Tolerance to ambien

[SueJohnson]

I am taking ambien for pulsatile tinnitus which does not let me sleep. It works very well at least for 5 to 5-1/2 hours. I have three questions. Has anyone been taking it for a long time and it still works? If it stops working I know I will have to wean off it, but can I start lunesta at the same time so I can still sleep? Anyone have experience with the controlled release ambien after using regular ambien? Since it releases it over time is it less effective?

[kaliska0]

Ambien works all of 2 days for me. It can even be quite strong the first day but within days it does nothing. It's one of the least common to work long term and most people get swapped to something else if their insomnia does not appear to be improving within a few months of taking ambien. I've heard of people finding ways to get up to 10x what the max prescribed dose is because it's all they know works but it doesn't work for long within the approved dosage range.

I took lunesta for a couple years without it losing effect. It probably would have failed eventually but before that my insomnia became considerably worse due to likely a variety of factors not recognized or understood by doctors. Lunesta was no longer useful after that. No single sleep aid worked at all for me within a couple years after that. I was taking 4-5 sedatives at once to get sleep for awhile before I decided this was a dead end and worse than just being sleep deprived. I concentrated more on finding and treating the cause even if doctors had no freaking clue how to do that.

Controlled release depends on the exact method and medication but with exceptions it is generally less effective after you have built tolerance. Those meds are usually designed to maintain a lower concentration for longer so you have a less rapid spike, longer period of the highest concentration the med formula can reach, and slower drop off compared to taking instant or immediate release versions. The more slowly drawn out dosage makes much the same quantity last longer but never peak as high. It's good if a med is working but just not working long enough, which is another common problem of ambien, and it can help avoid tolerance instead of taking a higher dose to have it last longer. It's not good if you need that rapid spike or the high peak concentration to get any effect. Needing more and more at once to get an effect is practically the definition of tolerance.

A few meds are just a regular formula and a delayed release formula combined in order to provide a second dose nearly all at once after a specific amount of time. If you don't process the med as quickly as the average person or your body manages to make use of the delayed portion faster than it's supposed to then the delayed release quantity can overlap the instant quantity resulting in a higher peak concentration than is typically prescribed. It wouldn't be for long though and it only applies to certain meds and certain people. I tend to eliminate meds faster than average so I end up with a reduced effect or no effect because the delayed releases are always designed to work after too much time to line up with how quickly I get rid of the first portion. Meds that should work for 8 hrs I'm lucky to have last 5 hrs so many types of delayed formulas do not work right for me.

You can generally swap between any z-drug or benzo and another with minimal issues. Just take a different one for your next dose. Some will have minor negative effects from the relatively small differences between the 2 meds. The exceptions are the very long lasting benzos with a stronger sedative effect. So basically the opposite of what they tried to do by creating z-drugs like ambien. The goal is to have them completely wear off before people wake up so they are not effected the next day. Those short acting z-drugs and many benzos have a high tendency to give me headaches and aren't all that effective because of how rapidly I eliminate them. I have never had much for symptoms stopping either z-drugs or benzos probably partially because they are gone from my body so fast withdrawal is over for me within hours to a couple days.

I use the benzos flurazepam or quazepam when I use a sedative at all. I found I can't just swap from one to the other of those whenever quazepam would disappear for awhile due to lack of demand because both meds continue to exert effects and can be tested for 3 days after most people stop taking either one. If I have to do a straight swap the next day it overlaps with what is still in my body from the previous one so for a couple days I get double dosed on them. Even I don't process those particular meds fast enough to eliminate them in less than 2-3 days. Part of the reason why they are at all useful for me.

Many things can promote sleep that are not direct sedatives with often better effects, less negatives, and work for longer or potentially forever. It's rare for a sleep aid to work long term and odds are you will have to keep swapping meds and adjusting dosages every few years. The two problems with finding a useful sleep aid that is not just a GABA impacting sedative is that most have never been studied specifically for sleep making it an off label use and also that many people need to feel the sedative effect to be able to make themselves go to bed on time and relax.

Some of the most effective long term sleep aids I've taken I didn't even realize they were doing anything. Some I've had to stop and start numerous times for months at a time before realizing just how much impact they have because they don't simply drug me into feeling tired. Since feeling tired does not equal able to sleep for me it's pointless for anything to make me feel more fatigued. That has minimal effect on whether I get sleep and my sleep and activity tracker I wear actually shows a negative correlation where the more exercise I get and the more physical strain my body has been under the less or worse sleep I get. The most useful things I take for sleep do not make it more difficult for me to stay awake if I tried to instead of making myself go to bed and try to sleep.

[davephx]

I have been lucky, been on Ambian/Zolpidem ER for maybe 15+ years. I have found peer review studies that go out 5 years of use and even indicate for some becomes more effective with long-term use, even though the guideline is for short-term.

According to my DNA per Ancestory.com I am genetically at 80%+ of the population a night owl. I shine with my mental peak after midnight and usually go to bed about 5 AM-6 AM taking Zolpidem ER an hour before. I do not feel tired at all but usually get to sleep quickly as soon as go to bed. However, if I wait say 1.5 hours it seems not as effective, half life is about that as I recall.

BTW I am age 77 next month. I have enlarged prostate and wake up once after a few hours but no problem going back to sleep.

Lately I sometimes sleep less like only 4-5 hours but wide awake and I have lots to do so if don't go back to sleep in say 30min get up and get working. Oddly often about 5 PM will be a bit tired and easily take about a 20-minute nap and then plenty of energy and not tired again till I force myself to sleep via Zolpidem ER. After a few nights of this, I may naturally sleep 8 or more hours, seemingly when my body needs it. Odd I can easily take a short nap later afternoon but almost never tired at say 5 or 6 AM even after taking a "pill" yet usually go to sleep easily.

At age 77 still have an active business life but am self-employed so clients know they may get emails from me in the wee hours when I shine. Am in the investment business so usually need to be up by about noon or 1 PM while markets still open to be sure don't need to do anything for a client. I am in Phoenix AZ with a busy life and many interests

Oddly if I need to get to the airport for an early morning flight I can set an alarm like in 4 hours and be wide awake. Fortunately do not have any hangover effect even with short sleep. Usually, I wake up naturally with no alarm anywhere after 6-8 hours of sleep. So, I assume I am getting what my body needs. I realize I am lucky to have what for me is a very effective schedule using my "pill".

When I first started using it I would have a bit of an amnesia effect or the next morning would see I typed something oddly. Once I fell asleep being laid back on the couch while talking to someone on the phone - my late-night friend in Toronto. I didn't feel at all tired but had taken the pill and it zooked me out just being not even flat but a slight angle on the end of couch. But that was only many years ago and no negative effects since.

When I first went on the pill, Dr had me do a sleep study to be sure not Sleep Alpena. They wanted me to go to sleep like at 10 PM. Oh, sure good luck unless I can take my pill. They had me take it and like when I go to bed early if need to be up early for travel or a meeting (zoom etc) I can knock myself out early in one hour after taking the pill - even though oddly I don't feel tired.

I am concerned after so many years it may be less effective but so far so good. I realize I am lucky to not have any real issues after this long-term use.