Christian: Reinstatement Question

[Christian]

Ok. I won't exceed a 1/2 an Ambien again. Also, is it necessary to continue to take Fish Oil since I reinstated ? Or is that used more if you don't elect to reinstate ?

[Skyler]

Ok. I won't exceed a 1/2 an Ambien again. Also, is it necessary to continue to take Fish Oil since I reinstated ? Or is that used more if you don't elect to reinstate ?

 

Christian.. just to clarify, you are going to take 1/2 a tablet of Ambien consistently every night as Alto has advised several days ago (see her post to you of Jan. 24 below).  I am a little confused when you say you will not take more than the half... I am not aware taking more is a consideration at this time.  From what you said, you did not take the half last night, and this is what the discussion is about.  This said, don't take more, don't take less.... 

 

It's all but certain you have an addiction to the Ambien, and if you make a second change this soon, either an increase or decrease, you may sabotage any stability you have gained.  Please work with us so we can better help you.

 

edited to include the last paragraph.

 

PS...

Thanks, Songbird. I'm hoping next time Christian checks in, we'll hear he's been consistent with the Lexapro and Seroquel and down to 1/2 tablet Ambien.

[Christian]

Skyler,

I have re-read my comment many times and don't understand what I have done wrong here. I am only confirming with Alto what the plan is so she knows I understand. Plus I didn't even use one last night so I didn't know if my dose should change as a result. I am working with everyone. That was the point of me giving this update.

[Christian]

I thought not taking one is a good thing. I only am supposed to take it if I can't get back to sleep if I get up at 230 am or so. That is mentioned in a prior post.

[Skyler]

Please be consistent with your Ambien intake. At this point, taking it inconsistently could be adding to sleep problems.

 

Christian... Alto said to take the dose consistently... that means do not increase, and do not reduce.  Take the same amount every night until both you and she decide otherwise. 

 

I don't recall her telling you to take less, and the snippet I just included clearly states she wants you to take 1/2 of a tablet.  With benzos, or any of these drugs.. you could be okay for a day or so.. then the symptoms start.  That's why it's best to keep steady.. When you make a change it should be carefully considered... you cannot effectively taper by deciding what to take on a daily basis, this is an excellent way to keep your CNS in an uproar.. something we are trying to help you to fix!

 

PS... I think you are getting input from other members, and could later be mistakenly attributing that input to Alto.. but Alto's input trumps that of everyone else here.  Hands down, NO contest.

 

edited to add the following.

 

Christian... I have an idea.  How about putting the meds and doses Alto has suggested you take in your sig. line... along with the date of her suggestion.  Then you can keep that right in front of you, and you don't make any changes in what you take unless you specifically confer with Alto.

[Christian]

Skyler,

On January 22nd Alto said "take Seroquel at bedtime and 1/2 Ambien should I wake up." I greatly appreciate everyone's help as I came here for it. But I don't understand how this conversation ended up like this. Yes, I understand Alto's advice is superior to everyone's on these issues.

[Skyler]

When she did tell you to take 1/2 a tablet consistently, you could have brought this apparent conflict to her attention.  In any case, I'm a BIG proponent of the "Keep it Simple" school of thought:

 

See what you think of putting the following in your sig line......

 

Current dose as per Alto's suggestion: 5 mgs Lexapro (time of day?), 1/2 tablet Seroquel  at bedtime (1/2 of a 50 mg. tablet is 25 mgs), 1/2 tablet Ambien upon awakening at night (1/2 of a 12.5 mg Ambien tablet.. 6.25 mgs.)  Each of these taken once daily.

 

You can run this by Alto to make sure she is in agreement, then put this in your sig line for easy reference.. In future, if Alto seems to suggest something other than what you recall, you can immediately ask her about it and refer to your sig.  

 

In the hopeful event you find yourself sleeping thru the night and consequently missing the dose of Ambien, you will need to think about taking it earlier, and maybe quartering the tablet (I'm thinking you will need to do a liquid taper at some point), but until then this would be your schedule.  

 

We can't help you if there is not some way we can all be on the same page, so getting this straightened out is VERY important.

 

edited to add times of the day for doses in the sig line, and the line immediately above this edit.

[KarenB]

Hey Christian,

 

Just chiming in to encourage you that you are doing a really good job of getting through this w/d.  It's complicated, and even more difficult to work out due to being in w/d.  Sometimes things take a little ironing out to ensure that any mis-communications are cleared up - and that can happen from either end.  The written word seems to cause more muddles than spoken words.  But the bottom line is we really want you to get through this okay.  

 

Thanks for all that detail you provided, it allows us to give more accurate advice and therefore you should be getting closer to getting stabilised.  

 

Hang in there  

Karen    

[Songbird]

Anxiety-constant (less intense) 

Social interaction fear-constant- (less intense)

Internal restlessness-constant- not as intense

Obsession with my health-not as intense but still bad 

Dizziness-a little better

No appetite-this has improved

 

Last 3 days havent been as bad as prior weeks. The anxiety is at a slightly lower level. Today I feel a little more rested cause I slept 6-7 hours plus not as many sleeping pills.

 

I'm seeing you reporting quite a lot of improvements, that's good news!  I agree with Karen - I think you're doing a good job of coping with all this.  I know it can feel confusing, especially when you're in the thick of it.  It's important to be patient and let your system have consistency so it can work towards getting stable.  I think you do need to come off the Ambien, but it needs to be done very slowly.

[Rain]

Hi Christian, good to see you have improvements, I feel better these days as well, so I see some hopes, I really wish you keep getting better!

[Christian]

Thanks all for your words of encouragement!

[Altostrata]

I understand Christian to be saying he is taking 1/2 tablet of Ambien per night, when he wakes up about 2:30.

 

Good to hear you're doing better, Christian.

[Christian]

Alto,

I am sorry to bring this to your attention so late but I never really considered it because of my ignorance of these drugs. I was prescribed Trazodone years ago. I was told to take 1-2 50 MG at bedtime to help with sleep. I took it every day for several years. I started taking it maybe 4-5 days a week once I started Ambien as well a couple of years ago. I would sometimes miss days and take an Ambien instead as well. I used it until roughly until November when I switched from al the sleep aids to mostly Melatonin. My question is this. What if there is a slim chance I might be suffering not Lexapro WD but Trazodone WD? What can we do about it now? Try a Trazodone to see if it reduces my symptoms? I see people on here with Trazodone WD and was curious. I never thought they would cause WD. I am probably     this is probably not Trazodone WD but just curious what you thought? Once again, I apologize for not bringing it to your attention prior but it was in my signature. 

[Altostrata]

Could be trazodone withdrawal is contributing to your sleep problems, Christian. Since you're on Seroquel now, I would not experiment with trazodone.

[Christian]

Gotcha. I figured it wasn't wise to go there with the Trazodone while taking Seroquel.

[Christian]

Hi Alto,

I've been on Ambien now 6 weeks straight. I started from one, then two pills a night during this time trying to tackle this insomnia. I'm down to 1/2 a night for the last week or so as you know. Just curious when I make my next taper. I took a 1/2 last night at 3 AM when I woke up knowing I needed to take it. I was up at 6 am and obviously this is probably why I'm so groggy in the AM. This has been a pattern since this all started on 12/24. Part of me thinks it's better to see if I can fall back asleep on my own vs taking the 1/2 pill for just 3 hours. But I know I can't cause I'll go through Ambien WD. Let me know your thoughts when you can. Hopefully your whole Sunday wasn't on this site!

[Altostrata]

Christian, keep everything the same for at least a month. Read

The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

[Christian]

Oh I didn't realize the same rules applied for sleeping pills.

[Christian]

I know Meds cause cognitive issues. But I'm curious if anyone had cognitive issues develop after they quit the meds. Mine started three weeks later. I'm talking hard to follow TV brain fog. Maybe even head pressure too.

[Skyler]

I know Meds cause cognitive issues. But I'm curious if anyone had cognitive issues develop after they quit the meds. Mine started three weeks later. I'm talking hard to follow TV brain fog. Maybe even head pressure too.

 

Christian, the cognitive issues you describe are withdrawal symptoms and they will go away in time.  Head pressure is also a withdrawal symptom.

[Christian]

Thank you Skyler. You made my night !

[Skyler]

Christian.. Alto is trying to get you to take things slowly and not make changes prematurely.. this so you do not needlessly develop more withdrawal symptoms.  As you can see from those you mentioned above, some withdrawal symptoms do not show up for weeks.

 

I moved these posts into your intro thread, because they tell me you are still grappling with an understanding of what withdrawal symptoms are.. and this part of your journey is very important.  As you learn more, you will become more patient with yourself, the process of tapering, and hopefully be less fearful as a result.

 

edited

[Christian]

I understand Skyler. I understand you want me to remain calm. It's hard for many of us when your brain dims when you have to support a family. I'm not alone I know and I know you suffered. When my brain turns back on I promise I'll post less. I'm just trying to determine if my current reinstatement is delaying my brain from turning back on since it shut off due to more than likely as adverse reaction from trying to reinstate a month prior.

[Skyler]

I'm just trying to determine if my current reinstatement is delaying my brain from turning back on since it shut off due to more than likely as adverse reaction from trying to reinstate a month prior.

 

The worry is your anxiety showing... you are over thinking in an attempt to quell your worry, but ruminations of this sort only put your anxiety on jet skis.  Try to refocus your thoughts.  I know you are struggling.  Not easy my friend, not easy at all.

 

Thanks for your thoughts about my taper... I had a good taper, about as good as it gets for someone who has been doing this for some years.  I went very slowly... like the proverbial tortoise, and I am only a few weeks out now from finishing the race.

[Christian]

I hope you make it! Sounds like you will!

[Flowers]

Hi Christian

 

I can't seem to reply to your pm. Do you want to re send it to me?

 

Flowers x

[Christian]

Hi Alto,

 

I have a new symptom i feel I must share. I have been getting intense headaches at night. I have headaches all the time but before bed it is worse. It is shortly after I take my Lexapro and Seroquel. This has happened the last two nights. When I wake up at 1-2 AM its still there and I take my Ambien and fall back asleep. When I wake up again between 430-5 AM its gone. Its not the usual headache. Its intense. Kind of like when I stopped the Lexapro after the one week reinstatement in December. What do you think it might be? It makes me kind of nervous about taking anything but I know that is not the solution. My other symptom is increasing bowel issues (very frequent with diarrhea 50% of the time). Sorry about the TMI there but its always a concern when one has low sodium issues.        

[Skyler]

 

 

Skyler,

 

I am sorry to bother you but I have a question. I have tried to look this info online with no luck. I know you and Alto have told me Ambien can cause increased anxiety and concentration issues. My question to you is can they cause them the next day? I now the concentration issues are from being hungover probably from the drug. I also understand how it could cause insomnia as it stops working after a period of time. But could it be causing anxiety the next day? Or is the anxiety at night when it stops working and I wake up after two hours. I am just trying to understand how these drugs backfire on us.

 

Christian... I'm going to answer this in your thread.  It's okay to PM me to let me know you have a question, but when I respond I'm going to do so there because we need to keep everything of yours together.  Hope this is okay with you.

 

Christian, it's possible you are having interdose withdrawal from the Ambien... this could account for the headaches as well... though I'm going to watch for Alto's answer.  Interdose withdrawal happens when the blood level falls and you start to have withdrawal symptoms between doses.  You can pretty much tell when this happens because you will feel better within a half hour or so of taking the next dose of ambien.   We can't tell for sure about the headaches, because you go back to sleep as the Ambien takes effect, but the fact the headache is gone when you next awake makes me think it's not the seroquel, or the Lexapro, but instead is the Ambien. Good for the accurate log keeping here... this is the sort of info that helps us help you.  

 

The increased anxiety and concentration issues could also be due to interdose withdrawal, or it could be withdrawal symptoms that you are having because you made large cuts earlier on.  Are these symptoms, especially the anxiety, worse in the morning, and then start to get better as the day progresses?

 

Now.. what to do about the iterdose withdrawal.  If I am correct, you are now halving your Ambien tablets... do you have a pill cutter or razor so you can quarter them.. is the pill such that you can do this?  It looks like we are going to need to help you make a liquid from Ambien at some point, but for now you may be able to get away with quartering the tablet.  If you can do so, you need to take a larger quarter, then a smaller quarter, etc. so as to more evenly split the dose.

[Skyler]

PS.. Christian, if you can quarter the Ambien, we'll work on walking the second dose back an hour a day, until you take the two doses 12 hours apart.  Doing this may also help with the sudden awakenings you are having.. (and possibly not), but my guess is the headaches may improve.. so it would be worth a try.  Alto, thoughts?

[Christian]

Thanks, Skyler. I have a pill cutter and also I had my Dr provide an RX for 6 MG of Ambien vs the 12.5 MG tablets I had. He also didnt like the fact my Psychiatrist prescribed Seroquel to get off of Ambien. He said Seroquel is too sedating. I dont know which is worse between the two. Below is the timeline of my Ambien usage if its useful......

 

 

Ambien Dose Timeline

12/12/15-1/1/16- 1 tablets 12.5 MG a night

1/2/16-1/23/16- 2 tablets 12.5 MG a night 

1/24-2/4/16- 1/2 tablet 6MG

[Skyler]

Okay... I'm going to give you a schedule to start walking the dose back.. pending what Alto says of course.

 

Good on you for getting the 6 mg Ambien tablets.  That will help.

 

See what you think of the following..

 

Take 1/2 a 3 mg tablet when you turn in tonight (or tomorrow night, wait until Alto weighs in to start), with the Seroquel.  Do this tomorrow or the next day as well.  I'm guessing you take the Seroquel around 10PM?  See how it goes for the two nights, then move the 3 mgs of Ambien to 9 PM, then to 8 PM, etc... an hour further apart each day until you are taking 3 mgs of Ambien at 2 PM and 3 mgs. at 2 AM.  Then let's see if any of the symptoms you reported above improve.  Sound doable?

[Christian]

Wow. So I will be taking them in the middle of the day? I will more of a zombie than I am now. Im not saying no I just didnt realize I would be taking them during non sleeping hours. I wish I knew this when I was first prescribed Ambien! 

[Skyler]

Wow. So I will be taking them in the middle of the day? I will more of a zombie than I am now. Im not saying no I just didnt realize I would be taking them during non sleeping hours. I wish I knew this when I was first prescribed Ambien! 

 

You could cross taper to diazepam, but I don't want to go there at this point, it might be easier for you than making a liquid, and your doc would need to be on board.  For now, how about moving the doses to rule interdose withdrawal in or out.. and once we determine if that's the culprit, we'll go from there.

 

 

The increased anxiety and concentration issues could also be due to interdose withdrawal, or it could be withdrawal symptoms that you are having because you made large cuts earlier on.  Are these symptoms, especially the anxiety, worse in the morning, and then start to get better as the day progresses?

 

Christian.. you did not answer my question..  See above.

 

It's more more likely you are having withdrawal symptoms and interdose withdrawal from the benzos and z-drugs (and other precipitous changes), than an immediate adverse reaction to Lexapro or Seroquel.  I know you are struggling with this.. that it makes more sense to you that the last dose of a medication must be the cause of any symptoms you may be having, but you are not accounting for the half lives of these drugs, nor the way withdrawal symptoms manifest in your body.  Please try to stay with us on this, it's VERY important.

[Christian]

 

Wow. So I will be taking them in the middle of the day? I will more of a zombie than I am now. Im not saying no I just didnt realize I would be taking them during non sleeping hours. I wish I knew this when I was first prescribed Ambien! 

 

You could cross taper to diazepam, but I don't want to go there at this point, it might be easier for you than making a liquid, and your doc would need to be on board.  For now, how about moving the doses to rule interdose withdrawal in or out.. and once we determine if that's the culprit, we'll go from there.

 

 

The increased anxiety and concentration issues could also be due to interdose withdrawal, or it could be withdrawal symptoms that you are having because you made large cuts earlier on.  Are these symptoms, especially the anxiety, worse in the morning, and then start to get better as the day progresses?

 

Christian.. you did not answer my question..

 

It's more far more likely you are having withdrawal symptoms and interdose withdrawal from the benzos and z-drugs (and other precipitous changes), than an immediate adverse reaction to Lexapro or Seroquel.  I know you are struggling with this.. that it makes more sense to you that the last dose of a medication must be the cause of any symptoms you may be having, but you are not accounting for the half lives of these drugs, nor the way withdrawal symptoms manifest in your body.  Please try to stay with us on this, it's VERY important.

 

I didnt mean to not answer. Its hard to say. Ill try and explain it. When I wake up at 430-5 AM I am not in terror like many people are. Its only once I realize how exhausted and drugged I am that I get the anxiety in the AM. Ill get up and be so sleepy anxiety quickly increases from still being in this situation. The exhaustion is unbearable until noon.  Anxiety kicks in in the afternoon until the evening where I have more of a wired feeling.  I hope I answered your question. I wonder if it would be better to have no sleep without meds than 4 hours with meds.      

[Altostrata]

Hi Alto,

 

I have a new symptom i feel I must share. I have been getting intense headaches at night. I have headaches all the time but before bed it is worse. It is shortly after I take my Lexapro and Seroquel. This has happened the last two nights. When I wake up at 1-2 AM its still there and I take my Ambien and fall back asleep. When I wake up again between 430-5 AM its gone. Its not the usual headache. Its intense. Kind of like when I stopped the Lexapro after the one week reinstatement in December. What do you think it might be? It makes me kind of nervous about taking anything but I know that is not the solution. My other symptom is increasing bowel issues (very frequent with diarrhea 50% of the time). Sorry about the TMI there but its always a concern when one has low sodium issues.        

 

Christian, I thought you had move the Lexapro to earlier in the day????

 

If you're concerned about low sodium, you need another electrolyte test.

 

As Skyler noted, I think it is possible you are getting rebound anxiety from Ambien. The half-life is 3-4 hours, you'd get rebound when it wears off.

 

If you're taking it at 2 a.m., you'd get rebound in the mid-morning.

 

Ambien hangover may account for your morning fatigue, too.

 

Are you taking an entire 6mg Ambien or are you taking 3mg, half a 6mg Ambien tablet?

 

You must take care not to complicate your problems with health anxiety.

[Christian]

 

Hi Alto,

 

I have a new symptom i feel I must share. I have been getting intense headaches at night. I have headaches all the time but before bed it is worse. It is shortly after I take my Lexapro and Seroquel. This has happened the last two nights. When I wake up at 1-2 AM its still there and I take my Ambien and fall back asleep. When I wake up again between 430-5 AM its gone. Its not the usual headache. Its intense. Kind of like when I stopped the Lexapro after the one week reinstatement in December. What do you think it might be? It makes me kind of nervous about taking anything but I know that is not the solution. My other symptom is increasing bowel issues (very frequent with diarrhea 50% of the time). Sorry about the TMI there but its always a concern when one has low sodium issues.        

 

Christian, I thought you had move the Lexapro to earlier in the day????

 

If you're concerned about low sodium, you need another electrolyte test.

 

As Skyler noted, I think it is possible you are getting rebound anxiety from Ambien. The half-life is 3-4 hours, you'd get rebound when it wears off.

 

If you're taking it at 2 a.m., you'd get rebound in the mid-morning.

 

Ambien hangover may account for your morning fatigue, too.

 

Are you taking an entire 6mg Ambien or are you taking 3mg, half a 6mg Ambien tablet?

 

You must take care not to complicate your problems with health anxiety.

 

I am not stressed about my low sodium. Only my WD recovery. My Dr is more concerned than me as he told me yesterday I need to come off Lexapro if I have low sodium in two weeks when I get labs for it. We agreed 2.5 MG of Lexapro in the AM and 2.5 MG at bedtime. I only take 1/2 an Ambien pill (6MG) at 1-2 AM when I wake up. That will keep me asleep until 4-5 AM. Ok so the rebound anxiety starts when it wears off not later in the day?