Sleeping pills stop the brain's system for cleaning out waste
arstechnica.com
arstechnica.com
I have a loved one who takes 1x/day of lowest dose of Ambien - and has for years. It's effective for them and is key for their functionality. They have never exceeded their dosage.
Their Dr (2hrs away) was replaced by a Dr who is hostile to responsibly prescribing sleep meds - a reflection of ever reactive medical laws being added to the books every year. It's the primary reason my loved one is migrating to another state.
Another loved one has the exact same story except it's ADHD meds. Their newly assigned Dr is openly hostile to them.
I have the same story as above. After 15y of responsible Adderall use, the practice I use was bought out and my Dr replaced by one who is slowly yielding to the ceaseless gov (DEA, state agencies) pressure stop prescribing ADHD meds.
A close/aging friend has crippling arthritis which he kept at bay with responsible opioid use for years. Until the nuance-less drumming against opioids led to the state to pass a 3-day-max Rx law. Afterward, his choices became black market or crippling pain.
Thankfully, kratom has walked that back somewhat. At least until short-sighted lawmakers take that away too.
Fed & state govs continually ratchet up pressure to abandon these effective meds; our doctors keep giving ground.
These drugs certainly improve quality of life for some people, but they have legitimate dangers. As we begin to understand them better, I think it's a good thing that we become more cautious in our approach towards recommending them to people.
I don't know your friends, and I cannot presume to know the exact details of their situations or their exact prescriptions. But have you ever considered that they're addicted?
Ambien (Zolpidem) is only prescribed for short term use (around 2 weeks) nowadays because of the risk for addiction and various psychological side effects (aggressiveness, agitation, even minor amnesia). But you said your friend has taken those pills for years and *plans to move to another state* just to get more of them?
As for your friend who has taken opioids for years, it's certainly possible to take them irregularly for years and remain in control. However, most people who regularly take opioids for several years become addicts.
I genuinely wish the best for all of your friends, and of course I hope we can invent better pharmaceuticals to treat these issues without the risks of current options. Unfortunately, quite a lot of people have had their lives ruined by those drugs, and I think your stance on this is underestimating the larger harm to society that they present.
When sleep issues are caused by mental conditions you can generally address them. But when it's the side effect of something physical the attempts to address such things without drugs do not fare very well.
> When sleep issues are caused by mental conditions you can generally address them. But when it's the side effect of something physical the attempts to address such things without drugs do not fare very well.
Actually, there are plenty of ways to improve sleep quality without drugs. Typically, Zolpidem is prescribed only after those methods have been tried. But again, the prevailing medical guideline is to only use drugs like that for a short term period in the neighborhood of 2 weeks. It's not recommended that you use them for years, even at a low dosage or on an irregular schedule.
This is a good illustration of my point. You express this concern as if we haven't had decades of relentless - and insanely disproportionate - demonization of these meds.
> But have you ever considered that they're addicted?
Of course. My repeated inclusion of responsible use is a strong signal that the risks (which are relentlessly bullhonred at us) have been considered.
> Ambien (Zolpidem) is only prescribed for short term use (around 2 weeks) nowadays because of the risk for addiction and various psychological side effects (aggressiveness, agitation, even minor amnesia). But you said your friend has taken those pills for years
This leaves out every key part of my assertion. It omits that they take the lowest manufactured dosage (a dosage so low, it can be difficult to source). It ignores the med is consistently effective and enables functionality. Omitting those details increases the alarm factor in your presentation and it sacrifices the nuances of our actual reality.
What you did there is important. Altering my point this way completely diminishes our challenges.
Once our challenges are cut from the discussion, you have room to present an anti-med narrative - the same narrative that fuels the harms being done to us.
> But you said your friend has taken those pills for years and plans to move to another state just to get more of them?
At this point you are presenting one surgically altered context after another. The context of my statement said
>a reflection of ever reactive medical laws being added to the books every year. It's the primary reason my loved one is migrating to another state.
.
You keep mischaracterizing my points, severely. This could be reasonably interpreted as bad faith on your part. However, I don't believe you're acting in bad faith.
Instead, I think you rewrite my statements inside your head. Once done, I think what you have doesn't reflect what I wrote.
I don't think it's disproportionate at all. These drugs can be extremely helpful for some, and they can be life ruining for others. There were > 80,000 deaths in the USA from opioids in 2022, including > 14,000 from prescription opioids. Those numbers are specifically for deaths, but many more are struggling with addiction as a result of their usage. If we can invent a superior class of pain relievers in the future with a lower potential for dependency, and perhaps less recreational appeal as well, it would save quite a lot of lives.
> It ignores the med is consistently effective and enables functionality. Omitting those details increases the alarm factor in your presentation and it sacrifices the nuances of our actual reality.
I never ignored effectiveness. I have no doubt that taking the ambien helps your friend sleep, or that opiates treat your other friend's pain well. For some, the benefits certainly outweigh the negatives, and as I said previously, I wish all the best for your friends.
> You keep mischaracterizing my points, severely. This could be reasonably interpreted as bad faith on your part. However, I don't believe you're acting in bad faith.
I'm not acting in bad faith. I genuinely believe that doctors should be cautious when prescribing those drugs, and that the public should be well educated about the risks of those medications. I think that if you take a step back and remember that hundreds of thousands of people have died from these drugs in a completely preventable tragedy, you might concede that it's not an "insanely disproportionate demonization" but rather an understandable reaction to a public danger.
And they're making the fundamental mistake of thinking you can cut a waste problem by cutting supply. No, in the real world the waste is better at defending itself and you end up disproportionately cutting the good.
There are dozens and dozens of classes of compounds that people take as a sleep aid. The differences between their actions can be immense.
I’ve given up on the CPAP, and I’ve managed to get off the Zolpidem as well…not that it’s addictive, but it was still the most effective way of getting me to drop off, though I have a tendency to wake up in the wee hours and have trouble getting back to sleep. I didn’t feel comfortable taking the Zolpidem long-term.
My doctor suggested melatonin. 1 mg is what she recommended, and it has been as good as the Zolpidem ever was at making me sleepy, and better at keeping me asleep.
I've always been like this but then I developed full-fledged insomnia 5 years ago. I also have a noisy brain and will happily chatter to myself all night long.
I could treat night owling and busy brain with some mental techniques and occasionally a rotation of low-dose chems.
To treat my insomnia, I found that a cocktail of (mostly OTC) chems at very low doses gives the best possible outcome. It's less risky and more dependable than amping up a single med.
My understanding is the body adapts quickly to the initial dose(s) of melatonin. That is, what you start at is what you'll need.
Stores offer dosages that are much higher than a first-time user needs. But non-users don't know that. The result is people using a lot higher dosages than they need to.