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Long term Restoril for insomnia vs. Ambien CR


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Everything I have read is that ambien affects only the one subtype of gaba receptor that affects sleep. Benzodiazepines affect all three subtypes to treat sleep, muscle relaxation, and anxiety. My question is why can ambien be used long term without tolerance issues while benzos rapidly develop tolerance? Both types of drugs are working on that third sleep receptor, so why is ambien ok long term but not benzos long term? What are benzos doing to that third type of receptor that ambien isn’t doing? 
 

I ask because I have always struggled with insomnia, and getting good sleep is as important to by bipolar disorder as my mood stabilizer and atypical, so I take one ambien CR 12.5 every night. It is what works the best with fewest side effects, however I sleep walk and sleep cook on it sometimes. Doctor suggested 7.5 mg Restoril but I was concerned that going from the highest dose of ambien to the lowest dose of Restoril might be a waste of time/pointless, and I was also concerned that if I’m going to become tolerant to the Restoril relatively quickly then there is no point in switching to Restoril in the first place and I may as well just stay on the ambien and deal with the sleep walking. Ambien has been approved for indefinite use and everything I read about Restoril seems like you need more, and more, and more, then you’re at the max and screwed and it doesn’t help insomnia anymore, anyway. 
 

And of course I will occasionally read someone say they’ve taken Restoril every night for 15 years and it works just as well now as it did on the first night lol. Realistically, what are the chances that I will be one of the people it does not lose effectiveness for? Remember, I want it as a sleep aid and not for anxiety. I have no anxiety problems.  I need and am going to take something every night, but if Restoril sleep is going to be a dragon I have to chase then I don’t want to bother trying it in the first place because tolerance is not sustainable and sounds like a pain in the ass. 

Edited by CantEven
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  • CantEven changed the title to Long term Restoril for insomnia vs. Ambien CR
5 hours ago, CantEven said:

What are benzos doing to that third type of receptor that ambien isn’t doing? 

I don’t think it has to do with what they do to the third receptor, more that benzos widely effect other GABA receptors that ambien and “z-drugs” don’t hit 

i agree that if ambien is a proven it might be risky to switch over, I guess it really comes down to the severity of your sleep behavior 

Edited by Iceberg
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5 hours ago, CantEven said:

  Remember, I want it as a sleep aid and not for anxiety. I have no anxiety problems.  I need and am going to take something every night, but if Restoril sleep is going to be a dragon I have to chase then I don’t want to bother trying it in the first place because tolerance is not sustainable and sounds like a pain in the ass. 

@CantEven, Have you considered or tried any other type of sleep aids other than benzos/z-drugs?

Rozerem, Belsomra, Dayvigo are a few more you might ask your pdoc about, if you don't want benzos or a z-drug....Those three are specifically approved for insomnia.

There are a couple of antidepressants, Trazodone and Remeron, that are sometimes prescribed off-label for sleep, but I don't know if those would play well considering you are bipolar.....I guess you could ask p-doc about them.

Edited by CrazyRedhead
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  • 5 weeks later...

My impression from what you are describing is that the doctor is looking for something with more oomph, but you may be on to something regarding the dosage.

Firstly, sleep-walking on sedatives is more common with drugs like zolpidem than it is with more broad-spectrum benzodiazepine drugs like temazepam. The goal with switching you from zolpidem to temazepam is to keep you from sleep-walking.

However, the problem with temazepam is its shorter half-life and duration of action. It is very effective for sleep initiation, but it is not very effective for sleep maintenance (i.e. it can wear off in the middle of the night). So the issue won't be with it getting you to sleep. 7.5mg of temazepam may feel as if you are taking 12.5mg of zolpidem all at once, but as if it were immediate release and not controlled release (Ambien vs Ambien CR).

This isn't a guarantee, though. Remember that the goal is to resolve the sleep-walking, which is a danger to your well-being, and that is probably in the forefront of your doctor's mind. So perhaps with temazepam, it will wear off enough to allow you to wake up coherently instead of sleep-walking the way that zolpidem does.

Another thing you might consider asking your doctor about is eszopiclone (Lunesta). It works similarly to zolpidem, but I'm not sure it has the same issue with sleep-walking. It does, however, have a long enough half-life to get you to sleep through the night and it is actually approved for sleep maintenance. Additionally, more recent studies have shown that eszopiclone improves mood during the day independent of sleep improvements.

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