Thursday, September 16, 2010

How I Went Off Sleeping Pills

I had been taking Ambien in various forms (CR high and low dose, regular high and low dose) for about 15 months. When I went on it I was in a place of desperation because of extreme and chronic insomnia and anxiety. I had tried every single conceivable herbal or non-invasive remedy out there. I'd had a sleep study that showed that yes, I had mild sleep apnea and yes, I was only sleeping 50-60% of the time and no, there is no reason we can find for it. I am by no means quick to request medication and am typically highly skeptical of a prescription. But I swear to the Flying Spaghetti Noodle Monster that I don't for one millisecond regret taking sleeping pills. Paired with anti-anxiety medication, it was absolutely what I needed at that point in my life.

However, a year later my life circumstances had become more stable, and my brain chemistry had recalibrated. While a sleeping pill used to give me a 7-9 hour respite, I was now sleeping for 12 hours and groggy for 14, even after tapering down from Ambien Continued Release to Ambien (Standard) in the lowest dose available. My body was telling me that it was time to move on.

So for myself, and anyone else wanting to change medication, I knew the first step was to talk to my doctor. And from here is where I draw inspiration for this post. The conversation went a little something like this:
S: I want to go off Ambien.
Dr.: Why? Is it not working?
S: It's working too well. I'm sleeping for 12 hours a night and I'm very groggy.
Dr.: Ok. We can put you on something else.
S: No, I don't want anything else. I don't want anything. I don't think I need it anymore. And it scares me to be on it long-term.
Dr: Oh it's safe. We have patients that are on it for years.
S: do I go off?
Dr:, I guess
S's brain: {why don't you *know*??}
Dr: ...........I guess you'll cut them in half for about 2 weeks. Then you should be good.

Um,.....*not* how this story went. I can't say that he wasn't supportive, but I got the distinct impression that in this practice, they very infrequently foster patients *off* of sleeping pills. As for the long-term safety...I'm pretty skeptical. I'm not a doctor, but I am a biologist and I am certainly capable of finding and interpreting peer-reviewed publications. Guess what? A medium search for Ambien studies defined "long-term" use as 30-60 days. (Medium search being between a 3-click lazy search and an intensive 3-day search.) One to two months, not one to two years. I stopped looking for evidence. I don't want to know. If there's damage, it's already been done. But I have a lot of faith in the brains' plasticity, and even more faith in my own judgement.

Because I had been taking the drug for so long, an abbreviated taper down schedule as outlined by my doctor was not going to work for me. I doubt it would work for anyone in the same situation. Bitter. Moving on.

I started out on the lowest prescribed dose (5 mg) of regular, ie not continued release, Ambien. I cut these in half, and switched every other night between a full dose (5mg) and a half dose (2.5mg). So, over the course of a week I had 75% Ambien in my system compared to the week before. I stayed here for about 2 weeks, before adding in another night of a half-pill. So now it was one night at 5 mg, 2 nights at 2.5 mg. After a few weeks here I move on to 2.5 mg nearly every night, and a full dose about once a week. This once a week was usually in situations where my routine was off- vising people, staying out late, etc etc. Anything that would disrupt my routine and cause excess stimulation, which my brain interprets as stress. My body responds with an elevated heart rate and pulse, breathing quickly-yeah, no sleep for you.

Eventually I was taking 2.5 mg a night. From there I cut those in half, and followed my same protocol outlined above with every other night, every two nights, once or twice a week....Finally, I was at the point where I was only taking 1/4 of a 5mg Ambien pill every 3 or 4 nights. I made the leap to go cold turkey at that point. The whole process took me about 4 months. The advantage of slowly tapering off was that I didn't have any withdrawal or kick-back insomnia. I was very motivated to avoid withdrawal effects that would worsen my anxiety (I am still on that med.) Perhaps someone without concurrent anxiety/ depression could go off more quickly.

I have been completely off sleep medication for about a month. I don't sleep great (there's still that sleep apnea), but I do sleep well enough. I signed up for a computer-based Cognitive Behavior Training for Insomnia. I'll post more after I've completed it- I don't like to write about things I haven't tried myself. I am on a cleansing program (Dr. Natura Colonix) to eliminate all vestiges of Ambien from my system.

I still want to pursue the source of my poor sleep and other health problems. This winter, after my defense, I'm going to try an elimination diet to look for gluten or other food sensitivities. I know that something internal is causing bad skin, distended stomach, insomnia, and possible even anxiety and sleep apnea. Has anyone out there tried this?

If you're out there and looking for support to go off sleep medication, I hope this helps. But keep in mind I sure as hell am not a medical professional.