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Emily/Julian, Hi, the ativan has always been so effective that we have never had to deal with the reduction of its helpfullness.The correct dosage was a joint decison. The doctor started Nancy out at a low dose and with an understanding of what a maximum dose would be that I could administer. There was a period of time when it was critical to us. Now it is rarely needed. I think the anxiety has a great deal to do with building up coping skills as the freezing and muscle tension begin to dominate the PWP's ability to move, especially in bed. As coping skills improve and different devices are used to assist, the anxiety can be reduced. Some of the aids that Nancy uses now include a trapeze over the bed, and satin sheets and silk pajamas. This increases her ability to rollover and due the things that most of us take for granted. Periodically I still have to help her out of bed and to the bathroom. In my opinion learning how to accept that helping hand was part of the anxiety reduction equation. Clozaril as best as I can figure actually permantly replaces lost chemicals or rebalances the brain chemistry to compenasate for the many alterations that come with dopamine loss. In six years we have titrated upward once and then back down again. Please remember that blood testing is mandatory on this one. Tweeking meds periodically can be a powerful asset in the fight but it has rarely come without much trial and error. As new PD meds have been tried such as Mirapex, Requip, Tasmar and Comtan we have had to monitor the effects on her other meds. This was also true with the surgeries that Nancy has had. This process requires a fair amount of patience and is often pretty stressful for both of us. Honestly, 26 years experiece with this blasted disease man be the most important factor in figuing out how to respond to a problem. Our current doctors all understand that now. None of them were with us in the beginning. Bob Martone [log in to unmask] http://www.samlink.com/~bmartone -----Original Message----- From: Parkinson's Information Exchange Network [mailto:[log in to unmask]]On Behalf Of Emily and Julian Brinac Sent: Monday, January 07, 2002 10:03 AM To: [log in to unmask] Subject: Re: Help for Sleep/Anxiety..? Importance: High Bob, your answer to Roberta is very interesting. But what do you do when human body needs more and more of the substance to get to sleep or to calm one down? Do you keep on adjusting quantity of medication? Do you at times have to change medication and , perhaps, go back again, once the substance is out of system. Did you try melatonin, natural sleep supplement? Emily ----- Original Message ----- From: Bob Martone To: [log in to unmask] Sent: Monday, January 07, 2002 10:45 AM Subject: Re: Help for Sleep/Anxiety..? Roberta, I went through that difficult time with my wife Nancy many years ago. She is 56 and has had PD 26 years. For immediate relief from anxiety I would give her ativan. The ativan was so effective that we jointly decided that I would help her in managing that aspect of her medication. In 15 to 30 minutes it would settle her down and allow her to fall asleep no matter what room of the house she was in. This was great but you can imagine me trying to get her from the kitchen/living room/bathroom etc. to the bedroom when I too was very sleepy and just wanted to get some rest. We worked through it and it was great. By the way she very rarely needs ativan (generic is lorazopam) anymore. For the nightmares, verbalizations, visualizations and phychosis that can come from PD/PD meds we found that Clozaril is the best and preferred my many professionals who understand the interaction of PD meds. Our problem was that we didn't understand that the neurologists seemed to prefer to leave that problem to the psychiatrists. The psychiatrist nailed it after one visit. Today (about 6 years later) Nancy is still on Clozaril but it is handled by her GP. The only down side is that you must get a blood test every two weeks for possible white blood cell count reduction. This has been a small price to pay for the benefit derived. Bob Martone [log in to unmask] http://www.samlink.com/~bmartone -----Original Message----- From: Parkinson's Information Exchange Network [mailto:[log in to unmask]]On Behalf Of Roberta Nelson Sent: Sunday, January 06, 2002 10:25 AM To: [log in to unmask] Subject: Help for Sleep/Anxiety..? I would greatly appreciate finding out what is considered 'safe' for sleep help for PWP's using Sinemet & Eldepryl. Apparently, most of the usual drugs for these problems may not be used. The only class of drugs I have found so far not contra indicated is the Benzodiazepines. My husband, 68, male, PD for 8+ years (Sinemet 10/100 3-4 X day, Eldepryl 5 mg 1 X day) is currently having a horrible time as bedtime comes. He gets anxious and restless. He has somewhat of a phobia about sleep time because he has SO much trouble going to and/or staying asleep (also has all the 'usual' PD nightmares, verbalization, thrashing, etc.) He sleeps little, and intermittently. It is becoming an overwhelmingly disturbing issue for him. I am researching this in several places, but would like to have your input -- what have you used/found to be helpful? He has tried Xanax and Vallium, neither seems to have much of an impact. I believe that an anti-anxiety drug may be a good choice. Before we go back to the Doctor (who is not very helpful) I would like to compile a list of drug possibilities. Therefore, I ask -- what has worked for you -- what would you suggest? Would an 'extra' Sinamet at bedtime be helpful? Thank You for any advice Roberta, CG for Clyde ---------------------------------------------------- ------------------ To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn ---------------------------------------------------- ------------------ To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn ------------------------------------------------------------ ---------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn