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Medications for Sleep

Treating sleep with drugs is challenging because there is no single medication that has proven helpful in solving sleep problems for people with CFS and fibromyalgia. Also, many patients develop drug tolerance, so that a medication becomes less effective over time. For both these reasons, sleep problems can benefit from a flexible, experimental approach that utilizes a variety of strategies.

If you think medications might improve your sleep, first consider over the counter (non-prescription) products like melatonin, valerian and tryptophan, simple antihistamines such as Benadryl, Tylenol PM and Advil PM, or doxylamine (used in Nyquil). These also help when used with other sleep treatments. Other non-prescription sleep aids include passion flower and chamomile. Amino acids, such as L-theanine and L-tryptophan are sometimes helpful when other treatments fail.) 

If none of these work, you can try prescription medications. A reasonable approach in this case is to find a physician willing to work with you to find what helps in your unique situation. Since people with CFS and FM are extremely sensitive to medications, your doctor should start with low doses and increase slowly to find a dose that is both effective and tolerated.
In patients who have trouble both falling asleep and staying asleep, a particularly useful combination is Klonopin (clonazepam) with a dosage of 0.5-1mg to initiate sleep together with trazodone 25-50mg or a tricyclic antidepressant to help maintain sleep. Examples of the latter include doxepin (10-25mg), amitriptyline (10-25mg) or nortripyline (10-25mg). Amitriptyline has been most widely and successfully used, but doxepin is available in a liquid form, so doses as low as one drop (equals 0.5mg) can be used.
Next step would be a non-hypnotic medication such as Lunesta (eszopiclone), Rozerem (ramelteon), or Sonata (zaleplon). These work to naturally stimulate the sleep center of the brain, and are not thought to be addicting. Sonata has the benefit of being short acting (3-4 hours, so it can be taken for early awakening). Lunesta has been approved for long term use. Belsomra (suvorexant) is the newest sleep medication. It works uniquely by suppressing orexin, a neurotransmitter that promotes wakefulness. Belsomra has been alleged to help patients not only fall asleep but stay asleep.

The hyponotic drug Ambien® (zolpidem) is useful for both sleep initiation and maintenance. Zolpidem increases the depth of sleep but users may adapt to the drug over time, and some people experience amnesia and/or sleep walking.
Analgesics and/or non-steroidal anti-inflammatory drugs (NSAIDs) can be used for pain and often benefit sleep as well.

Xyrem (sodium oxybate) has some appealing properties, because it increases slow wave sleep and restores rapid-eye-movement (REM) sleep. The medication has been approved by the FDA as a treatment for narcolepsy and, although studies have shown its effectiveness in fibromyalgia, the FDA has concluded that the risks outweigh the benefits in treating FM.
While medications can improve sleep, they can also make it worse. Some drugs disrupt sleep by reducing slow wave sleep or causing restless legs and periodic legs movements. These include benzodiazepines (except low-dose Klonopin), narcotics, and antidepressants such as Prozac and Wellbutrin. Also, some drugs produce side effects, like a feeling of grogginess in the morning. Medications that contain caffeine and some antihistamines may interfere with sleep.
High doses of opioid pain relievers such as morphine and oxycodone can disrupt sleep. Ultram (tramadol) has the potential to interfere with sleep (even at low doses) because of its antidepressant-like action. If you are on one of these opioids, you may consider taking a minimal amount at bedtime or earlier in the evening. Heat, topical analgesics, tizanidine / Zanaflex, and Lyrica may both treat pain and aid with sleep.
1) Dr. Lapp's clinic has developed online materials for physicians. They include information needed to diagnose and manage CFS/ME. 

2) For ideas on how to solve five common problems with medications, see the article Managing Your Medications on the self-help program website.