[RonA]

I had a bad bout of insomnia starting 4 months ago where I only slept between 2-4 hours a night.  I finally relented and started taking Ambian 6.5 mg XR 1 month ago to get to sleep which worked like a charm and I am now getting 5-6 solid hours every night.  Unfortunately, I am now finding it nearly impossible to fall asleep on my own again within the pill.  I have tried over the last week to sleep on my own and will lay in bed for 1-2 hours and will finally give up and take the Ambian and sleep well.

I know the pills are a dead end and am getting ready to cold turkey the Ambian and start sleeping on my own.   Does anyone have any advice on how to best approach and return to a normal sleeping pattern again?  I am willing to try CBT-I but I am not sure if that will be needed since I have been sleeping regular hours with the Ambian.   I am hoping for the best but am anticipating a rough time, especially since I had full insomnia before starting the Ambian and I have had real trouble falling asleep on my own the last week.

Thanks in advance for any help.

[RonA]

Ok update.  I tried to do sleep restriction last night.  I went to bed 1 hour later than normal and did not take an ambian.  I was exhausted.   I laid in bed for almost 3 hours and could not sleep at all.  Finally I relented and took a pill and got a couple of ok hours of sleep.

Is it possible to do sleep restriction while trying to get off Ambian?  Is sleep restriction even necessary and do I just need more patience?   After 4+ months, I feel like I am just spinning wheels,

[Martin Reed]

Welcome to the forum. It’s usually a good idea to taper off the medication slowly and on a planned schedule rather than going cold turkey.

Typically you’d reduce your dose on one or two nights of the week until you feel ready to continue. Then, you’d reduce on more nights of the week until you are on a reduced dose every night. You then repeat the process, by either reducing the dose further or eliminating the pills in a gradual fashion.

Have you discussed a tapering-off plan with your doctor? That is likely going to be the best course of action.

Remember that sleeping pills don’t generate sleep. They can certainly help you feel relaxed — and this can make it easier to fall asleep, but you are still the one generating sleep. Unfortunately, if you take a sleeping pill contingently, it might be harder for you to get your sleep back on track without them.

You might find this short video helpful: Does cognitive behavioral therapy for insomnia (CBT-I) work if you are taking sleeping pills?

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If you are ready to stop struggling with insomnia you can enroll in the online insomnia coaching course right now! If you would prefer ongoing phone or video coaching calls as part of a powerful three month program that will help you reclaim your life from insomnia, consider applying for the Insomnia Mastery program.

The content of this post is provided for informational and educational purposes only. It is not medical advice and is not intended to diagnose, treat, cure, or prevent any disease, disorder, or medical condition. It should never replace any advice given to you by your physician or any other licensed healthcare provider. Insomnia Coach LLC offers coaching services only and does not provide therapy, counseling, medical advice, or medical treatment. All content is provided “as is” and without warranties, either express or implied.

[RonA]

Hi Martin.  Thank you for your video.  That was very helpful.  I did speak to my doctor and he told me that Ambien CR has no rebound insomnia for up to 6 months.  He said I could quit it cold turkey and it was likely that I would return to a similar insomnia state as when I started the medication.    He suggested CBT-I if my insomnia returned.

I am a little confused about taking the pills contingently.  I have taken them every night, sometimes after sleeping a few hours first.   Is that contingently?  Do I need to taper off or quit them cold turkey first before starting CBT-I on your program?  I was hoping to start next week.   I desperately do not want to stay on Ambien.

Thank you!

[Martin Reed]

On nights when you have taken a pill after a few hours of sleep, were you planning to take a pill?

In other words, did you go to bed with the intention of taking a pill after a few hours of sleep?

If not, then it sounds as though you may have sometimes taken them contingently.

This can sometimes be a problem because you might attribute any sleep you get after taking the pill with the pill rather than your own ability to sleep – and this can erode sleep confidence.

Does this make things any clearer?

You do not need to taper-off or quit sleeping pills before starting CBT-I. Many clients I work with who are taking sleeping pills when they enroll start to taper (or even quit completely) as they progress through the course and regain confidence in their ability to sleep.

I hope this helps!

—

If you are ready to stop struggling with insomnia you can enroll in the online insomnia coaching course right now! If you would prefer ongoing phone or video coaching calls as part of a powerful three month program that will help you reclaim your life from insomnia, consider applying for the Insomnia Mastery program.

The content of this post is provided for informational and educational purposes only. It is not medical advice and is not intended to diagnose, treat, cure, or prevent any disease, disorder, or medical condition. It should never replace any advice given to you by your physician or any other licensed healthcare provider. Insomnia Coach LLC offers coaching services only and does not provide therapy, counseling, medical advice, or medical treatment. All content is provided “as is” and without warranties, either express or implied.

[RonA]

Hi Martin.  Yes that makes sense.  I have full intention of taking the sleeping pill when I wake up as I know I will have difficulty making it through the night.  Sometimes I fall asleep for 1-2 hours which is great which means I can get an additional 4 hours or so on the pill.  Sometimes, I cannot sleep and I take the pill right away an I only get 4 hours or so.  On the nights when I fall asleep on my own I think it helps my sleep confidence because it demonstrates I can sleep, even if just for a few hours.

However, my current sleep confidence is low.  It is almost impossible for me to relax when I lay down and I do use the pills to relax enough to sleep.  So I guess I am attributing my ability to sleep through the night on the pill right now.

I was planning to quit completely when I enroll and I expect I may have a few real tough days to start.  Are people more successful when they taper or is it just personal preference?

 

 

[Martin Reed]

Ultimately it comes down to personal preference and since it doesn’t have much effect on the outcome of CBT-I, I don’t think there’s any need to quit before starting CBT-I.

—

If you are ready to stop struggling with insomnia you can enroll in the online insomnia coaching course right now! If you would prefer ongoing phone or video coaching calls as part of a powerful three month program that will help you reclaim your life from insomnia, consider applying for the Insomnia Mastery program.

The content of this post is provided for informational and educational purposes only. It is not medical advice and is not intended to diagnose, treat, cure, or prevent any disease, disorder, or medical condition. It should never replace any advice given to you by your physician or any other licensed healthcare provider. Insomnia Coach LLC offers coaching services only and does not provide therapy, counseling, medical advice, or medical treatment. All content is provided “as is” and without warranties, either express or implied.

[RonA]

Hi Martin.   Thank you for your response.   Just a quick update.  I tried to “cold turkey” the ambien the last two nights and got very little sleep.    I think this is going to be tough.

I hope to start CBT-i  next week.   I believe the work starts with a sleep diary to get a baseline for how much sleep you are getting.  If I go back on the ambien tonight, I get a may average a solid 5-6 hours with few awakenings.  I would be ecstatic with lifetime of that kind of sleep.  Is it valid to use the type of sleep you are getting on pills to set your sleep restriction times?  Or should I tough it out and use the more realistic poor sleep I am getting without the pills to start the program?

[Martin Reed]

Going “cold turkey” is going to be tough over the short-term, Ron! It doesn’t matter if you are taking Ambien when doing the baseline sleep diary since this just gives us a starting point — the sleep window is modified (and remains flexible) as you progress through a course of CBT-I.

I hope this helps!

—

If you are ready to stop struggling with insomnia you can enroll in the online insomnia coaching course right now! If you would prefer ongoing phone or video coaching calls as part of a powerful three month program that will help you reclaim your life from insomnia, consider applying for the Insomnia Mastery program.

The content of this post is provided for informational and educational purposes only. It is not medical advice and is not intended to diagnose, treat, cure, or prevent any disease, disorder, or medical condition. It should never replace any advice given to you by your physician or any other licensed healthcare provider. Insomnia Coach LLC offers coaching services only and does not provide therapy, counseling, medical advice, or medical treatment. All content is provided “as is” and without warranties, either express or implied.

[GILL999]

Hi Ron – I just wanted to jump in and say hello as I’m in a similar position to you. I’ve had terrible bouts of insomnia for years (outside of the bouts I have no problems) and this time around has been by far my worst. I haven’t slept more than 4 or 5 hours (on a good night, usually it’s 0-2) in four weeks to the day. My doctor prescribed me with lots of things – zopiclone, diazepam, phenergen. None of it worked except the Zopiclone which sent me to sleep for about 2 hours then I’d wake and feel terrible the next day. I don’t believe that when I take sleeping pills I get a “normal” night of sleep – I can’t prove this without knowing my sleep cycle info, but I feel just as wretched the next day as I would if I haven’t slept at all.

I am now taking mirtazapine which is a sedating antidepressant at bedtime. It ‘worked’ once or twice and I had an ok day the next day but has also know stopped.

I feel the key for both of us is learning how to retrain our brain to sleep naturally as in my experience a sleeping pill doesn’t give you the same kind of sleep and just delays the problem. But as you say it is very tough to come off them and I’m not suggesting you should quit cold turkey.

I’m in the middle of doing my first week of sleep diary (which is all ove trhe place) and just literally trying to survive each day at the moment. I hope you get started and we both manage to get through it. Good luck x

[gsdmom]

Hi RonA, I am also struggling with taking or not taking Ambien. I took the 6.5 mg for a week or two but my sleep onset was too long with them and they made me groggy during the day. Currently I take the regular Ambien 5mg. I’ve been 3 plus months on and off of them, maybe stopping for a week then starting again. I cannot fall asleep on my own at a normal time unless I go 3 days with very minimal sleep. I’ve also had issues with sleeping with my spouse who has a noisy BiPap machine and very different sleep schedule. Doctor recommended I sleep separate from my spouse so I’m currently sleeping on the floor in a small room where it is at least quiet.

That being said with the 6.5 mg they are controlled release and you should not break them into smaller doses to taper off. Maybe ask your doc for the regular short acting Ambien that allows you to cut a pill in half to taper the dose. Another thing is you are supposed to allow yourself 7-8 hours for sleep on ambien So I don’t see how you can do SR on a med like Ambien if your sleep window was only 5.5 hours. So maybe taper until you get to a low dose of 2.5mg or less to start SR.

I’ve been following sleep restriction for a couple weeks here. If I didn’t take the Ambien I’d average 3 hours of sleep per night. I’ve had a sleep study and have to wait a couple weeks for the results, but that will only tell if I have sleep apnea. Right now the sleep doc has not mentioned SR and primary doc does not seem interested in my woes.

[RonA]

Hi GDSmom.   I did speak to my doctor about a tapering plan and he just recommended stopping cold turkey.   He said the Ambien CR 6,5 is the lowest dose anyhow and because it is timed release you are effectively only getting 3.5 mg to start.  Cutting a small regular in half would not make much of a difference.  Or so he told me.

I took Ambien last night and got 6 hours of great sleep.   I also don’t see how I can do sleep restriction with the Ambien since I am getting GREAT sleep while using pills and would have an unnaturally long sleep window.

You say you are getting 3 hours of night without the Ambien.   While 3 hours is no picnic, that sounds like a good starting point for Sleep restriction without Ambien.  I understand the first week is tough, but if you can avoid the Ambien for more than 1 week, perhaps the sleep will improve, at least it should with CBT-I.  I hope so, because that  is my plan.  I expect a bad 1-2 weeks but have no desire to keep on with the Ambien as a failsafe.

[gsdmom]

Stay strong RonA! I will probably be starting SR about the same time as you. Hope it goes well for both of us!

[RonA]

Hi Gill999.  Sorry to hear about your problems.  You say that you have had bouts of insomnia in the past.  Have you tried sleep restriction before and did it work for you?   I have a little different experience than you in that I find the sleeping pills do work for me.  I found the first few days I only got a couple of hours sleep on the ambien but my body must have adapted because I now get a steady 5-6 hours contiguous.   I understand how people get addicted to sleeping pills.  When they work they are great.

I have only been taking the pills for one month and my doctor says there should be no rebound insomnia.   He was making no predictions but it is likely I will just return back to the state I was in when I started the pills.  So cold turkey it is for me and I will start sleep restriction immediately next week.  I am waiting till next week because I will have more family support available which I think I will need.

Good luck to you!!!

 

[Martin Reed]

I just finished talking to a sleep physician I respect very highly. He told me that he hasn’t seen any guidelines or recommendations to say that CR drugs should be tapered and that he hasn’t come across any data saying it’s preferable to taper or that going “cold turkey” can be dangerous.

If you are taking Ambien and are concerned about any potential “hangover effect” when observing sleep restriction you could always start with a shorter sleep window over the weekend (or a day when you don’t have to be jumping in your car early in the morning to drive to work) and see how you feel.

I think the key message here is that when it comes to tapering or coming off any form of medication, you should use your own judgment and talk to your prescribing physician.

—

If you are ready to stop struggling with insomnia you can enroll in the online insomnia coaching course right now! If you would prefer ongoing phone or video coaching calls as part of a powerful three month program that will help you reclaim your life from insomnia, consider applying for the Insomnia Mastery program.

The content of this post is provided for informational and educational purposes only. It is not medical advice and is not intended to diagnose, treat, cure, or prevent any disease, disorder, or medical condition. It should never replace any advice given to you by your physician or any other licensed healthcare provider. Insomnia Coach LLC offers coaching services only and does not provide therapy, counseling, medical advice, or medical treatment. All content is provided “as is” and without warranties, either express or implied.

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