Olanzapine/Zyprexa Insomnia

[MegaInsomniac]

Anyone have insomnia after reducing or quitting Olanzapine/Zyprexa? I can't sleep. If I want to sleep I need Zopiclone or Lorazepam, nothing else works. I've tried all the sleep hygiene CBT stuff, doesn't work at all. I've had this problem for over a year.

[kaliska0]

Ahhh.. zyprexa.... the really expensive med that has gotten the company sued many times because they keep advertising it for various uses it has not proven effective for. Plus all their studies that do have a positive outcome have some serious red flags. For me it was a very expensive $800/month placebo. I'm not saying no one should try zyprexa but if anyone's doctor recommends that as the first antipsychotic to attempt they should probably find a 2nd opinion unless circumstances and symptoms are very unique.

Stopping antipsychotics (or anything that works as a sleep aid but especially that particular group of meds) will result in insomnia. It usually resolves within a few weeks. Occasionally a couple months for some people. On very rare occasion there are people who find it takes years and sometimes they never entirely return to "normal" after extended antipsychotic use.

If you are having serious or longer term problems you didn't have before then "been there, done that" and this is what I found in the years after I stopped more than a decade of antipsychotics and antidepressants.

Doctors do not recognize longterm complications after stopping a psychiatric med as being a possibility but almost no studies have ever run long enough to determine the truth and there are tons of first hand accounts that state otherwise. A couple meds such as amphetamines have actually shown to have lasting neurological changes in studies following patients for up to 18 months after they stopped all medications. It is fairly well proven that it's not impossible for a med to continue to alter brain or body function. It's just not accepted yet by the medical community as possible so those of us who find we have long term problems are on our own. If you do searches on long term negative effects of antidepressants you may find groups with other people that have suffered years of symptoms after stopping psychiatric meds. You'll also find a bunch of medication paranoia you should probably ignore when doing such online searches.

It took me about 2 years to overall recover from 12+ years of antipsychotics (mostly seroquel) and stabilize. I very slowly weaned off seroquel and had been off it completely for a couple months but I continued to have symptoms. My mood was actually better but I had a lot of ups and downs in energy and motivation. At one point I quit feeling the need to sleep and didn't manage to sleep for over 72hrs despite spending a fair amount of it quietly laying in bed. I don't recommend going more than 3 days without sleep. I also was only able to eat fish for meat or I'd feel sick and tired and despite never having more than the odd allergic reaction to something I developed horrid allergies that turned into chronic bronchitis. I spent 6 months seeing an integrative health doctor to improve it all and also lost about 100lbs in the process.

The weight problems, metabolic changes, and immune system rebalancing that can occur with psychiatric meds is often corrected relatively easily after stopping them. Then sleep or daytime motivation or unstable mood frequently become the biggest ongoing problem for a lot of people that took antipsychotics, high dose tricyclic antidepressants, or less often SSRIs. There is no way to know exactly why it happens but it certainly may require prescription sleep aids for a period of time. From what I've seen those that didn't start out with insomnia do often wean off the sleep meds but it sometimes takes a few years.

Benzos and z-drugs will probably be relatively useless or short lived and does not target anything the antipsychotics did. It usually takes a seriously high dose of a benzo to get anywhere near the sedative effect of an antipsychotic, even if it is zyprexa. I suggest thinking outside the box and looking closer at the actual pharmacology of the meds instead of only the general "how do we normally treat insomnia?" approach.

Hydroxyzine is often useful both for sleep and a variety of immune based problems that can contribute to sleep issues. It's an old antihistamine with a high level of sedation so can be useful as an off label sleep aid for people with various immune problems, arthritis, interstitial cystitis flare ups, severe allergies, when stopping something that also had a strong antihistamine effect like antipsychotics do, or just those who don't respond to other sleep aids. It has a relatively minor side effect list with no chance of addiction and minimal risk to worsen or trigger an existing psychiatric condition but you would of course need to consult your doctor on that. Have taken it in the past with tricyclic antidepressants and currently taking it now with belsomra and clonidine er.

Taking chlorpheniramine or doxylamine(unisom) would be some possible otc options along the same lines but with actually more odds of minor but annoying side effects and less odds of improved sleep than prescription hydroxyzine will potentially accomplish.

Mirtazapine and trazadone can be good temporary replacements for antipsychotics when we are talking insomnia. However, the reason you were on an antipsychotic or other neurological/behavioral reactions may make these bad choices and their side effect potential is higher than other things I'd suggest. Mirtazapine often loses it's sleep benefits within a month and may even act as a stimulant in some people. Not the first things I'd recommend trying but I did alternate using both of these at lower doses (25-50mg trazadone) to improve sleep and daytime motivation in the years immediately after I decided to no longer rely on antipsychotics or tryciclics.

I find belsomra to be one of the safest prescription sleep aids and extremely useful for getting to sleep without interfering with quality sleep. I take it nightly and probably will for life unless something magically cures my life long insomnia. Especially if you have any sort of agitation or restlessness that increases around bedtime I recommend asking about it.

One thing with belsomra is that you probably won't notice a sedative feeling. Despite being classed with the sedative hypnotics it works by blocking orexin, which triggers all sorts of substances that make you more alert, rather than increasing something sedating to the nervous system like every other sleep aid out there. Without the extra sleepy feeling if you don't also follow good behaviors for sleep you can completely negate the effects of belsomra. It probably contributes to how many claim it is not effective when studies under controlled conditions showed a very high success rate.

The way belsomra reduces the release of a lot of neurotransmitters, histamines, and hormones that trigger wakefulness and the similarities that has with the antagonistic actions of antipsychotics may be helpful when dealing with the effects of withdrawal or lasting residual symptoms from those meds. It also has absolutely no direct overlap in action with any other med since no other med exists that acts on orexin. Despite getting slapped with all the labels of the sedative-hypnotic class when you look at it's results in studies and backing it up with personal experience it has no potential for addiction, no withdrawal, no tolerance (if it works day 1, it works day 500) and mostly only showed a possibility for next day drowsiness as a side effect. Beyond it not proving helpful for many people there's practically no reason not to try belsomra for a sleep problem unless medical services don't cover the cost.

Valerian root is a good general otc option and frequently works better than melatonin unless you have a reason for problems producing enough serotonin or melatonin. There are some stronger gabapentenoids otc than valerian root but they can cause all sorts of problems and have really bad withdrawal that could leave you worse than you are dealing with the current problems. Gabapentin would be a prescription gabapentinoid sometimes used off label for insomnia with a low side effect rate. These things work on gaba like benzos and z-drugs you've been trying so may not be worth pursing prescription versions or the stronger, more expensive options beyond supplementing a little valerian root with other things.

I recommend caution with anything that impacts serotonin, melatonin, or dopamine. You may find you have increased sensitive and higher odds for negative reactions to typical recommendations like 5htp or st john's wort that raise serotonin.

Phosphatidylserine is an otc option that can be extremely useful for some people. It was mainly studied for how it lowers cortisol but it's also been used to treat ADHD related insomnia and some circadian rhythm disorders (inability to maintain a normal day/night sleep schedule). Sometimes a given brand won't work for a certain person while another that doesn't work for someone else will.

I stopped valerian root and gabapentin after a few years because they just weren't useful enough but I take phosphatidylserine 100-200mg about 4-5 nights, take a few days break, and then take it for 4-5nights. I find it doesn't work consistently if I just keep taking it every single day.

Magnesium glycinate is very useful for some as a general sleep aid. Both the magensium and glycine encourage sleep in the average person. However, when dealing with potential metabolic changes some things that normally make you sleepy like magnesium can actually cause a burst in energy. That's a sign you need to keep taking it to help correct a problem and just change the time of day depending on effect. You will probably find you still sleep better that night even if you take magnesium in the morning for energy instead of it making you sleepy.

A somewhat more complex otc option that has helped many people recover from a variety of psychiatric meds is racetams. Oxiracetam has been well studied for helping the brain recover from certain neurological strain, treating the decline of disorders such as alzheimer's, and in one study it reversed medication induced memory loss. It's still only theory but it's believed racetams might help restore normal neurotransmitter receptor function when your brain has been overwhelmed by meds or damaged by physical trauma.

Occasionally racetams have no effect at any dose on a particular person. Others find they have a very profound effect and improve all sorts of cognitive or mood issues. Hit or miss but they are relatively harmless to try if you don't go beyond the typically used dosages. It's hard to say which one to attempt for best results. Some are more energizing while some are used by people to treat anxiety or symptoms of stress. Others take them because they claim it improves creativity when doing art or fiction writing. Some are fairly neutral for mood or energy but good for memory and concentration. Fasoracetam might be the best to help immediately with sleep but it's possible one of the others might have a greater overall effect and end up working better long term or improving things you didn't realize were a problem. Some nootropics sites sell small dose sample packs of various racetams and rotating racetams is not a bad idea anyway. There are also various articles and youtube vids explaining different racetams or nootropics groups discuss them frequently.

Generally the only issue with racetams is they may convert choline to acetylcholine used by the brain at a greater rate than the body may be able to replace choline on it's own. Depending on diet, racetam dosage, and the individual they may cause fatigue, headache, and an overall crappy feeling the next day if not combined with a choline supplement. Easy to fix given choline supplements are cheap, common, and safe.

I take coluracetam in the morning, fasoracetam in the evening, and citicholine twice a week. Many take a form of choline daily but I find it triggers my insomnia if I take more than the minimum needed. Racetams are probably the most important thing I started taking to be able to function normally after stopping my years of high dose seroquel and amitriptyline. Even only taking coluracetam makes me both have more stable energy during the day and sleep better that night. Just not coluracetam too late in the evening or while I'll still be sleeping well, it won't be until after the sun comes up.

[MegaInsomniac in reply to kaliska0]

Thanks for all that, lots of info!

[Sonata2 in reply to MegaInsomniac]

I had bad insomnia coming off a minute dose of olabzapine. Googled and found that lots of other people had the same problem coming off It. I tried cutting the tiny tablets in half, then in quarters, so I could come off it as slowly as possible. It’s awful not being able to sleep! I also heard new curtains put in my bedroom which kept the lights out more to see if that would help. Unfortunately it took quite a long time to adjust. Maybe I should have tried other medication to help? But that depends what else if anything you are taking of course.

Someone mentioned melatonin that might be an idea. But would you get dependent to sleep on that? One medication causes sleepiness and is often now used as a sleeping tablet, but which actually the sleeping effect wears off over time is amitriptyline – brand name in the UK is usually Teyptazol. Originally it was just just used as an antidepressants, and is still used in that way also. But as an aid to sleeping you would just take a dose at night. I empathise with your problem. I have been on the mood stabiliser it called Quetiapine since that time. That has a very strong sleeping pill effects as well as being a mood stabiliser. Before the pandemic, I was able to reduce that medication to almost nothing. But I decided to stay on half the smallest dose available, again by cutting the pill in half, just to help me sleep. I didn’t wish to go through the problems of not sleeping for a very long time once again as I had with the typing as I had with Olabzapine. I have bipolar, so need to take medication all the time. I see that as being like a diabetic person taking their insulin. Despite side-effects, medication has helped my life to be less unbearable and more worth living. Would have been better still if I had had better mental health treatment and not been wrongly left on the CRM for 23 years!

When the pandemic started and lockdown was introduced in England, I decided to increase my mood stabiliser from being just a sleeping pill to be in a real mood stabiliser to help me cope. Over time I increased it to 100 mg. Later when there was a crisis I increased it again to 150 mg. Have started decreasing it now, partly because it may be causing physical health problems possibly – that’s being checked. I’ll add that I am H 75 and and there are not usually physical health problems with quetiapine except sometimes for older people.. The other exception with Kataya pain is possible weight gain. That hasn’t affected me really I am overweight but I don’t think it is caused by the Kataya peen because I have a lower dose and then quite a lot of people with bipolar needs. I can’t solve your problem about insomnia but hope some of the advice here has helped. It really depends on your overall condition, Your your age and health generally as to whether you would consider it trying to reduce the others then is a pain to half a tablet – that is half the minimum dose, if you were able to do that and then just keep taking that to help with sleep. However, I think it’s likely to be easier to reduce Quetiapine than olabzapine. You could consider things like meditation? Unfortunately it seems to be some sort of physiological cause that makes olabzapine hard to stop. I couldn’t take a higher dose of Olabzapine as it made me extremely hungry. Some people get. Completely knocked it out with sleepiness by Quetiapine when they start taking it. I have built up my dose very gradually. I took the very small dose of 25 mg at night when I was on coming off lithium, and it helped.

Wishing the best of luck with finding A solution! xxx

[MegaInsomniac in reply to Sonata2]

Thanks for your well wishes!