Posted by fachad on April 7, 2002, at 21:00:51
In reply to Re: Anyone Taken Ambien AND a Benzo for Sleep? » fachad, posted by Alan on April 7, 2002, at 16:08:46
ALAN wrote: BZDs aren't really designed for sleep disturbance problems long term. If you don't have an anxiety disorder, then it's best not to use BZDs for this purpose as the same dosage over time will become less effective.
fachad replies: Huh? Is this the same Alan that vociferously defends the safety, efficacy, and appropriateness of long term BZDs for anxiety?
Alan, your post genuinely intrigues me. If you have the time and the inclination, please review the stuff below for correctness and answer a few questions for me.
Please make comments on any errors of fact or interpretation; I'm genuinely open-minded and would like to know what a seasoned BZD expert thinks.
Just so you know, I have a "gut feeling" that you are correct, but I'm trying to determine if that feeling is rational and based on evidence, or if it is residual guilt secondary to indoctrination by the anti-benzo community.
(1) "BZDs aren't really designed for sleep disturbance problems long term."
Maybe it's just a semantic nuance, but I don't think BZDs were designed for any particular indication at all. They were just discovered and then marketed for all sorts of things, including insomnia and anxiety.
Years after the BZDs were discovered, natural BZD receptors were identified in the brain. Later specific subtypes of the BZD receptors were identified. Different subtypes mediate the BZD influence on anxiety, sleep, muscle relaxation, etc.
(2) "If you don't have an anxiety disorder, then it's best not to use BZDs for this purpose as the same dosage over time will become less effective"
This appears to me to be a variant of the classic anti-benzo "you'll develop tolerance" argument. The argument generally runs that tolerance will develop and dose will have to be escalated and dependence will develop and you will be in a worse mess for having started BZDs, so you should never start them in the first place.
But in this case, are you saying that the BZD receptor subtype that mediates the hypnotic effect will develop tolerance, but the BZD receptor subtype that meditates the anxiolytic effect does not develop tolerance?
That premise seems odd, but not impossible. Again, I am just trying to figure out if that conclusion is based on empirical data, clinical experience, anecdotal evidence, or anti-benzo bias.
Based on the considertions outlined above, do you still maintain that it's appropriate to use BZDs long term for management of anxiety disorders but not for sleep disorders?
-fachad
poster:fachad
thread:102248
URL: http://www.dr-bob.org/babble/20020402/msgs/102315.html