Dear Brain: Proceed directly to Hell, do not pass 'Go'

The BBQ Pit
1

As an atheist and mostly a materialist, I believe we are the products of our brain chemistry. I also believe that chemistry fucking sucks.

Because I have trouble sleeping – partly due to the side effects of other medication, partly due to other factors – my doctor prescribed me a sleep medication, Ambien. I’ve had the scrip for about a year now. She prescribed me thirty per month, to use “as needed,” but of course my insurance plan has a “Managed Drug List” component, they have decided that I “need” only fourteen per month. I can’t even buy the other sixteen at the list price on my own. So that’s problem number one.

Now, each night, I have a choice to make. If I want to get more than 3-4 hours of sleep, I can take an Ambien. Of course, if I do, I will spend any time that I awaken during the night, and part of the next morning, feeling like a punch-drunk boxer. So I’ll get 6-7 hours of good sleep, and not have real lasting drowsiness, but still pay a little price. But I have to ration them – only 14 available!

If I don’t take it, I’ll only get those 3-4 hours, but it’s natural sleep. The major problem there is, of course, that that isn’t enough to make me feel rested. The other problem is that, when I don’t take the Ambien, I suffer from nightmares. Usually two or three different ones, of a subjective length of several hours. Awful, hyper-realistic nightmares, that leave me feeling anxious, drained, depleted, frightened, and all those lovely things.

I feel like pulling a Billy Crystal “I hate when I do that” type of thing and just sticking a barbecue skewer or other pointy thing in my ear and just digging around in my brain until I knock out the portion responsible for dreaming. Stupid brain.

2

Would your doc be willing to write you a second script for some light valium or xanax? I don’t know how you feel about those kinds of medications, but when I’ve taken them they’ve helped me sleep like a rock with zero dreams. You couldn’t mix them with your sleeping pills, of course, but they’d be there for when you were out. For the record, my problem wasn’t getting to sleep, it was staying there. I’d wake around 2 or 3 am and that was it for the night.
Sounds like your situation is pretty similar and I don’t envy you that horrible, middle-of-the-night, three hours till sunrise, Why-the-fuck-can’t-I-sleep feeling. Ugh.

bella

3

pldennison, that sucks. Another victim of insurance companies playing doctor.

I did some searching on the internet and I see that Ambien is available in 5mg and 10mg pills. Which one are you taking? If you are taking the 5mg pills can you get your doctor to prescribe the 10mg pills? Some medication tell you not to break or crush the tablets, but Ambien doesn’t have that warning. This way you could effectivly double your prescription.

A link to my information source.

4

I’ve not been sleeping real well for the last 2 years or so, which correlates pretty directly to when my child was born and I quit working out.

For all I know you train regularly but if not, is an increase in exercise activity an option?

The few times now when I do work hard physically, I sleep better than even my child.

5

From what I have heard, Ambien is only supposed to be taken for one to two weeks, not to be used as a continuous sleep aid. It’s purpose is to reset your internal clock, so they say it’s best to start taking it when you have a week where you are not obligated to do anything (ie, take a week off work or school and start taking it then) This is why your insurance company won’t pay for 30 pills per month. I would second guess your doctor on this, I think he/she is overmedicating you.

6

Have you tried large doses of dietary supplement calcium?

It can & does help me sleep.

Also, consider valerian root.

7

No doubt about it, Phil- you’re getting shafted. I agree with the above- have the doc write for 10mg and split them. Or pay cash for the script (Are they expensive? I seem to think they weren’t when I worked in retail pharmacy).

If the insurance won’t pay for your whole script, I don’t see why you can’t pay cash for the rest- something smells fishy about that. I don’t recall that ever being a problem in retail pharmacy, and I’m in NY, home of the crazy drug laws. I’d phone another pharmacy and see if they agree that it must be filled the way your pharmacy is doing it. If your Dr. writes for #30, you should not have a problem getting #30, even if you have to pay for them.

8

pld, I emphathize. I too generally find that my dreams are unpleasant as a general rule. The thing about sleep is, we know damn near nothing about sleep.

In my case, I almost always have somewhat unpleasant dreams, but they vanish within about ten minutes of waking up. But quite frequently, they are horrendous.

Now, I offer this only out of empathy, I have no expertise. But I have noticed that a certain medicinal herb seems to be efficacious in the sense of lowering the incidence of dreams in general. That is, during times that, for whatever reason, my favorite herbal remedy is not at hand for more than a few days, I dream much much more. I’d prefer not. Not that I am recommending any etc. etc.

St. Johns Wort seems to help some too. If you are prone to allergy, look for the extract and not the “crude” product. A very few people get mildly negative reactions, test it out. A small dose as you head into the arms of Morpheus might be it.

Sometimes I wonder why I cant just have depraved sex dreams like everybody else seems to get.

9

(Standard medical advice disclaimers apply.)

I don’t like long-term benzos (or benzo-like drugs, like Ambien) for sleep, especially in younger people. If you’re still feeling groggy the next day on Ambien, you defininitely don’t want to try Valium or Xanax, as their half-lives are much longer.

Cutting back the dose on the Ambien might not be a bad idea. Half of the dose you’re on might help you sleep without the grogginess. If not, there are other avenues to take, such as a low dose of a tricyclic antidepressant.

Aside from the drugs, I can only make some recommendations about “sleep hygiene”, that I’m sure you’ve heard before: exercise, but not within a few hours of going to bed. Don’t lie in bed if you can’t go to sleep; get up and do something if it starts to look like you’re going to be lying there for a while.

Above all, the key is to not get worked up about not being able to sleep–the anxiety only makes it worse. Accept that you could go the whole night and not get one wink of sleep and still be up and around, if not quite at 100%, the next day. It takes some of the pressure off.

Good luck.

Dr. J, lifelong insomniac

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STAY AWAY from XANAX. Trust me. My psychiatrist was very concernced (read-pissed off) when he found out a former doctor had prescribed it for me-even though I had only been on it for about two weeks. It’s extremely habit forming.

Have you tried Sleepy Time Tea? That always helps me.

11

I have no idea if this will work for you, but it isn’t harmful, so you might as well try it. I started drinking a soy milk shake almost every night because it’s supposed to help with estrogen-related stuff. Well, it does diddly for my PMS, but about an hour after drinking one, I can barely stay awake. It took me awhile to figure out it was the soy milk, and when I started suspecting it, I tried a few nights without, then started drinking it again, and I feel I did enough experimentation that I can safely say it’s the soy milk helping me sleep. And, I’ve been sleeping WELL. I reported this to a friend who did her own informal experimentation, and she concurs. Mind, neither of us are doctors, and we reached this conclusion very unscientifically, but as I said, at least it won’t harm you in any way.

(Recipe: throw some ice in the blender, add a little chocolate syrup or chocolate milk powder and fill with soy milk. Blend to slushy consistency. Bananas are good, but optional.)

12

Thanks for all the advice so far, folks. I have to go back to the doctor soon to talk to her about my other medication (which I think I’m going to ask her to wean me off of, as it doesn’t appear to be doing anything at this point) and I’ll talk to her about other options then. I took an Ambien last night – at least 6 hours of uninterrupted sleep, and no bad dreams sigh

Usually, I find that if I’m not taking a pil, a couple of glasses of red wine or a nice belt of Scotch usually make me a little drowsy, but they sure don’t keep me asleep. The fact that I’m not getting any regular exercise isn’t helping either, as some of you have alluded to. I used to, but I cancelled my gym membership, because I had to get up at 5:00 to use the gym before work, and that was defeating the purpose. When we move in October, our new apartment complex has a giant, 24-hour fitness center including a racquetball court, so hopefully I can get back into something.

elucidator, you might be shocked (or not) to learn that I have never tried . . . herbal remedies. I wouldn’t even know where to find a druggist in my area who stocks or sells them!

13

St John’s Wort (and a lot of other herbal remedies) are sold with the vitamins at your local pharmacy.

[sub]Hi I’m a Rite Aid Drone. Any other Rite Aid questions?[/sub]

14

Interesting - I had a scrip for 10 mg Ambien for 6 months, and my doc assured me it wasn’t addictive, wouldn’t leave me groggy, etc. I see Dr. J has already mentioned this and he is much more qualified than I, but from personal experience of sometimes taking 20 mg a night (once at bedtime and once when, sure enough, I suddenly came wide awake 4 hrs later), I was never, ever groggy, so I, too, wonder if your dosage might not be too strong.

I thought the Ambien was wonderful stuff, best sleep I’ve ever had, but I was disturbed by losing memory of my last entire hour before going to sleep, and some evidence that I was ‘sleepwalking’. (Found my watch in the fridge one morning. Huh?) So, I tried the half-pill route - half at bedtime, half when I woke up later - and it worked just as well. I still had the memory loss, though, so I quit taking them - fortunately, I don’t have to keep a precise schedule, so decided I preferred my weird sleep habits to memory loss.

Anyway, try the half-pill routine, unless your Doc or Dr. J here says it’s a not-good thing to do with Ambien. That will help some with your sleep-and-supply problem.

But like others, I don’t understand why you can’t buy the rest of the scrip out of your own pocket. Just doesn’t make sense to me, if that is what the doc prescribed. I’d check into that a little more, if it’s not too expensive.