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Re: I Don't Understand? » Phillipa

Posted by lars1 on February 4, 2005, at 8:49:53

In reply to I Don't Understand?, posted by Phillipa on February 3, 2005, at 17:43:33


> How come everybody can fall asleep on ambien, seroquel{low dose}, klonopin, etc,. How come the pdoc puts me on a "cocktail of meds" and still I'm awake after 4 hours for more benzos? Is it because I've taken them for so many years {30), and have a tolerence to them?

Hi Phillipa,

After 30 years, it's to be expected that you may have built up a tolerance and need higher doses. That is not necessarily a problem, since you will also have built up a tolerance to the side effects.

I seem to recall that in another post you mentioned that you recently started taking Ambien and that it helped you get to sleep, but that you still woke up in the middle of the night. Ambien has a short half-life (1.4 to 4.5 hours), which is bad (you may wake up in the middle of the night), but also good (if you do wake up, you can take another dose and still not have much hangover in the morning). It's too bad they don't make an extended-release version. I wonder if you might have luck taking half your dose before bed, and the other half if/when you wake in the middle of the night? If that doesn't work, maybe you could ask your doctor about taking a full 10 mg dose at both times? I have had good results getting to sleep if I take Ambien "prophylactically" about an hour before bed, if I expect that I might have trouble falling asleep. I seem to be able to get by with a lower dose that way than if I wait until I've already been tossing and turning and trying to sleep.

I think that the Ambien may end up helping you a lot. As you know, benzos have many effects -- hypnotic, anti-anxiety, anti-seizure, etc. Once you've used them for a while, you may start feeling rebound effects as the drug is wearing off (that is, when the drug concentration is below the "average" that you've become used to). These effects are the reverse of the drug's normal effects: insomnia, increased anxiety, reduced seizure threshold, etc. As a result, if you use benzos during the day, you may start to have rebound insomnia at night. If you then use benzos to sleep you may have rebound anxiety in the day, leading to higher daytime doses to quell the anxiety, leading to higher nighttime doses, leading to... well, you get the picture. The 24/7 use promotes tolerance and can make the drug less effective for you.

Anyway, Ambien has a more specific effect than benzos, targeting sleep but not having much anti-anxiety effect. That means that it also doesn't have much daytime pro-anxiety rebound effect, only (theoretically) a daytime insomnia effect, which wouldn't be a problem for most people. So, I think that Ambien shouldn't lead to the same dose escalation cycle that benzos can. If you use Ambien instead of benzos to sleep, using a higher dose of Ambien if that's what it takes to get by without benzos, then over time you may find the benzos more effective during the day, and you might eventually be able to reduce the dose. That would reduce the tendency toward nighttime rebound effects from the benzos, so you might eventually be able to reduce the Ambien, too.

Finally, if you haven't already done so, you might read up on "sleep hygiene" and see if there are any non-medical things you may have overlooked to help you sleep well. (If I've already mentioned this to you, I apologize. I don't mean to repeat myself.)

Best wishes,
Lars


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URL: http://www.dr-bob.org/babble/20050202/msgs/453021.html