" Ah...To Sleep, Perchance To Dream..."

” Ah…To Sleep, Perchance To Dream; My Personal Adventure With The Sleeping Medication, Ambien: A Cautionary Tale “

05/09/12

To my very dearest, special friends, and—as always—to my gentle, loyal readers,

Regularly, now, because of my great pain, and subsequent long days of not feeling well, or of Agoraphobia-inspired contravention of practically all my former interests and pursuits that—ordinarily—would involve my leaving home to some necessary destination, or just to visit friends, I nonetheless frequently find myself, at end of day, feeling restless, unsatisfied, but tired and sleepy.

I’m sure all of us have experienced broken nights, full of tossing and turning, or, having to visit the bathroom, get a drink, or have a cigarette, or two; besides that nightly menu of illness, ferocious dreams, or simply lying there, watching as the clock advances time all through the night.

A night that used to be one of easy and restorative sleep is gone, and can no longer be relied upon.  The struggles of the just-past day remain to trouble us, and it would seem that any, little thing can rob us of our sleep,

especially for those for whom a night of solid and unbroken rest would probably help our various ‘conditions’ fully as much as some medications would.

For these are the cold hours; the long and dreary nights when sleep will not descend to convey us to an honest rest.

And so, how many times do we wake, with faces grey as grey the dawn; we know we had the opportunity to sleep, the motivation to sleep, and a comfortable bed, piled—often with soft pillows, sheets that smell of rain-washed sunshine--quilts, blankets, or other coverlets so sublime, that in gratitude, the body sighs, and we settle-down, and try to compose ourselves, free from annoying, left-over thoughts, or thoughts of what we must somehow try to accomplish the next day.

But, my sweet friends, how often have you kept company to an unenviable night, while your sleep-wear becomes itchy, or uncomfortably hot, or feels as though soaked in sweat, as we despoil our covers, knocking our pillows and spreads to the floor--in our discomfort--making  them a mess, or, worse—should it be the case—ruining the repose of someone next to us, particularly if they normally would not have the problems as have we, and…if left alone, would be sound-asleep, and snoring-away like Lords, or Ladies to the Manner born.

No matter their compassion and love for us, we cannot expect them to suffer each night’s vigil as we do, because it is not fair, or else, they may become outdone with us.  “Why can’t you just go to sleep!!?’

And some, who are—perhaps more accustomed to our dilemmas, either endure it like Saints, or grumpily grab their covers to move to a different and more quiet spot. Oh…how we envy them, disgusted in the knowing that the rest of the neighborhood is fast asleep, so why then aren’t we?

“ A brief, mid-point diversion that I hope will either better illustrate my point, or failing that, —at least may provide some mid-entry break” from my—too often—long, and labored exposition.

1)           We frequently had patients who, while in the grips of mania, would not sleep for three of four days at a time, and then, because their bodies somehow caught up with them, on the fourth of fifth day, would collapse, unable to be wakened up.  As you may well guess, such rude and terrible abuse of their bodies, eventually took its toll upon their health and lifespans.

2)           At one time, I also had the rather dubious pleasure of working the night shift with this younger woman, maybe less than twenty years old, who would rather breezily announce to all that (I leave up to you to fill in that, blond, young, too-happy, silly, and much too self –assured voice), “ALL I have to do is just take ONE, Tylenol PM, and I can sleep for twelve hours, straight!”. The rest of the staff looked at her with murder in their eyes, and I swung a too-tired neck that sounded as if needing oiling at her.  At the time, I was probably old-enough to her father’s, older brother.

“ H-r-r-r-u-m-p-h “ is all the disgusted reply I could manage to muster at the time; shit, everyone else I worked with had their own paths to hell in trying, ever, trying to get enough sleep.  Personally, with all my after-shift errands, and necessary things to have to be done, I was always tired, and, many times exhausted, whenever such sleep as I could manage to weasel from a day was never enough.  Yet, on the strength of one, damn Tylenol PM, our ‘walking-talking, Barbie’, could out-sleep the entire shift, and—of course—we hated her for that; if only one Tylenol would work nearly as well, we’d all be up to our asses in the stuff.

Many swore by the effects of ‘Sleepy-Time Tea’, or else took Melatonin; personally—in those long-ago days—I filched my mother’s sleeping pills,’Dalmane’, hoping then to find some sleep. But it made me so ‘wuzzle-headed’, that—at work—I, as did the others, powered-down the coffee, until it upset our stomachs.

While not even ‘three cows’ worth of warm milk—despite the tryptophan--would help; so off we go, on little journeys through the house.  We might stop here or there to make sure all the doors are locked; perhaps we pause upon the threshold of each bedroom, to ‘check’ up on the kids.

In these nightly trips, we often awake, and upset by accident, our loving pets, who seem never to have any problem whatsoever sleeping, and who look at us as though we just flew in from Mars.  For, although they cannot speak, they—too—can resent us in their own ways.

Do you—in your wanderings—pass the laundry room, and briefly contemplate running a load or two of wash? 

How often, in the literal, ‘dead’ of night, have we found ourselves hungry, and prowled-though the refrigerator for that left-over, chicken leg?  Or dragged out the peanut butter and jelly, for a sloppy, after midnight snack?  Or, more simply grabbed a bowl of ice cream, not necessarily because we were hungry (though, in truth, sometimes we are), NONE of us need those extra calories, but more importantly, it briefly occupies our attention, and passes time?

How many of us find ourselves, so tired that our eyes will hardly stay open, as we sit in front of our computers, playing games and games of ‘Solitaire’, or by the screen’s faint blue and unforgiving glow, in playing endless games of ‘Angry Birds’?

Or…to sit out in the living room, knees drawn up upon the sofa, perhaps clutching a sofa cushion to ourselves while watching some pointless infomercial, or stupid movie, with the sound turned down so as to not disturb the house?

And while a day or two of such ragged sleeplessness is enough to make one tired, having such a regular regime will make one exhausted and much ill-disposed to humor.

For I am fully convinced that—without—needed rest, or sleep, our ‘conditions’, and our pains are only more focused-upon, and made all  the more worse; and that ‘we’—perhaps, much more need simple, and uncorrupted sleep to help us feel better.

And so, many of us—myself included—turn to our Providers for medications that will help us sleep, in hopes of sleeping long, and well-enough to rise more or less refreshed, and ready for the coming day.  If they comply, hopefully the sleeping medication ordered will do what its supposed to do, without side-effects, or strangeness, or of feeling ‘loggy-headed and sluggish the next day, or allergic to it.

During the last ten years that I have been disabled, sleep has always been a major problem; even at the very first, Psychiatric Hospital where I was employed, I worked the night shift, which turn one’s awake/asleep patterns upside down.

This, my friends was in 1976, and on the staff—then was a Psychiatrist we all referred to as ‘Dr. Prescription Pad’. In those days, the ‘rules’ were loose or non-existent, so if—for example, a staff member needed anything for ‘sleep’, the kindly Doctor would oblige.

Therefore, then, it was the case that he prescribed for me, 1) Valium (which gave me horrific nightmares); and 2) Placidyl, which I believe may be made by only one, obscure pharmaceutical, now, as it—like so many very strong ‘hypnotics’ (sleeping medications), tend to also depress the respiratory system.  During the time that I took Placidyl, I will have to say that nothing since, has ever knocked me out, and kept me out so completley. This now is funny….looking back, but if I took a Placidyl with water, in the kitchen of my tiny duplex, I hardly had time to race to my bed, and there fall into it, dead asleep; and thus it kept me so for eight of nine hours.

What a miracle! What evanescent joy divine! I slept, not remembering a single thing; no apparent bad dreams; no wandering around in my sleep; regrettably—though—every Eden, must, perforce, come equipped with a serpent.  And so it was with Placidyl.

After about my third month’s refilling, I began to notice that it apparently depressed my respirations so much, that I awoke with a start, and a beginning great inhalation of breath, as if I had had Apnea, or perhaps needed a ‘jump start’; this scared me, so—with regrets, I stopped taking it.

My dearest, caring friends, because of my many different complaints, or conditions that are too often attended by rashers of great pain, or headaches, now my nights are filled to brimming with unquiet sleep, nightmare, and physical discomforts, so much, they often make me dread the night, and of replaying, and replaying, an endless horror show, I turned—desperately—to my Primary for some nostrum that would simply knock me out, and with hope, keep me asleep long-enough to have some energy for the day.

Within the fullness of time, and years, I tried various preparations: some made me barely drowsy; others did not last.  Some tasted unutterably horrible, such that it required an immediate ‘chaser’, to rid myself of the gagging flavor.  Some left me—the next day—feeling as if my head were filled with cotton.

And then, my dearest friends, was Ambien: much touted as a wonder drug, and one relatively free of side-effects.

“O.K.”, said I, “what have we to lose except—perhaps—a sound, night’s sleep without it.”  And so, my kind Provider put me on Ambien CR, 10 mgs. which actually seemed to work; I would take them just before going to bed, and they would make me sleepy, so I could doze off.

The ‘secret’ was—of course—the ‘CR’ affixed to the prescription; in that fashion, in taking a whole pill, it would time-release its effects all through the night.  And, I NEVER had a moments worry with it. I do not recall having any nightmares with it, and I seemed to sleep soundly, without wandering the house.

But then—as so often happens—faceless, nameless morons feel somehow compelled to always try to throw shit into the game, there came a time when on my Medicare part D, Prescription Plan, the Ambien ‘CR’ was dropped from the plan’s formulary, though, regular Ambien 10 mgs. remained.  Confused yet?

What that meant was that instead the medication being ‘control-release’, now one got the full Monty of effects nearly at once, with nothing to slow these effects down, or, make them last. While often, the Ambien 10 mgs, made me sleepy fairly quickly, they did not keep me asleep; and as further aggravation, straight Ambien taken at that dosage level can make you do odd things, such as finding oneself out at the kitchen counter, asleep, and, taking the whole shot can make one unsteady, confused, and irritable.

The worst affects I’ve noticed is the nightmares, and the tendency to roam out to the kitchen at night; and while it is not ‘sleep walking’ in the traditionally accepted notion, I find that it is close-enough; how often have I gotten up earlier than the middle of the night, to leave the front door wide open, lights on throughout the house, the patio doors open for Daisy, or to awake at any time, in an office chair I keep there, lying head on extended arms, after I have swept everything on that part of the counter to the floor: magazines, letters, cups (empty of full), ashtrays full of ashes, to make a mess under me, which—while it happens—I sort of know it—but do nothing about it.

And as I may have mentioned it, before, my dearest friends, I do not live in a neighborhood that encourages me to fall asleep out in the kitchen, while the front door is unlocked, and wide open. How could I possibly make it easier if someone wanted in?

The point of Ambien is to help one fall asleep faster, but not necessarily keep one asleep.  But because too many times, I have awakened in an agony of pain, just a couple minutes, before I actually GO to bed, now, I take:

1)           Ambien (Zolpidum) 10 mgs.

2)           Ciproheptadine HCL 4 mgs (this is an antihistamine that helps me with my sinuses; tends to make one drowsy; and, seems to work well, in conjunction to the Ambien, and with the Klonopin I take much earlier).

3)           Ropinerole (Requip), excellent for the treatment of ‘Restless Leg Syndrome’; although an anti-Parkinson’s drug, has a list of some very severe, potential, side-effects).

4)           Morphine Sulfate 30 mgs, for ‘breakthrough pain’, a term that confuses me; as ne is either in pain, or not in pain, with only the most brief moments of partial relief.

Please note that, where possible, generic forms of the drugs are placed in parentheses.

But, I hope there may be light at the end of the tunnel; my Psych. Nurse recently told me that the generic equivalent of Ambien 10 mgs may soon be available in ‘CR’ form; for me, that would be wonderful if it helped put me to sleep; kept me asleep; and kept me from wandering.

Please always know, my dearest, and most precious friends, and loyal readers, I am NOT a professional; nor am I licensed, and am NOT a Therapist, so that anything that I may share with you is my own experience, and my own opinion.

I am writing this to you, as so many at MDJunction have sleep disorders, and that I’ve read some people have had problems taking Ambien.  I would strongly urge that you bring up these concerns with a professional; on her next visit, I intend to broach my concerns (and hopes) with my Primary. If faulty memory still serves, I think I had fairly good results with Restoril 30 mgs.

I think you might be surprised at how much a regular, untroubled, nightmare, and pain-free night of repose will help restore you.

Besides…who really wants to play ‘Solitaire’ at 3 AM?

Please always know I wish for you days of much-lessened, or of ‘no pain’ or distress; family love and harmony; with genuine and kindly friends who truly love you for who you are; thoughts turning to family outings; picnics, BBQ’s, or trips to the beach; a reemerging desire to enjoy life, AND to have fun!  To find your laugh once more; of balmy, pleasant afternoons free from depression or want; a sense of security; nights of genuine tiredness (NOT exhaustion), and, with a day’s sense of accomplishment, of climbing into a bed that is clean, crisp, and delightfully cool; and gentle sleep that is nightmare-free, and restorative, filled—instead—with wondrous dreams; watched over, and kept safe by blessed angels!

And, always, please remember that I love you dearly!

‘Zahc'/Charles