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Will Ambien contribute to benzo habit formation ?


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Due to a severe, intractable case of insomnia I find myself forced to use medications at least one night out of three.  As you all know, there's only so many choices for prescription meds and all have a number of negative aspects.  I'm in a tough place and feel this is what I have to do in order to get some type of sleep while I continue to try and get a diagnosis of my underlying condition.

 

So ... here's my question.  I also have a prescription for Restoril but don't want to take that regularly due to habit formation.  My idea is to be able to alternate Ambien and Restoril and thus minimize developing a habit from either one.  Given that they both attach to the same brain sites will this stragtegy work or is taking Ambien essentially the same as taking a different benzo ?  Put another way, does crosstolerance occur between these or are they chemically different enough that use of one allows the other to clear the system ?

 

My research failed to find an answer to this so I hoped some of you who are more knowledgeable could fill me in.  I know the forum consideres the Z drugs to be essentially the same as benzos - and I understand why - but I don't see the crosstolerance question answered anywhere.  I know I'm in very risky water so we can skip all that.  I just need to know if cross tolerance occurs between Ambien and benzos or if alternating the two will minimize the risk of forming a habit with either.

 

Thanks for your help.  I know many will just want to warn me not to take any meds and I understand and respect those opinions.  However, in my case I cannot turn off whatever it is that's pumping the adrenaline (or some other hormone) and all the alternatives and good sleep hygeine have been useless.  I can't stay up more than about sixty hours without having to resort to something so while I continue to try and get a good diagnosis I'm stuck with the unfortunate necessity to use the drugs.  I chose Ambien after researching the other choices (trazadone, etc) and feel that as bad as it is it is the least of the evils for me.

 

So .... if you know the answer to the crosstolerance issue please let me know.  At least I'll be informed.

 

Thanks.

 

John

 

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I didn't even know what "cross-tolerance" was, John, so looked it up.  Is this what you are referring to?:

 

"Cross-tolerance refers to a pharmacological phenomenon, in which a patient being treated with a drug exhibits a physiological resistance to that medication as a result of tolerance to a pharmacologically similar drug. In other words, there is a decrease in response to one drug due to exposure to another drug. It is observed in treatment with antivirals, antibiotics, analgesics and many other medications."

 

You also asked about whether you could alternate Restoril and Ambien and avoid dependency and that isn't the same as cross-tolerance so I wanted to be sure to clarify the real issue.  I know I successfully alternated benedryl and melatonin for a while to avoid developing a tolerance to either (and thus loss of effectiveness) but they are not even the same class of drugs. 

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I think what I meant by the term crosstolerance is the same as defined here.  With respect to the Ambien/Restoril question at hand, I need to know:

 

if, having taken Restoril, the Ambien will be less effective and

 

if taking one will essentially be the same as continuing with the other in terms of developing a tolerance or habit since they work on the same sites (although are not technically/chemically the same).

 

 

If I have just confused things by using the crosstolerance term then just forget that and just address the question of whether alternating the two drugs would help avoid developing a dependence/addiction to either.  I hope that's more clear.

 

Thanks.

 

John

 

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John,

 

The Ashton Manual states that Ambien is cross-tolerant to benzos and 20 mg is equivalent to 10 mg of Valium.  Restoril has the same equivalence as Ambien.  I can tell you that when I was in acute withdrawal after discontinuing Valium but still taking the Ambien, my symptoms almost ceased when I took my nightly dose.  Not only was I sleepy, but I was also calm, my muscles would relax, etc.  So even though it is claimed that Ambien selectively attaches to the sedation sub-receptors only, my experience would seem to prove that it did act in somewhat of a non-selective manner just like the other benzos.

 

I'm sorry you are having to resort to this, but one can only cope for so long without sleep.  From what I know about your story, it seems as though you may have some issues beyond typical benzo withdrawal that were caused by Cipro?  Have you seen a neurologist about this?  Perhaps you have something going on that needs to be addressed completely seperately from the issue of benzos.  I'm sure you have thought about this from every angle.  It just seems that maybe the taper off and then wait to heal method might not fit for your specific circumstances...

 

-Ryan

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Oh, and to answer your question about switching back and forth, I could see two schools of thought on this.  In theory, they are equivalent drugs so it shouldn't make a difference.  In reality, I think our brains do adjust quicker to repeated doses of an identical substance so alternating could possibly extend the amount of time it takes to create dependency.  On the other hand, when you are ready to get off the pills, having two drugs in the mix could complicate things.
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Thanks Ryan.  Just to be clear, I have yet to develop a dependency on the Restoril but need to stop taking it so as not to get benzo hooked again.  I didn't like the side effect profiles of the several a/d's that are used for sleep so I broke down and asked for Ambien.  I don't like it, either, but I'm stuck.  I do think my insomnia is the result of some medical problem but haven't been able to get a diagnosis yet.  I haven't been to a neurologist but I did go to an endocrinologist as my symptoms fit hyperthryoidism (but blood work was normal).  Maybe a neuro is next.

 

So, what I'm hearing you say is that in terms of developing a dependency/addiction there isn't any difference between Restoril and Ambien; i.e. stopping one for a while and substituting the other isn't really any different/safer than just continuing the Restoril.  Is that right ?  If I take the Ambien its no different than, say, taking zanax one day and ativan another ?  I had hoped that was not the case but that's why I'm asking.

 

Can anybody else address this question ?

 

Thanks.

 

John

 

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Hi John,

 

I can see you're frustrated, I'm sure you've done a lot of research and have come up empty.  I hope someone will be able to answer your questions.

 

The only thing I have to offer is my own experience.  I pray you'll not experiment with alternating the Restoril and the Ambien, as I don't want to see your body develop a dependence to the Restoril.  As you know I was addicted to Klonopin and then Ambien and the Klonopin was by far the worst to withdraw from.  If you're at all concerned about withdrawals, please don't experiment like this.  If you can find no evidence that what you're contemplating will be useful, I hope you'll decide not to do it.

 

Pam

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So, what I'm hearing you say is that in terms of developing a dependency/addiction there isn't any difference between Restoril and Ambien; i.e. stopping one for a while and substituting the other isn't really any different/safer than just continuing the Restoril.  Is that right ?  If I take the Ambien its no different than, say, taking zanax one day and ativan another ?  I had hoped that was not the case but that's why I'm asking.

 

Typically, Ambien does have fewer withdrawal effects than the true benzos.  Valium was brutal and long to come off of, but Ambien withdrawal only lasted about 48 hours and wasn't that bad.  If I were in your shoes and had no non-benzo/non-z option, I would probably take the Ambien and stick with it over Xanax or Ativan.  Since sleep is the primary issue you're trying to address here, take the least addictive option that will get you some sleep.  You are very unlikely to end up with long term cognitive/neurological issues after Ambien like you can get with the benzos.

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Hi John,

 

I know you're in quite a dilemma right now.  But IMO, you are not "stuck".  I hope you'll always know that you have options, no matter what the situation. 

 

Here's an option for ya.  Have you considered taking one of the older tricyclic antidepressants?  Elavil is what I'm thinking.  It's quite sedating.  While many of the younger generation of a/d's are now used for depression, elavil is commonly used for insomnia, pain, migraines, etc.  The tricyclics don't create the same kind of (destructive) dependencies as benzos.  I took one about 20 years ago for only six months and got off it just fine.  I also take elavil occasionally for insomnia.  In fact, I can only take 1/4 of the 10 mg because it's so sedating.  As I recall, elavil works on seritonin. 

 

Also, if you have had the problems with cipro, and then problems with your body getting messed up quickly with benzos....I'd be verrrrry verrrrry careful with going there.  And there really are quite a few more options.  If you have not been informed as to what all they are, I'd find (yet) another dr.  Neurologists and pain specialists are, naturally, drug specialists....and know most of the possibilities.  Many general MD's often only know what the drug reps throw at them. 

 

In my experience, Ambien, Lunesta, Sonata and the lot of them don't work at all for sleep!  I would sleep two hours.  Which is how people get into taking 3 or 4 a night.  Try searching for "LadyoftheNite" thread on getting off Ambien if you want to hear some bad stories on how bad the side effects ON those drugs are.  Which necessiates getting off. 

 

One more suggestion.  If I were you, I'd get yourself lined up to try a couple things....like trazadone, elavil, whatever.  And then TRY them (one at a time).  You can't possibly know how they will affect you, or not, by reading about them.  I mean, it's one thing to make an educated guess, but good heavens, you've got some things you can try at this point, without going for the "worst" options...first.  Know what I mean? 

 

We're pulling for you John!!!

 

adelia

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John,

 

I have to agree with Adelia about the TCA's.  If you can find one that will work, I would jump at it before going on Ambien or especially a benzo.  I have tried just about every sleeping med there is and found most of them to be intolerable, including Trazodone.  That is why I shared my experience on Doxepin.  The stuff knocks me out, I sleep better than I did on Ambien, and it has been a piece of cake to taper off of.  I have not taken Elavil, but I have heard people describe it as "more friendly" than Trazodone.  They are way less harmful than the benzos and z-drugs, especially if there is already an underlying neurological issue affecting that part of your brain.

 

-Ryan

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So ... I tossed the Ambien and have called my doc to see if she'll prescribe Elavil.  I've done a lot of reading about it and trazadone and it does seem that Elavil is somewhat less heavy hitting and with perhaps a few less side effects.  Lots of people do experience side effects, though, to the degree that they can't tolerate it so I'm uneasy about trying it.  Also, some people report having a hard time tapering from it (although not as hard as benzo w/d).  My options are limited, though.  I hope my doc will write the script - and I think she will since she wanted me to take trazadone to start with - and I can give it a try tonight.  I'm thinking I'll only take 5mg as many say they have a hard time getting out of bed the next day even on dosages as low as 10mg.  I want to get some sleep but don't want to be sedated all day.

 

Anyway, last night I didn't sleep at all since I didn't take the Ambien and didn't want to take any more Restoril so tonight I've got to do something because I can't function after two nights without any sleep.  Wish me luck.

 

Adelia - what side effects do you have when you take the Elavil ?  It seems almost everybody gets bad dry mouth and wants to eat sugary foods no matter what dose they are on. 

 

Thanks all.

 

John

 

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I had to laugh John when I read that some people report having a hard time getting off of the Elavil.  It's obvious those people have never gotten off of benzo's, that stuff puts everything in perspective!

 

Glad you tossed the Ambien however I need you to keep in mind that your body is probably screaming for the benzo to help you sleep.  The Elavil will most likely NOT put you out like the Z or the benzo, it will make you drowsy but after that it's up to you to get you the rest of the way to sleep. 

 

Please let us know what happens. 

 

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I so agree with Pam!!!  I took prozac once for a year, then stopped it cold.  The brain effects I felt then just do not compare to getting off benzos....ho boy.  Talk about getting a perspective....

 

I'm allergic to elavil, actually John.  But the first time I took 10 mg, it put me out like a light!  All night and much of the next day too.  But I've taken it sporadically, mostly during opioid tapers and a few times during benzo recovery.  I only take .25 mg and that amount is still sedating to me, but not the next day.  Keep in mind, it's original use was as an a/d.  And most of them give the dry mouth thing. 

 

I think you've probably discovered what most of us are discovering, John.  That there really is NO good sleep medication.  If you do find one, please let the rest of us know, eh?  I have a sneaking suspicion that you will have side effects....no matter what you try.  So it's just a matter of finding one, if you have to, that you can tolerate the best while you find a better solution. 

 

BTW, I don't mean to be in the business here of recommending other meds.  I just wanted to make a point about you having other options besides benzos.  They are all very imperfect options, but at least it's something to hang your hat on, while you get some medical direction...right? 

 

I only experienced severe intractable insomnia once.  During the first three days of an opioid cold turkey.  So I know what kind of misery it can be.  I instantly became one of those folks that goes to the dr. and demands something to sleep.  Whew, that's not me at all.  Anyways, let us know how it goes, ok?

adelia

 

adelia

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  • 2 weeks later...

Hi John,

 

I am not sure about cross tolllerance, but I can share my experience.  When I went of Klonopin the first time (I relapsed soon after), I was only sleeping an hour or two a night.  I tried Ambien, as I had taken it in the past and it worked great for me...it did nothing for me post klonopin.  Sure, I got sleepy and it knocked me out, but I woke up a few hours later. Before the klonopin, i'd tried trazadone, serzone, doxepin, xanax, seroquel, zyprexa and the klonopin was the only thing that helped me sleep other than seroquel (which made me a zombie and totally unfunctional at .375 mg of a dose.

 

I tried a double dose of benadryl (diphahydramine) and was suprised it actually worked really well for sleep.  Just thought I'd throw that out there.

 

Good luck to you. Sleep is so important to help making us feel better!

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Hi JOhn,

 

Have you considered going back on the ambien and then tapering from it slowly? That helped me considerably. See my signature line... After 24 years on sleep meds (3 on ambien this last time around with it), I never thought I'd ever sleep without anything. I'm just like you.

 

Well, since I started tapering I'm now falling asleep on my own and sleeping hard for at least 2-3 hours before waking up. And I mean sleeping hard!  I feel more rested after those few hours than I do after the 2 hours of "ambien coma" I get when I break down and take 2.5 mgs. I don't do this every night now, either. Some nights I wake up and just go right back to sleep. I have many benzo w/d symptoms that wake me up and can keep me up at night, but, lo and behold, now I can actually fall back to sleep!  I'm not saying I'm feeling fantastic and raring to go when I wake up, but I'm thrilled that I'm actually sleeping on my own and am confident that this will continue to improve.

 

Over time Z's actually work against the body in putting it to sleep, and the quality of sleep is less than "regular" sleep. I used to knock out for 8 hours when I first started taking it, and it went down to 5 or so hours after I got off the K. This helped show me I was addicted to it.  The rough w/d I had when I went from 12.5 down to 7 showed that, too.

 

Z-drugs might not be as disabling or dangerous as benzos but it is just as addictive.  How about trying melatonin or benadryl instead?

 

Sweet dreams,

 

ginger

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  • 1 month later...
[cc...]
I take Ambien. I have had sleep problems since i was a small child. After not sleeping good for a solid year, i had to do something..  I'm not sure i get what cross tolerance is....i read this and still dont get it :-X........i lost my Dad, my job and my apartment, .....i HAD to have some sleep. I can get by without it, I just dont sleep longer than two hours or so. Even with it i get only about 6 hours. This sucks :-\
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I take Ambien. I have had sleep problems since i was a small child. After not sleeping good for a solid year, i had to do something..  I'm not sure i get what cross tolerance is....i read this and still dont get it :-X........i lost my Dad, my job and my apartment, .....i HAD to have some sleep. I can get by without it, I just dont sleep longer than two hours or so. Even with it i get only about 6 hours. This sucks :-\

 

Kate, 10 mg of Ambien is equal to .25 mg of Xanax.

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[cc...]

I take Ambien. I have had sleep problems since i was a small child. After not sleeping good for a solid year, i had to do something..  I'm not sure i get what cross tolerance is....i read this and still dont get it :-X........i lost my Dad, my job and my apartment, .....i HAD to have some sleep. I can get by without it, I just dont sleep longer than two hours or so. Even with it i get only about 6 hours. This sucks :-\

 

Kate, 10 mg of Ambien is equal to .25 mg of Xanax.

 

hey Pam...i dont get it....Ambien isnt a benzo..is it? how does that work? thanks for answering :D

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Hi Kate,

 

No, the Z class of drugs are called non-benzodiazepines, but they work on the same GABA receptors.  When I was taking Ambien, I started to experience interdose withdrawal.  The symptoms mirrored the Klonopin withdrawal I'd lived with months before.  When I finally stopped the Ambien, I felt so much better.  I had to learn how to sleep on my own though, the Ambien had destroyed my ability to do it on my own. 

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[cc...]

Hi Kate,

 

No, the Z class of drugs are called non-benzodiazepines, but they work on the same GABA receptors.  When I was taking Ambien, I started to experience interdose withdrawal.  The symptoms mirrored the Klonopin withdrawal I'd lived with months before.  When I finally stopped the Ambien, I felt so much better.  I had to learn how to sleep on my own though, the Ambien had destroyed my ability to do it on my own. 

 

thanks Pam..i really appreciate the info. I have to, at this point in my life, have some sleep. I  have had sleep problems my entire life. After a year living in a noisy apartment complex where i did not sleep through the night ever, I went on the Ambien. if i dont take it i wake up every two hours and get up feeling like i'm about to croak. thanks!

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[cc...]

Stay the hell away from Ambien.

 

I read some of your other posts Karl. not EVERY symptom is caused by benzos and/or ambien. going through severe stress such as a divorce can cause anxiety and pain

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Ambien is a Z drug that most certainly can prevent healing from benzos.

 

I don't want to speak for Karl, but I think that is what he was getting at, without saying it directly. :)

 

 

Tim

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Hi Kate,

 

No, the Z class of drugs are called non-benzodiazepines, but they work on the same GABA receptors.  When I was taking Ambien, I started to experience interdose withdrawal.  The symptoms mirrored the Klonopin withdrawal I'd lived with months before.  When I finally stopped the Ambien, I felt so much better.  I had to learn how to sleep on my own though, the Ambien had destroyed my ability to do it on my own. 

 

thanks Pam..i really appreciate the info. I have to, at this point in my life, have some sleep. I  have had sleep problems my entire life. After a year living in a noisy apartment complex where i did not sleep through the night ever, I went on the Ambien. if i dont take it i wake up every two hours and get up feeling like i'm about to croak. thanks!

 

Kate,

 

I've had sleep problems since I was a kid. You can snap your fingers in the other end of my house and it will wake me up. The tiny red light on our tv that's 15' from our bed is like a laser beam in my eyes.  I was on sleep meds of one kind or another for the last 24 years. I took ambien for a couple of years, then took all kinds of other things, then went back to ambien for the last 3-4 years.  I was SO afraid to go off - it didn't matter that so many others here (Pamster included) had done it successfully - I needed sleep, period. I'm bipolar, and the first thing that happens when I can't sleep for a couple of days is I go manic.  So there was no way I was ever going to go off it, despite the fact that Z drugs prevent the body from fully withdrawing from benzos, they have a lot of the same long-term symptoms (insomnia and anxiety for 2) and have a lot of the same withdrawal symptoms.

 

Well, I got to the point of desperation; my w/d symptoms were hellacious - so I took the plunge. What did I have to lose? If it didn't work, I'd go back on.  I started tapering in May and my last dose was in December. You can find my full story in my blog

http://www.benzobuddies.org/forum/index.php?topic=15030.360  - page 37.  I bet the way I did it would work for you, too.

 

Anyway, I'm here to tell you that it IS possible to come off the zhit and to sleep, as well! I now sleep about 3 hours before I wake up, and when I wake up I feel like I've slept for 6 hours, I feel that restored. I do fall back to sleep, and sometimes pretty soundly, but sometimes I just drift in  & out for another 3-4 hours.  I've learned to adapt.  I won't lie to you; when I only get 3 hours a few nights in a row, my mania starts bubbling.  But I've learned that in a couple of days I'll sleep hard, and I do every time. Best of all, I function pretty damn well on this kind of sleep. I don't even fall asleep during the day!

 

I urge you to get off. I'm here to help in any way I can. It IS possible, and you WILL be able to do it.  Please stop by my blog; I'll help you the whole way.  There are a lot of things you can do to help retrain your brain.

 

Drug-free sleep is MUCH better than the alternative. And your benzo w/d symptoms will improve significantly. I promise.

 

take care,

 

ginger

 

 

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