July 30, 2017

My first week on hydroxyzine.

All claims are for a nightly dose of 150 mg hydroxyzine. Melatonin (rapid release) was taken on all nights at the same time as hydroxyzine, generally at my usual melatonin dose of 150 mcg. Two nights I took 300 mcg melatonin, but I was more tired those days (possibly unrelated), so I discontinued. I will see if timed release 300 mcg melatonin tablets work better.

Objective and/or relatively falsifiable claims.
  • I've had no headaches since starting hydroxyzine, whereas I normally experience regular headaches. Insufficient data to definitively claim that hydroxyzine is the causal factor.
  • Sleep onset latency is reduced to less than 45 minutes (usually after waiting 1 hour for hydroxyzine levels to rise, making sleep onset less than 1 hour and 45 minutes post administration).
  • Earlier sleep onset is achievable. Early sleep onset usually results in early awakenings. Its possible that this issue could dissipate with time on a stable schedule.
  • Photophobia is reduced/eliminated. Insufficient data to make a proper analysis.

Subjective claims.
  • Sleep urge at peak concentrations (~2 hours) is insufficient to desire sleep.
  • Grogginess is reduced dramatically.
  • Tiredness is reduced between 2 to 10 times, depending on reference point.
  • Tiredness is extremely stable in comparison to previously, yielding very little deviation within a day.
  • Tiredness is inversely correlated with sleep quality, compared to a previously paradoxical and unstable relationship. Presumably, this may be due to a shift from a compensatory stress response to more conventional wake promoting mechanisms.
  • Inter-day subjective variable heterogeneity is reduced dramatically. There is much more homogeneity for sleep time, sleep duration sleep quality, alertness, and energy.

Preferences and wants.
I would like to continue taking hydroxyzine. However, I would like to try an increased dose. The reasons are severalfold. I would like to see if larger doses can induce sleep urge. I would also like to have the option of earlier sleep onset without worry of early awakenings. I hope that more stable and/or enhanced sleep can improve functioning and subjective states. Lastly, I would like an antihistamine tolerance to drug metabolism ratio suitable for sustained vigilance (a theoretical benefit, not necessarily accurate).

My second week on hydroxyzine (still 150 mg) has not been as successful as the first week in terms of sleep latency and sleep schedule. However, I seemed to be even less sleepy than last week. In fact, I think it was the fact that I was less sleepy that was giving me trouble sleeping. (Edit: in retrospect, I don't think it was sleep debt since I don't recall it working better after bad sleep. I think it's more likely tolerance to the antihistaminergic effects, which I was expecting, prepared for, and even counting on. I haven't quite nailed the time frame of tolerance, though given rapid tolerance to sedation from diphenhydramine/benadryl (2), I would expect to reach peak tolerance within a weak or two) Nevertheless, several differences between the two weeks need to be considered before drawing concrete conclusions. The first week I was visiting family, was woken up by their bustling (providing sleep debt to help me sleep), ate differently, and did different activities. Furthermore, this second week I tried incorporating methylxanthine (caffeine and theobromine) tolerance to enhance the effectiveness of the antihistamine. It hasn't really worked yet, but I'm discontinuing early because I think it was disrupting my sleep, and I don't particularly enjoy the acute effects.

I'll talk to my medical provider and try to convince her to give me the higher doses which I originally wanted. Namely, 200-300 mg, with my experience so far suggesting the high end might be appropriate. The highest dose I've found in a study is 400 mg daily; double a normal dose, (1). They found it effective for anxiety, but reported high incidence of sedation as a side effect. In fact, they had a high drop out rate due to "side effects". Sedation appears to be the primary reason larger doses aren't often used for anxiety. Obviously, that is not a side effect in my case. I find it absurd that they don't just try administering the drug at night.

Conclusion: 150 mg of hydroxyzine nightly has improved my subjective sleep quality dramatically. However, beyond a week of administration it failed to enhance sleep schedule or nighttime subjective tiredness. Daytime functioning remains enhanced. I wish to increase my dose to 300-400 mg. My original dose range preference (200-300 mg) was based on anecdotes. This study has me thinking that 300-400 mg may be a better range because some patients only reported mild, as opposed to marked, sedation on 400mg daily.

UPDATE 2: I've been taking the same dose for over a month now. No change from week two. I tried 200 mg for several nights (my prescription is still only 150 mg), and it seemed moderately more effective, but I didn't take that dose long enough to develop peak tolerance.

(1) http://www.sciencedirect.com/science/article/pii/0010440X70900064?via%3Dihub

(2) Tolerance to daytime sedative effects of H1 antihistamines. https://www.ncbi.nlm.nih.gov/pubmed/12352276

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