. Sinemet 10/100 (Rx) – 1 at 6 to 9PM each evening for Restless Leg Syndrome. Can substitute Mirapex.
36C. Cuddle-Ewe Mattress Pad – Use if pain interferes with sleep (800-328-9493, ext. 000 – company may offer a 90-day money back guarantee).
119. Zanaflex (Rx, tizanidine) – 4mg – Take with food – 1 to 3 tablets 3 times a day as needed for spasm and/or pain (sedating). Begin 4mg at night. If side effects occur raise dose more slowly. You can raise dose by 2mg each 2-3 day to a maximum of 36mg/day. May rarely cause hallucinations, delusions or liver inflammation and may lower blood pressure. Stop if it causes nightmares.
126. Neurontin (Rx, Gabapentin) – ____mg ____ times a day (to a maximum of 3600mg a day). Cut back if it causes any uncomfortable or unusual neurologic symptoms or excessive sedation. Begin with 300mg at night, slowly increase to 300mg 3 times a day as is comfortable. You can go up to 3600mg a day.
127. Baclofen (Rx) – 10 to 20mg 1 to 3 times a day (sedating).
Dr. Teitelbaum is a board certified internist and director of the Annapolis Research Center for Effective CFS/Fibromyalgia Therapies, where he sees CFS/Fibromyalgia/Chronic pain patients from all over the world (410-266-6958). Having suffered with and overcome these illnesses in 1975, he spent the next 28 years creating, researching, and teaching about effective therapies. He is the author of the best-selling From Fatigued to Fantastic!” and the newly released “Three Steps to Happiness! Healing through Joy”. His web site can be found at: http://www.vitality101.com
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