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Can't Sleep??

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Monday, April 5, 2010

Can't Sleep??

I was asked a question regarding Ambien (or Lunesta- basically prescription sleep aides) and the side effects. Now, I am going to give you medical facts regarding their use AND some stories regarding these drugs usage in patients. So, for those of you who don't know, Ambien (Zolpidem Tartrate) is a sedative used for short term sleep problems. Now, the manufacturer information lets you know that the major side effects are allergic reaction, for which you should seek immediate medical attention, you should make sure that you have 7-8 hours to sleep, and that you should never take Ambien during normal waking hours. In more recent months, they have also added that you may find yourself participating in activities that you may have no recollection of later. And the usual warning that you should not drink alcohol as it can increase the drowsiness effects of the medication, and to never take the drug and operate heavy machinery, operate a motor vehicle, or pilot a plane (that was a new warning...not sure if there was litigation based on this one, but I think it falls under the 'heavy machinery' clause). If you have liver disease you should not take this drug, as it is broken down in the liver (along with kidneys) and can have prolonged effects. With kidney or lung diseases you will be cautioned when taking this drug due to the metabolization in the kidney and it can slow breathing. If you have sleep apnea (obstructive) you may not be able to take the drug due to risk of losing your airway (risk of obstructing your throat and not waking up as you normally do due to a sedated state), and a history of Mysathenia Gravis (an autoimmune neuromuscular disease that inhibits muscle function and is worsened with activity) due to risk of causing an activation (or 'flare-up')of the disease. Also, there are risks of chemical dependancy, so anyone who has a history of mental disorders/suicide, or chemical dependency shouldn't take this drug. And, no one under the age of 18 should take these drugs.

So, that is the straight poop on the drug, its effects, etc that the manufacturer warns you about. I will tell you that especially when these drugs first came out about 8 years ago, EVERYONE was taking them. I would like to point out that one of the major issues with this drug is that people don't use it for short term useage as it was created, they use it every night long-term which can enhance the side effects. Every patient came in and was asking for Ambien by name, those same patients, who were usually over the age of 65 (I am not being ageist here, I am point out that drugs are metabolized differently by persons of different ages, and has similar effects on those over the age of 65 which has been studied extensively) would be getting out of bed in the middle of the night, falling and breaking hips, talking nonsensically....One night I heard yelling from a patients room (who happened to be a police officer that had gotten injured on the job who was casted hand to shoulder and directly a little sleepy himself), so I go in, and lo and behold, my little old man who had 3 hours earlier taken his nightly Ambien was in the wrong room, totally wrong hallway, cuddling this 35 year old who was NOT happy, and the older patient had NO recollection of the whole scene in the morning despite having a whole conversation with me and the other patient! I have had patients who were not supposed to be eating the night before surgery be totally normal, happy go lucky people, who get this drug early so they "can get a good sleep" and then find them chowing down in the fridge at 3am, totally confused as to why their surgery had to be delayed.

I am sure that some of you have heard about court cases where people use the 'Ambien Defense' to get off for killing people...basically using a mental disease defense because they are taking this drug to sleep, then go out an kill someone, but they have no memory, so it wasn't their fault. And, the people who have killed others are not over 65; these drugs can have this effect on anyone of any age who use them. People binge eat in their sleep and gain weight and have no idea why, people call others (the way some of us would 'drunk-dial' in our younger years!), and act completely out of character, yet are apparently not under the influence of any drugs....which is the scariest part of these drugs.

Now, I am not saying that insomnia is not a problem at all. I have had those times in my life where I would go weeks without getting more than cat naps all night, constantly felt exhausted, but couldn't sleep, and really just wanted to do anything to get to sleep. I totally understand that some people feel this way all the time, and I couldn't imagine never feeling refreshed, or the way you feel after an amazing night of sleep, and just popping open your eyes in the morning not wanting to throw your alarm through the window. And, let me tell you, the hangover associated with Ambien is unreal; you feel dazed for hours after waking up, despite caffeine! So for true insomnia, you need to see a sleep specialist who can study your sleep patterns and work with you on different methods to best treat your insomnia.

For those of us who are just wicked stressed out, can't shut their mind off, and need to get to sleep, there are different alternatives to taking an Ambien/Lunesta. First of all, you shouldn't try to fall asleep with the TV on, should you read in bed. Your mind needs to be trained to be turned off, therefore your beds should be used for sleep and sex only! Any stimulation like reading or TV will only keep your mind stimulated and will slow the shut off mode. Try drinking warm milk, or if that creeps you out, chamomile (or your fav NON caffeinated herbal tea), cut down caffeine to only in the am- stop before 12pm, and set a bedtime for yourself, just like when you were a kid. Bodies like routines!! If you do want to take something to try to sleep, try Benadryl; most OTC (over-the-counter) nighttime sleep aids are just that with extra additives. Benadryl is an antihistamine that causes some people to get drowsy and sleep, I must tell you that is does have the opposite effect of some and make people excited and jittery (there is no way to tell how you will react unless you take it). Some people swear by taking melatonin supplements, they say that it takes a week of taking them nightly to get the full effects, but by now you should all know my feelings regarding non-FDA approved supplements, I think it is a little psychosomatic in the effects of melatonin, BUT if it works for you, then great! Also, one overlooked, but very helpful for of relaxation is meditation...I have a guest blogger tomorrow who is trained in Kung Fu and Tradition Chinese Medicine, who will get into great detail about it!! Also, despite being exhausted, try to get some exercise, just even can help to de-stress, relax, and maybe even help you lull into sleep later that night.

I truly believe that the body can be trained to do anything, it just takes time and effort. So, for those of you who are exhausted and can't sleep, these aren't quick fixes, but give them a try, and let me know how you feel....if your problem is more serious than a few nights of crappy sleep, please go see your HCP and talk about other alternatives including sleep studies!!

Yours in Good Health!



At April 5, 2010 at 7:11 AM , Blogger Eliza said...

So if bodies like routine (and I agree, they do), do you have any non-pharm advice for the 50% off-shift, 50% day shift workers re: sleeping during the day? I usually take half a unisom, but I'm not thrilled about it. Doesn't seem like a routine is possible, and the melatonin would maybe work against you in this case??

Any thoughts on the amount of harm (if any) this mixed up routine causes to all things purely sleep-related (I've heard about the higher risks for HTN, obesity, etc)?

At April 6, 2010 at 6:07 AM , Blogger Nurse Bridgid said...

I wish I had some advice for you on that one....but that is one that I struggle with myself, as you know! I try to still keep a routine when I do my switches from days to nights. As in, I sleep late the day of my first night on, and have a regular day (with exercise) and try to get a 45 min nap in the afternoon before work (I usually just rest and not actually sleep), then work, and in the morning I walk my dogs a few miles through the exhaustion, then sleep! I make my room dark, and use the sounds of the ocean (on my ipod) to sleep. Granted, I only sleep 4 hours between night shifts, and I know that doesn't work for everyone.... If unisom works for you, then go for it.
Lack of sleep/exhaustion can cause mental confusion (like when we get giddy at 3am in the middle of the night), clumsiness, and weight gain. The weight gain ( which is usually due to a constant fatigue) can lead to HTN, and obstructive sleep apnea, etc. There have been plenty of studies on both animals and humans looking at sleep patterns with studies that were kept up all night and allowed to sleep during the day, they had more trouble reaching REM sleep, had decreased immune systems, and were slower with reaction times, seemingly fatigued, despite 8 hours of 'sleep'. Long story, short: staying up all night is not what your body is made to do, so try a routine that lets you get through it!


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