Ambien is the poster child of "what went wrong with the “Z drugs” which were supposed to be salvation for us benzo-dependent insomniacs.
It turns out the ‘Z drugs’ can be more dangerous than the benzos.
If you do decide to try Ambien, follow this: get in bed BEFORE taking it and STAY there.
The nightmare stories about Ambien are true - I experienced them. It does do nasty things re cognizance and logic. You will NOT be safe out of bed until it wears off.
The Lunesta I was looking for has been restricted by Blue Shield of CA (and probably every other insurance company).
I’m back with a benzo (temazepam).
10MG Zolpidem has been working exactly as prescribed for me since Feb. 2012 with no side effects. I take one, go to bed and am asleep in a few minutes. I usually have to make a BR run 1-2 times, but have no trouble falling asleep and getting at least 8hr.
Nor has it been addictive- I keep precise track of my doses, and they are as follows:
20 in 2012
33 in 2013
49 in 2014
22 in 2015 so far (yes, I notice the upward trend, but the Dr. prescribes 60 doses a year, and as long as I am well under that I should have nothing to worry about).
If it were not for Zolpidem I would gradually get to sleep later and later until well past dawn, becoming a day sleeper, which I have tried, and do not like.
I once knew a guy -a Dr no less, that would chat with me at night. I assumed it was due to his busy work schedule. He was very charming. Once he invited me to go out with him and his friends. When I asked about it later he seemed as if I invited myself. This happened once more, until I was just done. Later I found out he was taking Ambien. He had truly and absolutely no clue that he had invited me over, etc. Ambien is seriously bad news waiting to happen.
Short term, you should be fine with giving the Ambien a try. If you have a spouse/partner, have them note any unusual behavior after you take it (the above mentioned sleep walking, eating, cooking, etc), as that may be a sign it’s probably not a good choice for you, and don’t plan on driving unless at least 8 hours have passed after taking it (even then, I tend to suggest caution). It may not do a lot of good if your problem is staying asleep, however, as most of the evidence for immediate release ambien is supportive of decreases in sleep latency onset (time it takes to fall asleep), but not sleep maintenance. The same is true for supplemented melatonin (which itself only has weak evidence for use in many types of insomnia), which may explain your lack of relief with it.
I’d honestly suggest only taking it if you’re finding it difficult to fall asleep. While I’m sure some people exist who benefit in sleep maintenance from Ambien, the reviews and meta-analyses I’ve run across don’t seem to support it’s use for that purpose.
Also, if it’s 10mg, and you’re in the USA, it’s immediate release. The controlled release products are dosed at 6.25mg and 12.5mg, while immediate release products are dosed at 5mg and 10mg for the non-dissolving oral tablets, 10mg for the dissolving Edluar brand, and 1.75mg and 3.5mg for Intermezzo (another branded product), the last of which is used for middle of the night awakenings to put you back to sleep, as long as you have at least 4 hours of sleep left before needing to wake the next morning. If your problem is middle of the night awakenings, and you and your doctor have ruled out cognitive-behavioral therapy (which actually tends to have better evidence of efficacy in the long run, but isn’t necessarily offered everywhere) Intermezzo may actually be a better choice, though being brand only, it can be expensive and many insurances don’t want to pay for it.
Strictly speaking, this can happen with any of the positive allosteric modulators of GABA, including “regular” benzodiazepines, the z-drugs, ethanol, and the barbiturates. The effect is hypothetically more likely to occur with non-selective agents (pretty much everything other than zolpidem) at lower doses, where they can act mildly stimulatory and lead to disinhibition.
I’ve been taking 'script sleepers now for 15 years. Before that it was diphen and ethanol.
I used to try sleeping without them, as an experiment.
I got up to 4 days awake before I broke down and took a pill. Needless to say, I was completely worthless after 48 hours - would not trust myself to drive or operate cutting-type tools.
I mention this as simply a cautionary note for those who think sleep-in-a-pill is an attractive option.
I had a housemate who took Ambien every night. I don’t know what dose he took, but I got the impression he was dependent on it. One night at about 3:30 am we get a call from the hospital; he needed to be picked up. The cops had found him walking around in his underwear, and taken him to the emergency room.
It’s a lot like sleepwalking, but it seems you can’t be woken out of it until the drug wears off.
JayRx1981 - I hope you don’t mind a minor hijack, but you’re clearly very knowledgeable about benzos so I hope you wouldn’t mind helping me out with something. I’ve had been prescribed a 1 week course of valium for back spasms and my Dr. told me the best way to take them was to let them dissolve under the tongue.
Anyway, I tried that and it was pretty gross tasting so I googled it and it turns out there’s some debate about the best way to take valium but I couldn’t find anything authoritative one way or the other.
Is there a definitive answer on whether taking valium under the tongue is better (ie. quicker acting and more powerful) than just taking it like a regular pill? Cheers.
I take 10 mg Ambien for overnight bus trips, once a week. Always been functional the next day after 7 hours sleep. When I get home, I’ll crawl into bed and get another hour or two. I don’t feel like I had any REM sleep on the moving bus, and I’ll have vivid dreams once in bed.
Once or twice a month, I’ll take 5 mg if I need to get to sleep early, like last night when I had to get up at 4:30 AM.
Never had any sleepwalking or any issues like that. I’m a 250 lb. 6’ man.
I have seen visual phenomena when I took it and tried to stay awake just to see. Interesting, but nothing really trippy. Now I just let it do it’s work.
I took Ambien when my migraines became chronic, because in addition to the migraines, I also had major depression and terrible problems with insomnia. That wouldn’t have worried me, but I got the 3 AM crazies really badly, and would be weeping by 4 am.
So my doctor put me on Ambien (which, looking back, was *just *the thing to add to the cocktail of antidepressants, opiates, DHE-45, and Imitrex that I was on). :smack:
I didn’t have anything terrible happen, which was probably due to my weirdly high tolerance for drugs overall. But I did some truly spectacular “snacking” late at night that I would totally not remember when I woke up. Luckily, I made my quesadillas in an electric skillet and didn’t manage to set anything on fire. The first time it happened, my mom (who I’d moved in with) wondered why there was a hell of a mess in the kitchen we had left clean the night before, and where the pint of ice cream and new box of cookies had gone.
I’m more frightened by the fact that you combined quesadillas, ice cream and cookies in specific, than the concept of sleep-cooking in general
Someone I know on a mailing list once made peanut brittle while on Ambien. For people who have never tried candymaking, that kind of stuff involves sugar syrup at higher-than-boiling-water temperatures. You get a drop of THAT on you, it’s gonna do some damage.
Something I frequently suggest for difficulty falling back asleep (after a bathroom run or whatever) is to use the TV or an MP3 player with a podcast - set up with something vaguely interesting but not fascinating. The TV has drawbacks in that the light from the screen may interfere; I’ll sometimes put that on at the beginning of the night when my husband is going to be up for a bit. Certainly Discovery Channel, Science Channel etc. are something we use to relax with a bedtime.
I too used to have a fair bit of trouble with falling back asleep after a nighttime bio-break. Then I got the idea to pull out the iPod. With podcasts or an already-listened-to audiobook, it’s something I have grown to truly rely on (and in fact I get rather nervous if I’ve misplaced it). I’ll plug it in one ear, set the volume as low as possible, set it on sleep timer, and usually don’t remember the third sentence. If you have an iPod or whatever, this is worth a try.
YMMV on that. I’ve heard of people taking it in the bathroom and not remembering the walk to bed - I was never one of those. I could take it, and watch TV / read for a half hour and not have any issues. After a half hour, I’d realize I couldn’t entirely see any more and give up and turn the light off.
All in all, except for one rather hilarious incident (Sonata after 48 hours of nearly no sleep due to illness) where I didn’t quite put the computer away in time, I’ve never had any issues with doing anything regrettable on any of these classes of drugs. Except for the “hangover”, they’ve worked fairly well for me with my occasional use.
What the … !!!, I’d suggest doing as another poster suggested: try it for a couple of days, and ask your spouse / bed partner / roommate (assuming you have such) to let you know if anything odd happens. Ambien does have a reputation for causing odd behavior, but I don’t know what percentage of people have that happen - the “took it, fell asleep halfway in bed because it hit that hard, woke up 8 hours later stiff as hell” stories don’t get the publicity that sleep-driving etc. gets.
(side note: any time an Ambien thread comes up, it winds up sent to my spam folder in gmail :D)
I’ve not heard of it being done with Valium specifically (rectal administration, sure, though that’s only a good idea in a few instances like epileptic seizures lasting longer than 5 minutes and that’s most often in gel form, or in certain scenarios in hospice), but in hospice/end-of-life settings, lorazepam tablets or concentrated solution are frequently used sublingually to speed up onset of symptom relief. Diazepam (the generic name for Valium) likely absorbs similarly (quite a few benzodiazepines do), though in truth, most of it’s metabolites are also active (thus skipping hepatic first-pass metabolism via sublingual administration isn’t necessary), and diazepam, like alprazolam (Xanax), and lorazepam (Ativan) are among the fastest hitting benzodiazepines when taken orally anyways. I’d suspect the time to symptom relief for sublingual diazepam isn’t that much faster than just taking it orally, so if the taste is bothering you, just take it with a sip of water like any other pill and swallow it whole. Time to onset of relief usually occurs within 30 minutes of oral administration. Further, since benzodiazepines are drugs of abuse, and the magnitude of dopamine spiking in the nucleus accumbens (the area of the brain most often focused on as far as abuse/addiction potential goes, though far from the only area involved) increases the faster the concentration of drugs of abuse rises, sublingual administration may be more likely to cause a slightly higher “high” than oral administration, which might sound good at first, but could lead to problems down the line.
tl;dr version - sublingual diazepam is probably faster in onset but may increase risk of certain side effects, but oral/swallowed diazepam works pretty quickly on it’s own, so that’s probably what I’d go with if I was put on it, given the nasty taste you’re describing.
Yeah, candy making while on Ambien sounds like a potentially bad situation, particularly if the person in question sleeps au natural. There are certainly specific places on the body that I suspect one does NOT want to expose to molten sugar. My own experience with Ambien many years ago was that if I didn’t take it and immediately get in bed, I’d end up conversing with my brother (who was my roommate at the time) for an hour before stumbling upstairs to bed. I don’t remember any of this, of course, but he thought I was quite hilarious in that state.
Interesting suggestion with the podcasts though. Ordinarily, the recommendation with middle of the night awakenings is to get up out of bed and do something quietly until you are tired enough to fall back asleep, but I can see listening to a mildly interesting podcast in bed substituting for that suggestion nicely, if only to save you from potential fall risk as you make your way back to bed under the traditional recommendation.
I was sent for a sleep study - yes, I took my benzo with me - I was allowed to sleep for 3 hours, awakened and fitted with a CPAP and allowed to go back to sleep.
I was awakened by the sleep lab and kicked out about 07:00.
I drove home (15 minutes), did not bother putting the truck away and collapsed on the bed, sleeping until early afternoon.
This was the first (and, to date, only) time I have fallen asleep without some drug since approx 1967.
What happened? The sleep study claimed I reached REM during the CPAP test. So what caused that session of unmedicated sleep?
My only guess is a dream or two that really wanted to play out and forced me to comply.
For one, most of the benzos used for sleep have long enough half lives that enough of the drug (depending on dose) could have stayed in your system to make it easier to fall back asleep. If I’m remembering the other thread correctly, it was either temazepam or clonazepam. Secondly, sleep studies suck, for the participant, in many cases. When I had mine done, I was awakened practically every 2 hours because some electrode had popped off or developed some other problem, so it’s not hard to think that the sleep you got, even with the CPAP, wasn’t doing much for you restoratively (especially since CPAP tends to require a titration to an optimal pressure for your needs). Third, reaching REM isn’t all that unusual. Not ever reaching REM would be, but REM sleep tends to predominate later in the night anyways, compared to stage N3, especially in older men (if you’re not a man, I apologize), though both eventually start to suffer.
Best guess? You were exhausted, you came home, your brain said (paraphrased) “Fuck it, I’m out” and you slept.
The point of the podcast, for me, is to keep the brain from focusing on something else enough to keep my mind from stressing out about something, thereby REALLY waking me up. That can prevent me waking up enough to require the “get out of bed, do something else” approach.
I take Ambien on occasion (12.5 mg) - usually after a two or three nights of bad sleep, to “reboot” my body, so to speak. I usually take it an hour before lights out. Works like a charm each time, and I’ve never done anything more bizarre than the occasional loopy post on the SDMB.
Thank you very much for the advice! Yes it is the “regular” version however due to a mix-up I have another scrip for the slow release version on hold at the pharmacy.
I am going to experiment with it as soon as my wife gets home in a couple of days although she sleeps like a rock and isn’t likely to be much help monitoring my activity. A few questions…
Should I try the slow release version or should I try this one first?
Should I maybe try a half dose?
If it works perfect for a few nights should I a) stop so that I don’t build up a tolerance or b)be sure to keep using it steadily
Since I am going to Italy after all… is a little wine with dinner before bed ok???
Since you describe your problem as waking up 3-4 hours after falling asleep and not difficulty in falling asleep, the CR form is arguably the better choice for your type of insomnia. Immediate release zolpidem is decent as far as induction of sleep goes, but it has a fairly short half-life for most people and may wear off well before the night is over. The CR form, by contrast, releases a big chunk of it’s dose immediately but continues to release and get absorbed from the remaining portion over a longer period of time, hence keeping levels above a minimum threshold necessary to keep you asleep. It’s downside is that doing this leaves blood levels high enough the next morning to potentially cause next morning grogginess and impairments in cognitive ability, to the point that the medication guide which is required by law to be dispensed with each fill will actually say that you shouldn’t drive at all the day following the use of Ambien CR. If I’m remembering the FDA’s warning, correctly, this occurs with around 1 in 4 men, and 1 in 3 women, with the 12.5mg CR form. If you already picked up the IR form, go ahead and give it a try, as most pharmacists don’t like to “early” fill two controlled substances at the same time without justification.
A 5mg dose is frequently sufficient in many individuals (it’s actually the strongly recommended starting dose in females, while it’s only a suggested starting dose in males, since males may metabolize the drug faster and “need” a larger dose for effect), with the provision that the lower dose may again do less for maintenance of sleep than the higher dose, but that is balanced by a lower risk of next morning impairment and other side effects. I tend to be somewhat conservative when it comes to drugs and so would probably suggest giving the 5mg dose a try and see how you do with it before proceeding to the higher dose. If you go with the CR form, however, do not split them or you’ll break the controlled-release mechanism. Swallow those whole.
This is one of those areas that is debated. There are many who argue that zolpidem is somewhat unique and that regular use doesn’t induce a tolerance. This is supported by some of the approval studies, where many of the study participants only used the drug a few nights a week and suffered from no rebound insomnia upon discontinuation. However, anecdotal and clinical experience suggest there are some individuals who do develop a degree of tolerance with regular use, with at least some individuals experiencing a rebound insomnia for a day or two after stopping their dose. The key to why this is may lie in what the underlying cause of the insomnia is, since most of the efficacy studies were performed on individuals with idiopathic primary insomnia, who had psychiatric comorbities, sleep apnea, restless leg and periodic limb movement disorders, as well as other common causes of insomnia (like hypothyroidism) ruled out before being randomized into the study. I can say that when I was on zolpidem, it worked for about 2 weeks of continuous use before a tolerance built up and it stopped working for me, but I also have a diagnosis of ADHD, so would have been excluded from the original study populations (as an interesting aside, the evidence in children with ADHD so far is that zolpidem doesn’t actually do much of anything for them, according to a couple of meta-analyses–melatonin is still the gold standard in that population, albeit based on relatively low quality studies).
Textbook answer: mixing a sedative-hypnotic, like zolpidem, with alcohol greatly increases the chance of respiratory depression, in some cases to the point of death, as well as increases the risk of various parasomnias (sleepwalking, driving, eating, sex), so it isn’t recommended. Consuming a standard glass of wine (that would be 5 ounces, which is generally much less than you get from a restaurant) or two and waiting several hours (ethanol is cleared from the body at a linear rate of about one standard drink per hour) probably decreases the risk if you were to then take a zolpidem tablet, but that risk is still likely higher than not drinking at all. Safest bet is to avoid the use of zolpidem if you have drinks with dinner.
