Archive for March 3rd, 2007

Does Xanax work for sleep?

Saturday, March 3rd, 2007

I am not crazy about long term use of Xanax (or any other benzodiazepine) for treatment of chronic insomnia because they don’t produce all the normal sleep states (esp. stage 4 deep sleep).  Whether this is the case in everyone and whether this effect persists indefinately has not been adequately studied.  My main concern is that lack of stage 4 sleep can be associated with less secretion of growth hormone and other restorative processes that occur during the deepest sleep states - e.g., maintaining the immune system.  There may also be some reduction of REM sleep - that might impair long term memory.  None of this is adequately studied.

 
Xanax is a great medication for anxiety and can be used long term - but I prefer that it not be the primary medication for insomnia.  Ambien CR, Lunesta, Sonata, or regular Ambien provide normal sleep.  Tenex (Guanfacine) or Clonidine help induce deep sleep.  Trazodone and Seroquel in low dose seem to provide relatively normal sleep although they are stronger meds and have other potential side effect issues.
 
Rozerem, a prescription med that stimulates specific Melatonin receptors associated with sleep problems (mainly with circadian rhythm problems) is also a possible solution.
 
Before considering any sleep meds, sleep habits (See Do’s and Don’ts of Sleep on my website) need to be addressed.  One of the biggest causes of sleep problems is inadequate am bright light, and too much bright light at night (especially TV and computer screens).
 

 

 

How can I live like a normal person when I have ADHD?

Saturday, March 3rd, 2007

Most of my ADHD patients do well and many if not most like being ADHD.  There are some who haven’t found the "right medication(s)", but there are frequently new medications that become available.  Within 4-8 weeks we will have Vyvanse, a new form of Dexedrine that has research benefit higher than currently available medications.

Sometimes it takes a combination of meds like Adderall XR or Methylphenidate + Tenex (Guanfacine).  Sometimes it takes a different form of medication (like the Daytrana patch) which is a form of Methylphenidate that avoids first pass metabolism in the gut and liver.  This is a plus for patients that are rapid metabolizers and don’t get enough of the tablet forms into their brain.  There are also people that don’t tolerate any of the stimulants except Desoxyn.

www.askdrjones.com/2007/07/16/vyvanse-new-treatment-for-adhd/

 

Another possibility is that you are not just ADHD.  At least 85% of people with ADHD have other conditions that have to be addressed.  You are 3 times more likely than the general population to have a mood disorder, an anxiety disorder, substance abuse issues, or impulse control disorder.

We already know 11 different gene variants that are more common in people who are ADHD.  All these possible complexities need to be addressed as well as basic health habits (especially sleep) to enable you to have the quality of life you want and deserve.