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Zolpidem use?
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DocWils Offline

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Post: #11
RE: Zolpidem use?
We tend to not recommend any sleeping medications if we can in my country, but Swiss medicine is a bit different, in that we do recognise and recommend "natural" medicines when we find them to be effective, so Baldrian (Valerian) is the go-to choice for getting people to sleep, but I often think it is the brandy that it is suspended in that actually does the job - 40 drops in a little water and off you go, no side effects, unless you are intolerant to the ingredients. I would suggest you try it instead of any sleep meds.

We prescribe Zolpidem sparingly. But then, we prescribe most things sparingly. For a country that is partly based on the pharma industry, we tend to keep the use of them relatively low ( heck, cardio aspirin is restricted and only available under prescription here). Our training is to exhaust all natural methods before resorting to "school" medicine if we can.

Tyrone's point about the rarity of the extreme side effects with most drugs is true - what is included in the actual drug's literature is a pretty good break down of the frequency and severity of the side effects for most, but not all people. Sure there are some horror stories, but it comes down to a lot of different things, from varying body chemistries to problems of non-compliance (our biggest problem in medicine, to be honest) to interactions with other medications, often without the prescribing doctor's knowledge, to unforeseen effects of diet (we only learned about grapefruit's dangers to some medications relatively recently, for instance, and that was after a certain class of drugs were, for years, showing inconsistent results in certain populations, until some doctor in Florida twigged) and so on and so on. Sometimes effects were confused with possible causes, as in some suicides thought to relate to using Prozac - they now have a warning on them that it may increase suicidal feelings, but there is no solid proof of it, rather a suspected causal relationship (which may be muddied by other factors) so as to make the prescribing doctor AND the patient not take the use of Prozac so lightly. Ambien has clear warnings of what to mix it with or not, and if you ignore it, you are your own fool. I have suspected for a very long time that Americans are rather blithe when it comes to taking medicines and it certainly explains many of the horror stories that one hears. But then again, I have never encountered prescription medicines being openly and attractively advertised on television except in the US. I thought it utterly mad.

As for Zolpidem's effects on SA, there is no solid evidence one way or the other - the nature of the drug would suggest that it could increase CA events in some cases, and may create false positives in OA events by depressing the respiration rate, thus making the CPAP machine assume a borderline event via flow limitation, even when there is no actual event. the best way to be sure is to test it for yourself, as it may have an entirely different effect on you than on the next person. The literature holds no clear answers in this regard. My trusty desktop CPA is silent on this, as is Journals In Respiratory Medicine. This does not mean the phenomenon does not exist, only that it has not been documented to the point that it is published. On the whole, though, sleep medicines are a risk of depressing the respiratory process, just as alcohol is, so if you suffer from SA, even when using a CPAP, best to avoid it. And to put it in perspective, since I suffer from hexenschuss often ( a sort of muscle spasm in the back for which i have long since forgotten the English term or the medical term since we use hexenschuss here as a medical term - aren't we Swiss cute?), I regularly must take a muscle relaxant, Sirdalud in combination with Olfen Retard before going to bed, which has a strong combination that in me knocks me out - if I do take it, I always hook up my pulseox with an alarm for desats below 80% for more than 3 seconds, just in case, and because my CPAP will not be able to do enough were that to happen. Luckily, it has happened only once that the alarm was triggered, and it woke me quickly. But even on nights where the alarm was not triggered, the read-out the next day showed a clear increase of desat events and increase in severity, in comparison to normal nights when I have not used the combination of the two drugs.

That is a long winded way of pointing out that you need to be aware of what you are taking, test the dangers reasonably, assemble data from your own use and always use any drugs advisedly and with caution. And of course, don't mix with alcohol or other drugs.
01-14-2015 06:42 PM
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Jim Bronson Offline

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Post: #12
RE: Zolpidem use?
DocWils: Thank you for bringing the topic back on track. As I stated, my personal goal is to get off Zolpidem, even though my insurance pays for it and I have no obvious side effects. I like the brandy suggestion BTW.

TyroneShoes: I can only say wow! How you could take my post as a personal offense baffles me. I don't recall mentioning you at all, nor was that my intention. The third paragraph is a general statement. It isn't worth continuing the discussion, but I would like to know exactly how one would verify personal experiences of anyone on message boards. Or perhaps that pesky word "experiences" threw you. In any case, you clearly took offense when one was neither intended nor stated.
01-14-2015 08:43 PM
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DocWils Offline

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Post: #13
RE: Zolpidem use?
Jim,

Taking Baldrian tincture should not be mixed with Zolpidem, because of the alcohol base. One or the other. you need to check with your pharmacist as to the correct procedure for weaning off of Zolpidem, if it requires it. Either way, try the Baldrian (Valerian) rather than straight brandy - although miniscule amounts of brandy may well do the same trick, at this point that is just my suspicion rather than established fact. Warm milk does the same thing, too, as does a toddy, hot of course. Each works a different way, though.

Since your meds are paid for, there is no harm in weaning off for a while, see how things go, find substitutes and if not return. Generally, weaning off this class of drugs, if you have been a long term user, take anywhere up to 20 weeks (depending), with 5 weeks being the minimum safe period for a course of reduction to total withdrawal and the normal being 12 weeks, otherwise there will be strong withdrawal symptoms and concomitant health issues. Do NOT, if you have been using this class of drug for more than a month, quit cold turkey. Either your doctor or your pharmacist can advise you, based on your history, on the best course of reduction.

For a bit more info on reduction, have a look at this brochure from Montreal's McGill university Medical School: http://criugm.qc.ca/images/stories/les_chercheurs/risk_ct.pdf
(This post was last modified: 01-14-2015 09:35 PM by DocWils.)
01-14-2015 09:21 PM
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Jim Bronson Offline

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Post: #14
RE: Zolpidem use?
(01-14-2015 09:21 PM)DocWils Wrote:  Jim,

Taking Baldrian tincture should not be mixed with Zolpidem, because of the alcohol base. One or the other. you need to check with your pharmacist as to the correct procedure for weaning off of Zolpidem, if it requires it. Either way, try the Baldrian (Valerian) rather than straight brandy - although miniscule amounts of brandy may well do the same trick, at this point that is just my suspicion rather than established fact. Warm milk does the same thing, too, as does a toddy, hot of course. Each works a different way, though.

Since your meds are paid for, there is no harm in weaning off for a while, see how things go, find substitutes and if not return. Generally, weaning off this class of drugs, if you have been a long term user, take anywhere up to 20 weeks (depending), with 5 weeks being the minimum safe period for a course of reduction to total withdrawal and the normal being 12 weeks, otherwise there will be strong withdrawal symptoms and concomitant health issues. Do NOT, if you have been using this class of drug for more than a month, quit cold turkey. Either your doctor or your pharmacist can advise you, based on your history, on the best course of reduction.

For a bit more info on reduction, have a look at this brochure from Montreal's McGill university Medical School: http://criugm.qc.ca/images/stories/les_chercheurs/risk_ct.pdf
I had never heard of the tincture version of Valerian. One sample I found is 50 proof, so, as you cautioned, I wouldn't take it with Zolpidem, but it might be a substitute someday.

I already tapered from a split dose (two 5mg doses) of Zolpidem about two months ago with no obvious adverse effects. I used to cut 10mg doses in half and take one half at bedtime and the other half when I awoke in the middle of the night. My doc said that would be OK. I no longer take the second dose, and I would like to taper off the bedtime dose. I'll talk it over with my doc and show him the program in the attachment. That's the first tapering program I've ever seen. I'm eager to try it using 5mg tablets. After reading the attachment, I'm more motivated than ever.

Many thanks for the info.
(This post was last modified: 01-14-2015 10:16 PM by Jim Bronson.)
01-14-2015 09:53 PM
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OMyMyOHellYes Offline

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Post: #15
RE: Zolpidem use?
I have quit cold turkey a few times after extended periods of use. Usually would go to sleep by the third day and would sleep pretty well after that for a long while, though still get up earlier than I would prefer - 6 hours is a long sleep night.

OMM
(This post was last modified: 01-14-2015 10:33 PM by OMyMyOHellYes.)
01-14-2015 10:32 PM
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sumzzzs Offline

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Post: #16
RE: Zolpidem use?
I value each of your contribution to my post. AS for me, tonight I'm going to taper my dose, because my numbers are really bad. I had many episodes of CA last night, I'm a new patient on CPAP and I'm quite concerned. My sleep is just incredibly fragmented. How do you all feel about taking Melatonin?
(This post was last modified: 01-15-2015 12:32 AM by sumzzzs.)
01-15-2015 12:31 AM
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DeepBreathing Offline
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Post: #17
RE: Zolpidem use?
I take 5mg zolpidem for sleep issues secondary to fibromyalgia. Even with the Z I would often lie awake for hours - usually end up watching some late night TV, which is a horror not to be contemplated. Since going on the hose, I very seldom suffer from insomnia, so I should probably go off the zolpidem. But when my dose is already so low (half a tablet) is there a practical way to taper off? Would taking it only every second night be a sensible way to go?

As an aside I've never (to my knowledge) had any of the bizarre behaviour side effects. One night recently, however, something strange happened. It had been a biggish occasion and I had taken a small amount of alcohol (I'm normally a non-drinker). I couldn't get to sleep so I took another half tab of Z and went off. When I woke up next morning, my mask, headgear & hose were not there! I found them in the bathroom - hose & headgear neatly hung over the towel rail, mask separated into its various components and also hung up. I can only assume it was a combination of alcohol and a higher dose of zolpidem which caused this unusual behaviour.

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
01-15-2015 12:38 AM
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sumzzzs Offline

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Post: #18
RE: Zolpidem use?
Just going to go with 5mg tonight, maybe take the other half when I awake later. I tapered off Zolpidem before, lets see how my numbers are in morning. I don't seem to be having ill effects the next day, but as I'm sleeping? Don't know...
(This post was last modified: 01-15-2015 12:48 AM by sumzzzs.)
01-15-2015 12:46 AM
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Sleepster Offline
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Post: #19
RE: Zolpidem use?
(01-15-2015 12:46 AM)sumzzzs Wrote:  Just going to go with 5mg tonight, maybe take the other half when I awake later. I tapered off Zolpidem before, lets see how my numbers are in morning. I don't seem to be having ill effects the next day, but as I'm sleeping? Don't know...

The AHI (especially as measured by a CPAP machine) is not very precise. For example, there is no clinical difference between a 1 and a 4. Certainly do not base decisions on just one night's data.

Sedatives relax the muscles that keep the airway open, making it more likely to collapse. And that is a huge problem if you don't have a CPAP machine. But if you do have one it will likely prevent the collapse, especially if you have a auto-adjusting machine.

I can't tell from your profile which machine you have. Please identify your machine in your profile:

http://www.apneaboard.com/forums/Thread-...8#pid75378

That second digit (edit: meant to say first digit) in the model number is critical here. If "6" you have a fixed pressure, but if "7" you have an auto-adjusting machine which should raise the pressure when necessary and so avoid in large part the effects of sedatives.

My doctor prescribes Trazodone to help me sleep. I like it because it works better than over-the-counter sleep aids and for me it's not habit forming. For me Zolpidem (Ambien) is habit forming in that if I take it tonight I won't be able to get to sleep tomorrow night without it. And it stopped working after I took it for a while. I can go years without it, and but even then when I take it it doesn't work anywhere near as well as it did at first. I don't have these problems with Trazodone. What I usually do is take half if I can't fall asleep, and then take half if I wake up and can't fall back asleep.

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
01-15-2015 12:53 AM
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sumzzzs Offline

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Post: #20
RE: Zolpidem use?
(01-15-2015 12:53 AM)Sleepster Wrote:  
(01-15-2015 12:46 AM)sumzzzs Wrote:  Just going to go with 5mg tonight, maybe take the other half when I awake later. I tapered off Zolpidem before, lets see how my numbers are in morning. I don't seem to be having ill effects the next day, but as I'm sleeping? Don't know...

The AHI (especially as measured by a CPAP machine) is not very precise. For example, there is no clinical difference between a 1 and a 4. Certainly do not base decisions on just one night's data.

Sedatives relax the muscles that keep the airway open, making it more likely to collapse. And that is a huge problem if you don't have a CPAP machine. But if you do have one it will likely prevent the collapse, especially if you have a auto-adjusting machine.

I can't tell from your profile which machine you have. Please identify your machine in your profile:

http://www.apneaboard.com/forums/Thread-...8#pid75378

That second digit in the model number is critical here. If "6" you have a fixed pressure, but if "7" you have an auto-adjusting machine which should raise the pressure when necessary and so avoid in large part the effects of sedatives.

My doctor prescribes Trazodone to help me sleep. I like it because it works better than over-the-counter sleep aids and for me it's not habit forming. For me Zolpidem (Ambien) is habit forming in that if I take it tonight I won't be able to get to sleep tomorrow night without it. And it stopped working after I took it for a while. I can go years without it, and but even then when I take it it doesn't work anywhere near as well as it did at first. I don't have these problems with Trazodone. What I usually do is take half if I can't fall asleep, and then take half if I wake up and can't fall back asleep.

Thank you Sleepster for your help, I believe I have correct machine in profile now, but I'm not sure it auto adjusts pressure at all? If it does it doesn't appear to be anticipating my CA, which to be honest I'm not exactly sure how to interpret every one on Sleepyhead. Some don't appear to not disrupt my breathing but most do....
01-15-2015 01:57 AM
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