Zolpidem symptom relief and dependence

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32
Hello. I've been on Zolpidem for years, but new at taking it while having CFS (9 months). In the last nine months, I found that Ambien provides significant symptom relief. While I take 20mg through the night to sleep, 2.5mg taken later in the day (around dinner time) brings the head pain and ringing down while improving malaise.

I am now down to 2 extra 10mg pills, leaving 8 (1/4 tablet) treatments. Am afraid when I run out that life will get difficult, since I have to work half time.

Is it possible that I've built up a CFS related dependence, such as might happen with gabapentin? I don't know the neurochemistry very well, but I understand they are both GABA analogs or agonists, if that's the same thing.

I'm reading in the marvelous work "A Roadmap for Testing and Treatment" that gabapentin reduces pain and oversensitivity to stimuli while enhancing deep sleep. That sounds like the benefits of zolpidem.
 

mattie

Senior Member
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419
While I take 20mg through the night to sleep, 2.5mg taken later in the day (around dinner time) brings the head pain and ringing down while improving malaise.
The head pain and ringing may very well be caused by Interdose Withdrawal. (look it up: Ambien interdose withdrawal symptoms)
Zolpidem withdrawal can even mimic many ME/CFS symptoms.
I had horrible interdose withdrawal symptoms while on 10 MG of Zolpidem.

https://americanaddictioncenters.org/withdrawal-timelines-treatments/ambien

If I understand correctly you are now on a total of 40 MG a day? That is really a high dose.
Tolerance develops quickly with Zolpidem and you will at some point need even more to maintain the effects.
Zolpidem is extremely short acting. That is why it is so likely to cause interdose withdrawal. For symptom relief during the day a lower dose of a longer acting benzo (Klonopin) may be the safer choice. But consult your GP / ME-specialist. Klonopin certainly is not without risks either.

If you ever decide to cut down, please do so very slowly and carefully and consult your GP.
Also read the Ashton Manual before you do. As many doctors are not aware of the dangers of tapering too fast.
These Z-drugs are not meant to be taken all day, every day, long term.

If you manage to get off those 40MG you may eventually experience some very significant symptom relief.

FDA recommendation: Dosage in Adults
Use the lowest effective dose for the patient. The recommended initial dose is 5 mg for women and either 5 or 10 mg for men, taken only once per night immediately before bedtime with at least 7–8 hours remaining before the planned time of awakening. If the 5 mg dose is not effective, the dose can be increased to 10 mg. In some patients, the higher morning blood levels following use of the 10 mg dose increase the risk of next-day impairment of driving and other activities that require full alertness.The total dose of Ambien should not exceed 10 mg once daily immediately before bedtime. Ambien should be taken as a single dose and should not be readministered during the same night.
 
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outdamnspot

Senior Member
Messages
924
Funnily enough I have a very similar problem and have had to contend with the guilt of being an 'addict': I can only get one Zolpidem script a month (30 tablets, one per night). However, I require 2-3 tablets to induce sleep and also sleep through the night, which means it will only last me 10-14 days. It's one of the few things that can really rescue me from a severe crash, and also improves focus and mental energy and anhedonia a lot the next day. If I stay on it too long, I do crash eventually however so maybe it's for the best that my supply is limited.
 

Stretched

Senior Member
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712
Location
U.S. Atlanta
Funnily enough I have a very similar problem and have had to contend with the guilt of being an 'addict': I can only get one Zolpidem script a month (30 tablets, one per night). However, I require 2-3 tablets to induce sleep and also sleep through the night, which means it will only last me 10-14 days. It's one of the few things that can really rescue me from a severe crash, and also improves focus and mental energy and anhedonia a lot the next day. If I stay on it too long, I do crash eventually however so maybe it's for the best that my supply is limited.

I need 2 Ambien x day as well, which requires 2 scripts. I don’t see why it is otherwise limited to 1 x 10mg pill per night. Surely a 210lb person requires more as a standard dose than 150lb person (or 110lbs). I’ve gotten a pharmacist to overwrite a minimum dose on several occasions when refilling rx, where dr. wrote rx for 2/24 hours.
I’ve withdrawn from Ambien a couple of times and that usually involves no sleep for ~3 days. It’s unpleasant but doable. As for addiction my doc says ‘so what, if it helps?’ I agree as sleep is hard to come by w/o some medication. To offset the loss of affect I’ve found that rotation with Lunesta or Sonesta helps a lot.
 
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Messages
32
Mattie, Thank you for your response. I appreciate it but I think you are not quite right about this. First, my daily doses 20 mg for sleep plus an additional 2.5 mg for symptoms.

I recently switched from zolpidem to Lunesta and found the withdrawal symptoms to be mostly absent. I switched in a matter of three days with very little difficulty.

The reason I went back to zolpidem is that Lunesta upsets my stomach and doesn't relieve CFS symptoms. It is my personal opinion that most of the negative press around zolpidem comes from overblown 'hype' related to some early mildly hallucinogenic reactions people experience with this drug. It is ideal TV news and stand up fodder. I personally saw a tinge of red plaid moments before falling asleep the very first time. Not a single symptom since.

Regarding dosage, psychiatrists in the Dallas area I've talked to over the years report that extended use of zolpidem at 10 mg will result in a gradual reduction in sleep time, leveling off at about five hours of sleep. This was exactly my experience and why my dosage was raised. I break a second 10 mg tablet into four pieces (which I take after the previous wears off) and can get 9+ hours sleep.

My question was not about sleep-related addiction (dependence) but instead CFS symptom relief and zolpidem similarity in this respect (if any) to gabapentin.
 
Messages
32
It's one of the few things that can really rescue me from a severe crash, and also improves focus and mental energy and anhedonia a lot the next day. If I stay on it too long, I do crash eventually however so maybe it's for the best that my supply is limited.

Wow interesting. I agree completely that zolpidem greatly improves crash symptoms. If I exceed 2.5 mg on a horrible day, the effect is stronger, but there is an odd feeling accompanying it. I feel a bit like an empty trash dumpster. It is better than severe symptoms but I agree that the supply should be limited for this purpose.

So how do you sleep after your supply runs out?
 

mattie

Senior Member
Messages
419
Sorry I misunderstood you @NickMDal .
While I take 20mg through the night to sleep,.........I am now down to 2 extra 10mg pills,
That’s how I got to to 40mg.
But my reply would have been the same for 22.5 mg.

I never mentioned the Zolpidem induced sleep-walking that has been hyped it the media.
It happens but it's rare.

Interdose withdrawal on long term usage of a benzo or z-drug with a half life of only a couple of hours however is not rare at all.
 
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Messages
32
Thank you again for helping and I am sorry for being unclear. I don't see that research supports significant withdrawal problems with zolpidem. Yes major problems discontinuing would be expected, but primarily for the lack of a sleep aid.

My frustration about hype is partly because almost all search results for "ambien addiction, withdrawal" lead to financially incentivized rehab websites. I have not found convincing research supporting medically significant (xanax type) withdrawal symptoms.

I would like to know if using zolpidem for CFS symptom relief may come at the cost of slowing one's potential for recovery from CFS. I.e. would regular use for symptoms weaken the CNS's natural (though impaired) ability to calm down neuronal activity? What do you think?
 
Messages
32
Mattie I've been thinking about your posts and am only now getting your point. "Inter" dose withdrawal. It never sunk in even though you've said it twice. This makes sense to me since I had been sleeping for 9+ hours on zolpidem and using it for symptoms. I'd even added a quarter pill for late morning sleep to stave off the boredom of lying there So zolpidem has been acting on my brain from 9 to 15 hours per day.

I get it now and am pulling way back. Please accept my apology and thanks. It makes sense to me finally that interdose withdrawal could manifest as impairment of my natural ability to calm down.
 
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