Sleep: The Prescription Medicines

Sleep Medications for Lyme Disease

Sleep is often disturbed in chronic Lyme disease. Lack of adequate sleep

• worsens pain,
• causes fatigue,
• increases inflammatory cytokines, and
• suppresses the immune system.

It appears that in response to infection, the excess inflammatory cytokines produced by the immune system disturb the sleep centers of the brain. A restorative amount of sleep is 7-9 hours of sleep a night. Sleep during the few hours before midnight is most restorative. A restorative amount of sleep is 7-9 hours of sleep a night. Sleep during the few hours before midnight is most restorative.

Before trying the prescription sleep medicines outlined in this article, be sure to follow the recommendations in Sleep in Lyme Disease. The Basic Steps. It is most important to follow the recommendations on lowering cytokines and sleep hygiene. In addition you may want to try the supplements and herbs recommended in Sleep: The Natural Medicines. The natural sleep medicines may also be used in combination with the prescription medicines listed below.

General RX Approach for Sleep in a Lyme Disease Treatment

People with chronic Lyme can have problems falling asleep, staying asleep, or both. Because of this I break medications into two groups: the "get you outs" and the "keep you outs." Medicines in the get you outs, are better at getting a person to sleep. Those that are the keep you outs, are better at keeping a person asleep.

It is best to start with a get you out even if a person has more of a problem staying asleep. The get you outs can often put a person in deep enough sleep that they will maintain sleep through the night.

Get you outs are short acting, and therefore tend to have less of a hangover effect the next day. However many people will require both a get you out and a keep you out sleep medication used in combination.

One final rule is to layer sleep medications together when needed at lower doses. This approach helps avoid side effects that can occur at higher doses of any one sleep medication while getting partial benefit from each medication that together combine for a good night of sleep.

The get you outs are medicines approved for sleep by the Food and Drug Administration (FDA) here in the United States. The medications that are keep you outs are not generally not approved for sleep, but have sleep causing side effects. In medicine physicians use medications for "off label" medical problems even when they are not approved for that purpose by the FDA.

Warning

In general, these medications should only be used if all natural medicines and lifestyle sleep modifications do not work. Of these medications, the Trazadone recommendation is the safest.

Consider seeing a sleep specialist for help with the non-Trazadone medications to weigh out risks and benefits and to review other alternatives.

The Get You Outs

Zolpidem (Ambien) 10 mg .5 to 1.5 30 min before bed. This medication is approved by the FDA for sleep. It is available in generic form. Be aware the general top dose recommended for insomnia is 10mg but in chronic Lyme sometimes more is needed. In addition if the medication works for getting you to sleep but you wake in the middle of the night, then take another .5 pill. Rarely this medication can cause night time sleep walking or even sleep driving!

Zaleplon (Sonata) 10 mg .5 to 1 pill 30 min before bed. The medication is approved by the FDA for sleep. It is available in generic form.

Eszopiclone (Lunesta) 2 mg or 3 mg 1 pill 30 min before bed. This medication is approved by the FDA for sleep. However it is not available in generic form. Because of this insurance companies will often refuse to pay for it. Without insurance coverage it can cost nearly $300 a month.

The Keep You Outs

Gabapentin (Neurontin) 300 mg 1 to 4 pills 30-60 minutes before bed. Start at 1 pill and increase every 3 nights if needed up to 4 pills. It is approved by the FDA for the management of seizures and for nerve pain. It is available in generic form. I like this medication for people that have seizure-like or tremor-like disorders in addition to insomnia. I also like it as a sleep medication in a person that has nerve pain.

Pregabalin (Lyrica) 50 mg to 300 mg 30-60 minutes before bed. It is approved by the FDA for seizure management, nerve pain, and fibromyalgia muscle pain. It is not available in generic form and can cost around $250 a month. Because of its cost insurance will often refuse to pay for it for sleep. Think of using this as a sleep medication in a person with nerve pain or who has a lot of muscle pain. It is a modified version of gabapentin and tends to have less side effect problems. So use it if gabapentin works for a person but causes side effects.

Trazadone (Desyrel) 25 mg 1 to 4 pills 30-60 min before bed. It is approved by the FDA for depression and insomnia.

Lamotrigine (Lamictal) 25 mg to 200 mg 30-60 minutes before bed. It is approved by the FDA for management of manic depression disorder and seizure disorders. It is available in generic form. I like this medication when someone has either mild anxiety or mild depression as part of chronic Lyme disease. Although it is not approved by the FDA for these uses it can be helpful.

Quetiapine (Seroquel) 25 mg to 200 mg 30-60 minutes before bed. It is approved by the FDA for managing schizophrenia and manic depression disorder. It is available in generic form. This is a useful medication when nothing else is working. However it has a lot of side effects including parkinson like symptoms and extreme weight gain. For these reasons, use it as a later resort.

A Get You Out and Keep You Out

Sodium Oxybate (Xyrem) 4.5 gm 2 times a night. You must set your alarm 4 hours after the first dose to take the second dose. This is the last resort medication. It is approved by the FDA for narcolepsy. It is also known as the "date rape drug" and is extremely restricted. In the USA it is only allowed to be distributed through one source due to federal law. It is also quite expensive and can cost nearly $600. Most insurance companies will not pay for it for insomnia but will cover it if a person has narcolepsy which is a day time disorder where someone falls asleep suddenly even repeatedly throughout the day. However, in spite of all of this, it is an effective sleep medication.

Disclaimer

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