Insomnia is New York. New York is insomnia. We have a 24/7 metro system, last call at 4am, and 24hr restaurants everywhere. Leave the office, stay up all night and catch a cab, because in a few hours, it’s time to get to the office and start it all over again.
But you toss and you turn. Every night is the same. You’re still awake. So what can you do about it? See a sleep doctor or psychologist to treat the underlying reason for your insomnia and get a long-term solution. Who has time for that shit though? Dark circles are practically mandatory for many jobs. You can’t get into a lot of bars without the bouncer putting a flashlight to your face to ensure they’re the right size and sickly shade of exhaustion.
So see your doctor or shrink for some pills to knock you out, when you can actually afford to sleep. Here’s a few of them.
Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam), and others are classics that express the 5 typical benzo behaviors: sedative, hypnotic, muscle relaxant, anxiolytic, and anticonvulsant. They act at the GABA receptors. If it ends in -pam or -lam, it’s likely a benzo. These are fine for short term use. Your doctor shouldn’t be giving you a recurring 30 days worth but that’s in an ideal world where doctors read prescribing guidelines. They were expected to replace dangerous barbiturates as a safer option. Whoops! They’re as addicting as alcohol, if not more, because they can be so subtle. Their side effects too turned out to be serious. Do not use more than once or twice a week. Blackouts, bad ideas, mysterious bruises and possibly a fatal seizure during withdrawal await you.
Ambien (zolpidem), Lunesta (eszopiclone), and Sonata (zaleplon) are Z-drugs, nonbenzodiazepine hypnotics that act on a subset of the receptors that benzos hit. The US Air Force uses them as “no-go” pills for pilots. They were thought to be safer than the benzos. Surprise! Turns out they were dangerous in an exciting new way. The Z-drugs are far better at provoking blackouts and a peculiar form of highly active, coherent sleepwalking. Even US Congressmen aren’t above an Ambien-induced blackout climbing out of bed, driving around for a quick car crash, and arguing with the police. They are just as addicting as benzos and fatal withdrawal syndromes are possible.
Seroquel (quetiapine) is an atypical antipsychotic. It is a relatively new entrant and wasn’t meant as a sedative/hypnotic. It was designed as an antipsychotic or neuroleptic drug to control manic episodes in the bipolar and psychosis in schizophrenics. They were supposed to cause less side effects than their “typical” brethren, but they — shockingly! — didn’t. Seroquel is unusual in that it has a strong antihistamine effect which causes profound sedation. Some doctors prescribe it as an unfun and unaddictive sleep aid. Too bad! It turns out atypical antipsychotics can cause interesting side effects like tardive dyskinesia, weight gain, and diabetes. It even requires a taper to avoid Seroquel withdrawal after long-term use like any other addictive drug. My favorite symptom of withdrawal from Seroquel is “excessive non-stop crying.” Doctors will prescribe this in a low dose of 25mg for insomnia. 100mg is for the homeless man you ignore on your way to work every morning.
Certain antidepressants also can be used to fight insomnia. Insomnia is a symptom of clinical depression, after all. Trazodone is a phenylpiperazine of the serotonin antagonist and reuptake inhibitor class of antidepressants. At a low dose of 50mg, Trazodone hits the right serotonin receptors to cause sleep. While it is an antihistamine, that’s a very weak effect. It comes with its own laundry list of side effects, the most dramatic being priapism and an increased sexual drive. Seek a doctor if after marathon fucking, your dick still can’t get down. Trazodone is not habit-forming, unless you have an addictive personality, then good luck with everything.
Remeron (mirtazapine) is another antidepressant that has seen use as a sleep aid. It is a tetracyclic antidepressant of the noradrenergic and specific serotonergic class (NaSSA). Remeron is also a strong antihistamine. NaSSAs differ from the more familiar SSRI (selective serotonin reuptake inhibitors) antidepressants because of that “specific serotonergic” action. By only hitting a specific set of serotonin receptors it lacks the anorexia, insomnia, and sexual dysfunction effects of SSRIs like Prozac (fluoxetine) or Lexapro (escitalopram). However that means it can make you fat via increased appetite and cause spontaneous orgasms, which for men and some women means changing your underwear and sheets. “Spontaneous orgasms” is tied with “excessive non-stop crying” for my favorite side effect. There is also a withdrawal syndrome if you try to quit Remeron cold turkey; you will need to taper down. Doses start at 15mg.
Of course, you may not have insurance, so seeking a doctor not possible. Luckily, there are over-the-counter options. Many of the drugs mentioned above have antihistamine action that explain their sedative/hypnotic properties. Therefore you can use antihistamines like Benadryl (diphenhydramine) and Unisom Sleep Tabs (doxylamine) to help you get to sleep. Other brands of Unisom are actually diphenhydramine in disguise. Take 50mg of diphenhydramine or 25mg of doxylamine. They’re supposed to be non-habit-forming and not that fun to abuse because the euphoria and hallucinations they cause in overdoses also comes with discomfort in the form of your lungs and heart stopping.
If you’re a hippie, you can choose a variety of herbal treatments. I can’t cover all of them, but I can cover two major ones available at any supermarket. Chamomile Tea is a common choice. Some of the compounds in the chamomille plant act on the GABA receptors, like benzos and Z-drugs. You have to eat a bushel of daisies though to get anything abusable, so there have been no reports of that. Drink a cup of tea before bedtime. You’ll also find Chamomile Tea with Valerian Root or just Valerian on its own. Compounds within the valerian plant are chemical relatives of GABA and are suspected to have action there. You drink the tea the same way. However, I cannot tell you how many valerian root capsules to take due to the loose laws around herbal dietary supplements. Follow what’s on the bottle and pray it’s not Chinese arsenic herbs.
Then there are common drugs of abuse that can cause sedation. You can drink yourself to sleep, but you’ll become addicted to ethanol and then your liver will die. You can take opioids like heroin or Oxycontin (oxycodone) but those too are obviously addictive. “When does a heroin addict poop? Sunday.” You can smoke yourself to sleep with cannabis. THC is supposed to be effective. But it’s still mostly illegal, and still a chemical crutch. In the end only a lifestyle change with the help of an experienced doctor can banish your insomnia long-term. The pills and tea are so much easier though.
Sleep well; try not to die.