Taking the full, 10mg dose of Ambien “worked” better than the 5mg dose I tried two nights ago. I say “worked” in quotes because it’s confounded with lots of other things. For one, I was already more sleep deprived. For another, my anxiety is coming down somewhat about my diagnosis and what to do about it. That alone should help me sleep.
So, the fact that I woke at around 4:45AM on 10mg instead of 2:15AM on 5mg may not have been caused by the dosage difference. Also, to be more precise, on 5mg, I slept from 9PM to 2:15AM (5.25 hours), with a few, trivial moments of sleep thereafter, which hardly count. On 10mg, I slept from 10:15PM to 4:45AM (6.5 hours), with a bunch of quite nice, multi-minute dosing until 6AM (so, let’s say I got more like 7.25 hours of sleep).
But, still, what woke me both times, and interrupted my dosing thereafter, were apnea events. I’m sure of that now. This ain’t no insomnia of yesteryear.
So, my fundamental question remains: As I wait for the gears of the health system to turn to deliver me a longer-term treatment, how can I best remain unconscious during/through those events? My trouble spot is typically 1-2AM onward.
One physician recommended a dose of sublingual zolpidem (brand: Intermezzo), taken in the middle of the night. The purpose of this variant is that it is intended to treat difficulty returning to sleep from nighttime waking. I would like to try it, but my PCP hasn’t provided a prescription. The active ingredient is the same as Ambien, so I’m tempted to try a half dose of that tonight in the wee hours, maybe chewed up to speed its delivery. Crazy? (Anticipatory concern: If I end up using Ambien for a week or two, I wonder how to come off it. Taper? Or, should I not use it regularly over that span? Take a break every few nights?)
1. While dosing intermittently this morning, I messed around more with a pile of pillows to try to get the tongue gravity assist I wrote about yesterday. I don’t think it helped. Maybe the gravitational force one can get to act on the tongue while sleeping on one’s side — constrained by the limits of comfortable neck contortion — is simply not enough. I forgot to try some sort of stomach sleeping, but I’m pretty sure I won’t find that easy to pull off.
2. I’m on a retreat with a bunch of buddies, three of whom have OSA. All use and like their CPAP machines. Two have given me demos of theirs. They are way quieter than I imagined. They’re also bigger than I had hoped, particularly with the humidifying attachment, which also acts as a noise dampener. (Cleverly, one fellow puts ice in his humidifying compartment in the summer.) We talked at length about all the wonderful and annoying things about the machines, masks, etc. (I’ll talk to the third friend today. He’s also used oral appliances.) One thing they suggested is that if I am going on a short trip and don’t want to be bothered bringing the machine, I could just not. My case is mild and I can get a passably decent night sleep with a dose of Ambien (or maybe even without it). Be flexible. It’s nice to have a support group.
3. A TIE reader and sleep specialist physician in Calgary reached out to me. After some email, we spoke by phone for an hour yesterday, going over all my questions. This was AMAZING! I am incredibly grateful to him for the time. It’s exactly what I needed and was not getting from the US health system, within which I feel like I’m on a conveyor belt. No clinicians I’ve seen here want to talk about all the confusing issues I’m dealing with. This is all old and boring to them and I’m just one patient of dozens they have to cram into their busy days. It sucks. This kind Canadian offered to try to help me find someone locally who would give me the attention I want, if that’s possible here.
He also sent me some reading:
- Canadian Agency for Drugs and Technologies in Health’s evidence review on OSA treatments. It’s more current than the ICER or AHRQ reviews I had reference in prior posts.
- An even more recent clinical review
- A collection of patient resources