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Comment by bxtt | Hacker News Reader

I’ve been taking Zolpidem for about 13 years now and suffer from addiction. I’ve sought treatment for this but it doesn’t work as now I cannot sleep without taking something. If you haven’t taken Z-type sleeping aids, I would definitely suggest not to start, as from experience the consequences outweigh the benefits. I’ve lost a considerable amount of friends/reputation/etc. from the abuse. Every experience that you hear about from sleeping aids, I’ve been through it (from the loopy fun to binge eating to weird sex to psychosis to crashing my car)

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Take this with all the weight a message board advice from a non-doctor is worth but have you tried Trazodone instead? It’s used widely for sleep issues and it’s effective for many. And have you looked at something like Ketamine for a possible long-lasting solution?

I had a good experience with Trazadone. Very easy to get to sleep, eliminated anxiety about going to sleep, and got restful sleep, with only a little grogginess in the morning. No withdrawal when I stopped cold turkey after 2 years. Nowadays I just have valerian tea or magnesium before bed.

Trazodone has a mild side effect profile, but it is an anticholinergic. You don't want to do it long term; there is an association with dementia.

Seconding Trazodone. It is not addictive but does have a rebound effect if you discontinue it without weaning yourself down.

I got a subscription for 1 package when I had major sleep issues as a young adult and i immediately wanted more. Best 2 weeks of sleep i ever had. Luckily the doctor did not allow another subscription

I really like zolpidem and other substances. I almost never took them for more than 3 consecutive days. I still have a lot of zolpidem laying around and don't take it, because I know the brain gets uses to them and the magic is gone. Amazing how people react differently to addicting substances.

Back when I used zolpidem, I found that it is best to use it as a reset button, not as a daily crutch.

I do take 300mcg melatonin but I found it has no diminishing returns and in fact it has a negative feedback -- after 3 days of melatonin, I don't need it for at least another week. I keep the zolpidem for "recreational" usage, but I don't want to use it with my wife and daughter in the house in the remote possibility I get sleepwalking(never actually happened, I just get amazing auditory hallucinations before I fall asleep).

When you immediately want more of something is a REALLY good sign to walk away.

Same here. Got like 2 weeks' worth once, a few years ago. Never had a better sleep than on the Z-s.

That bums me out. I’ve tried two different z-types for very occasional days where I need to get up early - maybe 4 days a year. Anyways, I feel like I’ve had 2 hours of sleep on them even when I get a full 8 or 9 hours. They must really disrupt my sleep patterns.

(Genuinely curious and not trying to downplay the seriousness at all)

What would happen if you took a month off work and all your obligations and stayed home and didn't take anything for a whole month? My understanding is the human body can't go more than about 10 days without sleep [1].

So I assume at that point you would fall asleep, and then over the coming ~20 days hopefully you could normalize it and get back to some kind of unassisted "regular" sleeping.... ?

[1] https://www.healthline.com/health/healthy-sleep/how-long-can...

I've actually decided to take some time off work because of my addiction issues. It's more so the cycle. I'll stop taking Zolpidem/Zopiclone for several weeks/month (the first several days -- terrible shakes, chills, nightmares, several days without sleeping etc. Zopiclone/Benzo withdrawal is far worse) After a while, I'll eventually adjust but I have insomnia/poor sleep so I'll eventually cave in due to sleep deprivation then I'll pick back up.

For the past year, I would roughly take 90mg of either Zolpidem/Zopiclone in a single night. On average, I roughly go through 100 pills a week (I have pharmacies that sell to me...I know sketch).

It wasn't always like this, when I first started taking medication after going to Stanford Sleep Clinic, I would just take a pill or two a night and have fantastic sleep. It was like this for several years but eventually my tolerance increased and my work stress/insomnia got worse with age.

I want to reiterate that I've destroyed/damaged every meaningful relationship in my life. I state this all out because I've realized that people have a strange fascination with Ambien.

I can understand the strange fascination with Ambien. My wife was prescribed it one time. She would take it and then soon after want to have sex. Mind blowing sex (for me) every time. She was insatiable and wanted to do things way outside her norm. But the next day she had absolutely no memory of any of it. That weirded me out and I encouraged her to stop taking them. Though to be honest I wouldn't mind one or two of the ambien fueled sex sessions a year. Absolutely mind blowing, but also exhausting.

That really makes you question how much free will we have, if a drug can produce that kind of behavior and affect short term memory.

But more fascinating still is what functionality in the brain even enables that.

I'm of the school of thought that we have at 2 minds, my guess is this drug inhibits our egoic executive mind and our unconscious mind takes over.

I've been witness two sleepwalking events with different peopl. Both were fully conversant and aware of their surroundings, they just did odd things and we assumed they were drunk. Later we found out about the ambien and how neither had any recollection of the event.

It’s often a question of how much.

Do we have free will when sleeping? No. There goes a large part of our life.

How about when zoned out? No.

Do we ever have free will? Atheists looking at the scientific evidence argue that we never have free will.

If I were you (and I was) I'd seriously consider going to rehab. They'll have experience easing your withdrawal symptoms and getting you on a road to breaking the cycle.

For the past year, I would roughly take 90mg of either Zolpidem/Zopiclone in a single night.

Holy crap. The typical dose is 5 mg or 10 mg. I’ve taken 10 before and I’m out.

90 mg?!?

According to Wikipedia, withdrawal symptoms can be severe including seizures, vomiting, etc. To do nothing of the discomfort from a lack of sleep. It would take incredible will power to overcome something like that.

It also sounds like there are some treatments that can help fight an auction, including other medications that bind to some of the same receptors. Or very slowly weaning someone off (but then you have to figure out something else for the insomnia.)

10 days without sleep is a great recipe for an epileptic seizure. Don't experiment with this kind of stuff without consulting a neurologist / sleep expert.

I periodically used to periodically take a day off work and sleep pretty much the entire day to refresh myself during periods when I was having trouble sleeping at night. I found getting yourself back to sleep when you never get to 100% awake is a lot easier than getting to your initial sleep, of course this was with rather mild sleep issues related to stress and anxiety.

This isn’t really an option anymore as a father of young kids

I've had some weird side effects from Zopiclone. They're effective, even when benzodiazepines haven't been, but the side-effects are concerning. On multiple occasions, I've woken up and the room appears to bathed in a yellow light (even though no lights were on and it was still dark outside), and on a few occasions I've been looking at the time on my phone, blinked, and it's suddenly four hours later. I've no idea whether I just fell back asleep and checked the time again, four hours passed and I did _something_, or it just made me misremember the first time. They're not drugs I would use lightly.

Benzodiazepines on the other hand I've had no issues with (no desire/need to increase the dose, no withdrawal even when I've been taking them for prolonged periods, no side effects), but I don't find them as effective. I have seen the destructive effects they can have though - a family member had to taper off them over six months, and at the end she was cutting the smallest dose tablets into quarters as she still couldn't quite get off them.

I had a week course of Zolpidem and it only worked first two nights. The rest was what some describe as the visit of a walrus. I thought I was sleeping but I was doing things.

Could you elaborate on that phrase 'visit of a walrus?'

I googled around and found that walruses sleep in some pretty weird positions. Is that what you're referring to?

Super curious.

Op was most likely referring to the Beatles song.

https://en.wikipedia.org/wiki/I_Am_the_Walrus

Edit, just kidding, it's this: https://knowyourmeme.com/memes/ambien-walrus

Oh nice catch I never would have discovered that one.

that's horrifying, so sorry for the situation you're in right now.

Ah geez dude, I’m sorry to hear this. Getting over benzos was a huge, year-long drag. But you’re going to need to do that at some point...

Is it possible to very very slowly taper over a long period of time? Like take a 5 pct lower dose every week by scraping off some and using a scale?

Seriously, tell your doctor. They will stop prescribing these and help you find an alternative that works and has less potential for misuse.

Op should work with their doctor to taper off.

Try getting prescribed seroquel instead. A lot more powerful, and will help you sleep. Less (known?) downsides as well. I guarantee you that you will be able to sleep with it.

I am happy that this works for you, but you can't really compare a Z-Drug with an atypical antipsychotic. That's some dangerous medical advice.

Also (from wikipedia) on Seroquel / Quetiapine: "Despite being widely used as a sleep aid due its sedating effect, the benefits of such use do not appear to generally outweigh the side effects."

https://pdfs.semanticscholar.org/8812/afd4bc713c03435b68f2bb...

Personally I would only take antipsychotics when absolutley necessary. Nasty stuff.

He's saying prescribed seroquel. That means he would have to consult with his physician beforehand.

This guy drove away his friends, crashed his car and had psychotic episodes. During a 13 year addiction to the zolpidem. That's way past the "there may be some side effects" phase.

This is a gross misunderstanding of what Seroquel is used for. It's one of those medications that several different side effects depending on the dosage.

Yes, it can be used as an anti-psychotic. However, in most of the cases I've heard, it's used as a sleep aid.

This was the case for me, too. I was on it for 10 years and ultimately went off because I grew out of my chronic insomnia. Aside from a muted personality and nightmares (the latter controlled by another medication), it was pretty fool proof and had very little consequence in my particular case.

As always, it depends on the person, but the blanket statement you quoted doesn't seem fair.

Seroquel is quetiapine. People are calling it an anti=psychotic because it is an anti-psychotic. That's its main use, and that's what it's licensed for.

https://bnf.nice.org.uk/drug/quetiapine.html

https://www.nami.org/About-Mental-Illness/Treatments/Mental-...

> Quetiapine is a medication that works in the brain to treat schizophrenia. It is also known as a second generation antipsychotic (SGA) or atypical antipsychotic.

If doctors are prescribing seroquel for sleep problems i) that's pretty scary and ii) it's an off label use.

EDIT: here's the FA information showing that seroquel is an antipsychotic and is not licensed to treat sleep problems. https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/02...

Quetiapine is labaled an anti-psychotic yes, but its pharmacological characteristics are not that straight forward. It has a much higher affinity for H1 (histamine) receptors than for D2 (dopamine) receptors. Meaning that in low doses it acts like an anti-histaminergic drug, having a very limited effect on dopaminergic systems. Around 60% of D2-receptors need to be blocked for a typical anti-psychotic effect, and that is nowhere near what is happening with say 50mg of quetiapine, which is a normal dose for sleeping aid. In those low doses it mainly acts on H1, alpha-1, M3, M1, and some 5HT type receptors. At a minimum of 300mg per day, it pharmacologically starts to act as an anti psychotic.

There is a nice brief summary of this in Stahl's Essential Psychopharmacology.

To be clear, I am very much against prescribing anti-psychotics as sleeping aids. But I don't think there is a strong case for calling quetiapine anti-psychotic in low doses.

> Yes, it can be used as an anti-psychotic. However, in most of the cases I've heard, it's used as a sleep aid.

I've never taken anti-psychotics. I've asked my doctor for anti-depressants a few times (usually during relationship issues) and they are not my thing.

You're not a medical doctor, right? Obviously, or you wouldn't be giving out such frivolous advice. Dude... it's an anti-psychotic drug.

And? Do you even know what that means?

If you're referring to anti-pyschotic drugs, then no, I don't - at all. I meant no offense, I was just suggesting caution that's all.

Edit: I just wanted to acknowledge that there are probably a lot of beautiful people who find this drug helpful. I didn't mean to get down on you, I struggle too. I'm sorry if I jumped the gun with my statement.

Please point to where I gave advice.

Looks like that poster is in a completely different category from the general population. It says so in your quote as well: "does not appear to _generally_ outweigh the side effects".

That's a rather common mistake and I'd guess many doctors do it as well. Treatment risk depends only on alternatives. A pill that gives your a 0.01% chance of sudden death is an absolute no-go for genpop, but may be heaven-sent for a particular patient.

I've taken it for over 10 years and am better than ever. Hasn't suffered any harmful side-effects either. Of course, side-effects differ from person to person. But it's worth a try. Z-drugs and benzos are way worse.

Moreover, if you're severely addicted to Z-drugs like OP, the benefits probably do outweigh the side-effects. Not every person is the same, and the cost benefit analysis differs accordingly.

Antipsychotics ruined my life and gave me tardive dyskinesia.

Could you expound? It's always been in the back of my mind and I take a fairly low does, but would love to hear more about how it started, symptoms, and how it's affected your life.

I'm really sorry, that sucks. There is some new medication that is supposed to treat it (I think I saw an ad on TV for it).

I took olanzapine 5mg for a while, but my doctor kept increasing the dose as I was "non-compliant" up to 10mg, then more to 20mg as I kept getting hospitalized for compulsive suicide attempts because the medication completely axed my judgement.

I gained about 40 pounds on it, developed dyskinesia after about 6-8 months and ended up cold turkeying off of it, but 5 years later, the movement problems still stay... Unfortunately it also destroyed my executive function too; I can barely even string together coherent thoughts and perform programming work without being overly medicated on ADHD drugs.

I know there's valbenazine and other Parkinson's drugs (selegiline works decently enough on a daily dose, but MAOIs can become dangerous in certain circumstances), but they don't solve the root problem.

Now I can barely even control my hands, legs or face and it's mildly disfiguring, but it's not like I care anymore...

Same. I’ve been on Zolipdem for about 5 years now ya amazing not to take 2 or 3 hours to fall asleep.

I’ve never had any meaningful side effects. No sleep walking, binge eating, or anything.

I am certainly, in the clinical sense, addicted - eg if I miss a dose I certainly notice, and there is some degree of tolerance, but I’m still better off than before I went on it.

> I am certainly, in the clinical sense, addicted - eg if I miss a dose I certainly notice, and there is some degree of tolerance

I believe the correct term is "dependent".

There is a lot of misinformation and stigma out there, so I think it's really important to distinguish between addiction (e.g. insatiable cravings), medical dependence (e.g. someone taking anti-psychotics because they will otherwise have psychotic episodes, or someone taking antidepressants because they otherwise have manic depressive episodes), and physiological dependence, where your body's receptors have up/down-regulated to adjust to a "new normal", and withdrawal symptoms may occur if treatment is stopped.

I've been here too! Took zopiclone for a bout of insomnia but after two weeks I was dependent, either I wasn't sleeping without it or the quality of sleep was terrible if I tried going natural. Got prescribed Quetiapine at 25mg, which at that dose is not for psychosis but sleep (or an adjunct for people with bipolar, which is not my case either) Only needed 3-4 days of it and I could reset myself, back to normal sleep. Was already scared that I'd become dependent on this, but atypical neuroleptics in low doses are less associated with tardive dyskinesia. Do seriously consider it. Otherwise you could try an antidepressant with sedative qualities, like trazodone or mirtazapine, both very effective too. Best of luck to all, insomnia sucks.

Seroquel makes you wake up. at night and wanna eat chocolate. Too much of it makes you feel like a zombie the next day. SCAREQUEL should be the name. Ive sleep walked on that stuff

Lol, for me it's cheerios.

Non z drugs that make u sleep exist too such as the new OX Based sleep meds such as Lemborexant

Use for sleep is off label but some psychiatrists still do it. Don’t expect anyone to offer it as a replacement without a very good reason.

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