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Help me knock myself out
April 19, 2012 8:08 AM   Subscribe

Help me get over my irrational fear of sleep medication.

I have had difficulty sleeping for my whole life. For years, I’ve considered 5 hours of uninterrupted sleep a gift, and I’ve endured more entirely sleepless nights than I can count (it happens at least once every two weeks).

Within the past year, I have started to suffer worsening depression and anxiety, which has troubled my sleep even more. I started seeing a psychiatrist about a month ago, and he put me on 5mg of Lexapro (which he plans to increase over time). This medication has impacted whatever regular sleep I was getting, making it seemingly impossible for me to fall into a deep slumber. At this point, I am so sleep-deprived that I can barely function at work. Moreover, I feel unable to assess whether the medication is having antianxiety or antidepressant effects, because I spend my days in such a gauzy haze of exhaustion.

Here is the twist: I’m irrationally terrified of sleep aids. My psychiatrist prescribed 10mg of ambien three weeks ago, and I’ve had it sitting on my desk since then. I have been unable to bring myself to take it. I know that I would feel much better if I were well-slept, and that the ambien can help with that. But I chicken out whenever I am about to knock one back.

I have two irrational fears: 1) that I will die in my sleep / pass into a coma and 2) that I will wake up somehow “changed”—i.e., that the drug will somehow permanently affect my personality or cognitive functioning. It’s likely that the first fear is part of the reason I have sleep trouble to begin with, and I have discussed both of these issues with my doctor. He is understanding, but the only thing he can say in response is that he recommends trying the ambien—it is my choice, of course, but he thinks it will help me and does not think it will hurt me.

I want to get well, and I believe that paying back my sleep debt is a necessary component of that. I know I have a tool in front of me to help. How do I make the leap?

Has anyone dealt with similar fears around sleep drugs? Is there any basis to my worries? Tips/tricks/advice?

If it makes any difference, I am a 29 year old male working a 9-5 desk job. Thank you so much.
posted by anonymous to Health & Fitness (26 answers total) 2 users marked this as a favorite
 
Have you tried taking melatonin? It's an hormonal supplement, so you'd just be taking something your body is already making, just not in the required quantities. It doesn't put you to sleep, but sort of knocks your brain into "ready for sleep" mode. I can take some and have no significant cognitive impairment whatsoever until I decide it's time to go to bed. In fact, sometimes, I'll take it a little while before I think I'm going to bed and then accidentally spend another 3-4 hours dicking around on the internet.
posted by griphus at 8:13 AM on April 19, 2012 [2 favorites]


Oh I am sorry you are going through this. I haven't had these specific problems but I have had a problem with out-of-control anxiety that was negatively impacting my life and having a bottle of pills on the table prescribed by a doctor that I was afraid to take. At some point it dawned on me that the thing that the pills were for was also the thing that was keeping me from taking the pills [i.e. my irrational fears of taking medicine that is basically known to be safe for the thing I had been prescribed it for were a manifestation of what the medicine was supposed to treat].

So I basically put myself in a controlled experiment situation where I took them the first time with a friend around so that if something did go kablooey I would have someone there who could help out. And honestly it was a huge deal, getting to re-connect with my brain without the constant worrying about things that I logically knew were irrational but I could not get free from. And now I have the medicine and I take it only "as needed" (my doc says this is okay) and to me this means basically only if I'm in what to me is a bad situation like where I haven't been able to sleep more than six hours for two nights or whatever. And this is the indicator. So even if I think "Well I know I'm sleeping like shit but it's for $_REASONS and bla bla bla I don't need medicine for all these other reasons...." I just sort of realize that is my anxious mind talking which, like any parasite, wants to keep itself alive sometimes at the expense of my own well-being. And so I have some external indicator of when I need this that isn't really open for discussion and that helps.

I know this isn't easy but I'd try some sort of safe situation where you have as close to a controlled environment as possible and see what happens. At some level I decided that even if I woke up "changed" [and this was a concern of mine as well], it would beat the hell out of the life I was living at the time. Best of luck.
posted by jessamyn at 8:18 AM on April 19, 2012 [9 favorites]


I personally would not start out with 10mg of Ambien, tbh. As Jessamyn says above, definitely see if you can get someone to hang out and supervise you the first time you try it if you can, but I'd start with half the pill or even a third the very first time. And as soon as you feel sleepy, LIE DOWN and do your best not to fight it, because it can be a little unnerving at first.

Sorry, I don't mean to make you worry more.
posted by elizardbits at 8:24 AM on April 19, 2012


For some reason I feel much less anxiety-ridden with OTC sleep meds. I would turn to prescription strength sleep-aids as a last resort. It just seems too . . . strong and I think I'd feel the same way you do about taking it.

Have you tried any OTC aids? Melatonin, is a good option to try. I use 1/2 a pill of doxylamine succinate (sold as Unisom) each night and it's great. It's actually the same stuff they use in Nyquil. Are you comfortable taking Nyquil? If so, this might be a great option. Another option would be taking a benedryl (or 1/2). These are both antihistamines - stuff found in allergy medication but makes me fuzzy headed enough to get to sleep quickly and stay asleep. It doesn't KNOCK ME OUT, which takes care of some of the fears associated with being completely knocked out with Ambien.

So, maybe start out small with OTC stuff before graduating to the big guns (Ambien). Because, maybe you don't need something as potent as Ambien. Maybe the answer is in something not so strong.

It just seems like a big jump from no sleep aid to BAM! AMBIEN!
posted by Sassyfras at 8:36 AM on April 19, 2012 [2 favorites]


I strongly recommend calling the prescribing doctor. What you are going through is normal, and your doc should be able to put your fears to rest.

I also second the idea of having someone you trust hang out with you the first time you take it. I'd also further that idea to say, once you take the pill, you should put on some tv or a movie that you like, to distract you. You are probably going to be pretty nervous when you take the pills, and having something to distract you will make you feel better.

Good luck!
posted by emilynoa at 8:50 AM on April 19, 2012


I love Jessamyn's suggestion. The thing is when you're sleep deprived it keeps you from making good decisions about your well-being. You can always choose not to take the medication, but maybe taking it once or twice will get you to the point where you feel better enough to make that judgement for logical reasons. So by all means, if it makes you feel better to have someone around to help allay your fears, do that. But prioritize helping your brain and body get the rest it needs so you can think more clearly.

I sometimes have insomnia and I take melatonin and tryptophan. It typically helps me feel sleepy in the first place (I'm a "mind racing" insomniac) and helps me get back to sleep quickly if I wake up, but it doesn't make me feel groggy if I need to be awake. Sometimes it doesn't work (this morning I woke up for good at 2 a.m.--there's a lot going on in my life right now), but it works most of the time and that has changed my life.
posted by Kimberly at 8:51 AM on April 19, 2012


If you really don't want to take medication, you might consider trying biofeedback. When used to treat insomnia, it basically trains you to recognize the way your body feels when it's falling asleep, and to figure out ways to encourage your body to do those things. (Biofeedback is sometimes associated with woo, but its effect on insomnia is one of the things that there's actual evidence for.) There are no drugs whatsoever, it's all your own body and brain doing the work.
posted by showbiz_liz at 8:58 AM on April 19, 2012


Oh hey look, an article on Psychology Today from three days ago that talks about how hard it is to make decisions while you're sleep deprived.
posted by Kimberly at 8:59 AM on April 19, 2012 [1 favorite]


Nthing melatonin instead of ambien-or if you have anxiety, try asking your doc if he's heard of the new work with prazosin. Originally a blood pressure drug, the VA found out it also helped enormously with anxiety-related sleep problems.

I sound like a drug pusher, but: ambien is not the greatest starter drug for this, because if you have a bad reaction to it, you are likely to be turned off from sleep medication forever, and it's one with a good risk of #2. Melatonin or prazosin have helped a lot of folks I know.
posted by corb at 9:03 AM on April 19, 2012


I've been in the same boat, with the same anxiety. I found that Benadryl works better for me than Ambien, as it doesn't come on so quickly. Could you try taking just one Benadryl and seeing if that helps you? It's just one little allergy pill and it won't kill you, but it might be enough for you to get some rest... which will then help you see things more clearly.

I recommend Benadryl over melatonin, as some people have unpleasantly vivid dreams with melatonin. This might not be your experience, of course.
posted by The corpse in the library at 9:06 AM on April 19, 2012 [1 favorite]


Like Sassyfras, 1/2 pill of doxalymine succinate works for me. Here are a few reasons you might feel less anxious about it:

It's OVER THE COUNTER.
It's HALF the over the counter dose.
They let PREGNANT WOMEN take it.

In fact, I think the main risk is that 1/2 pill might do nothing for you. But definitely worth trying.
posted by kestrel251 at 9:14 AM on April 19, 2012


Have you considered that your anxiety may be the reason that you are not sleeping well. A 25mg Xanax helps me sleep throughout the whole night. You also may want to get a sleep test, you would have some form of sleep apnea or (like me) restless leg syndrome. (BTW is a misnomer, its not just your legs that move, its everything.) If it is a sleep disorder you can get a CPAP machine which forces you to breathe at night so you wont have to worry about dying in your sleep or going into a coma.
posted by jmd97 at 9:57 AM on April 19, 2012


Also, the corpse is right, benadryl works pretty well if you cannot get a RX for Xanax.
posted by jmd97 at 9:58 AM on April 19, 2012


Just a data point, Benadryl makes me feel completely and uncomfortably whacked out. I have somewhat vivid dreams when I take melatonin, but I think they're fun, not unpleasant. So yeah the standard "your mileage may vary" caveat about any of the advice in this thread applies.
posted by Kimberly at 10:06 AM on April 19, 2012


Hi, I've been through all of this. I had super bad anxiety/panic attacks/depression and also have narcolepsy (which interferes with my sleeping).

When I was younger, I was afraid to take any sort of medication. I tried every "natural" method known to man with no results.

I then hit rock bottom and was afraid to leave the house. My mother said to me, "Would taking these pills be any worse than how you are now?"
I decided to take 1/4 of a pill of xanax (pretty much nothing) with my mother nearby in case anything happened. Then gradually worked my way up to the prescribed dose. With no side-effects, no death. I then was able to feel less anxiety about trying an antidepressent. But still started out with 1/2 a pill.

A few years ago I was prescribed a highly regulated sleep aid for my narcolepsy. I was pretty scared. But I waited until I was super tired - only took a little bit - and I had my roommate hang out with me (and watching stand-up comedy) until I fell asleep. I woke up the next morning fine and dandy. Increased that to the recommended dose.

If I had never tried these medications, I have no idea how long it would have taken me to leave the house and stop having panic attacks. It wasn't a way to live, that's for sure. Especially when you're 18.

So, I guess, really, the biggest help was having someone there, starting off slow and distracting yourself (call a friend before/after you take it).

Also, I will mention, the Bob Marley drinks (I find them at EarthFare/Whole Foods) put me right to sleep. Way more than over the counter sleep-aids/nyquil, etc
posted by KogeLiz at 10:20 AM on April 19, 2012 [1 favorite]


Do you take your Lexapro in the morning or at night? I've taken a few different SSRIs and had to experiment with what time of day I took them. Celexa, taken in the morning made me a zombie for the rest of the day. Taking it at night, however, put me right to sleep. YMMV, but it might be worth talking to your Dr. about when/how you take it.
posted by Constant Reader at 10:29 AM on April 19, 2012


A couple of things to consider:

(1) Millions of people take sleeping pills, and they don't die or have a changed personality because of it. So that wouldn't happen to you, either.

(2) I have insomnia sometimes, and my doctor prescribed me Sonata instead of Ambien. Sonata only stays in your system for four hours, so maybe that would make you less anxious about trying it. My prescription is for 5 mg pills, even though the standard dose is 10 mg. So I can take a half-dose if that's all I think I need. I take it anywhere from once or twice a week to once every two weeks.

I was nervous the very first time I took a sleeping pill about a year and a half ago. But I learned to just take the pill and then lie in bed and forget about it, and think calm or neutral thoughts (about TV shows or American history or whatever), and realize that whether I fall asleep or not is up to the universe to decide, and therefore not worry about it too much.
posted by Tin Man at 12:20 PM on April 19, 2012


Hi, I have crippling insomnia (because of a neurological and immune illness) and also crazy amounts of new-pill anxiety (because I've taken so many things over the years that have gone pear-shaped on me).

My insomnia is so bad that I take, with my doctor's blessing, no kidding, half a dozen different prescription medicines a night to improve my sleep. Over the years, in arriving at my current successful sleep protocol, I've probably tried another dozen other drugs singly or in combination. I have not yet gone into a coma even once. :)

With new pills, I take an approach that others have mentioned above. I start with a chip of the pill. The tiniest, tiniest chip, sometimes just a few stray powdery bits of it gathered from my pill splitter. And then when nothing bad happens, I up it bit by bit to an eighth of the dose, and up to a quarter, and a half, and then the whole thing if all of that has gone well.

Because my system is so whacked out by my chronic illness, sometimes something weird happens at one-quarter or one-half. And then I always feel grateful that I've been careful with it and I don't have to burn through the whole dose to get it out of my system. So if you're sensitive to meds or side effects, or if you think it'll help you deal with the anxiety better, definitely consider doing the same.

As others have also said, I would not start at 10 mg. That's a lot for someone naive to it. And Ambien, like any drug, works well for some people and not others. If it turns out it doesn't agree with you, that's okay, because there are tons and tons of other things to try - OTC sleep aids, other z-drugs, and lots of drugs with other primary uses that are prescribed off-label for sleep.

Sweet dreams to you.
posted by jocelmeow at 1:30 PM on April 19, 2012 [1 favorite]


I love my Ambien! I was afraid to take it, too--it took me months after the prescription was written, but, like you, my sleep deprivation was seriously impacting my life. All I needed to convince me was that first night of easily falling asleep. I started with 5mg and now take 10, and I fall asleep right away--it's heaven!
posted by feste at 3:02 PM on April 19, 2012


Perhaps it might help you to know that the reason why Ambien is prescribed over other sleep aids has to do with its short half life (the quickness it gets processed by your system and is gone). Ambien's half life is 1.5-2.5 hours or so. That means by the time you wake up (assuming you didn't take it very shortly before you needed to wake up) it is out of your system so you can wake up feeling awake and not with residual drowsiness.

I think Ambien is much preferable to benzodiazepines like Xanax, Ativan, or Klonopin because those medications can be habitforming, and withdrawal from benzos can be dangerous and even life threatening (by the way, jmd97 is not taking 25mg of Xanax, that's way above the maximum recommended dosage of 4mg daily). Ambien is not typically considered to have much addiction potential - it has been shown in studies to have a risk for abuse that is correlated with patient history of prior drug abose, but it's much less likely to be abused than benzos. "Complex sleep behaviors" like eating in your sleep are rare. 10mg is not the typical starting dose, 5mg is, so I'm with the other folks who recommended starting with a half a tab. I consider Ambien to be a very safe medication and I would not refer to it as a "big gun".

As for melatonin, try it if you want to... it's not usually harmful but studies don't prove it to be helpful for most people who suffer from insomnia.

Benadryl/diphenhydramine or its cousin doxylamine are indeed over the counter, but from my perspective as a prescriber and a doctor who sees a lot of overdoses in the ER, I see a lot more Benadryl/doxylamine overdoses and toxicity cases than Ambien. Also, Benadryl stays in your system for a very long time compared to Ambien so you may still feel sleepy in the morning. IANYD. I hope that is helpful.
posted by treehorn+bunny at 4:07 PM on April 19, 2012 [1 favorite]


Oh and I meant to add, I was thinking perhaps the reason you are worried that you will be dead in the morning is related to concerns about respiratory depression and the fact that you hear about famous people who die after using sleep aids.

Those people did not use those medications at normal doses, and they typically combined them with other things like alcohol or narcotics (for example Whitney Houston had cocaine, Benadryl, Flexeril, Xanax, and marijuana in her system when she died). Ambien does not cause respiratory depression.
posted by treehorn+bunny at 4:14 PM on April 19, 2012 [2 favorites]


You could always go natural

Sleep/wake cycle is regulated by the melatonin/serotonin cycle. When you wake up in the AM and get in the SUN, your body says "Ok, it's daytime- stop that melatonin". When you get sufficient daylight (1 hour, 2 hours sometimes for people with severe delayed phase syndrome), your body then triggers melatonin release at night. It also helps to try to keep your meal times roughly the same as they effect your circadian rhythm as well. If you live in a cloudy area, light boxes serve this purpose as well.

If you simply cannot get in the sun at all during the day (even for lunch), then you could take melatonin at night. Start out with .5 or 1 mg at first to see how it work, taking too much might make you sleepy the next day.

EXERCISE
Makes your sleep better, relieves anxiety and pent up energy, gets down cortisol (which has been shown to interfere with sleep) . If you can combine sun and exercise in the AM, this would help a lot.

OTHER REMEDIES

Some chamomile or Sleepytime tea at night, Valerian, at least 400mg of magnesium (not magnesium oxide. This is the cheapest form and your body only absorbs a small amount).
I do the tea, magnesium thing every night. Take the melatonin when I really need it.
posted by eq21 at 4:20 PM on April 19, 2012


A few points, I'm onto this subject a lot recently....

- Take less than the tab of Melatonin if you try that, and it is ONLY meant to "reset" when you feel sleepy and fall asleep, so only take it for a week or so.

Larger doses give me nightmares, which I normally do not suffer from. Taking a smaller dose alleviates this problem entirely, and just makes the "sleepy feeling" kick in about an hour after taking it.

- Ambien kinda sucks, IMHO. It's the BIG GUNS. Put that off if nothing else helps!

- I just read yesterday about a doctor who recommended this behavior change... The first night stay up all night and do not sleep, the second night set your alarm and only sleep one hour, the third night only allow yourself three hours of sleep. After that, you should be falling asleep OK.

No idea if this works, but it sounded intriguing.

- Um, you do know that until the last 200 hundred years or so, humans were SUPPOSED to fall asleep, wake up in the middle of the night, and then an hour or so later fall back asleep? IT'S NATURAL TO HAVE INTERRUPTED SLEEP! Who knew??

Go ahead and Google this. It's an anthropology thing, but it will sure as heck take away your ill-feelings about waking up in the middle of the night. People who live in isolated tribes still have this sleep pattern, and they visit with each other after they wake up, or stay in bed to read/journal/think. It's like, a totally normal thing.

- Just read about a combination of vitamins, ZMA, that is supposed to work better than Melatonin! It's Zinc and some other stuff. Haven't tried it yet. I'll post back here if it works.
posted by jbenben at 1:29 AM on April 20, 2012 [1 favorite]


I suggest getting a second opinion from another psychiatrist, actually.

Sleeplessness is a side effect of Lexapro. Obviously going sleepless is a shitty, horrible way to live and interfering with your life more than the original depression/anxiety, and if using sleep aids is going to produce more anxiety than the Lexapro was originally treating, I'm not sure I see how the Lexapro is helping you. Sometimes psychiatrists get in the habit of adding meds to counter the side effects of other meds. Sometimes that is totally justified and useful, but sometimes it's not, hence the second opinion.

(I am not a doctor at all.)
posted by the young rope-rider at 7:24 AM on April 20, 2012


Oh, and I am definitely not saying not to take the ambien or whatever, just that maybe a second opinion would also be useful. I don't see anything horribly wrong with ambien and I think you will be fine if you take it.

Good luck with this--it sounds really hard.
posted by the young rope-rider at 7:26 AM on April 20, 2012


How long have you been on the Lexapro? When I was on it I definitely experienced the sleeplessness for a couple of weeks, but that calmed down pretty quickly. I'm not an insomniac, but at least for me that side effect did diminish. And, as above, changing when you take it can have a significant effect. I tried a bunch of different meds until I found one that worked, and I don't even remember which one I absolutely had to take in the morning and which one it was completely necessary for me to take in the evening anymore. I had to split my dose of my current medication to keep my levels consistent. Messing about with these things helps sometimes.

I'm afraid I have no experience with anything like your fear of sleep meds, so I can't offer any useful advice there. And it sounds like that's much more the problem than the Lex, since that seems to be only the straw that broke the camel's back on a lifelong problem. But it sounds dreadful, so I am still offering my tiny advice. Good luck.
posted by Because at 10:03 AM on April 23, 2012


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