Buprenorphine sublingual at 0.4 mg. Still struggling…

[dickJones]

I’ve been on the 0.4 mg tablets for a week now and although by and large my nightly PLMs are being suppressed, I’m still struggling. At best I’m getting by on a series of short-scale sleeps running at 30 to 50 minutes in duration. At worst the insomnia side effect is dominating. Last night I had no sleep at all between 23.30 and 06.30. What remedies, over-the-counter or prescription, have Buprenorphine users found effective for these challenges to sleep?

[Joolsg]

Dick, has the PLM and RLS settled? Are you experiencing opioid induced insomnia, so your RLS/PLM is controlled but you're alert and can't sleep?If that's the case, you may have to add a small dose of a sedating medication like pregabalin/gabapentin and/or medical cannabis ( a sedating strain). Medical cannabis oil with THC can help with insomnia.

[dickJones in reply to Joolsg]

Yes, Joolz, PLMs largely receded but sleep hostage to an alternating mixture of short-scale slumbers and wide awake insomnia. Last night I was awake continuously for 6 hours 30, the worst night yet. I have both Gabapentin and Pregabalin capsules to hand, the former at 100 and 300 mg. What strength should I use and in what quantity?

[Joolsg in reply to dickJones]

I find I only need a very small dose of pregabalin- 25mg. But I take it for opioid anxiety. Opioid 'alerting/insomnia is something I don't have.If you have 100mg pregabalin pills, you could try cutting it and halving the powder and take 50mg just before bed. Or 100mg if that doesn't have any effect. Pregabalin and gabapentin are sedating usually. Cannabis oil with 20% THC I take about an hour before bed and it definitely helps with sleep.

As others have suggested you could try zolpidem (ambien) but no more than twice a week because tolerance builds quickly.

[TeddiJ]

Awful for you! If you can get them, I have taken small doses of Ambien or THC gummies, along with the Suboxone (BUP) and both work well.

[dickJones]

Thanks, TeddiJ. A chat due with - hopefully - the decent doc this morning!

[Ticki]

I’m on 8 mg.one a night.

[dickJones in reply to Ticki]

Are you in the UK?

[Ticki]

Washington State.Tacoma

[dickJones in reply to Ticki]

Then you benefit from the Mayo Clinic recommendations on dosage. There’s no UK equivalent protocol and our doctors won’t step from under the NHS umbrella and risk following Mayo guidelines. I never thought I’d express a preference for any aspect of the American health system over our ‘free at the point of use’ NHS, but here I go…

[enjoy2013]

I have managed to control my RLS +PNLM with lyrics, zopiclone, magnesium, melatonin, iron, vitamin B3 AND gym. "AND" because when I eventually get some RLS, it usually happens on days where I didn't exercise for 2 - 3 days (if I have enough iron on board)

If you don't exercise, I strongly recommend you do. I think Vit B3 is also interesting

[dickJones in reply to enjoy2013]

I exercise. And neither zopiclone nor melatonin work for me. Sadly - or happily - we’re all at the mercy of our unique constitutions.

[enjoy2013 in reply to dickJones]

Have you tried any form of B3. In RLS, anecdotal cases have value. Not to mention its effects on sleep in people with no RLS.

[dickJones in reply to enjoy2013]

Vitamin B3. I’ll try anything! Thanks for the tip.

[dickJones]

Another Buprenorphine question! Since beginning with the Buprenorphine patches back in the summer and now having graduated to sublingual tablets, I’ve experienced appetite loss. A number of the side effects lists include appetite loss as reason to notify one’s doctor. I’d be grateful for any observations on both the phenomenon and whether I should flag it up.

[rls-insomniac in reply to dickJones]

I've not experienced loss of appetite since taking buprenorphine. I did suffer with a bit of nausea initially, which settled down after a short while . But it depends on whether this is a problem for you really. Are you suffering with any nausea, which might be a reason for your loss of appetite?

[dickJones in reply to rls-insomniac]

No nausea, just a general loss of appetite. It’s listed as a sometimes side effect and I just wondered whether anyone had experience of it.