Ambien side effects??

RandyJ wrote:Have you considered other drugs? I don't have personal experience with them, but I have heard of Lunesta, Trazadone, etc.

During the First War on Insomnia, I tried both Ambien and Sonata. The 5 mg dose of Ambien cause real problems with the morning "hung over feeling" and since I was on a sleep restricted schedule with a max time in bed of 6 hours as part of some serious CBT by the same person prescribing the Ambien, we both felt that it would be worth while if I could take something later in the night with a shorter half-life. And so she switched me to Sonata, but the Sonata weirded me out instead of encouraging me to sleep in the first 30-40 minutes after taking it.

The current sleep doc knows this history. So far he has not mentioned Lunesta or Trazadone. I'm leery of Trazadone since I have some known genetic anomalies that affect the metabolization of many medicines including Trazadone. The genetic testing was done after I developed some very serious mood-related side affects to the medicines that were prescribed for my migraines. As with most migraine prophylactic meds, the meds I was put on were developed for and are still commonly prescribed for conditions other than migraines. In my case, the three meds they tried on me were antiseizure meds commonly prescribed as mood-stabilizing drugs. The psychiatrist I see has told me that I need to be very, very careful with anything that is commonly used to treat mood disorders of any sort. (All of these facts are also known to the sleep doc.)

The idea behind using Ambien is that, except for Sonata, it's got the shortest half life of the commonly prescribed sleep meds: Given how "hung over" I feel in the morning after taking even the small doses of Ambien, I've been told that sleep meds with longer half-lives (such as Lunesta) are likely to increase that particular problem.

robysue,

what else have you tried in your War on Insomnia. Have you ever done CBTI?

what did your "serious CBT" consist of? how long was it? What were you asked to do and how long did you do it for?

OKCSleepDoc wrote:robysue,

what else have you tried in your War on Insomnia. Have you ever done CBTI?

The First War on Insomnia was largely based on CBTI and it helped tremendously. I still use the CBTI techniques on a nightly basis as much as I can. The biggest problem I've had is maintaining a constant wake up time 7 days a week when I don't have regular monthly meetings to discuss the CBTI stuff. The current sleep doc is impressed with my knowledge of CBTI and has encouraged me to continue doing the things that I believe help. (And a lot of the stuff helps a lot.)

The First War lasted approximately 6-8 months before the insomnia was pretty much controlled (in my opinion). The complicating factor was that I was also involved in the First War on Migraines at the same time. And each time a new med was prescribed for controlling the migraines, the migraine med caused some real backwards slippage in the War on Insomnia. After the third migraine med triggered intolerable side affects, the PA who was seeing me for the migraines suggested the first of the genetic tests. When it turned up positive, she changed the approach to controlling the migraines from anti-seizure meds to Deplin (a massive dose of the metabolized version of folate), Magnesium, and a massive dose of Riboflavin. The vitamin regime brought the migraines under control in about 6-8 weeks and along with the improvement in the migraines, the insomnia was reined in through CBTI. At the time bedtime was 1:30 (or when I got sleepy, which ever came SECOND) and wake up time was 7:30. The First War occurred during the first half of 2011. And the main complaint at the start was that I simply could not get to sleep with the BiPAP on my face unless I was falling asleep on my feet and bedtime was getting later and later and later. In other words, the big problem was bedtime insomnia with late night wakes playing a very secondary role. By summer 2012, wake up time had slipped to 8:00 and during that summer I just could no longer force myself to get up out of bed when I didn't really need to. And so the circadian stuff started to revert back to my old pre-CPAP patterns during that summer.

Things were OK in the sense of my waking up feeling decently rested and being able to handle the sleep schedule until about one year ago. Around November 2012 things fell apart. I was no longer waking up feeling particularly rested and I started waking up a lot during the second half of the night (which was a NEW insomnia pattern for me.) And the headaches started up again, but this time there was a lot of tension headaches in the mix. And the TMJ problems kicked in too.

Since then the first hope on the insomnia was: Once the headaches and TMJ issues are resolved, the insomnia should get better. But even with the hard work to rein in the headaches and the TMJ, the sleep issues just did not resolve. And as a result progress on resolving the headaches and the TMJ issues has been characterized by a lot of "two steps forward, one and a half steps backwards." And that's why the sleep doc, the headache PA, and the TMJ dentist all have agreed that doing something to resolve the sleep in the short term with something beyond the CBTI

If its more EMA than bedtime insomnia, some studies have shown that Silenor/Doxepin may help as opposed to BZRA. IMO, CBTI is King in terms of treatment of insomnia. Generally it will fix your sleep, but if your sleep becomes broken, you can always do CBTI again. I would consider being a bit more aggressive with your sleep restriction/stimulus control but this would be more helpful if you were keeping sleep diaries and your current sleep doc understands how to do CBTI (essentially its worth doing under the supervision of your sleep doc, rather than the sleep doc just saying to keep doing it). Does your current sleep doc know how to do CBTI (I know most will defer to a clinical psychologist with more formal training in CBTI).

Only sleep aid that works for my wife is a 1 mg Zanex. Ambien, Lunesta and all that really turn her loopy. She had to take an Imitrex injection last night for migraine and ended up talking in her sleep for an hour. In 15 years of Imitrex use that is only second time she has had that reaction. Sometimes old school meds are better than the new miricale drugs. I do have some meds tailored at a compounding pharmacy.

I take Stilnox CR on a as needed basis. I try to take it only twice a week now. Thankfully I haven't suffered from the strange side effects of sleep eating and walking.

Roby I do get the hung over feeling in the morning, but I don't seem to suffer as much now as I did at first. My bed time is supposed to be 10pm, although due to the recent change for daylight savings that has gone a bit screwy, maybe the fact that you go to bed so late and wake early is causing the hangover effect?

I used to take generic temazepan pre cpap, but it wasn't working very well.

I've not had anything "crazy" happen the half dozen times I've taken Ambien. Had no idea anything like that happened until I read it here. No morning hangover either, at least nothing different than I usually feel.

OKCSleepDoc wrote:what did your "serious CBT" consist of? how long was it? What were you asked to do and how long did you do it for?

The CBTI lasted about 6-8 months. The main pieces of the CBTI included:

• Setting reasonable goals and basic review of sleep hygiene and a discussion of what I was doing right and what I needed to work on.
• Using a sleep restricted schedule to consolidate my sleep cycles with a rigid wake up time and a more flexible bedtime. The PA who was responsible asked me what time I needed to get up by in order to function at work and that I'd be willing to get up on weekends. I said 7:30. The PA set my bedtime at "1:30 or when you first get sleepy AFTER 1:30". It was NOT a struggle to stay up to 1:30 and most nights at the beginning of the CBT I was getting to be much later than that. Getting up at 7:30 was difficult, but was necessary that particular semester.
• Getting out of bed if I got angry at the PAP for any reason at all. Getting out of bed if I had not fallen asleep within 30 minutes (as estimated by my mind rather than looking at a clock). Getting out of bed if I woke up and was not able to get back to sleep within 30 minutes (as estimated by my mind rather than looking at a clock).
• No napping was allowed (except if I had a nasty migraine)
• Keeping a sleep journal where I had to estimate the length of time it took me to fall asleep at the beginning of the night, the number of wakes I remembered during the night, and an estimated total sleep time for the night. I also was asked to write a note or two about how I felt immediately on waking up for the day.
• Monthly meetings with the PA to evaluate the progress made and to reinforce the importance of reasonable goals.
• Judicious use of Ambien to prevent too many "sleepless disasters in a row" The idea was that I would take an Ambien on the night after I had a really bad, disastrous night in terms of insomnia. The PA left the definition of "disastrous" up to me. When I ran into problems with wanting to try to get to sleep on my own, but then having to get out of bed, it became clear that I needed to be able to make the decision to take a sleeping pill at 3:00 am rather than 1:30 am on some nights. That's when I was switched to Sonata, which never worked as well since it weirded me out right after I took it rather than making me sleepy.

The original idea was that after I was sleeping for at least 85-90% of the six hour TIB window that I'd start increasing the TIB by 15 minute intervals by moving bedtime back. Unfortunately, every time I tried, the latency to sleep increased and the general restlessness in later part of the night. The light box was added after I had made several attempts to move bedtime back. And during the summer of 2011, I was also told to move wake up time to 8:00am since I was not teaching and that would work with my Fall 2011 teaching schedule.

Overall I was quite pleased with how the CBTI worked. It really helped shorten my latency to sleep, which made the BiPAP much more bearable. By the end of it I was still waking up in the second half of the night, but the wakes were really short and no longer seemed to bother me. I never was able to extend the TIB window to much beyond about 6.5 hours and I more or less settled into a roughly 1:30-2:30 bedtime and a 8:00-8:30 wake up time during the fall of 2011. I was waking up feeling rested most mornings and even refreshed on some mornings. And so as far as I was concerned, the insomnia monster had been reined in enough for me to feel like I was sleepy decently enough.

For a long, thoughtful reflection on my CBT, you should see my blog entry at http://adventures-in-hosehead-land.blog ... omnia.html. It was written about a year after I officially "finished" the CBT.

OKCSleepDoc wrote:If its more EMA than bedtime insomnia, some studies have shown that Silenor/Doxepin may help as opposed to BZRA.

I'm lost in the acronyms, but I think I get the gist of what you are saying. Silnenor is a tricyclic antidepressant used for insomnia, isn't it? One of the gene anomalies affects the way many tricyclic antidepressants, but I will keep this in mind.

IMO, CBTI is King in terms of treatment of insomnia. Generally it will fix your sleep, but if your sleep becomes broken, you can always do CBTI again.

I agree 100% with this. As I said in the previous post, I was very happy with the outcome of the CBTI the first time around. It took a long time, but it worked well until the simultaneous return of the insomnia, the migraine and tension headaches, the migrainous related veritigo, and the TMJ issues all started spiraling out of control about a year ago. With the help of my (new) medical team, we were able to stop the downward spiral by late last spring. But I've been "stuck" since then on just about everything and this fall the vertigo has started to deteriorate again, and with it the sleep seems to have been adversely affected.

I would consider being a bit more aggressive with your sleep restriction/stimulus control ...

This is something I have come to believe myself and I'm working on being more aggressive on the sleep restriction and stimulus control ...

but this would be more helpful if you were keeping sleep diaries and your current sleep doc understands how to do CBTI (essentially its worth doing under the supervision of your sleep doc, rather than the sleep doc just saying to keep doing it). Does your current sleep doc know how to do CBTI (I know most will defer to a clinical psychologist with more formal training in CBTI).

I've been intermittently doing the sleep diaries all along. The current sleep doc has said he'd be more comfortable if I worked with the clinical psychologist that I currently see for anger management, but the psychologist has said I know more about this stuff than he does. However I think that I do need to be doing this under some kind of supervision---if only keep me motivated. Maybe I should push the sleep doc and the psychologist a bit harder about how to find someone who could properly supervise me.

What about a clinical psychologist who is certified in behavioral sleep medicine? You could see if one is in your area:

http://www.absm.org/bsmspecialists.aspx

If not, you would just need to ask each psychologist that you were considering how well versed they are in CBT applied to sleep.

OKCSleepDoc wrote:If its more EMA than bedtime insomnia, some studies have shown that Silenor/Doxepin may help as opposed to BZRA.

What is EMA? BZRA? Which of the tricyclic antidepressants are good for sleep maintenance insomnia, but do NOT leave a hangover and contribute to EDS?

SleepingUgly wrote:What about a clinical psychologist who is certified in behavioral sleep medicine? You could see if one is in your area:

http://www.absm.org/bsmspecialists.aspx

If not, you would just need to ask each psychologist that you were considering how well versed they are in CBT applied to sleep.

SleepingUgly,

Thanks for the link. There are three names on the list that are in the Buffalo metro area. This does give me something to investigate!