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» LymeNet Flash » Questions and Discussion » Medical Questions » ambien withdrawal?

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Author Topic: ambien withdrawal?
monkeyshines
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I had quite a fun time the other night eating, working on my computer, who knows what else .... all while fast 'asleep'. My LLMD had me abruptly stop Ambien, which I've been taking for more than 2 years. At the same time I started two supplements -- Cortisol Control and Limbic Balance Night Formula -- which are supposed to help over time.

Today I feel awful and have a really bad migraine-type headache (day 1 off Ambien). Overall body pain is worse than it has been for a while. I didn't sleep much, either. Does anyone know how long this will last? Is it dangerous?

monkeyshines

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Cass A
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Hi!

You should write an adverse event report for MedWatch.

Too many of the psychiatric drugs are addictive, and this is cameoflaged by saying they have "rebound" effects or "discontinuation syndrome" or some such. Psychiatrists define addictive as CRAVING the drug, not that you will experience horrible side effects trying to get off of it!! For example, many people who started Paxil after 9/11 to handle their upset are now suing because they can't stop!!

Dr. Peter Breggin has a book, Your Drug May Be Your Problem, that goes over withdrawal from psychiatric drugs and how to do it.

Many of these drugs are harder to "kick" than heroine, according to a friend of mine who worked in a drug abuse center.

For immediate relief, you might try high doses of B complex and B 1, along with calcium and magnesium and Vit. C.

Hope this helps.

Best,

Cass A

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Lymetoo
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It's VERY possible THIS is your problem:

"At the same time I started two supplements -- Cortisol Control and Limbic Balance Night Formula -- which are supposed to help over time."

When added to the Ambien, there's no telling what happened.

I've taken Ambien off and on for about 3-4 yrs. I've been taking it every night for quite awhile....as low a dose as I can get by with.

[There is one yr where I went completely off the Ambien and had no problems whatsoever.]

Why not drop the herbs??

--------------------
--Lymetutu--
Opinions, not medical advice!

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jamescase20
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ambian is a benzopine period. You NEED to call your duck and start with a tapering dose. 3/4 pill week 1, 1/2 pill week 2 1/4 pill week 3 then cold turkey it or 1/8 for a few days...thats what I will do when I gotta go off.

you can even vomit from withdrawl.

on and off is fine, its the chronic non stop use thats getting addiction brewed.

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Lymetoo
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James, are you sure it's a benzo?? I took it every night for more than a year and then stopped cold turkey.

NO PROBLEM whatsoever.

http://www.drugdigest.org/DD/DVH/Uses/0,3915,712|Ambien,00.html

--------------------
--Lymetutu--
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Keebler
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-

Some people might be very lucky. However, there have been some very serious problems for many with Ambien use.

I thought I'd saved a few articles that I ran across. But I don't see them. I think I can find a couple ones that might help and will come back later if I find the ones of note.

The company itself suppressed information about the side-effects, according the the articles that I read.

Especially troublesome are the figures for DUII with ambien.
It can make people drive the wrong way, etc. So instructions are only for before bedtime (that is no later than say, 10 pm . . . and not for day time use or to have in the bloodstream while driving.

For anyone with slow clearance the drug could say in bloodstream beyond the waking time.

All that said, some people report no problems while some have reported severe reactions from its use - and from too quick of withdrawal.

-

[ 19. January 2008, 06:17 PM: Message edited by: Keebler ]

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Keebler
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www.drugdigest.org/DD/DVH/Uses/0,3915,712|Ambien,00.html

excerpt from the manufacturer's own information.


What should I watch for while taking zolpidem?


Visit your prescriber or health care professional for regular checks on your progress.

In most cases zolpidem should only be taken for a few days and for not longer than 1 or 2 weeks. [ NOT LONGER THAN 1 -2 WEEKS]


Keep a regular sleep schedule by going to bed at about the same time nightly.

Avoid caffeine-containing drinks in the evening hours, as caffeine can cause trouble with falling asleep. When sleep medicines are used every night for more than a few weeks, they may lose their effectiveness to help you sleep.

This is known as tolerance. Consult your prescriber or health care professional if you still have difficulty in sleeping.

Sleep medicines sometimes cause a type of memory loss, in which the person may not remember what has happened in the several hours after taking the medication.

This type of memory loss is usually not a problem since zolpidem is taken right before bedtime; however there have been reports of driving or performing other activities while asleep after taking a sleep medicine.

Be sure to talk to your doctor if you think you are having memory problems while on this medication.


If you have been taking zolpidem for several weeks and suddenly stop taking it, you may get unpleasant withdrawal symptoms. Your prescriber or health care professional may want to gradually reduce the dose.

Do not stop taking zolpidem on your own. Always follow your prescriber's advice.

After you stop taking your zolpidem prescription, you may notice some trouble with falling asleep. This is sometimes called 'rebound insomnia'. Do not get discouraged, because this problem usually goes away on its own after 1 or 2 nights.

You may get drowsy or dizzy. Do not drive, use machinery, or do anything that needs mental alertness until you know how zolpidem affects you.

To reduce dizzy or fainting spells, do not sit or stand up quickly, especially if you are an older patient. Alcohol can increase possible unpleasant effects.


Do not drink alcoholic drinks while taking medications to help you sleep.

If you or your family notice any changes in your behavior, or if you have any unusual or disturbing thoughts, call your doctor immediately.


***

Do not take zolpidem unless you are able to get a full night's sleep before you must be active again.

For example, zolpidem should not be taken on an overnight airplane flight of less than 7 to 8 hours since 'traveler's amnesia' may occur and you may experience a short-term loss of memory.

***

If you are going to have surgery, tell your prescriber or health care professional that you are taking zolpidem.


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Lymetoo
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Is zolpidem a benzo?

--------------------
--Lymetutu--
Opinions, not medical advice!

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Keebler
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www.nytimes.com/2007/03/15/business/15drug.ready.html

EXCERPT:
The review was prompted, in part, by queries to the agency from The New York Times last year, (after)

after some users of the most widely prescribed drug, Ambien, started complaining online and to their doctors about unusual reactions ranging (from)

from fairly benign sleepwalking episodes to hallucinations, violent outbursts, nocturnal binge eating and -- most troubling of all -- driving while asleep.

--------------------------

F.D.A. WARNS OF SLEEPING PILLS' STRANGE EFFECTS

Ambien and Lunesta are among the 13 sleep medications that the F.D.A. has ordered to use strong new label warnings.

By STEPHANIE SAUL March 15, 2007

The most widely prescribed sleeping pills can cause strange behavior like driving and eating while asleep, the Food and Drug Administration said yesterday, announcing that strong new warnings will be placed on the labels of 13 drugs.

The agency also ordered the makers of the well-known drugs Ambien and Lunesta and the producers of 11 other commonly used sleeping pills to create patient fliers explaining how to use them safely.

The fliers, which the agency says it requires when it sees a significant public health concern, will be handed out at pharmacies when consumers fill their prescriptions.
Although the agency says that problems with the drugs are rare, reports of the unusual side effects have grown as use of sleeping pills has increased.


Sales in the United States of Ambien and Lunesta alone last year exceeded $3 billion. Use of those medications and other similar drugs has soared by more than 60 percent since 2000, fueled by television, print and other advertising. Last year, makers of sleeping pills spent more than $600 million on advertising aimed at consumers.


The review was prompted, in part, by queries to the agency from The New York Times last year, after some users of the most widely prescribed drug, Ambien, started complaining online and to their doctors about unusual reactions ranging from fairly benign sleepwalking episodes to hallucinations, violent outbursts, nocturnal binge eating and -- most troubling of all -- driving while asleep.


Night eaters said they woke up to find Tostitos and Snickers wrappers in their beds, missing food, kitchen counters overflowing with flour from baking sprees, and even lighted stoves.

Sleep-drivers reported frightening episodes in which they recalled going to bed, but woke up to find they had been arrested roadside in their underwear or nightclothes. The agency said that it was not aware of any deaths caused by sleep-driving.


The reports gained credence from scientific studies. A forensic toxicologist in Wisconsin, Laura J. Liddicoat, gave a presentation at a national meeting on six instances of Ambien-impaired driving.

And Dr. Carlos H. Schenck and Dr. Mark W. Mahowald of the University of Minnesota said that they had been studying cases of nearly 30 Ambien users who developed unusual nighttime eating disorders.


Last May in Washington, Rep. Patrick Kennedy, Democrat of Rhode Island, blamed Ambien when he crashed his car near the Capitol building.

The agency also received reports of people making phone calls, purchasing items over the Internet, or having sex under the influence of sleep medication.

In each case the consumers had no recollection of the events, which they said had occurred after they took their pills and headed for bed.

An agency official said yesterday that the activities associated with the drugs went beyond mere sleepwalking.
"We do believe that sleepwalking is different from these behaviors," said Dr. Russell Katz, the F.D.A.'s director for neurology products. "Sleepwalking is considered more of a reflex.

These behaviors are complex and they're different fundamentally because of the complexity. People get up, they take their car keys and they go drive. As you might imagine, that might be potentially dangerous to the patient and others as well."


Dr. Katz said that it was not entirely clear whether people reporting the problems had been technically asleep or awake.


Although Dr. Katz said the side effects were rare, the agency said that the few dozen reports it had received probably did not represent the full extent of the problem.


Drinking alcohol before or after taking the drugs appears to increase the chances of having such a reaction, Dr. Katz said.
A defense lawyer in Atlanta who specializes in impaired-driving cases, William C. Head, said he had received calls from people around the world who had been charged after using such medications.

"Ninety percent of these cases involve alcohol as well," Mr. Head said. Often, though, the people arrested had only a glass of wine or two, then took a sleeping pill, he said.

"You can't even keep your car on the road," Mr. Head said. "I think any warnings that they give, any advertisements should say not a drop of alcohol."


The medication guides that the agency has called for will clearly explain that risk, according to Dr. Katz, who said the drug makers must submit drafts by May.

He said the drug makers had been working with the F.D.A. on the wording since the agency notified the companies three months ago that the changes would occur.


Besides warning against alcohol use, the new labels and guides will tell consumers that they should not take the pills with other drugs that suppress the nervous system.

The warnings labels will include some general language required by the agency, along with language that the companies will be required to draft that describes the side effects of their specific drugs.

The drugs affected include newer products as well as older and widely used ones that are sold under brand names and generic names.

Most of the drugs already carry statements warning against alcohol use and of the risk of hallucinations. Advertising for the drugs has also included such warnings. But the labels will make those statements more prominent, and the medication inserts will emphasize the risks when the consumer gets the prescription filled.


The warnings also are to include information about an unrelated and rare risk of life-threatening allergic reactions with sleep medications.

Some patients have recently reported such reactions, in which the air passages or face swells up, after using one of the newest drugs in the group, Rozerem, Dr. Katz said.

After reviewing reports, the agency determined that those reactions were also a potential side effect with other drugs in the group, he said.

Although most of the reports of sleep-driving and sleep-eating have involved Ambien, the agency concluded that the behavior can be caused by any of the sleeping pills.

One sleep expert, Dr. Mahowald of Minnesota, said that Ambien had received the most publicity because it was the most widely used. But "there's no question that any of the sedative hypnotics can do this," he said.

Ambien and its extended-release formula, Ambien CR, made by Sanofi-Aventis, dominated the market last year, accounting for 27.6 million of the 44 million sleep drug prescriptions in this country, according to data from Verispan.
In second place, with about 7.3 million prescriptions, was the drug temazepam, a generic that is also sold by Tyco Healthcare under the brand name Restoril.

Lunesta, by Sepracor, was next with 5.8 million prescriptions.
Dr. Mahowald directs the Minnesota Regional Sleep Disorders Center, where doctors have been involved in a study of about 30 patients who developed sleep-eating while using Ambien. Some of the patients gained weight before discovering that they were getting up at night to cook and eat.


"Hopefully this will make doctors think twice before blindly giving patients a prescription," said Dr. Mahowald, who advocates a combination of medication and behavioral therapy to treat insomnia.

He also criticized marketing of the products. "I personally think the extent of advertising has just been unconscionable," he said.
Data from the research firm TNS Media Intelligence shows that in 2005 and 2006, Sanofi-Aventis spent a total of nearly $350 million to advertise Ambien and Ambien CR.

Sepracor spent more than $500 million on advertising for Lunesta during that same two-year period. And Takeda, which makes Rozerem, spent about $100 million.


After yesterday's F.D.A. announcement, Sanofi-Aventis immediately posted the text of a "Dear Doctor" letter to its Web site, outlining the new warnings.

The agency has ordered all the companies to send such advisories to prescribing doctors.

In a statement last night, Sanofi-Aventis said that information about sleepwalking had always been included on its label. In company clinical studies, it occurred in fewer than 1 in 1,000 patients, the statement said.


The agency also said that it was recommending that the drug makers conduct additional clinical studies involving sleep-driving and other reactions to determine whether any of the sleeping pills do not cause those problems.

But those studies will not be required. And so far, none of the companies have announced plans to conduct them, Dr. Katz said.


The agency's move follows a warning last month by authorities in Australia, where Ambien is marketed as Stilnox.

The Australian drug agency said that it had received 16 reports of unusual activities by consumers using the product, including sleep-driving and sleep-eating. In one case, a woman woke up with a paintbrush in her hand, discovering she had painted the front door of her home while asleep.


Copyright 2007 The New York Times Company


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sixgoofykids
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quote:
Originally posted by Lymetoo:
Is zolpidem a benzo?

This is from medicinenet.com

quote:
DRUG CLASS AND MECHANISM: Zolpidem belongs to a class of drugs called sedatives or hypnotics. Zolpidem is closely related to a family of sedatives called benzodiazepines. These drugs cause sedation, muscle relaxation, act as anti-convulsants (anti-seizure), and reduce anxiety. Zolpidem has selectivity in that it has little of the muscle relaxant and anti-seizure effects and more of the sedative effect. Therefore, it is used as a medication for sleep.


--------------------
sixgoofykids.blogspot.com

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Keebler
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-

http://en.wikipedia.org/wiki/Zolpidem

ZOLPIDEM
From Wikipedia

(while site accepts many contributions to listings, it may not be the ultimate word However, is a place to start if you want an explanation of the chemistry.)

EXCERPTS:

Zolpidem is a prescription medication used for the short-term treatment of insomnia, as well as some brain disorders.
It is a short-acting nonbenzodiazepine hypnotic that potentiates gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, by binding to benzodiazepine receptors which are located on the gamma-aminobutyric acid receptors.[1]


It works quickly (usually within 15 minutes) and has a short half-life (2-3 hours). Some trade names of zolpidem are Ambien,[2] Stilnox,[3] Stilnoct, Hypnogen, Zolt, Zolfresh, Nimadorm, Sanval, and Myslee.[4]

Its hypnotic effects are similar to those of the benzodiazepine class of drugs, but it is molecularly distinct from the classical benzodiazepine molecule and is actually classified as an imidazopyridine.

. . .


MECHANISM OF ACTION

Zolpidem binds with high affinity to the _1 containing GABAA receptors, about 10-fold lower affinity for those containing the _2, _3-GABAA receptor subunits, and with no appreciable affinity for _5 subunit containing receptors.[19]

Like the vast majority of benzodiazepine like molecules, zolpidem has no affinity for _4 and _6 subunit containing receptors.[20]

Zolpidem positively modulates GABAA receptors, probably by increasing the GABAa receptor complexes apparent affinity for GABA, without effect desensitization, or peak current.[21] Zolpidem increases slow wave sleep and caused no effect on stage 2 sleep in laboratory tests.[22]

A meta-analysis of the randomised controlled clinical trials which compared benzodiazepines against Z drugs has shown that there are few consistent differences between zolpidem and benzodiazepines in terms of sleep onset latency, total sleep duration, number of awakenings, quality of sleep, adverse events, tolerance, rebound insomnia and daytime alertness.[23]


[ poster's note: last paragraph: "few differences" would mean Z drugs act very similarly to benzos. ]


- full entry at link above.


-

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Lymetoo
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Keywords:

"closely related"

Thanks, Six!

--------------------
--Lymetutu--
Opinions, not medical advice!

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Keebler
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-

http://en.wikipedia.org/wiki/Imidazopyridine


The imidazopyridines are a class of sedative drugs related (in terms of their effect) to benzodiazepines. They include:

_. Zolpidem (Ambien)
_. Alpidem
_. Saripidem
_. Necopidem

As they are not chemically related to the benzodiazepines despite their similar effect, such drugs--as well as the pyrazolopyrimidines and cyclopyrrones--are sometimes grouped together and referred to as "nonbenzodiazepines".


cont'd at link above.


-

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Keebler
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-


Poster's note: for anyone with liver function problems or problems metabolizing any drug in the Cytochrome P-450 detox pathway this drug can cause problems - one of those could be the buildup of excess porphyrins. Tthat can be very serious and have many neurological, toxic reaction (and could be fatal to anyone with one of the porphyrias or a secondary porphyria).

Although it's excreted primarily through urine, metabolism is through the liver. There is a hepatic (liver) caution and dosing adjustment. Again, short-term use is how this drug is supposed to be used, and sudden stopping or fast changes in dosing can pose risks.

Those with impaired respiratory function are also cautioned.

==============================


www.epocrates.com


https://online.epocrates.com/u/10a385/Ambien
EPOCRATES ONLINE
Ambien: Adult Dosing
Dosage forms: 5,10

insomnia, short-term tx - sleep onset

Dose: 5-10 mg PO qhs; Max: 10 mg PO qd; Info: give on empty stomach; in elderly or debilitated pts start 5 mg PO qhs

renal dosing
no adjustment
HD/CAPD: not defined

hepatic dosing
adjust dose amount
hepatic impairment: start 5 mg qhs


Ambien: Contraindications/Cautions
hypersens. to drug/class/compon.
caution if CNS depressant use

_. caution if alcohol use
_. caution if alcohol/drug abuse hx
_. caution if depression
_. caution if psychiatric disorder

_. caution if impaired respiratory fxn
_. caution if impaired liver fxn
_.
caution in elderly or debilitated pts

Ambien: Adverse Reactions

Serious Reactions

_. depression, worsening
_. suicidal ideation
_. aggressive behavior
_. complex sleep-related behavior
_. hallucinations
_. amnesia
_. anaphylactic/anaphylactoid rxns (rare)
_. withdrawal if abrupt D/C

Common Reactions

_. headache
_. drowsiness
_. dizziness
lethargy
drugged feeling
back pain
- allergic reactions
diarrhea
_. sinusitis
_. pharyngitis
_. dry mouth
_. lightheadedness
_. flu-like sx
_. palpitations
_. depression
- rash

Ambien: Safety Monitoring
Pregnancy: C
Lactation: Possibly Unsafe
Monitoring Parameters: no routine tests recommended


Ambien: Pharmacology
Metabolism: liver; CYP450: 3A4 substrate

Excretion: urine primarily; Half-life: 2.5-2.8h

Class: Anxiolytic/Hypnot, Non-BZD

Mechanism Of Action
interacts w/ GABA-benzodiazepine receptor complexes

Caution Advised

[This section Lists many drugs. Just touching cursor to drug's name shows the effect. Most, as the few below are: risk of CNS depression; psychomotor impairment]

excerpted products:

acetaminophen/caffeine/CNS depressant combos

aspirin

cannabinoids

ibuprofen/oxycodone

-

Ambien: Safety Monitoring
Pregnancy: C
Lactation: Possibly Unsafe

- full page at link above.


============================


Get Help ! If you or someone you know needs emotional help, please call the National Suicide Prevention Lifeline during a crisis. You can reach the Lifeline by dialing 1-800-273-TALK (8255) .

=============================
=============================

http://en.wikipedia.org/wiki/Porphyria

PORPHYRIA

Some very good information here. It leaves out some matters of interest but they can be found at the foundation sites.

===============================

http://www.cpf-inc.ca/

CANADIAN PORPHYRIA FOUNDATION

Call (in Canada) 204-476-2800 or toll-free at 1-866-476-2801

They have a fabulous Doctor's Guide to Medication in Acute Porphyria.

===================================

www.porphyriafoundation.com/ Another great site.

AMERICAN PORPHYRIA FOUNDATION


===========================

This author explains secondary porphyria in relation to Cpn. This article seems to mirror lyme in some ways. And some lyme pts. may also have this. Whether treating one chronic infection or another, this article may be relevant for many.


www.cpnhelp.org/secondaryporphyria

Secondary Porphyria: what you should know before starting a CAP

excerpt:

Symptoms of Porphyria-
Porphyria may affect the nervous system or the skin.

When porphyria affects the nervous system, it can cause:

chest pain
shortness of breath
abdominal pain
nausea
muscle cramps
weakness
hallucinations
depression
anxiety
paranoia
seizures

===========================


--

[ 19. January 2008, 08:37 PM: Message edited by: Keebler ]

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tailz
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I took Klonopin, a benzo, daily for about 15 years. Early on (5 or more years into it), I stopped it abruptly - no withdrawal - no problem. I did this several times.

When the cell phone population grew astronomically in the mid to late 90's, however, I started to experience withdrawal if I stopped this medication, even when I tapered it slowly. My shoulders would jerk in my sleep, my legs would convulse, severe insomnia, debilitating anxiety.

I NO LONGER BELIEVE IN BENZO DEPENDENCE OR ADDICTION.

It is the medical community's way of blaming and belittling the patient when in fact the medication was wrongly prescribed to treat infection of the nervous system precipitated by the wireless boom:

http://tinyurl.com/ynoeh4

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jamescase20
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EMFs dont come from cell phones!!!! Thats is whole different thing.
Cell phones is like sticking your head in the microwave and turning it on, thats what a cell phone does to you. Same with the towers.
Cell phones may kill the buggies too, but kill you too, YES!!!

Read consumer reports if you dont believe me!

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lymex5&counting
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I am so sorry you are going thru this. I did not read every post. It made my eyes [Eek!]

But SLEEP is so important! You won't get better if you don't get stage 4 sleep.

If I don' t sleep I am in so much pain the next day.

The generic Ambien (Zolpidem) or however you spell it. Sometimes I have 2 take 2 (20mg) it just doesn't seem as effective, (I guess that could be nights when I ate late). Pharmacist says that is okay.

An old LLMD told me to dissolve it under my tongue so it works immediately.

The 12.5 never worked for me. I woke up all night long.

I do not have any info or experience with the other 2 things you are using.

But maybe you can get him to give you something else.

There are nights. I have to take Darvocet, Neurotin, Xanax and an Ambien to go to sleep.

My kids take Melatonin now or they won't sleep, the llmd has all of them on it and it works wonders.

I test very well through ART on Melatonin but strangely enough if I take it I can't get out of bed I am in such severe pain in the am.

Just remember you have to sleep to get better. And be careful my llmd gave me Tezepam or something like that (It was only $6, I thought how awesome) It made me so paranoid. I stopped it immediately.

Accupuncture can also help sleep issues.

Have you had a sleep study done? 2 Dr's wanted me to have one but like I have x for that!!

Have you had your Serotonin level checked?

I had it checked several years ago and it was very low. I hadn't slept in 5 days. 12.5mg of Zoloft in the am has helped also.

Best wishes for some [sleepy] zzzzzzz's
lyme x 9

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