Ambien and Valium withdrawal

I've been taking 10mg of ambien at night for almost ten years. Amazingly I've never had to escalate the dose and it's remained efficient until now. I'm absolutely not going to go beyond 10mg so I will need to make a substitution and I will also take this chance to see if I can taper down overall. In addition to the 10mg of ambien I have also been taking 10mg of valium per night. I'd appreciate any thoughts on my plan:

 

- switch the ambien to valium 1:1 so that makes 20mg valium.

- given valium doesn't have the 'knockout punch' of ambien, I think I will need to add something like an additional 5mg to make me dozy enough to fall asleep. I don't want to take anything short acting.

- so in summary, I switch from my current 10mg ambien and 10mg valium --> 25mg valium.

 

25mg is most definitely higher than I'd like to be on but I'm familiar with most of the benzo family ranging from midazolam to lorazepam through to nitrazepam. I don't see any benefit from adding any other benzo into the mix and reducing the valium to 20mg. I've done multiple valium tapers and they have never caused any problems, they are just a pain in the ass. As I said it's more of a psychological issue right now. In the grand scheme of things I appreciate 25mg is not a lot but I try to be very strict about my dosages and this is hitting a 'virtual' red line. Does this plan sound reasonable?

According to the table we use, 5mg of Valium replaces 10mg of Ambien: https://www.benzo.org.uk/bzequiv.htm

You’d only need 15mg of Valium total.  If the goal is to taper off, why add another 5mg? The sleep benefits will be temporary and then you’re at a higher dose to taper.

 

Multiple withdrawals tend to become more symptomatic. Sounds like you’ve been lucky so far, but that can change. Not trying to fear-monger, just passing on what I’ve seen happen many times with multiple withdrawals.

 

Just my two cents.

I read all your posts since you joined in 2012, so my reply above probably isn’t what you’re looking for.  In January of 2014 you posted this:

 

Hi there.  I've been on 10mg of zolpidem every night for the last five years (I understand, in the grand scheme of things it could be worse).  I've tried a direct taper several times but I always hit a floor at about 6.25mg after which I get really bad rebound insomnia.  I've also tried some straight diazepam subtitution tapers which haven't worked (see below).  I went to my doctor yesterday and we've agreed on a new plan.

 

As you know, the general substitution drug for zolpidem is diazepam and in my case it would probably be around 10mg.  However here's the issue: as I'm sure some of you are aware, zolpidem really punches the lights out, far more so than diazepam (well it certainly does for me).  While 10mg of diazepam may be 'equivalent', it's not sufficient to induce sleep for me, even if it can maintain it.  Therefore what my doctor and I have decided is that I'm going to begin the substitution by taking 5mg of diazepam and 5mg of nitrazepam.  Nitrazepam, which is also known as Mogadon (amongst other names), is an older generation benzo that's specifically used as a 'sleeping pill'.  I know the distinction between sleeping pill, anti-anxiety etc. is somewhat arbitrary but there is also some sense to it.  The idea is that the nitrazepam will partially substitute for the 'punch' I was getting from zolpidem so there's more chance of me falling asleep than if I was taking solely 10mg of diazepam.  Once I've stabilised on the new regimen, I'll taper off the nitrazepam slowly and then the rest of the diazepam.  That's the plan at least.

 

I don't know how kooky this sounds.  To be honest, I'm just looking for a bit of reassurance as I'm pretty nervous about starting this.  However I would genuinely be interested if people can speak to this plan from direct experience or knowledge.  Thanks in advance.

 

How we can help you? Is your goal to reduce your benzodiazepine intake? Quit altogether? If so, the reality is that insomnia is going to be an issue.

Challis99, I very much appreciate you taking the time to read my previous posts and noted re. ambien/valium equivalencies.

 

You have kinda hit the nail on the head - what am I trying to do? I think part of me won't let go of the idea of returning to being a natural sleeper with no meds which I think, given how long I've been taking them (decades) is unlikely. I think, therefore, my number one priority is to get off ambien. Of course as you say if I do a substitution and then taper, insomnia is indeed going to become an issue so I guess I don't know where I'm going to end up at that point. I've done this exact taper before and I thought once I reached zero all would be well. As you know, that was misguided to put it mildly. It felt like my food had been spiked with a stimulant each night when I tried to sleep so eventually I went back to the current regime.

 

So partial answer to your question is quit ambien but in all honesty I don't have a strategy for what happens next and I do need one. I would like sleep to be regular and restorative but wouldn't we all. I don't have a concrete plan so why don't I put it like this: if there's a realistic path to leaving benzos in the past and sleeping enough to function, I believe that's what I need to do, no matter how difficult.

 

I'd like to ask you, from what you've seen and what you know, what are the options for someone who aims to quit prescription sleep meds but would like to have some form of regular sleep afterwards which doesn't involve hangovers like one gets from old school anti-histamines or other otc aids? What are my options if I follow my proposed taper plan when, inevitably, my valium dose is too low to sedate me and insomnia kicks in? I'm realistic that enduring some insomnia is likely to be part of this.

 

Thanks again for taking an interest.

cdjrdl I am doing what you are doing. I started alprazolam and ambien 2.5 years ago. God I loved the ambien! It got rid of the very vivid and colorful and sometimes a little disturbing (even if nothing disturbing happened in them) dreams. As I was tapering the xanax I got to a point where I thought I needed to reduce the amount of ambien I'm taking. So I cut my 10 mg ambien to 7.5 mg ambien. I noticed no difference, so I cut the ambien again to 5 mg. I still noticed no difference. Well, almost no difference. The dreams have come back again. I usually wake up twice, once at 6 hours and once at 8 hours, before getting up 10 hours after I've gone to bed. (I've always had to sleep that much. I hate it.)

 

I should add that I take mirtazapine 45 mg at night too. So the mirtazapine is probably what's really knocking me out.

 

Here's a wild aside: a few weeks ago after filling my pill box, that first night when I poured out my night pills, I was like, where's the ambien? I looked, and I had put the half tablet in the morning boxes. Which means that morning I had taken 5 mg ambien after eating breakfast and drove to work!  I didn't notice a thing!

 

So now that I've gotten the xanax to a lower level, I'm thinking I need to reduce the ambien again. I usually feel fine in the morning, but the last few hours of the day before I go to bed my head is starting to feel foggy and I feel a little wired and it sort of feels like benzo withdrawal. I'm thinking maybe I'm going through ambien withdrawal and the xanax is too low to carry me through the day.

 

Ooo, that felt good typing that out. I think I feel like you do. I know what I need to do (reduce the ambien), but I don't want to do it. Even though I do want to do it. But I'm scared what it will be like.

Challis99, I very much appreciate you taking the time to read my previous posts and noted re. ambien/valium equivalencies.

 

You have kinda hit the nail on the head - what am I trying to do? I think part of me won't let go of the idea of returning to being a natural sleeper with no meds which I think, given how long I've been taking them (decades) is unlikely. I think, therefore, my number one priority is to get off ambien. Of course as you say if I do a substitution and then taper, insomnia is indeed going to become an issue so I guess I don't know where I'm going to end up at that point. I've done this exact taper before and I thought once I reached zero all would be well. As you know, that was misguided to put it mildly. It felt like my food had been spiked with a stimulant each night when I tried to sleep so eventually I went back to the current regime.

 

So partial answer to your question is quit ambien but in all honesty I don't have a strategy for what happens next and I do need one. I would like sleep to be regular and restorative but wouldn't we all. I don't have a concrete plan so why don't I put it like this: if there's a realistic path to leaving benzos in the past and sleeping enough to function, I believe that's what I need to do, no matter how difficult.

 

I'd like to ask you, from what you've seen and what you know, what are the options for someone who aims to quit prescription sleep meds but would like to have some form of regular sleep afterwards which doesn't involve hangovers like one gets from old school anti-histamines or other otc aids? What are my options if I follow my proposed taper plan when, inevitably, my valium dose is too low to sedate me and insomnia kicks in? I'm realistic that enduring some insomnia is likely to be part of this.

 

Thanks again for taking an interest.

 

I took Temazepam for decades, then Xanax for 8 or so years (dropped the Xanax because I slept when I took it, although it was prescribed for a different reason). 

 

Insomnia was incredibly bad for awhile at the end of my taper and for some time after it ended.  Terribly frustrating. But I hung in there and it eventually and slowly turned around. I never took anything else for sleep although I did drink chamomile tea at night, which has been called the ‘benzo of the herbal world’.  I’d double bag in a small mug.

 

Slept alone in a dark cool room with ocean waves recording playing on my phone at first.  I went from 20 minutes a night to 40 minutes to two hours etc.

 

It’s a long process. But I have to say it was worth it.

Challis99: that's what I really needed to hear: you made it to the light at the end of the tunnel. As I said, the one and only time I did manage to withdraw fully (thinking that was the only challenge), it literally felt like whatever part of my brain that was responsible for sleep had packed its bags and left for good. Just to hear one person say it can be done, that one just needs to hang in there, is worth more than the opinions of a boat load of doctors. Thank you for the sharing your story.

 

 

HopeToDoThis: yeah, seems like we may be going through some similar stuff. I was reading Ashton's site (aka the bible) the other day, I'm sure you know it (https://www.benzo.org.uk/index.htm) and she was talking about triazolam, one of the most powerful benzos around, and was saying you don't really experience withdrawal because it's so short acting (stays in the body around 2-5 hours) that it's left your system before you get withdrawals. I believe she also said it was a similar situation with zolpidem. Perhaps that partly explains why you could take 5mg (which, let's face it is almost a sugar pill for long term users) and go about your day pretty much fine!

 

Obviously it can't be that simple and there's the whopping counter-example of xanax - super shorting acting yet quite the challenge to come off totally. I've spoken to quite a lot of pharmacological chemists and researchers over the years and I wish I had more expertise to elaborate on this but they all said there's something very special about the xanax drug molelcule. One of them described it as the 'most perfect' drug molecule he'd ever studied. Of course I can't really say what perfect means but I'm guessing it's a combination of its strong affinity for the relevant GABA receptors it works on and some other more general observation about its chemistry - the pattern in which the atoms are arranged and the specific bonds that join them.

 

I say all this to kind of underline that we're all in a big boat of a lack of knowledge - experts included. Sure there has been a lot of progress in understanding, especially as genetics has grown as a discipline but there's more we don't know than do. Funnily enough, while it shouldn't, this gives me some reassurance. Despite all of this, people do get through the experience of having to deal with drugs *despite* the obstacles. You've gotta have common sense, the support of others (no one can do this alone) and faith that you will succeed. And if all that's true, yeah it's a bummer we don't know more but we'll be okay.

 

I'm sure you know the one sentence that is always printed on the inserts put into pill boxes - like every pill box everywhere. It goes: "The exact mechanism of action of this drug is unknown". No sh..t Sherlock!!

How interesting. I'm actually an analytical chemist in the pharmaceutical industry. I've worked with many many drugs (including zolpidem, fentanyl, other opioids). I've never worked with alprazolam or other benzos. I wonder what they mean by it being "the perfect molecule."