“A Prescription For Sleep”: Sleep Drugs For CFS and FM

Alternative medications may be the first choice for chronic fatigue syndrome (ME/CFS) patients but they are often not effective enough. A panel of prominent ME/CFS doctors indicated that while they were open to the use of over the counter products like melatonin, Benadryl and Tylenol PM that they don’t usually provide enough relief. Prescription drugs may have some side effects but most doctors  regard the tradeoff as acceptable.

I’ve come to believe that while natural is best, if you don’t sleep, if you cannot develop some kind of restorative sleep, even medicated sleep, it’s one of the worst things about your illness.” Dr. Bateman

As with any treatment there will be a broad spectrum of responses. Dr. Bateman says “Every drug has this spectrum of how it will work; every drug on here has proven value, proven safety, yet it could be horrible for any one person….Topamax (for instance) is really hard for some people, but for others, it’s incredible, so you can’t generalize about a drug.”

Several physicians reported their patients often need two types of sleep drugs, one to put them to sleep and one to keep them asleep. Dr. Teitelbaum goes further arguing that getting a solid eight to ten hours of restful sleep is worth taking the time and effort to settle on as many as five or six different sleep aids if necessary. Since most of the side effects (and fewer of the benefits) come at higher doses, he believes patients can maximize their benefits by taking small amounts of several sleep aids at once.

“Many people….are afraid to take enough medication to get adequate sleep. They are so grateful to get five hours of sleep a night that they settle for that. That’s a bad idea. I recommend taking whatever is necessary to get eight to nine hours of solid sleep..even if it means taking several of these medications at one time”.

Prescription and OTC Drugs:

These drugs have shown promise in assisting sleep in chronic fatigue syndrome (ME/CFS). See the chart below for more recommendations from ME/CFS physicians.

Prescription Drug Chart

The IACFS/ME ME/CFS Primer For Clinical Practitioners (2012) written by CFS physicians provides the following recommendations for sleep medications.

Medication Dose Comments
 Tricyclics: Amitriptyline,   Doxepin, Nortriptyline 5-100 mg  Take 5 hours before bedtime. May worsen dry mouth, con-stipation, orthostatic intolerance, or cause daytime sedation
 Cyclobenzaprine  5-10 mg  Same comments as tricyclics above
 Trazodone  12.5-200 mg  May be the least likely to lose effectiveness for sleep
 Quetiapine  12.5-100 mg  May cause weight gain or extrapyramidal symptoms
 Gabapentin 100-1500 mg  May help nocturnal pain and restless legs syndrome
 Pregabalin 50-450 mg  Helpful for nocturnal pain, but very sedating for some
 Antihistamines: Promethazine, Diphenhydramine  10 mg/50 mg  Anticholinergic side effects
 Clonazepam  0.25-1 mg  For restless legs, muscle spasms or anxiety.
 Orphenadrine  100 mg  For restless legs or muscle spasms (not available every-where)
 Ropinirole or pramipexole  0.125-0.25 mg  For restless legs or muscle spasms (not available every-where)
 Melatonin  1-3 mg or more, 2-3 hours before bedtime  May help patients who have altered circadian rhythms
 Zolpidem  2.5-10 mg  Short duration of action may lead to rebound insomnia
 Zopiclone  7.5 mg  Short duration of action may lead to rebound insomnia
 Mirtazapine  7.5-15 mg  May cause daytime sedation; tolerance may develop

 

The chart below provides recommendations from nine prominent ME/CFS physicians. While their recommendations vary they display a general consistency that is encouraging.

ME/CFS Physician Recommendations for Prescription Sleep Medications

ME/CFS Physician

 Sleep Initiators

Sleep Prolongers

Dr. Bateman

Ambien, Sonata, Lunesta, Restoril, Melatonin, Rozarem, Zyprexa

Trazodone, Remeron, Neurontin, Lyrica, Amytriptyline

Dr. Bell

Flexeril, Carisoprodol, Elavil, Klonopin, Ambien, Sonata

Trazodone

Dr. Klimas

Sinequan (Doxepin) elixir, Elavil, Flexeril, Klonopin

Dr. Lapp

Clonzepam, Sonata, Lunesta, Ambien, Klonopin

Trazodone

Dr. Levine

Sinequam (Doxepin), Klonopin

Trazodone, Amytriptyline, Norpramin, Neurontin, Cyclobezaprine

Dr. Pocinki

Ambien/Ambien CR

Amitryptyine, Trazodone

Dr. Rosenbaum

Elavil, Sinequan (Doxepin) elixir, Sonata

Dr. Teitelbaum

Ambien, Klonopin, Sinequam, Flexeril, Zanaflex Trazodone, Neurontin, Sonata, Amitryptyline

Dr. Wallace

Ambien, Klonopin

Neurontin

Sleep treatments for ME/CFS from Phoenix RisingSleep Series on Phoenix Rising

______________________________________

Lucinda Bateman, MD., 2006. “Tips and Travails of Treatment”, An abridged version of a seminar transcript of a Nov. Lecture in Auckland, New Zealand by Pat Fero and David Thompson.

David S. Bell, M.D., 02-13-2002, “Medications for Chronic Fatigue Syndrome and Chronic Pain Control”, ImmuneSupport.com. http://www.immunesupport.com/library/showarticle.cfm/ID/3343

The IACFS/ME ME/CFS Primer For Clinical Practitioners (2012)

Charles Lapp, MD., 1999. “The Treatment of Chronic Fatigue Syndrome and Fibromyalgia”. ImmuneSupport.com, 07-03-2006. http://www.immunesupport.com/library/showarticle.cfm/ID/2926

Carol Sieverling. 2000. Paul Cheney, M.D on Klonopin Protecting Your Brain.by Carol Sieverling from the CFIDS and FMS Support Group of Dallas Fort Worth.

 

Jacob Teitelbaum, 2007. From Fatigued to Fantastic, Avery Publishers.

2 comments

{ 2 comments… read them below or add one }

Amanda August 15, 2012 at 9:10 pm

How can I contact one of these drs? Dr example dr Lapp?

Reply

Chuck March 10, 2013 at 2:52 pm

Amanda,

You can contact Dr. Teitelbaum on his website Endfatigue.com.

I am very hopeful, for the first time in over 30 years, with his help.

Please note that I have only been working with Dr. T and his staff for 2.5 months. However, I can now sleep through the night (most nights-seems to go hand in hand with stress levels).

Chuck
.

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