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Re: anyone use sleeping pills long term?

Posted by Elizabeth on April 25, 2002, at 0:15:25

In reply to anyone use sleeping pills long term?, posted by CtrlAlt n Del on April 24, 2002, at 17:28:03

Hi. I use Ambien every night. It doesn't lose its effectiveness after at least a year, perhaps longer. However, some people say that they do become tolerant to Ambien. My only problem with it is that sometimes it wears off before I want to wake up, and I end up awakening in the middle of the night.

Tolerance is much more common with other types of sleeping pills, such as benzodiazepines and barbiturates, as well as certain similar drugs such as alcohol. (Unlike Ambien, these sedatives can also cause dangerous withdrawal symptoms.)

I'm not sure about the rate of tolerance to other kinds of drugs (antihistamines, tricylic antidepressants, trazodone, Remeron, clonidine, antipsychotic drugs, etc.) that are sometimes used to help people sleep. Personally, I've tried all of these and found that they lost effectiveness very rapidly, after at most a few days.

Over-the-counter pain medications, such as acetaminophen (Tylenol and others), ibuprofen (Advil, Nuprin, others), and the like, are not effective sleeping pills; some, like Excedrin, even have caffeine (useful for migraine, not so great if you want to get to sleep). Variations on these, such as "Tylenol PM" and "Excedrin PM," help people sleep because they contain an antihistamine (usually diphenhydramine, the same one in Benadryl, or similar ones like doxylamine and dimenhydrinate; sometimes these are marketed as sleeping pills (e.g., Unisom), sometimes as allergy pills (Benadryl, ChlorTrimeton (chlorpheniramine), Tavist (clemastine), etc.). You're probably better off taking only the stuff that you need, as Cecilia says. For example, if you want to get to sleep but don't have any pain, it doesn't make sense to take a pill that has a pain medicine in it as well as an antihistamine -- if you're choosing between Tylenol PM and Benadryl, then Benadryl would be the better choice in this case. (If you do have pain, it may make sense to take the Tylenol PM, of course.)

Last but not least, there are a bunch of strategies collectively referred to by the unfortunate name "sleep hygeine" that help a lot of people. I think that this is always worth a try, even if you have a primary sleep disorder.

To reduce dreaming, a tricyclic antidepressant is a good bet, preferably one of the more sedating ones such as doxepin or amitriptyline (desipramine is a bad choice for a TCA to take before bed). MAOIs work great to virtually eliminate dreaming, but they tend to cause some insomnia too. Benzodiazepines should also be helpful. I'm not sure about the over-the-counter antihistamines.

Can I ask what problem you have that you think there's nothing you can do about? You're free not to discuss it if you'd rather not, but there might be someone here who's familiar with it and can make suggestions. Just a thought.

best,
-elizabeth


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poster:Elizabeth thread:104018
URL: http://www.dr-bob.org/babble/20020416/msgs/104070.html