What to do? Help needed.

Edit: see my signature for a clearer summary.

I took zolpidem / Ambien for 4 weeks as prescribed for insomnia related to my chronic illness — 10mg bedtime + 5mg later at night. There were about 5 non-consecutive nights where I added 3mg of bromazepam to ease the neurological symptoms of my illness (1/2 pill, equivalent to 10mg zolpidem). I came off zolpidem cold turkey on March 1, except I kindled myself once every 3 nights until March 10th by taking 3mg bromazepam.

I didn’t know until March 10th that I was experiencing severe withdrawal symptoms — extreme anxiety and dizziness, insomnia, restlessness, night sweats, muscle twitches, tremors in my extremities and vibrations, bright lights with eyes closed, ears ringing, voices/music in my head, loud pops and bangs when I try to fall asleep —.

I read the Ashton manual and I started a taper with 5mg Diazepam (equivalent to 10mg Zolpidem). It has now been 2 weeks. The symptoms eased a lot by day 8-9 with only moderate auditory hallucinations and mild tremors remaining, but the symptoms have intensified these past 6-7 days. My sleep is very poor, though thankfully I am not agitated or particularly anxious. Overall, they are hovering around the limit of being bearable/manageable.

For my taper, should I increase the starting dosage of diazepam to 7.5mg or 10mg (equiv 15-20mg Zolpidem) or just stick to 5mg for 2-3 more weeks to see if the symptoms are relatively acceptable? I will be doing a micro taper, either dry or liquid.

I have obtained medical advice from a psychiatrist-pharmacologist who recommends increasing to 7.5mg, as does another MD who tapered off Xanax over a few years. But it would make the taper longer, and I am not sure it is guaranteed that I will be stable despite the updosing.

A major issue to factor in is that I am 24/7 bedbound from a chronic illness and both agitation and insomnia are putting me in danger of aggravating my health because it taxes all my energy (overexertion makes me way worse).

Unfortunately, after holding for about 18 days at 5mg, the withdrawal symptoms have truly come back. I am worried that updosing to 7.5mg would only kindle me (?), but I need to sleep at least a bit — right now I’m not able to fall asleep at all. I might give it another day or two at 5mg but it seems pointless if I am to updose. Thoughts please?

I'm a bit confused. Where did the valium come from? Your post says you CT'd zop after 4 weeks use. Are you also taking bromazepam?

If you added a signature it would be easier for people to try and help.

Sorry, I should have mentioned that the Valium was prescribed by my GP. Once I realized I had WD symptoms from the zolpidem, he agreed to giving it to me. However, he isn’t supervising my withdrawal - the psychiatrist-pharmacologist I talked about is.

I am not using bromazepam anymore. I only ever used it those few (~5) times I mentioned in the post.

I have updated my signature, I hope it summarizes the situation clearly enough.

Sorry, I should have mentioned that the Valium was prescribed by my GP. Once I realized I had WD symptoms from the zolpidem, he agreed to giving it to me. However, he isn’t supervising my withdrawal - the psychiatrist-pharmacologist I talked about is.

 

I am not using bromazepam anymore. I only ever used it those few (~5) times I mentioned in the post.

 

I have updated my signature, I hope it summarizes the situation clearly enough.

Ok, I get it now. 1st thing 1st, you are not kindled, you took a few additional doses. So you can stop worrying about that, it's not helping and feeding your anxiety / fear response will make matters worse.

Your CNS has had a bit of a shock from the CT, and will take a little while to calm down. How is your psych doc with prescribing you? I ask because if it was me personally, I would wait now until you are stable before considering tapering. This could take a little while, so hopefully your doctor would help and not rush you into a quick taper too soon. It's quite normal for things to be a little up and down for a while until you stabilize. But things will level out. Then I would discuss a slow taper with your doctor. There's plenty of knowledge here with regards to tapering.

If you can not updose anymore, obviously your taper will be shorter, but if you really aren't stabilizing it is an option I suppose. I'm sure there will be someone with more experience on crossing over to valium and tapering with advice for you

Thank you. I probably understood the definition of kindling wrong. It’s nice to know it didn’t happen indeed.

The psychiatrist I reached out to is very understanding, and he knows that the taper must be done slowly. He suggested increasing to 7.5mg and hold 2-3 weeks there to see if I could stabilize before initiating the taper. The idea was that given the dose of zolpidem I took, plus the bromazepam, 5mg Valium might be a too small starting dose and 7.5mg would be more adequate.

As for the taper itself, I will be leading the pace (planning a dry micro taper) - he is really just supervising the whole situation.

Of course I would like to wait a bit more at 5mg. I am trying to hold on to this dose as much as I can. Good to know that my CNS might still be adjusting while giving me bumps on the ride - that gives me hope to continue this hold. Is there any timeframe that I can expect before stabilizing (weeks, months) or is it unforeseeable?

Thank you. I probably understood the definition of kindling wrong. It’s nice to know it didn’t happen indeed.

 

The psychiatrist I reached out to is very understanding, and he knows that the taper must be done slowly. He suggested increasing to 7.5mg and hold 2-3 weeks there to see if I could stabilize before initiating the taper. The idea was that given the dose of zolpidem I took, plus the bromazepam, 5mg Valium might be a too small starting dose and 7.5mg would be more adequate.

 

As for the taper itself, I will be leading the pace (planning a dry micro taper) - he is really just supervising the whole situation.

 

Of course I would like to wait a bit more at 5mg. I am trying to hold on to this dose as much as I can. Good to know that my CNS might still be adjusting while giving me bumps on the ride - that gives me hope to continue this hold. Is there any timeframe that I can expect before stabilizing (weeks, months) or is it unforeseeable?

It's good to hear you have an understanding doctor to work with, it's not always the case. The stabilizing question is a hard 1, how long is a piece of string? You need to way up the options I suppose. You'll probably stabilize quicker @ 7.5mg, but you'll have a slightly longer taper. You will probably get more replies this evening (EU) as many of the members are in the US, and come on later. I'm not one to advise on crossovers and tapering as I was CT, and you don't want to do that as you've found out.

Just know things will calm down

You'll probably stabilize quicker @ 7.5mg, but you'll have a slightly longer taper.

This is the dilemma, essentially. And I have been told by someone with protracted post-WD symptoms that it is not guaranteed I would stabilize at 7.5mg either.

You will probably get more replies this evening (EU) as many of the members are in the US, and come on later. I'm not one to advise on crossovers and tapering as I was CT, and you don't want to do that as you've found out.

 

Just know things will calm down

I really appreciate your help and reassuring words. Thank you. I will be waiting for more input from other members.

I wish we could tell you what you should do but we can't.  If you were feeling this way and didn't have an underlying illness I'd say hold at 5 mgs for awhile longer then begin your taper but only you and your doctor can determine if this will cause you further problems.  In the grand scheme of things 2.5 mgs isn't a lot, yes it will make your taper longer but given your need to go super slow, it's going to be a long taper anyway.  Maybe accepting this taper is going to be a part of our life for a long time will help you figure out what to do. 

Using the drug as a withdrawal aid to gently get off the drug is the purpose of a taper so use what you need to in order to live the best life you can while you do this.

Kindling - The Alliance for Benzodiazepine Best Practices

https://benzoreform.org/kindling/

Kindling - Benzodiazepine Information Coalition

https://www.benzoinfo.com/kindling/

You are right, Pamster. I need to accept that it will take a long while.

Essentially, I think that my question boils down to - given the dose of zolpidem I took (plus the bromazepam some nights), which of 5, 7.5 or 10mg would generally be recommended as a starting dose of Valium?

I see it as a medical mistake and carelessness on my part (I thought Z-drugs were safer than benzos), but what is done is done. I am bedbound 24/7 getting smashed by debilitating symptoms already, so I have some “experience” in handling difficult situations — though I admit benzo WD symptoms are hellish. I can only try to follow my breath gently when the wave hits and combines in synergy with the symptoms of my illness.

My symptoms are indeed worsening, mostly the auditory hallucinations, tinnitus and visual flashes/bright lights. I am holding on to 5mg as much as I can, and I’ll see where I’m at by next Monday or maybe next Friday. Though, right now, I would not feel able to start tapering down - assuming the symptoms would worsen more as I do.

I remember feeling that the 10mg dose of zolpidem at bedtime was starting to become less effective by day 12 of continuous usage (out of 30 days). So I am not surprised that I have some/possibly too much tolerance to the equivalent diazepam dose of 5mg.

Hi potatosaur,

I am so sorry you are having to go through this on top of other underlying, chronic issues.  I agree with Pamster and Having a Mare -- there isn't really any guarantee, but sometimes when we are suffering we eventually need to try something.  It sounds like you have some good benzo wise docs at least to navigate this with and that is at least really good news. 

For me personally, after I hit a bad snag in my taper, I eventually decided to updose and while it wasn't immediate relief, I did end up after a while (two months or so) hit a place of higher functionality.  Unfortunately, once we become a pickle it can be hard to getting back to a cucumber in any sort of quick or timely manner -- (I had a lovely retired psychiatrist share this pickle metaphor with me -- wasn't what I wanted to hear at the time but he was kind and and sort of spot on)

anyway, just wanted to say I'm pulling for you!

Thank you Pamster and 300days. I very much agree with the pickle/cucumber metaphor!

I have stayed at 5mg for the past couple of days and the symptoms seem to be fairly stable. I will try to hold for another week to see if this stability remains. How long can I hold at a certain dose — it seems some people hold for months at a time?

I am getting better at figuring out the intertwining between the symptoms of my disease and those of benzo WD. Specifically, physical, cognitive and sensory overexertion (which, being ill, is a point I reach extremely quickly) intensifies both significantly. Pacing my activities is part of the way I have to cope with the disease in any case, so I do it, but it is not easy.

I was also thinking - I went on one 5mg dose of Valium at bedtime, but I had two doses of zolpidem - 10mg at bedtime and 5mg later at night / early morning. I imagine an equivalent cross-over would have had 2 doses of Valium, 5mg at bedtime and 2.5mg in the morning, or simply one dose of 7.5mg at bedtime. So am I not in fact already tapering down while crossing over?

You sound better than you were, do you think the 5 mgs is going to work for you?  I'm glad you've been able to distinguish between your illness and the withdrawal symptoms but I can see the toll its taking on you. 

As for your question about the 5 mg being a dose reduction, its hard to say.  Professor Ashtons equivalencies are typically on the heavier side of the range, so you may be okay at 5 mgs. Are you sleeping?

You sound better than you were, do you think the 5 mgs is going to work for you?  I'm glad you've been able to distinguish between your illness and the withdrawal symptoms but I can see the toll its taking on you. 

 

As for your question about the 5 mg being a dose reduction, its hard to say.  Professor Ashtons equivalencies are typically on the heavier side of the range, so you may be okay at 5 mgs. Are you sleeping?

I wasn’t aware of this about Prof Ashton’s equivalencies, thank you for letting me know.

It is difficult. Most nights I am getting a few hours of sleep, but I’m not sure where I’m headed - towards an increase or a decrease. It feels like the latter: although I can’t fall asleep without Valium and it stops the hot flushes / night sweats that come on as I try to fall asleep, the 5mg dose seems to have no sedative effect at all anymore. So I am reliant on low dose doxepin (20mg) to knock me out, but even then it is a struggle because I often jolt awake suddenly when I finally start drifting off to sleep (which never happened before withdrawal, then went off on the first 10 days of Valium, and is intensifying seemingly every day).

The tinnitus(es) are also getting louder even at day, and I would even say deadeningly loud in the evening before I take my dose. Thankfully the Valium essentially stops them, but I am doubting how much longer it will remain effective.

I wanted to show you this tool, while it doesn't include Zolpidem you can see by comparison what I said about Ashtons numbers. https://clincalc.com/Benzodiazepine/

Do you think since the Valium isn't helping you sleep that splitting your dose and taking one in the daytime would help with your tinnitus?

Indeed. I found a table from an official source that seems even more conservative: https://www.sahealth.sa.gov.au/wps/wcm/connect/83838b80407711959274ba222b2948cf/Benzodiazepine+equivalents-DASSA-August2014.pdf

Sorry, I was probably not very clear in what I said. The Valium doesn’t sedate me but if I don’t take the full dose at bedtime, I get night sweats and I jolt awake when I drift off — so it is crucial to enable sleep, but it doesn’t provide any benefit. If I were to split the dose in half and take the other half at day, I very likely wouldn’t be able to sleep at all.

For now, I can bear the tinnitus at day. Breathing through it as best as I can.

I would like to ask this question again because I thought it might have been a bit buried in my previous post:

How long can I hold at a certain dose — it seems some people hold for months at a time?

Tough question, some do hold for months, others will reduce as soon as they feel stable enough to be able to face another reduction.  Oftentimes members will worry about growing tolerant to their hold dose and begin to reduce again, its different for everyone.

Here is some information about tolerance of you're concerned.  http://www.benzobuddies.org/benzodiazepine-information/tolerance-and-dependency/

Thank you, this is exactly what I was wondering about. I am concerned that I am having relative withdrawal symptoms, so essentially the solution would be to taper now despite the symptoms… I’m really not sure about it all. Difficult spot.

However, the page does state:

It is sometimes said of Relative Withdrawal that by staying at a particular dose for too long, you will develop 'Relative Withdrawal' effects to this specific dose, whereas if you were instead tapering, this would not occur - this not how Relative Withdrawal occurs! Whilst it is true that by stretching out your taper longer than necessary you might increase your chances of developing Relative Withdrawal symptoms, it is not the result of you sticking at a particular dose for too long. Rather, it is the result of protracted use of benzos, whether or not you are withdrawing at the time, which can lead to Relative Withdrawal symptoms.

Agh. I am so conflicted. It will be 4 weeks at 5mg on Friday - clearly, as the symptoms are not evolving much now, I’m setting this as my deadline to decide whether to updose or to start tapering. I don’t have anxiety or agitation and insomnia wise, I can get a bit of sleep (not enough, but as expected) right now. They might come back quickly though if I taper now.

I read about tolerance withdrawal again, this time with a clearer head.

Having crossed over from Zolpidem to Valium, I can’t know whether I am experiencing tolerance withdrawal symptoms (the auditory hallucinations and the tinnitus, maybe some very mild anxiety) or whether I am underdosed on Valium.

I have been on 5mg of Valium for nearly 5 weeks now, and my symptoms have remained the same both in nature and intensity for the last 3 weeks. I could cautiously increase to 7.5mg or lower — i.e. updose to 6mg, then give it 2 weeks to settle in, and repeat this in increments of .5mg until the symptoms are gone, up to a maximum of 7.5mg. If I am currently underdosed, then this will stabilize me better and I will be able to start to taper symptom-free. However, if I am experiencing tolerance withdrawal, this will not work, and I am better off just starting to taper now.

I just don’t know how likely it is that I am experiencing tolerance withdrawal (or not). The MD who tapered off Xanax who has advised me told me that it seems unlikely, since I haven’t been on Z drugs and benzos for long, but I am aware that it can develop in a matter of weeks for some people.

If I have anything to go by, then the last 3 weeks at the same dose of Valium with unchanged symptoms might indicate that I am underdosed rather than in tolerance withdrawal. Additionally, before I quit zolpidem cold turkey after 4 weeks of constant usage, I don’t remember having experienced symptoms indicative of tolerance withdrawal (in hindsight, for what it’s worth). Do these data suggest that I am unlikely to be in tolerance withdrawal?

What a conundrum. I cannot bring myself to updosing as I fear it would be a mistake (and it lengthens the taper), but I cannot bring myself to facing the war that is ahead if I start tapering now. Not that it might be particularly easier if I updose, though.

(And if I am being honest, given the difficulties of living with my chronic illness and of tapering with it, the best case for me would be updosing until my symptoms resolve and hopefully never develop tolerance withdrawal. Alas, this is wishful thinking. I regret ever getting on zolpidem in the first place.)