Please give me Ambien

This is post 7 in the series Chronicle of Sleepless nights.
Previous post: First Diagnosis, More Pills

Treatment 5: New sleeping pills

I went back to Dr. R and begged her to prescribe Ambien for me. She said that doctors were much more reluctant to prescribe Ambien these days and instead, she gave me a prescription for an antihistamine called hydroxyzine.

I warily took the prescribed dose that night and waited. Nothing happened. I couldn’t sleep. I was tired, frustrated and angry. I wanted and needed to sleep. I thought my life was disintegrating. I could not get up the energy to go to the Y. I skipped my classes and workouts. I could not even nap during the day to feel better. I craved sleep, but my body kept defying me.

Each day after a sleepless night, I typically had a low-grade headache and burning dry eyes. I felt powerless and depressed. I was supposed to be working one day a week at my university office, usually Wednesday. I could barely drag myself into the office to meet with my students, and once there, it was hard to concentrate. I longed to go home, lie down, and rest. I seemed to tear up and cry at the drop of a hat. I called Dr. R’s office and again, begged her for a prescription for Ambien. Finally, she relented and prescribed a small dose: 5 mg. I was so happy and relieved. At last, I could take my pill and go to sleep.

That night I prepared for bed with relief, and just a tiny bit of anxiety about taking this pill. I knew if it worked one day, the next night I might not be able to sleep without it. But I was desperate, and I finally had a little bottle of Ambien pills on hand. So I took a pill. Then I got into bed and turned off the lights, adjusted my pillows and blanket, and waited.

Nothing happened. All night long I waited for sleep to come, but it did not. I even took a Trazodone during the night. When I had picked up the prescription for Ambien, the pharmacist, noting I also had an open prescription for Trazodone, had told me I could take both pills together since they worked differently. I knew that Trazodone was actually an anti-anxiety drug that had drowsiness as a side effect, while Ambien was a sleeping pill. At 7 a.m., I finally fell asleep for an hour, and then I was up. I was horrified, frantic, and exhausted. I barged into Michael’s room, crying. I did not know what to do. What was wrong with my body, or my brain? Why would a sleeping pill not work for me?

I thought about what people do when they need help and cannot get it at any local medical clinic. They go to the Mayo Clinic in Rochester, Minnesota. So I called Mayo and asked if I could be seen for my sleep problems.

Mayo Clinic told me they had a long waiting list for their sleep specialists, and I needed a referral. They booked patients for a two-day visit, and explained the process of having an overnight sleep study and follow-up appointments. I asked them to put me on their waiting list and called Dr. R to get a referral. She suggested I first see a sleep doctor in her clinic and gave me the name of a pulmonologist. I called, but could not get an appointment. This doctor was so backed up with patients he would not make new appointments at all. Dr. R then gave me a referral to Mayo Clinic and I waited for Mayo to schedule an appointment for me. I felt so impatient. It would take months to get in, and how could I wait so long to get help? Drugs were not working. I called my HMO and asked if there was any other sleep doctor I could see. They told me I could see Dr. D in February. I took the appointment, but it was months away, and I was determined to keep trying for something sooner.

Then I decided to find a psychiatrist who could prescribe a different medication to help me sleep. After all, psychiatrists knew medications and gave prescriptions. I called my clinic and they had no available appointments. I called another clinic, and they were not taking new patients. Then, on the Internet, I found the name of a local psychiatrist who had a private practice, so I called her.

I left a voice message for Dr. S and she called me back later that day. I was so thrilled to talk to her, as she was kind and compassionate. She wondered if there was something causing anxiety that was not allowing me to sleep, and when she heard I was retiring, she suggested that was the problem. She talked to me for about 10 minutes and when I told her I had taken Ambien and it did not work, she asked if I had tried Valium. I had not. She said she would not see patients just to prescribe drugs, but only if they would undertake psychotherapy as well. If I just wanted a drug, she suggested I ask my primary care doctor for Valium. Since I already had a therapist, K, I declined an appointment for more therapy. Instead, I called my primary care doctor, Dr. R, again, who agreed to order a prescription for Valium: 2 mg pills. I picked up the prescription and that night I took one pill as instructed. I managed to sleep a few hours. That was it. I felt like I was starting to go crazy.

Valium (diazepam) is a medication of the benzodiazepine family that typically produces a calming effect. It is commonly used to treat a range of conditions, including anxiety, and sometimes has a side effect of causing sleepiness. I learned that it increases the effect of the neurotransmitter GABA. I knew what that was! But Valium did not produce enough sleep for me. I was not sure what to do next.

I made an appointment with K, to see if she could help me sort through the deepening mess I found myself in. When she heard my story of the drugs I had tried and how they had not worked, she told me that she took a time-release version of Ambien every night. Although she could not prescribe pills, we discussed having me try two of the 5 mg pills of Ambien, since one did not help me sleep. She also suggested taking a tablespoon of almond butter 15 minutes after taking the pills. Finally, she suggested listening to music or soothing sounds on my iPod to fall asleep. I tried the two pills and almond butter and slept for four hours, half what I needed. I was up from 2 a.m. until morning. Another night’s disaster. I was angry, frustrated and scared. What was wrong with me? Why did the pills not work? Why could I not sleep at night?

I started to think about finding a hospital where I could go and be drugged into a deep sleep. I longed for release from this ongoing nightmare. My mind could not stop thinking about my sleep problems. Each night, I kept trying to figure out what I might do that would make a difference.

During this dark time, winter was settling in. I was missing so much of what was my regular routine, and I felt that I was losing my muscle mass and strong body that I had been so proud of. The one thing I managed to do was put on my heavy clothes and boots and walk to Lake Harriet, about a mile from our house. I would walk around the lake and home. It took about 90 minutes and I always felt better, until I returned home.

While I walked, I listened on my iPod to the wonderful novel, Norah Webster, by Colm Tobin. Ironically, Norah had a period of sleep problems caused by a pain medication she was taking. She was exhausted, but could only sleep for about 20 minutes at night. During the day she would fall asleep at her desk at work. Finally, she went to her cousin for help, who gave her a strong “sleeping draught.” It knocked her out and let her sleep for 15 hours. I was so envious. I wanted that sleeping draught, but none of the pills I had taken fit the bill. I needed to go back to my doctor yet again, and beg for more help. I also tried to find anything other than a drug that might help me sleep.

Next post: What else can I try to help my body fall asleep?