Thank you so much for all of your advice! One more question before I start my trial…
I think I’ll stay away from the CR version. What if I took a half (5mg) and then took the other half during the night if I wake up after about four hours?
Happy to help. I suspect that like our physician colleagues, most of use pharmacists don’t have the time to really explain things like this in detail when we’re at work, so it’s kindof nice to be able to do so here.
The risk of next morning impairment may actually be greater than just taking 10mg IR at the start of a night and getting 8 hours of sleep time, since we’re dealing with an exponential decay process (ie your body gets rid of more drug earlier on, reducing it’s plasma concentration by half every half-life, the average of which is about 2.5 hours). Rather than use the equations to make exact calculations, I’ll just drudge up some easier to understand numbers to demonstrate why. Pharmacokinetics aficionados, I apologize. Feel free to cringe at my oversimplifications.
If we assume that you’re the person who hits the mean non-elderly values for the 10mg dose, the mean half-life is around 2.5 hours, and Ambien hits its mean maximum concentration, called Cmax, of 120 ng/ml (in a mean time to max, or Tmax, of about 1.5 hours after taking the dose on an empty stomach), then 2.5 hours after Cmax, levels will have dropped to roughly 60 ng/ml, 5 hours after the peak (6.5h post dose), we’d be down to 30 ng/ml, and 7.5 hours after the peak down to 15 ng/ml which is about 9 hours after you’ve taken the 10mg tablet. I rounded some of the numbers up or down very slightly to make them easier to work with.
Contrast that with the 5mg tablet, which has a mean Cmax of about 60 ng/ml at 1.5 hours, and would have a concentration of 30ng/ml 2.5 hours after Tmax. But since that’s your 4 hour mark, you’re adding another “peak” of ~60 ng/ml 1.5 hours after that, which is partially balanced out by the amount of drug your body is still happily eliminating in that span of time. Your body will eliminate some portion of it’s plasma concentration in that 1.5 hours until the second dose peaks, and then you’d use whatever value the second Cmax peak reached (which would be higher than the first Cmax given that our dose interval is short enough to allow for drug accumulation to occur), and start cutting that value in half every 2.5 hours. I could use a calculation to figure it out, but I just woke up not too long ago, so I’m gonna cheat and just guess a value of 10 ng/ml lost at 1.5 hours post second dose (so down to 20 ng/ml) + 60 ng/ml from the second dose, such that at 5.5 hours into the night, your Cmax is now roughly 80 ng/ml. 2.5 hours later, your plasma concentration would then be 40 ng/ml which is 8 hours past your first dose of 5mg. Even another 2.5 hours later (10.5 hours since the first dose), your plasma levels are still higher at 20 ng/ml than they would have been at 9 hours with just a single 10mg tablet. First-order elimination kinetics is fun! 
tl;dr - 10mg administered once using mean kinetic characteristics would result in ~15 ng/ml blood levels 9 hours later, while 5mg dosed twice, four hours apart, would result in ~40 ng/ml at 8 hours post first dose and ~20 ng/ml at 10.5 hours, thus greater risk of next morning impairment.
Of course, that’s just the mean. If you’re unlucky, Cmax for 10mg as a single dose can go as high as ~270 ng/ml and up to about 4 hours for a half-life (Tmax seems to remain relatively consistent at 1.5 to 1.6 hours post dose, as long as we’re administering on an empty stomach), meaning 5.5 hours after taking a 10mg dose, you could end up with 135 ng/ml left in your system and 9.5 hours after your dose 67.5 ng/ml, which will probably impair you given that exceeds the max concentration you’d get with mean kinetics at a single 5mg dose (60 ng/ml as above).
The FDA, per the Data Summary tab from this link, seems to use >= 50 ng/ml as a cutoff point for next morning impairment, fyi, and this impairment may still occur even if you don’t feel sedated.
For me, Ambien and the ilk, also work 1/2 as long with a 1/2 dose and 1/4 long with 1/4 dose. In other words, if I’m having trouble falling asleep, 1/4 ambien can put me over the edge. And then I sleep naturally.
My daughter, with horrendous sleep issues related to austism, often wakes me up at 3:00 or 4:00am (used to be much worse) and then I end up being wide awake. 1/4 ambien and reading or lying quietly in bed leads me to fall asleep within about 30 minutes, and I stay asleep naturally.
Just my experience…
I’m not sure if it’s the aging, but I also feel like my long term memory has been affected by the Ambien. I hate to use correlation to prove anything, but starting around the time I started on Ambien (about ten years ago - about 2X per week 5/10 mg per dose) my memory has gone from phenomenal to goldfish. Maybe just aging, so I can’t say for sure, but I take Ambien as minimally as possible at this point. But I still take it to stave off really bad bouts of insomnia or for time changes.
Yeah, I had weird snacking episodes with Ambien, and wondering how a stack of papers was strewed all over the floor in the morning.
But I actually broke my hand of the stuff and didn’t even realize it. I woke up with a swollen hand, but my fingers wiggled fine and it didn’t really hurt, so I figured the swelling would go down. When it did, one knuckle was now shorter than the others, because it had snapped in two and then healed without setting.
Not something I would go on again.
Just to raise a point from earlier in the thread; I wouldn’t take a sedative on a plane unless you are very sure you won’t have any unwanted side effects. Becoming a flight risk 36,000 feet above the Atlantic wouldn’t be the best way to start a holiday, and you wouldn’t want to wake up in a jail cell and be the cause of having a flight diverted. 
Don’t worry, if the movie Airplane has taught us anything, a line will form of fellow passengers waiting to shake you, slap you, brass knuckle you, and hit you with a baseball bat should you start freaking it.
Surely you can’t be serious?
Just out of curiosity, if every night one were to drink a few beers and take one of these, stay up for an hour or so and then go to bed, is there anything wrong with that? A coworker of mine does this and it doesn’t seem to affect him at work, but that can’t be great for his health, or is it pretty benign?
I am serious…and don’t call me Shirley.
I’d go with “can’t be great for this health”. While the Z-drugs don’t appear to mess up one’s sleep architecture at standard doses (unlike the benzodiazepines which appear to reduce Stage N3 and REM sleep), alcohol does mess with sleep architecture, so at the very least, he’s likely mildly impaired the next morning due to poorer quality of sleep. The current recommendations, at least here in the states, are that men should be drinking no more than 2 standard beverages per night so if your coworker is exceeding that, he’s putting himself at greater risk for alcohol related problems. The combination can also be fatal, but if he’s built up a tolerance to ethanol, the chances of respiratory depression go down (but don’t get eliminated entirely, so far as I know), without necessarily affecting the chances of memory impairments at the peak effect of both the sleeping pill and alcohol, which may up the chances of disinhibited actions and parasomnia-like behaviors (essentially, relatively automated behaviors like sleep walking, cooking, etc, with a lack of memory formed that the individual in question is doing these things).
Alcohol, in general, is a pretty terrible sedative-hypnotic.
So far …
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I tried the half and then the other half method before I read the negative reply. It did in fact leave me to groggy for too long in the morning.
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re a hangover… by that do you all mean grogginess? I can deal with that but was afraid you were all talking alcohol hangover pain
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It doesn’t knock me out right away… it takes me at least 45 minutes to an hour to fall asleep. I do get about 6- 7 hours of relatively uninterrupted sleep.
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Hooray for my impromptu imprecise kinetics being right! That was the class most of my classmates dreaded (tons of math, including the calculus-based derivations of how the equations we use came to be). I actually did pretty well in it, though in retail the uses for it are largely for drug interactions and theoretical estimations of what a given drug-dose regimen would look like on a concentration versus time graph. Bummer it left you wiped out for too long though.
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Grogginess, slowness of thought, brain “fog”, and delayed/slowed reaction time. Nothing like alcohol hangover pain. More like (assuming it puts you to sleep, like most people) Benadryl when used at hypnotic doses, really, though with less dry mouth, dry eyes, blurred vision, etc.
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45 minutes to an hour is a bit on the longer side, but not unreasonable. Was that the 5mg dose or the full 10mg? Did you take it on a completely empty stomach or with some food? It is meant to be taken on a completely empty stomach, as food decreases it’s max concentration, increases time to peak concentration, and reduces your overall exposure to the drug. Good on the 6-7 hours uninterrupted sleep though. Some people, sadly, don’t get that much.
Except for the half plus half misstep, I’ve been taking 10mg on a relatively empty stomach. Eat about 6:00, take it about 9:00, fall asleep about 10:00…wake about 5:00 (maybe once to go to the bathroom).
Now at the risk of disappointing my very helpful new friend…I’m considering adding the following variables to my experiment…a little alcohol, sitting up like I will on the plane and even taking 15 or 20 mg. :eek:
I’m glad I read this thread. I suffer from periods of insomnia for days followed by days where I could sleep 20 hrs a day. I’ve often wondered whether a sleep drug might help me even out my sleep patterns. But after reading everyone’s experiences with such drugs, I think I’ll just deal with my issues on my own.
I do that too. If I get out of bed, I don’t necessarily get tired for a loooong time. By listening to something sort of boring, my mind focuses on that and I can fall back asleep (after a while). My thing to listen to is episodes of the old show “Leave it to Beaver” since the dialog and plots are all pretty simple and the sound profile is very consistent.
One thing that listening to shows taught me about my insomnia is that I’m not awake as much as I thought. When I have the show playing, I’ll sometime realize I missed a big block of the plot. I am actually going in and out of sleep, but without the show I don’t realize the time I was sleeping. I feel like I’ve been awake the whole time because I don’t have a sense of time when I was sleeping.
One thing I do sometimes is to listen to a show on Netflix that has German audio. I don’t know German and it sounds similar enough to English that it works the same way to my brain. The benefit of German is that I don’t try to follow the plot and don’t notice the gaps when I was sleeping.
I am one of those with Restless leg syndrome. That crawly feeling that makes it impossible to keep your legs still enough to fall asleep. It drove me nuts for years, until my doctor prescribed Tramadol for me. On nights when I’m twitchy, I take 2-50 mg pills and within 15 minutes my legs are silent. It’s been like a miracle drug for me
Prior to finding that I tried Trazodone, and other sleeping pills, but they were torture because while they made me incredibly sleepy, I still couldn’t keep my legs still for those few minutes needed to fall asleep.
In reading about Tramadol online, I see that many people have a problem with becoming addicted to it, so I’m very careful to only take it when I absolutely need it.
+1. I could have written this post myself, word for word.
Another tip for those considering ‘sleep in a pill’ and onset times:
I need to note the time I drop the first pill.
If I am still awake 1 hour or more later, I find I have ‘burned off’ the first and now to start over - this time with 1 1/2 (tabs) or 2 (capsules).
If I take the second within an hour, it is cumulative; after that time, it is worthless, and I end up using 3 (1 +2) instead of 2 (1+1).
Then again, I have bizarre body chemistry re any/all CNS depressants.
Nice recipe for blot clots.
I speak from experience and did about what you’re writing about. Forget all the other stuff, you do realize blood clots, ER diagnosis and a night in the hospital will run at least $10k? The rest of the experience ain’t great, lemme tell ya.
Now when I fly long distance, I do an injection of Fragmin at $100 per.
If you must, invest in a pair of compression socks…
That would sure ruin a vacation to Italy wouldn’t it!!! Are you specifically talking about going overboard with a larger dose and/or alcohol? For the flight, I just want to be able to sleep as well as the average person does on a flight.