by Dr. Bill Rawls
If you experience the symptoms of poor sleep or sleeplessness that often accompany people with Lyme disease, fibromyalgia, and other chronic illnesses, you’re probably desperate for some help. Can medications like low-dose naltrexone (LDN) and low-dose gabapentin provide relief for those wired but tired nights? Watch as Dr. Bill Rawls discusses the use of LDN and low-dose gabapentin and the ways in which they might be of benefit to you. Read more about Lyme disease and sleep here.
Question: Can low-dose Naltrexone or Gabapentin improve sleep?
Tim Yarborough: Our next question here is asking about LDN (low-dose naltrexone). I heard that low-dose, as well as low-dose gabapentin for helping with better sleep. Have you heard anything about that, Dr. Rawls?
Dr. Rawls: Well, there are two different things. Of course, low-dose naltrexone is an opioid blocker and gabapentin is a drug that mimics GABA in the brain. So, low-dose naltrexone was a drug developed back in the 70’s, I believe, to help opioid heroin addicts get off heroin. So it blocks opioid receptors in the body. So if you’re taking heroin or a narcotic, you just don’t feel any of the effects.
It didn’t work out very well because it didn’t have any effects for controlling pain or other kinds of things, so people just wouldn’t take it. But somebody along the way found that if you use 10% of the dose, then it had this interesting effect of very briefly blocking opioid receptors and the body responded by making lots of endorphins, and so we’ve been using that for some years. It has to be compounded. So they have to take the drug and drop the dose down to 1.5 to 4.5 milligrams, which is a fraction, about 10% of the normal prescribed dose, that you would use for a narcotic addiction.
So it really doesn’t have that much in the way of side effects in most people, and a lot of people do get a boost of endorphins, so it can be very valuable. I used it in my practice. I found that it was about 50/50, honestly. About 50% of people noticed a significant difference. About 50% of people got nothing from it. And at either end of the spectrum, I had some people with terrible side effects, and other people that it just was a wonder drug, so I think it’s worth trying.
The safety profile with it is very high. It is not habituating. It does not have any opioid effects, whatsoever, and it will not really, it directly in itself, help with pain. You cannot be on any kind of narcotic and use it. So you have to be off of all narcotics to use it, and it can be valuable for decreasing pain. Some people actually do sleep better on it, so it is worth trying.
Though CBD does some of those things, CBD boosts endorphins also, and you can use them together because they work completely differently. It’s fine to use CBD and low-dose naltrexone together.
Gabapentin is another drug that affects GABA receptors, and it does cross over into the brain a bit, but it’s more affecting the peripheral nervous system. So you have different types of GABA receptors all through your nervous system, in your brain, and in your peripheral nervous system. So gabapentin, it was more designed for paresthesia and irritated nerves peripherally, but some people find that they do get a central GABA effect from it. It does help with sleep a little bit.
They will tell you, at least they told that the thing with the drug is, they said it’s not directly metabolized by the liver, and it’s not crossing into the brain, so it’s not habituating at all. It turned out that that was completely false. It’s not as habituating as a benzodiazepine, but it is habituating. So the longer you take it, the more of it you’ll need and sometimes you do have withdrawal symptoms getting off of it, when you decide you want to get off of it.
So it can be a drug that is valuable. It can work something like a sleeping pill. It’s not quite as addictive as a sleeping pill, but it’s still habituating. You’re still going to pay some price with it.
Problem with these things though, is that once you get habituated to it, you need more and more of a dose, and eventually you get to a dose that it just doesn’t work anymore and then you have to go to a stronger drug to sleep, and that’s the issue with the drugs.