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March 25, 2012 1:28 PM Insomnia, Ambien and Personal Harm-Reduction

By Jesse Singal

Gayle Greene’s Sunday Review piece defending sleeping pills shines some valuable nuance on the medicate/don’t medicate debate. Greene, who has long struggled with severe insomnia, writes that a new study claiming to find a link between sleeping pills and premature mortality doesn’t really pass methodological muster.

That said, she isn’t blind to the dangers of sleeping pills. But she is a realist:

These medications alter sleep cycles, so that the sleep they provide may not have the deep restorative benefits of natural sleep. They adversely affect memory and coordination, which can be bad news for the elderly, the group that takes them most. And you can develop a tolerance to them, causing you to take larger and larger doses to get the same effect. But the sleep they provide may make the difference between having a life or not.

Greene’s piece hits pretty close to home for me, because I’m currently on Ambien and have encountered firsthand all the thorny issues that come with it.

For as long as I can remember, I’ve been a terrible, terrible sleeper. I just can’t fall asleep; it takes me hours, usually. My brain is unable to turn off, and there are many occasions when I will be dead-tired at the end of the day, unable to think of anything but sleep, only to feel my brain starting to whir up from idle like an airliner’s engines the second I lay down. (That said, I should acknowledge that it sounds like Greene had a tougher time adapting to a constant lack of sleep than I did—I certainly had my fair share of zombiefied days, but never the difficulties she writes about.)

I resisted medication for a long time. But at some point last year, I realized that my chronic lack of sleep could be seriously screwing up my health in profound ways, so I reluctantly got a prescription for Ambien.

The stuff works for me. That’s not to say I wake up feeling as refreshed as I want to, or that I don’t still have nights when I’m tossing and turning, but on the average night I take an Ambien before I go to bed, I fall asleep quickly—something I just wasn’t capable of before I got my prescription.

Ambien has some serious, weird potential side effects, and dependency/tolerance are major issues as well. So it’s understandable, to a certain extent, that neither of the doctors who have prescribed me Ambien (one in Cambridge, where I used to live, and one at Princeton) have done so in a carte blanche manner—both encouraged me to make other, non-pharmacological attempts to improve my sleep, and my current prescription is contingent on regular appointments with a behavioral sleep specialist.

So I get that it’s not ideal to be be on Ambien. But at the same time, I haven’t experienced any side effects. It’s doing what it’s supposed to be doing. And yet every time I get a refill for a medication that really does improve my quality of life, I have to go through a process that makes me feel like a drug trafficker, I have to get lectured about how I shouldn’t be so reliant on this medication that I never really wanted to be on in the first place. At some point the medical professionals in my life may cut me off, whether or not I’ve made enough progress to cast the pills aside.

It’s frustrating. But what it comes down to is that we are rarely presented with ideal options. In the public-health world, “harm reduction” is a popular concept; it basically means, as the name implies, figuring out what will reduce harm in the real world, rather than evaluating policy through the prism of unattainable ideals. In a perfect world we could simply get everyone off heroin; in the real world, there are hardened, treatment-resistant heroin addicts, and from a harm-reduction standpoint it might actually make sense to simply give them heroin in a clinical setting.

I had to make a more personal, micro-level harm-reduction decision about Ambien. My choice wasn’t between insomnia and a drug that would fix everything at no cost; it was between insomnia and a drug that would greatly improve things, but one that I could become dependent on and which might lead me to one day sleep-drive to the store or wake up with a tattoo of Rick Santorum on my thigh. At the time, it was an easy choice—I was sick of not getting sleep.

I’m still happy with the choice and will continue to make it, assuming they let me. But there does seem to be a tacit assumption that Ambien is worse than non-Ambien, even for people who suffer no ill effects from it, and that’s why I constantly feel like I’m on the defensive about this, like I need to couch what has so far been a pharmacological success story in an endless series of explanations and justifications.

Jesse Singal is a former opinion writer for The Boston Globe and former web editor of the Washington Monthly. He is currently a master's student at Princeton's Woodrow Wilson School of Public and International Policy. Follow him on Twitter at @jessesingal.

Comments

  • Solidsid on March 25, 2012 1:51 PM:

    Ambien is a sleep aid....it is not a
    sleeping pill. I have been using it for 15 years. I have not experienced any of those side effects.

    Enjoy your rest. Make sure you can get 7 or 8 hours
    of rest.

  • Ron Byers on March 25, 2012 1:51 PM:

    Jessee, I don't have a thyroid and have been taking the hormone every day since 1985. I would give anything to have the freedom not to take that pill. As you age you will find your doctor is a pill pusher who puts you on drugs but never takes you off. Tragically dependence is the key feature of the American way of health.

    Start exercising, wear yourself out with physical activity. Get off Ambien as soon as possible. Postpone becoming dependent on drugs as long as you can. Once you are dependent, your life will never be yours again.

  • mshare on March 25, 2012 2:12 PM:

    People who have not had serious chronic insomnia don't know what hell they're talking about. They talk about exercise, sleeping cycles, waiting it out, sleeping lights, herbal products, dark rooms, sleep therapy, etc. etc., etc., etc. You NAME IT, I TRIED IT.

    Well as person who has had chronic initial and secondary insomnia, I'm here to tell you ambien and the rest of the sleeping aids are a god send to people like me. I have had severely chronic insomnia for over twenty years. I have done and tried EVERYTHING. Many times. Many, many times. I spent several years (several period times) using nothing just thinking I'd get over it eventually and suffering everyday feeling like I was sick. I "pushed" through it. It was hell. I did this FOR YEARS!

    Well, THAT's over and by taking ambien I AM taking control over my life. At this point, I don't take to get to sleep but because I have chronic secondary and tertiary insomnia (early waking and then NOT being able to fall back asleep), I take a half pill each time. I sleep fine. It works. I can function during the day.

    There's this societal meme that sleeping aides are not akin to taking other medications for other necessary medical disorders. That somehow they're an addiction, etc. The problem is a "chronic" sleeping disorder IS a medical disorder. No more or less than any other medical disorder. It can be completely debilitating and harmful (try driving, working or using machinery on minimal sleep. THAT'S dangerous. Lack of proper sleep can other medical conditions.)

    I do think for many people they should use sleep aide medication only minimally. But for many in the population, like me, this is something entirely different. It's a serious medical disorder and we're taking medication for that disorder. People need to get off their high horse judgments about that.

  • mshare on March 25, 2012 2:22 PM:

    Oh, and I want to say, in support of Jesse, I, too have been "shamed" by doctors over my use. When this first started happening, I had two doctors (both male) lecture me and treat me like I was a child and an addict wanting pills. One refused any help and the second gave me mild muscle relaxants that did absolutely nothing. I will never forget how shamed I felt by them. Ever. Then I saw a woman doctor who finally got what I was going through and how much I had avoided actually going to a doctor about this problem.

    This lecturing, etc., usually happens with a new doctor UNTIL I tell them my history. I also have panic attacks and have mild anxiety disorder. If a doctor doesn't "get" the sheer hell that I have gone through, I'm done with them. Period. There are doctors who do understand. I take my pills responsibly and I don't have side effects. This is what works for me. And I expect them and everyone else to understand THAT!!

  • elisabeth on March 25, 2012 2:25 PM:

    I don't think of doctors as "pill pushers." They want to help. The drugs can help, so why shouldn't they be offered to people -- and certainly, for something like thyroid problems, there isn't an alternative. The idea that if you have insomnia it is "your fault" or if you have pain you should "tough it out" isn't helpful. And I think it is reflected in the anti-health care folks' attitude that somehow we should all be able to handle any health problem on our own, including buying unaffordable insurance.

  • Brian Link on March 25, 2012 2:40 PM:

    Well, I tried Ambien for a while. It is indeed a miracle drug - pop one, 20 minutes later I'm out like a light.

    However, I did have the misfortune of having a couple beers and then taking my Ambien. I literally woke up outside, in the rain, in my underwear, about an hour after I'd taken it. Luckily it was pretty late in the evening, but I switched to Lunesta after that incident.

    Lunesta doesn't have the clout that Ambien does, but it does help me get to sleep, and if I do have a beer before taking it, I still manage to wake up in my bed.

  • Stumpy McGrumpy on March 25, 2012 3:39 PM:

    Interesting insights on the sleep-aid dilemma.

    My own experience with Ambien™ was that I could take a pill, seem to be awake for an hour or more afterward, and then not remember anything that happened during that hour by the next morning. A small price to pay when the insomnia is really bad. Since then, I have found that 5-10 mg of alprazolam at bedtime will slow the whirling of the brain enough that in combination with a white noise generator on my nightstand, it helps me get to sleep. It does not, however keep me asleep, and in that regard, Ambien is more effective.

    I first took Ambien™ when I was being treated for depression, and I was worried that I would have to go on an SSRI. My doc said, "There's a relationship between your depression and your insomnia, so before we try to treat the depression, let's get the insomnia under control." The Ambien™ let me sleep well enough that I felt like a different person the very next day. Nowadays, I take the alprazolam only when I'm stress and know that I won't be able to fall asleep easily.

    All this is simply to say that insomnia can be at the root of so many other problems that it's a good thing to have some options to deal with it; sometimes, drugs such as Ambien™ make it possible to break a vicious cycle in which insomnia and anxiety/depression build on each other. Addiction is a risk, but it isn't as much of a risk if you are careful with how often you use it, and it certainly isn't as much of a risk as having insomnia and doing nothing about it.

  • TheOtherJim on March 25, 2012 5:36 PM:

    I haven't tried Ambien, but I have a prescription for Clonazepam, have tried Benadryl, melatonin, valerian, passion flower, and a handful of over-the-counter combinations. Clonazepam more or less works -- it's pretty mild and fairly short-acting -- but it's addictive. Benadryl works, but I have to drink a gallon of coffee the next morning.

    But I live in California, which means I have access to medical marijuana, which works pretty well. I have some portion of a cookie before bed and I invariably get somewhere around eight hours of sleep, and I don't have to worry about calling old girlfriends or going for a ride in my underwear. I do have to worry, just a little, about the Feds busting my door down, though.

  • ComradeAnon on March 25, 2012 5:57 PM:

    Having fought insomnia for decades myself and finding relief through a serotonin something something uptake something type drug, I remember Ambien as one of the first things my doctor did to help me break the no sleep cycle. Heaven. But he would only let me take it for a few weeks. (This was a long time ago.) I always thought it ironic that the choice was that I could not sleep or become addicted to something that would let me sleep.

  • Dutchgirl on March 25, 2012 6:51 PM:

    Thank you mshare for so thoroughly expressing how things really are for those of us with insomnia. I makes me so mad when others without insomnia think they know more about my condition than I do, having lived with it all my life. While I have not taken the step to using a prescription sleep aide, I keep inching closer to that decision. Anyway, thanks for sharing and making me aware of the "shaming" that may well happen to me too.

  • internet tough guy on March 25, 2012 6:56 PM:

    If the choice is between Ambien and eating a telephone pole because I fell asleep at the wheel, I shouldn't feel ashamed for choosing the former.

  • Ron Byers on March 25, 2012 9:25 PM:

    I stand by what I said. The American way of medicine is to never ever cure anyone for whom you can prescribe some sort of drug masking the symptoms. Every medical practicioner in America is financially rewarded for hooking patients on what big pharma sells.

    That is what has happened to people who suffer from chronic insomina and are prescribed some long term drug or another. I feel sorry for people who tragically admit they have been hooked on some drug or other for 25 or more years. It isn't their fault, there just isn't any money in actually curing any such chronic condition. All the money is in providing drugs that mask the symptoms.

  • internet tough guy on March 26, 2012 7:23 AM:

    Oh if only us little pill poppers had your strength of will Ron, we would all be better off.

    You first.

  • CharlieM on March 26, 2012 9:18 AM:

    After years of being unable to keep from awakening after just a couple of hours and *then* not being able to get back to sleep (never any problem initially falling asleep), doctors finally prescribed Trazadone.
    Occasional use (once every week or so) to disrupt pattern of sleeplessness has made it a godsend.
    I'll take the "dependence" of occasional use over the unending stretch of days/weeks/months of sitting at my desk or at home on the sofa unable to get much of anything done because I'm too brain-blasted from lack of sleep.

  • "Fair and Balanced" Dave on March 26, 2012 9:22 AM:

    I took Ambien for while but I developed a dependence on it. I quit taking it "cold turkey" and as a result I wasn't able to sleep for almost 2 days.

    I tried Lunesta. While it enabled me to fall asleep, I got the most awful taste in my mouth the following morning (it tasted like I had gargled gasoline) that took forever to go away--it even lingered after eating breakfast, brushing my teeth, even using mouthwash.

  • zandru on March 26, 2012 11:06 AM:

    "have to go through a process that makes me feel like a drug trafficker"

    Oh, you've never bought sudafed? Seriously, it takes much more paperwork and time to buy a packet of decongestant than it does to pick up a prescription.

    I'm not going to comment on chronic severe insomnia and the drugs that help.

  • Califa on March 26, 2012 2:20 PM:

    Doctors are pill pushers. That's all they know to do to treat a condition since a naturally growin plant that can help many people with medical problems is illegal. (thank you tricky Dicky for the War on Drugs)

    I have trouble sleeping also, but it's not as bad as others have said in this blog. All I know is eating and smoking the Canibus plant helps me with insomnia and other conditions much better than any of the pills I've taken with no side effects.

    I recently talked with a social worker who works with the disabled and the eldery. He said that the people who use Canibus take fewer or no pills.

    In turn, costing taxpayers and Medicaid/Medicare budgets less. But hey, if more sick people used Canibus instead of pills the extreme profits of the Pharma Welfare Queens would be less and we all know that profits are more important than people.

  • Crissa on March 26, 2012 4:54 PM:

    Often these wider studies give suggestions and answers which aren't helpful. They aren't checking just people using these drugs for one reason, but people using them or all the reasons. And then, they're comparing those people against a general population - not a population who has let their condition go untreated.

    And in many cases, I don't think they're seeing any increase because they're not checking the right thing. The long-term meds I'm taking, I'm taking because otherwise I would be on hard time and may not have made it. But here it isn' sixteen years later, and I'm still around. But I personally know that of my friends I made in support groups when I started treatment, I'm still here, and those friends I made... Are not.

    I wish they were able to maintain treatment. They weren't. I'm not here just because I'm healthier or had a less severe version or whatever - I'm here because I was able to maintain treatment 100% the entire time.

    Drugs are crutches, and should be treated as such. You should always endeavor to learn and adapt around using them if possible. I can't learn and adapt to replace a thyroid, but I can learn and adapt around other things. Some people won't be able to adapt and it's not a personal failing. Just like getting exercise is something we should always be trying to do.

    I swear I typed in the correct captcha. Sometimes I have to refresh it when I've typed a long time...