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Hello all. I am within the strategy of reviewing the literature and doing background work on this, however I need to submit my preliminary ideas instantly in case it’s of use to anybody else making an attempt to information their very own benzodiazepine taper.
The submit is lengthy, so abstract first: I imagine you should utilize wearable coronary heart price monitor measures of stress or coronary heart price variability (HRV, a measure of the distinction in length between coronary heart beats) to information the tempo of a benzodiazepine taper. I’m utilizing a Garmin Fenix 5 sports activities watch. In Garmin’s case, they report a steady “stress” measurement all through the day and evening. To find out “stress”, Garmin primarily fashions modifications in HRV. As mentioned, I imagine this will likely observe physiological stress induced by withdrawal. I’ll try to do that over the subsequent few months and can report again if there may be curiosity. If it doesn’t work, I’ll discover a neurologist and get correct medical care. Nobody ought to have to do that by themselves however right here we’re.
Decreased HRV seems to correlate with elevated sympathetic and decreased parasympathetic exercise in addition to elevated coronary heart price. Benzodiazepine use to deal with insomnia and nervousness will increase HRV and reduces arousal, whereas withdrawal does the other. References to observe, however that is clear within the literature. I can’t discover any direct analysis on HRV monitoring and withdrawal, however there may be substantial work on HRV variations related to insomnia, nervousness, and despair (related to decreased HRV), in addition to initiation of benzodiazepine therapy (elevated HRV). (In case anybody in drugs is studying this, I’m conscious that is an oversimplification.) Consequently, it’s cheap to foretell that withdrawal will lower HRV and that the magnitude of withdrawal stress will probably be mirrored within the magnitude of this HRV change.
**III. Modifications in HRV and sleep high quality throughout Etizolam and Diclazepam withdrawal (n=1)**
I just lately by accident turned depending on benzodiazepines however didn’t imagine it was that dangerous. I had thought I would have to taper however determined this was pointless and stopped taking Diclazepam, solely utilizing Etizolam “as wanted” (which it actually wasn’t; my judgment was skewed). After three or so days, as soon as Diclazepam was out of my system, I started going into repeated Etizolam withdrawal each 4 to 6 hours and undoubtedly in a single day. At these occasions, my nocturnal HRV principally vanished and I exhibited fixed “excessive stress”. (I’ll submit photos of those readings if there may be curiosity). Subjectively, I might continually have nightmares, my coronary heart would race, and I might get up gasping. I noticed that the watch stress measure instantly tracked my subjective expertise of evening terrors, tremors, and nervousness, and determined to make use of it as a information. This was actually about 4 days in the past and it appears to be working but it surely’s very new.
After two days of the Etizolam withdrawal horror final week I noticed that this meant I had a major problem and wanted to taper, so I started with a loading dose of Diclazepam, anticipating my sleep to enhance. Setting the dose is admittedly exhausting as a result of I don’t know the purity of the Diclazepam and even the Etizolam, I don’t understand how rapidly I metabolize and eradicate Diclazepam, and I don’t belief the RC benzo equivalence measures anyway. I made a decision to extend the Diclazepam dose till I hit a transparent plateau the place I used to be in a position to sleep and never doped throughout the day after which minimize it in line with regular procedures within the FAQ.
As Diclazepam dose elevated over the previous few days, my sleep returned to regular, and my stress stage at evening plummeted to near-normal as effectively. Common stress measures had been within the 70s or 80s out of 100 throughout withdrawal and are actually within the low 20s. Though there are at present spikes at evening that I usually wouldn’t have, this common appears because it did after I was not depending on benzodiazepines. My stress stage within the day is now truly decrease than I feel it must be, and I really feel doped, suggesting I’ve accrued an excessive amount of Diclazepam / metabolites and am not absolutely sober. My subsequent step is to decrease the dose till every little thing appears and feels balanced after which plateau there briefly.
My hope is that I can then use modifications in HRV as a quantitative indicator of physiological adaptation to the taper and use this to information dose modifications. My non-medical understanding is that bodily withdrawal is the lag between a lower in drug use and the reversion of organic diversifications to that drug use that had been meant to revive homeostasis. A taper is supposed to induce average however not excessive withdrawal stress and keep away from seizures and many others. I need to have the ability to sleep however I additionally need to induce intervals of elevated stress by reducing the Diclazepam dose, permitting my physique to begin to return to regular. The hope is that this stress / HRV measure can quantifiably information will increase in stress to a average somewhat than insupportable stage and thereby discover a dose minimize magnitude and frequency that’s adaptive and never overwhelming.
**IV. Why even trouble with quantitative measurement?**
This will appear extreme and pointless, however I don’t suppose it’s. First, I’ve the watch already so it’s not going out of my method. Nonetheless, quantifying that is actually useful as a result of I’m horrible at utilizing judgment to dose myself or decide sobriety, which is what allowed me to turn into dependent by accident after a PTSD-inducing assault two years in the past. I don’t belief my very own subjective judgment. I’ve a baseline measure from watch readings previous to dependancy—most likely round 300 days of this. I hope that this may doubtlessly eradicate some guesswork in order that I don’t need to subjectively set my dose. I shouldn’t be my very own physician, however since I’m being, it could be higher to do it empirically.
Over the subsequent month or so, I intend to mannequin the impact of magnitude and frequency of dose decreases on will increase in stress / decreases in HRV. If this truly measures adaptation, I’ll use it to information the remainder of my taper. If there may be any curiosity on this or if it really works, I’ll submit follow-up materials. I most likely will both method as a result of I don’t intend to do publishable work on this, and if I discover a software which may be useful, I’d like folks dealing with the identical drawback and trying to find sources to search out this. I’m glad to edit this submit to replace it and so as to add photos of the info.
I’d love to listen to your ideas about whether or not this will probably be helpful and know if anybody else has executed one thing comparable.