Prescription Sleep Medication

[Snowdog]

This Monday I’ve got an appointment to see my doctor about my insomnia and medications to combat it.  For many years, twenty or more if memory serves me correctly, I’ve had horrible difficulties falling asleep and staying asleep.

For the first fifteen years I simply lived with it, laying in bed for sometimes hours before I fell asleep and heaven help me if someone or something woke me before it was time to get up. 

Five years ago, I started using OTC sleep aid such as Unisom and the ilk and found they worked great.  However, after a year of use, I began having to up the dosage in order for the medication to work.  Besides any possible adverse health problems this might cause, I was also spending a pretty penny every month just for the luxury of steady quality sleep.   On EBay, I found 1000-pill-bottles of 50mg Diphenhydramine (the active ingredient in many sleep aids) for $28.  This has been a life saver financially, but I’m still concerned about the long-term effects of using 250-300 mg of Diphenhydramine every night.

My wife, but a bit more concerned than me decided to make an appointment and hold me to it.  I am to ask about Ambien and Ambien CR and if they’re recommended for long term use.  My wife (a nurse) tells me the latest version of Ambien (CR) is often prescribed for long-term use, so that's my main interest at the moment.

Does anyone here have any advice concerning these prescription sleep aids (or any other I can inquire about)?  

Seriously though, if you plan to recommend counting sheep, avoiding caffeine, drinking warm milk or reading the bible to fall asleep, save it.  After 20 years, I’ve heard it all and tried it all.  Insomnia isn’t about having difficulties falling asleep once or twice a month; it’s far more insidious and cruel. It's every damned night, regardless if I'm "dog-tired" or mentally drained.  I also never snore or display any symptoms of sleep apnea and I certainly don't have RLS.  My mind simply refuses to wind down.  This was the case when I was a teen and it's grown far worse now that I'm an adult.

Any advice about Ambien or its competitors will be most welcome!

[ilbob]

The drug you are taking to help you sleep is cheap, effective, and has been on the market a very long time with little in the way of side effects.

Unless your doctor has some violent disagreement with the dosage of your current sleep aid, I'd be inclined to stick to it. You just do not know what these new drugs are going to do long term.

[grislyatoms]

I took the "original" Ambien (only prescribed for the short term) several years ago during a stressful time. It was extremely effective, with no "hangover" type symptoms the next day. I slept more deeply and soundly than I had in years.

I am assuming that 250-300mg of the other stuff is beyond (way beyond?) the recommended dosage. Let the Dr. know about this!

[Lee]

This is not a recommendation -as I don't know the long term effects. But I'll tell you what works for me.
After enduring 20 years of insomnia, I started taking on the original Ambien about three years ago. For the the first 3 months or so, I went back and forth between 5-10 mg and got mixed results from both.  In an attempt to slowly wean myself from the drug, I started breaking the 10mg pill into thirds.  I found that the apprx. 3.3mg dose worked like a champ for me.  I also found that if I stop taking it, I will will revert to me old 'insomniatic' self in 2-3 days. 
Bottom line- I've taken the 3.3 mg dose for nearly three years and have slept pretty well over that time.  My liver tests and such have been normal.
My Doctor used to work in a sleep disorder clinic, so he knows where people like you and I are coming from.  I would love to stop with the Ambien, but the alternative is not something I can no longer bear.  I've gone two days with no sleep, and then crashed on the third night, only to sleep soundly for 10 minutes, and then bolt upright out of bed and start all over again.  Good luck to you.       

[Snowdog]

Lee,  sorry if this souds like the old maxim "misery loves company", but I must say you pegged the symptoms and I'm glad to see Ambien works for you.

Ilbob, that's certainly one the things I'm going to ask.  Diphenhydramine works and I've found a cheap source.  It's a very good point.

AM, your assumption is correct.  50mg is considered the highest recommended dosage.  I have to take 5 to 6 times that dose for it to work.

[Jamisjockey]

I drink beer while counting sheep.....
 
Seriously.....I used to work shiftwork, and suffer from insomnia because my body lacked a discernable sleeping pattern.  I was in a flightmed status, so sleep aids were prohibited.  If, though, I were to take them...hypothetically....it was only to catch up on my weekend. 
If you're worried about taking them every night, you might just consider every other night, third night, etc.  Of course, go with the recommendations of your doctor.

[Manedwolf]

Melatonin is also a good, no-impact gentler thing that works for a lot of people. Knocks me right out.

If that doesn't work, valerian caps are good, too.

I try to avoid popping drug-based downers and uppers, and Unisom and others are indeed downers.

[Lonestar49]

...

Snowdog, first my compliments on your avatar picture (snowdog).. Beautiful Shepherd.  I'm a Shepherd man myself, 7 so far thruout my life..  Never been without one or two at a time, along with no robberies of my homes I have lived in thruout the last 37yrs.

Now about sleep meds that work.  Like you, I can't wind down, and stay down (deep sleep) unless I use sleep meds.

I have tried them all, over the counter, prescription and none worked long, as you say, up the dose until ya know it's too much for the job.

It's a nerve thing of course, and now I have been taking Valium 5mg pills, and all it takes, and has for the last 5yrs is half of a 5mg pill and 2 Tylenol night pills, and within 30 mins, the sleep-ferry strikes..lol

I'm not a doctor, but as I said, for 5yrs, I have not had to up the dose, with exceptions of now and then, to a full 5mg pill when the ol brain is fired up good.. lol

It's/their cheep, in generic form, unlike many of the constant "new sleep meds" that cost a lot being new.

Any good country Doctor that knows his meds will not hesitate to give you a tryout prescription of them, and if it works, you're good to go, as I said, it all comes down to turning down the nerve-juice that your brain is working full-time to produce the non-sleep mode feeling.

As far as know, they come in either 5mg or 10mg form, or higher, wouldn't know, never had to up the dose.

The other good part IMO, about Valium, is that not after too long of use, you wake up without that doped over feeling.



Good luck with this,



LS

[Marnoot]

I've had good luck with Ambien. I tried Lunesta, but will not do so again. It didn't work quite as well as Ambien for me. But more importantly, for 24-hours after taking it it tasted like that luminous green butterfly in the commercial had taken a big dump in my mouth. It's a nasty, bitter, metallic taste that gets 10 times worse if you try to eat or drink anything. I'm sure some people don't have that side effect, but I certainly did. If Ambien doesn't work out, then Lunesta is certainly worth at try; just don't try it on a night before you're planning to go out somewhere good to eat or anything like that. They should market the stuff as a diet pill, you don't really want to eat much when it all tastes like butterfly poo. 

[Manedwolf]

I've had good luck with Ambien. I tried Lunesta, but will not do so again. It didn't work quite as well as Ambien for me. But more importantly, for 24-hours after taking it it tasted like that luminous green butterfly in the commercial had taken a big dump in my mouth. It's a nasty, bitter, metallic taste that gets 10 times worse if you try to eat or drink anything. I'm sure some people don't have that side effect, but I certainly did. If Ambien doesn't work out, then Lunesta is certainly worth at try; just don't try it on a night before you're planning to go out somewhere good to eat or anything like that. They should market the stuff as a diet pill, you don't really want to eat much when it all tastes like butterfly poo. 

If something causes enough of a system or CNS effect that it's causing phantom tastes in your mouth, I'd hate to see what it's done to your liver or brain cells in 20 years. 

[Gewehr98]

My wife's in the same boat.  She's an insomniac, never goes into REM sleep, and even when she finally does sleep she wakens at the slightest sound. That's not healthy.

She had a trial run of the original Ambien, and it worked like a charm for her.  Problem is, our HMO (Dean Care) won't prescribe her Ambien until she goes through all the cheaper prescriptions first, even if our physician wrote the prescription.  The pharmacy said we can pay for it ourselves, at roughly $130.00 for a 30-day batch.   

Benadryl, Tylenol PM, Unisom, and the majority of over-the-counter sleep aids all rely on Diphenhydramine to do the trick.  It works on the majority of people, but not my wife.  The after-turkey snooze ingredient, tryptophan, has no effect on her, nor does melatonin.

So she's now forced to use the pharmacy's ladder of prescription sleep aids in varying degrees of effectiveness.  To date, her prescription of 15mg Temazepam pills has done nothing to help her, either.  So eventually, we'll get her Lunesta or Ambien, but only after the HMO forces her to try everything else first.    

(I'm just about to the point of budgeting $130/month to get her the Ambien...)

[Manedwolf]

My wife's in the same boat.  She's an insomniac, never goes into REM sleep, and even when she finally does sleep she wakens at the slightest sound. That's not healthy.

She had a trial run of the original Ambien, and it worked like a charm for her.  Problem is, our HMO (Dean Care) won't prescribe her Ambien until she goes through all the cheaper prescriptions first, even if our physician wrote the prescription.  The pharmacy said we can pay for it ourselves, at roughly $130.00 for a 30-day batch.   

Benadryl, Tylenol PM, Unisom, and the majority of over-the-counter sleep aids all rely on Diphenhydramine to do the trick.  It works on the majority of people, but not my wife.  The after-turkey snooze ingredient, tryptophan, has no effect on her, nor does melatonin.

So she's now forced to use the pharmacy's ladder of prescription sleep aids in varying degrees of effectiveness.  To date, her prescription of 15mg Temazepam pills has done nothing to help her, either.  So eventually, we'll get her Lunesta or Ambien, but only after the HMO forces her to try everything else first.    

(I'm just about to the point of budgeting $130/month to get her the Ambien...)

Have you tried Valerian root capsules? DO NOT ever break the capsules, as the stuff smells horrid, but man, does it knock you out. Gently, it's just a natural sedative. Any supermarket will have it with the vitamins and herbs section.

There's also valerian teas. It seems to work for some people. Chamomile gives me a headache, so I don't use that. Lindenflower is also another mild sedative put in a pleasant tasting tea, used in Europe for centuries.

Also, melatonin now comes in caps from 200mg up to 3g (!)...which I think would put me out for a week.

[SpookyPistolero]

If you are taking that much diphenhydramine, you're definitely pushing the maximum dose. Even as used for severe allergic reaction, the maximum dose is only a bit above 300 mg/day. This amount decreases with age, as there is an increased half-life in the elderly. As indicated for sleep, it's most definitely outside an acceptable range. Aside from simple physical adverse reactions such as sore throat and blurred vision, you can have paradoxical excitement and aggitation (causing more problems with insomnia), and more importantly can cause some CNS depression leading to breathing problems (potentially severe).  It's a bit like trying to fix a sinking ship with 300 roles of duct tape.

Ambien and Lunesta are two great possibilities, though the latter might cost you a bit more and usually isn't a preferred drug on formularies.  I'm not a clinician but your description does imply your problems are based more with anxiety than anything, so something like a diazepam or temazepam may work best for you.

Basically, I'd very strongly reccomend against taking doses of diphenydramine above the reccomended 50 mg for sleep. The reason it's a better antihistamine (than say a second generation like loratadine) is that it crosses the blood-brain barrier to work centrally. That's a lot of drug flowing through your brain at those doses. See your doc as quickly as you can and get the right tool for the job.

[Felonious Monk/Fignozzle]

Snowdog, nice to see you here at APS.

A couple of folks have recommended OTC stuff like Valerian (which I have no experience with) and Melatonin.

About 7 years ago, I began to have fairly mild (but still annoying) insomnia.  A friend and fellow IT guy turned me on to the Melatonin; I have only seen it in dosage from 100mcg (that is, Micrograms) to 5mg (milligrams).
The perfect dosage for me is 3mg, and has worked without fail and without having to titrate upward in 7 years.

I realize your situation may be quite different, but melatonin has worked for a surprising number of folks who (like me)tend to dismiss most OTC remedies as profit generators for their bottlers.
Wishing you the best,
Fig

[Manedwolf]

Snowdog, nice to see you here at APS.

A couple of folks have recommended OTC stuff like Valerian (which I have no experience with) and Melatonin.

About 7 years ago, I began to have fairly mild (but still annoying) insomnia.  A friend and fellow IT guy turned me on to the Melatonin; I have only seen it in dosage from 100mcg (that is, Micrograms) to 5mg (milligrams).
The perfect dosage for me is 3mg, and has worked without fail and without having to titrate upward in 7 years.

I realize your situation may be quite different, but melatonin has worked for a surprising number of folks who (like me)tend to dismiss most OTC remedies as profit generators for their bottlers.
Wishing you the best,
Fig

The difference with melatonin is that rather than a medicinal herb, it's something that, if your body is lacking, might result in insomnia. If it has an effect, it's to let your body be able to realize "Ah, it's time to sleep!" and do so.

Valerian is a medicinal herb used as a relaxant for millenia. Yes, it does work. A lot of medicinal herbs do work, but like any compound, a little knowledge is a dangerous thing, and "herbal" doesn't mean "You can take the whole bottle."...you'd still end up in the ER if you did that.

It's just that actual safety studies have shown that while valerian is pretty harmless in the typical dosages, some others, now mostly off the market, like kava-kava, CAN have side effects, especially for people with some medical conditions. And other herbals are downright dangerous, like ephedra, which, though it can act as a decongestant and stimulant, can also raise some people's blood pressure to dangerous or even fatal levels.

As with all things, research is best. Don't automatically discount all herbals, some of them have been used successfully for thousands of years. Others are recently promoted snakeoil.

Generally, if it's meant as a relaxant or stimulant, it has a good chance of doing just that, safety issues varying. Just steer clear of anything that makes any other claims, like weight loss or appetite suppressant. That's just nonsense.

As a side note to that, valerian is DIRT CHEAP, always a good indicator that something is just an herb, not a fad miracle cure of some type. And a wise thing to do with any herb is to try it in a mild tea, first. If you have a violent sneezing fit or find it difficult to breathe, you may well have an allergy to it and would be glad you hadn't injested a full capsule of it.

Caveat emptor. But body-pummeling psyochoreactive compounds from labs, things of unknown longterm bodily effect...aren't always the only solution, IMO. Some of the listed side effects on the commercials for various things ought to set off warning bells. May cause backache, on some... Backache?

The makers of Ambien have a vested interest in convincing you that their $$$ pill works better than a $3 bottle of herb caps. Their profit depends on it.