Baclofen
Directions:
Unless directed otherwise:
- Start with 5 mg at bedtime – this is 1/2 of a 10 mg pill.
- If you aren’t experiencing sleep improvement, increase your dose by 5 mg every night up to 20 mg as tolerated (2 pills).
- Expect sleep improvement but not a knockout pill.
- Side effects can include some mild early morning grogginess. Occasionally, some people feel a little morning nausea that goes away after a few days.
If you wake in the middle of the night and cannot fall back asleep keep increasing the dose as detailed above. If this continues even after 20 mg, add a second agent that we may have talked about (e.g., tizanidine, tiagabine), or even a third agent if this is your second agent. Remember the idea of a sleep equalizer; we are using different but complimentary mechanisms to facilitate sleep quality.
What is Baclofen?
Baclofen is a muscle relaxant that has been around for a long time. It increases “deep sleep” or Delta-sleep and even helps to cause growth hormone release. While it is not a “knockout pill” like some sleep medications it clearly promotes sleep and allows one to drop back into sleep after the normal waking periods throughout the night.
Background
Baclofen is a muscle relaxant that has been around for a long time. It increases “deep sleep” or Delta-sleep and even helps to cause growth hormone release. It is usually taken three times per day when used for muscle relaxation but it can be used once at night as a sleep promoting agent with few side effects and a large safety margin. It comes as either 10 mg or 20 mg pill and is safe even in much higher doses. While it is not a “knockout pill” like some sleep medications it clearly promotes sleep and allows one to drop back into sleep after the normal waking periods throughout the night.
Baclofen is a “GABA-b agonist,” which means that it activates the main receptor that helps to calm neurons and make it harder for them to fire. Most sedative drugs ultimately act upon the GABA system, but through the GABA-a receptor instead, which also calms but has some unfortunate characteristics. GABA-a agonists include the old sleeping pills (e.g., Temazepam, Halcion) and even the newer sleeping agents (e.g., Ambien, Lunesta). Also along this line are many of the anti-anxiety drugs (e.g., Klonopin, Valium and Xanax). Unfortunately, it is a characteristic of all GABA-a activating drugs that they do little to improve “deep sleep” or delta-sleep despite the fact that they are FDA approved for sleep. Amazingly, the old sleeping pills even reduce the amount of deep sleep. Though you may sleep longer you do not sleep deeper on these medications.
Deep sleep is very important for both physical and mental health. It is the first stage of sleep that occurs, as if the body knows just how important it is. During deep sleep the hypothalamus and the pituitary synchronize and many important hormones are released. Deep sleep loss is linked to depression and anxiety, and even to fibromyalgia and chronic fatigue. Not surprisingly the loss of deep sleep leads to these disorders and these disorders lead to loss of deep sleep.
The bottom line is that improvement in deep sleep quality is an appropriate target for intervention in psychiatric care. In addition to direct attempts to help promote sleep with Baclofen, we will work toward improving your deep sleep quality through treating your primary psychiatric issues, addressing your behavioral habits that can inhibit sleep quality and looking into your physical health problems and promoting wellness and balance.
