Safe medications to take for sleep maintenance insomnia?

As 2019 nears its end, I wonder if there is anything we could take for sleep without worry so far.

Earlier in March I took very polyphenol-rich cacao nibs for a few days and ever since then I am consistently unable to sleep for more than 3.5 hours. Two nights ago I crashed further from having an emotional breakdown. My 3.5 hours of sleep has now been reduced to 1.5 hours. I am in an urgent state, screaming out for help here.

What medication or supplement if any is safe or at least is worth the risk for dealing with our insomnia? I’ll list some of the ones that I deem off the table for me based on perceived risk:

Benzodiazepines and z-drugs e.g., zopiclone and Ambien (zolpidem) - Consistently shown to increase risk of cancers across the board akin to or even greater than smoking packs of cigarettes. Despite this fact, its cancer risk is rarely brought up anywhere. Increased depression and suicidal ideation. Increased all-cause mortality is associated with benzodiazepines. The safest of the bunch seems to be diazepam which happens to be a TSPO ligand.

Etifoxine - If it were more effective we’d hear more about it from people who have tried it. Like diazepam, it binds to TSPO = increases conversion of cholesterol to neurosteroids e.g. allo. Some concerns of acute liver damage, and rarely severe skin disorders like SJS. Episodic liver function monitoring is recommended.

Trazodone - PSSD, fatal arrhythmia, priapism. I personally experienced arrhythmia on this.

Mirtazapine - Very potent 3a-HSD inducer =lowered androgens, scattered reports of PSSD from an unlucky few, tetracyclic class of AD associated with high risk of dementia

Gabapentin - Memory loss (halts synaptogenesis), bone resorption/loss

Seroquel - Tardive dyskinesia, diabetes, fatal arrhythmias

Belsomra and orexin antagonists - Merck’s next Pandora’s black box. Long term safety profile unknown due to no large clinical studies thanks to the FDA. Orexin receptors are expressed in the heart, for a potential surprise. Its safety is being investigated for use in heart failure patients for insomnia in Japan. The Orexin system regulates the serotonergic neurons of the raphe nuclei, which means it could agonize 5ht-1a. May cause narcoleptic symptoms like cataplexy, paralysis, and hypnogogic hallucinations.

Hi Mercked

I’ve been using Xyrem for 6 weeks or so and it has had some mild benefits. Certainly has helped staying asleep after the 4-5 hour mark, but it’s still relatively light sleep. It also seems to help with nocturnal and morning erections.

Certainly not a cure by any stretch, but has improved sleep from 3/10 to 5 or 6/10. Downsides are the cost (which frankly I should be donating to research/foundation, but I have a high stress job and any sleep helps) and the fact I currently purchase illegally due to the ridiculous hoops one has to jump through to obtain legally.

If you’re interested in trialling, hit the dark web and I can recommend a good reliable vendor.

Cheers

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Thank you. Sending a DM.

Explain your insomnia symptoms…

Hydrocortisone may be beneficial in certain instances.

I can sleep for only 3.5 hours at a time then I’d be up for a few hours. There’s no anxiety whatsoever. I just wake up exhausted but wouldn’t have the sleep pressure to go back to sleep until a few hours later.

best bet might be to get a 24 hour urinary cortisol test.