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Sleep med combo-good or bad?


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I have been having serious trouble sleeping. so last night I took two klonopin at 10 pm to calm me down at 11 I took two advil pm and at midnight I took 20 mg ambien. It worked like a charm. I didn't think it was so bad but my Aunt wigged out. So did I fubar here or what?

Lilie

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sometimes i add a benzo (in my case librium) at night to give me that extra agent of sedation that might put me to sleep, but generally benzos aren't recommended as a regular sleep aids. there's the risk of dependency etc. and i think its just not a good idea to rely on it as a sleep aid. imo it would be like drinking beer each night to get to sleep. its not your body's natural sleep inducing chemical. if it works it works, but my suspicion would be that this combo is not something you could use every night for sleep. if however you use it for a couple of nights, wake up early, and start getting into a regular sleep/wake cycle and be able to pull yourself off some of the three meds you used last night once you do, then it might prove beneficial.

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See the problem is that I'm a lifelong insomniac. My parents were too. Even now my Dad only sleeps 4 hours a night and he's 75. So what I used to do is say screw it and stay up til I collapsed. I did that all the way through my 20's. But in my 30's it wasn't so easy as it shot my manias to a whole new level of crazy. So now I'm trying to make sure that even if I don't sleep every night I at least get one maybe two nights a week when I sleep. So I did the ambien 10 mg til it pooped out-went all the way up to 30 mgs then when it didn't work went to ambien cr-it helped a little but nothing regular-then lunesta-nothing-then sonata-nothing-then rozerem-nothing. The benzo I tried to help relax my mind so hopefully the other meds could take hold without my constant mind chatter overriding everything.

So I was kind of at a loss and freaked out by my lack of sleep. I just don't know how to get regular sleep. it sucks. :embarassed:

lilie

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I have been having serious trouble sleeping. so last night I took two klonopin at 10 pm to calm me down at 11 I took two advil pm and at midnight I took 20 mg ambien. It worked like a charm. I didn't think it was so bad but my Aunt wigged out. So did I fubar here or what?

Lilie

i dont know if u need that advil PM. if u have a headache try the regular advil but dont use this as part of your sleep combination. id ask your doctor about trazodone as a substitute for whatever antihistamine is in that advil PM. other than that it sounds fine as long as you are not taking more klonopin and ambien than ur supposed to.

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zsandoz it's an antihistamine in advil pm? that can't be right can it? antihistamines make me tweak. I'd be up cleaning the top of the refrigerator with a toothbrush. man wtf? maybe the ambien and klonopin just overruled the advil in someway but the two alone don't do squat. sigh...oh and I did trazadone-doesn't work.

oh well here's to persistence (holds up an imaginary glass)

lilie

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zsandoz it's an antihistamine in advil pm? that can't be right can it? antihistamines make me tweak. I'd be up cleaning the top of the refrigerator with a toothbrush. man wtf? maybe the ambien and klonopin just overruled the advil in someway but the two alone don't do squat. sigh...oh and I did trazadone-doesn't work.

oh well here's to persistence (holds up an imaginary glass)

lilie

Yep = it is an antihistimine in Advil PM.

Rule of thumb - any otc advil pm, tylenol pm, etc. the PM is always an antihistimine.

NEVER NEVER NEVER TAKE ONE OF THESE MEDS LONG TERM BECAUSE THE PAINKILLERS IN IT CAN REALLY FUCK UP YOUR LIVER.

It's not the antihistimine that fucks your liver, it is the painkiller (tylenol, etc).

Diphenhydramine is what makes you sleepy when you take Advil PM. The brand name of Diphenhydramine is Benadryl. If you want to use an OTC sleep-aid just buy a box of the generic Benadryl and take that. It is cheaper and the extra unneeded painkiller won't be in it.

Now if you had a backache or something for insomnia - then something like Advil PM might be your best choice. But if it is just sleep you are after - DITCH THE PM AND TAKE GENERIC DIPHENHYDRAMINE. Your liver will thank you.

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I thought benzos were contraindicated with Ambien, et al because the combination induces hallucinations. My pdoc warned me about this when he first prescribed Xanax, but the first night I tried taking the Xanax (without Ambien), I didn't get sleepy, so an hour or two later, I took an Ambien. Bad idea. Major hallucinations (fortunately not scary ones) and sleep paralysis.

But for some reason, it's okay to take Xanax XR and Ambien - I did well on that for a while.

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I thought benzos were contraindicated with Ambien, et al because the combination induces hallucinations. My pdoc warned me about this when he first prescribed Xanax, but the first night I tried taking the Xanax (without Ambien), I didn't get sleepy, so an hour or two later, I took an Ambien. Bad idea. Major hallucinations (fortunately not scary ones) and sleep paralysis.

But for some reason, it's okay to take Xanax XR and Ambien - I did well on that for a while.

I dont think these are ever contraindicated, unless there are drug-drug enzyme interaction problems. both are addictive, so i think this is overkill for sleep.

rozerem could be a helpful add-on to a benzo sleep aid (restoril, klonopin, xanax XR) or a semi-benzo hypnotic sleep aid (ambien, lunesta, sonata), instead of taking both. klonopin plus either rozerem or a prescription neuroactive antihistamine (remeron, trazodone, etc.) might help someone with insomnia and daytime anxiety.

lilie, halo,

the antihistamines on the market that are OTC are all anti-cholinergic, so they have additional side effects ("drying" side effects) and are not pleasant sometimes or good to take with an underlying MI sometimes. thats why i dont even recommend diphenhydramine.

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I dont think these are ever contraindicated, unless there are drug-drug enzyme interaction problems. both are addictive, so i think this is overkill for sleep.

Ambien is non-addictive and is classified as a non-benzodiazepine hypnotic (along with Sonata, Lunesta, and probably a few others).

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  • 1 month later...

I dont think these are ever contraindicated, unless there are drug-drug enzyme interaction problems. both are addictive, so i think this is overkill for sleep.

Ambien is non-addictive and is classified as a non-benzodiazepine hypnotic (along with Sonata, Lunesta, and probably a few others).

Ambien is addictive. It's just less addictive than benzodiazepines. Read the prescribing info or something if u dont believe me.

Lilie, Seeing u have chronic insomnia, using addictive drugs (Klonopin and Ambien) is a bad idea. While in the short term they can give u a break from insomnia in the long run they fuck u up (rebound insomnia and anxiety if u stop taking them). The drug in advil PM that helps u sleep is diphenhydramine, an antihistamine with a sedative side-effect. If u want to use that buy it on its own without the painkiller. At the pharmacy ask for diphenhydramine 50mg pills. I think they r called Unisom Sleepgels. I have used it and built up a tolerence and they stopped working pretty damn quick so its probably not much use long-term. What's working for me is Remeron (Mirtazapine). It's an antidepressant that makes u sleepy so its prescribes a lot for insomnia. It's made me sleep better than anything else i've tried (Unisom Sleepgels (diphenhydramine), Unisom Sleeptabs (doxylamine) and Valium (diazepam)) And it seems to be working for my depression(unipolar) too. So if u havent tried Remeron talk to ur docter about it.

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The drug in advil PM that helps u sleep is diphenhydramine, an antihistamine with a sedative side-effect. If u want to use that buy it on its own without the painkiller. At the pharmacy ask for diphenhydramine 50mg pills. I think they r called Unisom Sleepgels.

Unisom is doxylamine succinate. Benadryl is diphenhydramine. I sometimes alternate them.

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Ambien is addictive. It's just less addictive than benzodiazepines. Read the prescribing info or something if u dont believe me.
Addiction, tolerance, and dependence are three very distinct things. The definitions used in the Ambien PI sheet are the definitions established by The American Society of Addiction Medicine. For more info, see this article).

From the Ambien PI sheet (emphasis mine):

Abuse and dependence: Abuse and addiction are separate and distinct from physical dependence and tolerance. Abuse is characterized by misuse of the drug for non-medical purposes, often in combination with other psychoactive substances. Physical dependence is a state of adaptation that is manifested by a specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist. Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug effects over time. Tolerance may occur to both desired and undesired effects of drugs and may develop at different rates for different effects.

Addiction is a primary, chronic, neurobiological disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving. Drug addiction is a treatable disease, using a multidisciplinary approach, but relapse is common.

Studies of abuse potential in former drug abusers found that the effects of single doses of Ambien (zolpidem tartrate) 40 mg [**see note below] were similar, but not identical, to diazepam 20 mg, while zolpidem tartrate 10 mg was difficult to distinguish from placebo.

Sedative/hypnotics have produced withdrawal signs and symptoms following abrupt discontinuation. These reported symptoms range from mild dysphoria and insomnia to a withdrawal syndrome that may include abdominal and muscle cramps, vomiting, sweating, tremors, and convulsions. The U.S. clinical trial experience from zolpidem does not reveal any clear evidence for withdrawal syndrome. Nevertheless, the following adverse events included in DSM-III-R criteria for uncomplicated sedative/hypnotic withdrawal were reported during U.S. clinical trials following placebo substitution occurring within 48 hours following last zolpidem treatment: fatigue, nausea, flushing, lightheadedness, uncontrolled crying, emesis, stomach cramps, panic attack, nervousness, and abdominal discomfort. These reported adverse events occurred at an incidence of 1% or less. However, available data cannot provide a reliable estimate of the incidence, if any, of dependence during treatment at recommended doses. Rare post-marketing reports of abuse, dependence and withdrawal have been received.

Because persons with a history of addiction to, or abuse of, drugs or alcohol are at increased risk of habituation and dependence, they should be under careful surveillance when receiving zolpidem or any other hypnotic.

First of all, 40 mg is four times the recommended dose. When taken as directed, the chances of addiction, or even tolerance, are all but non-existent. When taken long-term (but otherwise as prescribed), some degree of dependence has been fairly well established, but typically in the form of rebound insomnia.

That's all the official clinical data. Here's some anecdotal information based on my own experience:

I've been on 10 mg of Ambien mostly non-stop for almost two years. I have not developed any tolerance. This dose, at times, has been ineffective but I'm pretty sure that has more to do with other stuff going on in my life. I've tried 15-20 mg doses (under my doctor's care) and never noticed much increase in efficacy. So basically, no tolerance.

I'm most definitely dependent on it. I cannot sleep if I don't take it. The few times I've gone off it, I have experienced rebound insomnia, but no other withdrawal symptoms. But dependence is not addiction. Read the AADM definition if you don't understand the difference.

On the other hand, I've been on 1 mg of Xanax XR daily for 18 months. While I haven't developed any significant tolerance, it has become less effective over time. And even at this very small dose, the physical dependence is extremely noticeable. I have no addictive tendencies, but I can see how easily it would be to become addicted to this medication.

As for the comparison between Ambien and benzos, do we really need to discuss the potential for abuse, dependence, addiction, and tolerance of benzos?

I'm not totally knocking the use of benzos for any use - including insomnia. However, it's definitely not the safest option, nor typically the most effective - especially long term.

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