Does the concept of tapering a Z-drug even make sense?

Since it is 3 AM and I seem to be well on my way to a sleep-free night, I thought I would go ahead and post about something that I have been chewing over for a while. My general impression has been that Z-drugs (thinking of primarily zolpidem, zopiclone and eszopiclone) are very difficult to taper. If you think about the qualities they have--very short half-lives, wash out of the body quickly, you can see how this would be the case. It is generally accepted that it is much easier to taper long half-life benzos, and in practice I have found this to be the case. Having a more steady blood level of the drug gives much less inter-dose withdrawal, and enables the body to adjust GABA levels more evenly. On a drug like zolpidem, you are going to be in complete withdrawal every single day, unless you take small amounts all day long. This has to be very hard on the body, and indeed people who have been on the drug for a while are often quite ill.

 

The other issue is that eventually you get to a point where you cannot sleep, or can only sleep for a few hours at a time, when the dose is lowered. What to do at this point? Most who reach this point elect to updose. Not sleeping on a z-drug is worse that plain old not-sleeping and taking the drug guarantees rebound insomnia, creating a vicious circle. If you have to split the dose to get enough sleep, how do you manage that in the context of a taper? How do you assure an even dosage drop? In my short experiences with trying to taper zolpidem, this quickly became a problem I could not get around.

 

It's easy to see why the idea of a slow taper would be appealing. The thinking is--if I taper slowly enough, I will be able to still get my sleep, function well every day, and get off this drug without much suffering. It's not hard to find buddies who have done relatively painless tapers off of drugs like Valium or Klonopin. Why wouldn't the same principle apply to Ambien?

 

From what I have seen here, in practice tapering does not seem to go very well. I did an analysis of all the buddies who posted on the Z-drug support group. I'm going by the information in their signature, as well as some posted info. Of the buddies who successfully got off of the drug, the breakdown is as follows:

 

16 cold turkeys

6 rapid tapers of 3 weeks to 6 weeks (some with other drug as back up), 1 described only as "rapid taper"

2 cross-overs to Valium

1 cross-over to Klonopin

1 slow taper with mirtazpine as back up

1 slow taper with morphine(?!) and other drugs as back up

2 slow tapers that did not appear to have any other drug as a back up

 

So out of 29 who successfully got off a z-drug, only 2 were able to accomplish this feat via a slow taper without another drug to back it up. And those 2 seemed to have a quite difficult time.

There were 41 other buddies who posted. I did not keep stats on their status, but almost all were either looking for information regarding how to do a taper, or trying without a lot of success to taper off a z-drug. Most eventually disappeared, so we don't know for sure their ultimate status. At some point I'll do a similar analysis of "success stories".

 

I hate to see people suffering, struggling and not making a lot of progress, so I thought it might be helpful to put that information out there. I welcome disagreement and a discussion about the merits of tapering a z-drug directly.

I dont know. What I do know is that (almost??) everyone tapering or cold turkey benzo's experiences troubles with sleeping to severe insomnia. It is part of the process.

 

Hugs!

I have limited experience with Zolpidem, but I do think it would be hard to taper. Even without tapering it's a pretty horrible drug. You tend to get bad interdose withdrawals. With tapering you'd get insomnia as well.

 

My tapering experience tells me that long half-live benzos are easier to taper. I am currently tapering Valium and doing well. No symptoms, no insomnia yet and I am down to 2.3mg/day. I hope to be benzo free in another few months.

 

I'd recommend anyone on a Z drug should cross to Valium and taper that.

 

Chessplayer

 

 

 

Amazing, and yet the 3 Zs still seem to be doctors' sleep meds of choice.  I've often thought they're worse and arguably less effective than benzos, just not (presumably) as addictive.  I'd thought Belsomra (expensive) might replace Z drugs, but it appears to be a dud.

Yes. Doctors are clueless.

 

Z drugs are extremely addictive. They are effective for sleep - you're out cold within 5 minutes, which in itself is scary. But tolerance develops quickly, and you need to take more and more for the same effect. The interdose withdrawals are horrific. I'm sure many people on Z drugs don't make the connection, but the next day you tend to get really bad anxiety / panic attacks. Plus the Z drugs muck with memory. They really are drugs from hell.

 

My one week of experience with Z drugs was in December. I had tapered off Ativan and was experiencing horrible insomnia. An incompetent shrink prescribed Ambien, and I took it without realizing I was effectively going back on benzos. I slept, but... what I discovered was that there are things even worse than total insomnia. The next-day panic attacks I got from Ambien were worse than any panic attack I ever got withdrawing from benzos. They were like being trapped in a horror movie. Plus the drug messed with memory - I couldn't construct a timeline of events in the past week. Really scary stuff. I discontinued the Ambien, but by then I was in such bad shape I wound up reinstating benzos. Hopefully this story will have a happy ending - I crossed to Valium which really stabilized me, and I am now tapering the Valium.

 

Take care,

 

Chessplayer

I know when tapering off a zdrug you hit a point where you just dont sleep and the small amount you are taking really does not do much, I experienced this when I got to 2.5mg of Ambien.  Barely slept for 2 weeks and caved in and updosed as I was feeling desperate.

 

I am now taking 50mg Seroquel and 5 mg ambien.  Last night I slept 5 hours solid then 2.5 hours more after my 4am wake up.  Seroquel has been helping a lot in regards to allowing me to sleep longer and deeper.  I am going to drop down to 2.5mg ambien again this weekend and try it out.

 

So hard to CT so hard to Taper but I guess it works differently for everyone.  I would love to be as strong as some of the others that CT and stayed the course.  For myself I figured a long taper was fine and I wouldnt beat myself up too hard if I have a bump in the road every once in a while.

I did not cold turkey from Ambien for fear of seizing since I had been taking at least 20 mg. a night. Instead I did a 10 day rapid taper. Had I known about crossing over to Valium I might have gone that route, but I don't know about purposefully addicting myself to another drug.

 

Nothing fun about the period of acute withdrawal that I went through, although the interdose withdrawal symptoms were also pretty nasty. The protracted withdrawal that followed was mostly all about pretty intense and persistent insomnia. It is now approaching 11 months off the drug and I feel that my purging by fire is almost over. My sleep cycles are still scrambled on many nights, but I am falling asleep fairly fast and getting enough sleep to feel normal the next day. I am just glad that I freed myself from the Ambien. I really feel that I would not have been able to do it with a slow taper. It would have just prolonged the misery and I would have put so much more Ambien into my system to do it.

 

Meowie,

I'm sorry that you had such a bad night's sleep, but at least you had some productive and informative research to help pass the time.

 

 

I'll be watching this thread.  I'm not off zopiclone yet, but I did manage to cut down the dose a bit.  I cut a pill in halves and take half before bed, and the other half when I wake up from first sleep.  I wish they can have a slightly longer half-life.  My sleep is not consistent even with zopiclone.  Some nights I only get a couple hours, some nights I get 8 or 9 hours.  Wish I can just even them out and have consistent sleep every night.  That will truly change my life.

Chessplayer,  I tapered off Ambien CR while I was doing a crossover from Klonopin to Valium.  My doc said it would be ok to occasionally (3 or 4 times a month) take an Ambien CR.  do you have an opinion on this?  I know I have read with other drugs you taper from that you should never take it again once you have tapered off.

Secondly, I am impressed with how quickly you have been able to taper from 9 mg Valium. I assume you are doing cut and hold, do you just metabolize Valium well?  Do you have many symptoms?  If you are having a pretty smooth ride down, do you have any tips to share?  Thank you. Cross

 

I have limited experience with Zolpidem, but I do think it would be hard to taper. Even without tapering it's a pretty horrible drug. You tend to get bad interdose withdrawals. With tapering you'd get insomnia as well.

 

My tapering experience tells me that long half-live benzos are easier to taper. I am currently tapering Valium and doing well. No symptoms, no insomnia yet and I am down to 2.3mg/day. I hope to be benzo free in another few months.

 

I'd recommend anyone on a Z drug should cross to Valium and taper that.

 

Chessplayer

 

 

 

Yes I have an opinion on what your doctor said about the Ambien. Actually, 2 opinions: (1) Your doctor is an idiot, and (2) Avoid Ambien like the plague. Ambien is hitting the same GABA receptors that are trying to heal when you are tapering benzos. Taking it a few times a month would be equivalent to taking a large dose of benzos a few times a month. You are at serious risk of kindling if you do this. Please stay away from *any* Z drug. They are really bad news.

 

On my taper: My theory of tapering is that you can go fast at the start but need to slow it down as you get closer to 0. I call this a "long tail taper plan". So yes, I dropped quickly from 10mg Valium down to 5. I had no symptoms at all during this phase. As I get lower I am slowing down my taper. At this point I am at 2.2mg Valium per day, and I am dropping .1mg every 5 days. When I get below 2, I will slow it down even further by holding even longer between .1mg cuts. Symptoms have been minimal, and I am hoping to avoid an acute withdrawal phase with this plan. My previous taper attempt was more linear but ended in failure. Based on my experience with that I developed this long tail taper plan. I am optimistic this will work out better.

 

Take care,

 

Chessplayer

On my taper: My theory of tapering is that you can go fast at the start but need to slow it down as you get closer to 0. I call this a "long tail taper plan". So yes, I dropped quickly from 10mg Valium down to 5. I had no symptoms at all during this phase. As I get lower I am slowing down my taper. At this point I am at 2.2mg Valium per day, and I am dropping .1mg every 5 days. When I get below 2, I will slow it down even further by holding even longer between .1mg cuts. Symptoms have been minimal, and I am hoping to avoid an acute withdrawal phase with this plan. My previous taper attempt was more linear but ended in failure. Based on my experience with that I developed this long tail taper plan. I am optimistic this will work out better.

 

Chessplayer--I really like your concept of a "long tail taper". I think that holds for just about any drug that binds with receptors in our body and is long-acting enough to have stable blood levels. This is definitely true for ADs--as you get lower, you have to go really slow. Higher dosages can be chunked down pretty quick.

 

But note--this does NOT hold for a short-acting drug such as zolpidem. Blood levels on this drug are never stable, so even with super-slow tapering you are going to get wild swings in blood levels. A slow taper buys you nothing with this awful drug.

I know when tapering off a zdrug you hit a point where you just dont sleep and the small amount you are taking really does not do much, I experienced this when I got to 2.5mg of Ambien.  Barely slept for 2 weeks and caved in and updosed as I was feeling desperate.

 

I am now taking 50mg Seroquel and 5 mg ambien.  Last night I slept 5 hours solid then 2.5 hours more after my 4am wake up.  Seroquel has been helping a lot in regards to allowing me to sleep longer and deeper.  I am going to drop down to 2.5mg ambien again this weekend and try it out.

 

So hard to CT so hard to Taper but I guess it works differently for everyone.  I would love to be as strong as some of the others that CT and stayed the course.  For myself I figured a long taper was fine and I wouldnt beat myself up too hard if I have a bump in the road every once in a while.

 

Murph,

Wishing you good luck on your next cut.

Thanks, chessplayer, I appreciate your opinions. Funny that, my "idiot" doctor is 'benzo-wise' has celebrities and other rich people fly in from all over to see him and yet, though he seems to be able to help people taper off benzos and is very smart, I question so many of his suggestions so I end up coming to BB to see if his advise is sound in other areas.  I drive about 6 hours round trip to see him.  Glad you said no more Ambien, that's what I sensed. What is kindling?

 

Thanks for explaining your taper method, so happy it is working for you. I will do a screen shot of your reply to refer back to, if that's not ok, just let me know and I will delete it.  Again, thanks much.  Cross

 

Yes I have an opinion on what your doctor said about the Ambien. Actually, 2 opinions: (1) Your doctor is an idiot, and (2) Avoid Ambien like the plague. Ambien is hitting the same GABA receptors that are trying to heal when you are tapering benzos. Taking it a few times a month would be equivalent to taking a large dose of benzos a few times a month. You are at serious risk of kindling if you do this. Please stay away from *any* Z drug. They are really bad news.

 

On my taper: My theory of tapering is that you can go fast at the start but need to slow it down as you get closer to 0. I call this a "long tail taper plan". So yes, I dropped quickly from 10mg Valium down to 5. I had no symptoms at all during this phase. As I get lower I am slowing down my taper. At this point I am at 2.2mg Valium per day, and I am dropping .1mg every 5 days. When I get below 2, I will slow it down even further by holding even longer between .1mg cuts. Symptoms have been minimal, and I am hoping to avoid an acute withdrawal phase with this plan. My previous taper attempt was more linear but ended in failure. Based on my experience with that I developed this long tail taper plan. I am optimistic this will work out better.

 

Take care,

 

Chessplayer

"kindling" is a phenomenon where repeated sequences of exposure to a drug then withdrawal from that drug causes the nervous system to become sensitized to the drug. Withdrawal symptoms become worse and worse after you bounce up and down like that. It can happen with alcoholics who binge drink - they wind up with PAWS (post acute withdrawal syndrome, a state similar to benzo withdrawal). It can happen with benzos too. See https://en.wikipedia.org/wiki/Kindling_(sedative-hypnotic_withdrawal) . Taking a Z drug a few times a month when you are tapering off a benzo is similar to an alcoholic who is now sober except he binge drinks a few times a month. The latter is the classic recipe for kindling. I speak from experience here - I kindled myself badly in December when I unwittingly took Ambien for a week while in benzo withdrawal at the end of a taper. Luckily, unlike diamonds, kindling is not forever. I had a bad month or so but I did stabilize, and now I'm doing fine. At this point I would not touch Ambien with a 10 foot pole.

 

Take care,

 

Chessplayer

Oh, and I have no problem if you want to print out my replies and show them to your doctor. Your "benzo-wise" (hah) doctor needs some education about benzos...

Unfortunately, very few doctors would tolerate one of their patient's attempts to educated them. After all, that is an insult to the very expensive education that they had to endure. You can try, but good luck.

Chess,  do you take anything other than the low dose of Valium to sleep? 

I thought I was in bad shape coming here with an addiction to both Ambien and Ativan. As it turned out, the Ativan helped me get off the Ambien during a 5 week rapid withdrawal. I can't imagine what it's like for a person withdrawing from a Z-drug without a longer-acting benzo to back them up.

 

I quit the Ambien over a month ago and am sleeping better. I still wake up 2-3 times a night but get back to sleep relatively soon. I'm taking magnesium, melatonin with theanine and the occasional OTC sleeping aid. Even then, I've noticed if I have something bothering me, I'm going to have trouble sleeping no matter what. But the good nights outweigh the bad.

 

I'm not going to spend a lot of time worrying about it, but I anticipate sleep problems as I slowly taper off the Ativan. But at least the Ambien is gone - for good. After having both habits, I actually consider the benzo to be the lesser of the two evils.

I thought I was in bad shape coming here with an addiction to both Ambien and Ativan. As it turned out, the Ativan helped me get off the Ambien during a 5 week rapid withdrawal. I can't imagine what it's like for a person withdrawing from a Z-drug without a longer-acting benzo to back them up.

 

I quit the Ambien over a month ago and am sleeping better. I still wake up 2-3 times a night but get back to sleep relatively soon. I'm taking magnesium, melatonin with theanine and the occasional OTC sleeping aid. Even then, I've noticed if I have something bothering me, I'm going to have trouble sleeping no matter what. But the good nights outweigh the bad.

 

I'm not going to spend a lot of time worrying about it, but I anticipate sleep problems as I slowly taper off the Ativan. But at least the Ambien is gone - for good. After having both habits, I actually consider the benzo to be the lesser of the two evils.

  so you agree with Chess?  That a crossover to Valium is better than a straight taper of Ambien?.  The last time I stopped Ambien Cold Turkey I was up for 75 hours,  then slept a broken up 6 hours,  then was up another 40.  It was Horrible.

Lonelysoul, your case is a bit different as you are on such a high dosage, which is rather unusual. Have you tried tapering down to a more normal dose before jumping? When you C/T before, what dosage was that from? Are you dosing throughout the day also (for inter-dose withdrawal symptoms)?

Lonelysoul, your case is a bit different as you are on such a high dosage, which is rather unusual. Have you tried tapering down to a more normal dose before jumping? When you C/T before, what dosage was that from? Are you dosing throughout the day also (for inter-dose withdrawal symptoms)?

  No,  I Just suffer throgh the Interdose withdrawl,  I had no choice too CT Ambien,  my dose was 30MG a Night and my prescription ran out in 10 days.  I did cut it down to about 22MG for almost a week,  but wasn't feeling a thing and gave in and took the extra pill.  I never take ambien during the day.

I take Trazadone to help with sleep.

Well,  last night was rough,  tried the crossover thing with Valium, took 20 MG didn't feel a thing,  i have a feeling they were less than 10MG pills,  that's just my opinion. I didn't get those Valium from a Doctor.  At 3 Am still wide awake.  Took a few More Valium,  finally what 15MG of Valium supposed to feel like and fell asleep At 5AM.  Was out cold,  deep sleep until 8AM,  was awaken by a very Active house.  The last 4 days have been like this,  Day 1.  Valium only,  fell asleep 6AM woke up at 740Am,  terrble Night.      Day 2.  30 Mg of Ambien slept,  but Interdose withdrawl was terrible.  Day 3.

  Valium Helps with Ambien withdrawl but doesn't put Me to sleep,  A few hours later took Ambien 12MG, very low dose for me and put me to Sleep.  A better Night.  Day 3. Valium Only,  3 hours of sleep,  but if I was left alone could have slept much longer. 

 

 

Hi Lonelysoul

 

What time do you try to go to bed at?  I try to be pretty consistent about bed time which for me is in bed by 10:30 and lights out by 11pm.  Do you sleep alone or with a partner?  My wife gets up early so I have to be on her schedule for the most part.  I think at the amount you are on you need to talk to your Dr and get on a real crossover plan with a taper process that you can follow.  30mg of Ambien to sleep is a very large dose as you are aware.  I think the only way you will be successful is by really contacting an addiction specialist and someone specializing in benzo/ z drug addictions.  Their is no shame in admitting you have a problem, I think once you get to that point you can really start working on the addiction.  Valium takes longer to get into the blood stream and last longer than Z drugs that is why people cross over since it is supposed to be a smoother safer ride.  For that reason it might not have the knock out power like Ambien does and that is why you arent falling asleep easily when taking.

 

Ambien is a crazy drug.  I have been down to 5mg recently with the help of seroquel to sleep.  I am sleeping typically 4 hours straight then a few more hours of broken sleep after my main block of sleep.  At my worst I was getting less sleep than this while taking way more meds and alchohol.  Took me a while to get to this point which still isnt great but at least I am not experiencing those ID withdrawals.  Last night sucked for me as I ran out of my Ambein script so all I had to take was my 50mg of seroquel.  Whilst it does make me sleepy it just doesnt put me to sleep like Ambien does, so I totally understand where you are coming from.

 

Do you have a Dr you can talk to?  Obviously they know you are running out of your script early right?  I just think it is going to be very hard to accomplish anything positive the way you are doing it at the moment with Ambien one night and "street valium" other nights.....

 

I hope you can find someone to help you out.

 

 

I thought I was in bad shape coming here with an addiction to both Ambien and Ativan. As it turned out, the Ativan helped me get off the Ambien during a 5 week rapid withdrawal. I can't imagine what it's like for a person withdrawing from a Z-drug without a longer-acting benzo to back them up.

 

I quit the Ambien over a month ago and am sleeping better. I still wake up 2-3 times a night but get back to sleep relatively soon. I'm taking magnesium, melatonin with theanine and the occasional OTC sleeping aid. Even then, I've noticed if I have something bothering me, I'm going to have trouble sleeping no matter what. But the good nights outweigh the bad.

 

I'm not going to spend a lot of time worrying about it, but I anticipate sleep problems as I slowly taper off the Ativan. But at least the Ambien is gone - for good. After having both habits, I actually consider the benzo to be the lesser of the two evils.

  so you agree with Chess?  That a crossover to Valium is better than a straight taper of Ambien?.  The last time I stopped Ambien Cold Turkey I was up for 75 hours,  then slept a broken up 6 hours,  then was up another 40.  It was Horrible.

 

I've never had the occasion to taper off a Z-drug by itself and I'm glad I will never have to. But let's say I was facing that situation, judging from everything I've read here, I would crossover to Valium. It has a long half-life, even more than most other benzos and has a reputation for being sedating. And the small tablet sizes may help when you taper off them.