An Insomniac goes Cold Turkey After a 12-year Dependency on Ambien.
My battle with insomnia began the night before my first day of eighth grade and lasted almost sixteen years.
While I can’t tell you the exact cause, a lot of things were going on which may have contributed: my best friend moved away, which caused me great anxiety and depression; I anticipated my classes getting harder; and last but least, I’d recently gotten my first period. So the causes could have been physical, emotional, chemical, hormonal, or most likely, all of the above.
In high school, I had a host of other factors contributing to my insomnia. I spent most of my sophomore year in an abusive relationship, while at the same time struggling to balance my straight A’s, my friendships, and my identity, all in a place I didn’t always feel like I belonged. I was anxious and depressed, which only made sleep even more difficult. As a result, I learned to function on very little sleep. I could take tests, study, drive, and party with my friends. My doctor prescribed a low-dose antidepressant to address my insomnia. In addition, my mother was a NICU night-shift nurse, so occasionally I tried her “remedies:” popping a couple of Benedryl tablets, or drinking Sleepytime tea. But none of the remedies I tried were very effective in solving my insomnia.
My senior year, I met a girl who worked at a health food store and swore by Valerian root as a sleep aid. Valerian worked for about a year, but by this time I had started college, so my new remedy was to drink until I passed out.
When I came home for winter break, that same friend had been prescribed the new “wonder drug” for sleep. Ambien didn’t knock you out as hard as Trazodone or leave you in a fog all day like Halcion. Best of all, it was said to be non-habit forming. When my friend brought me one of her pills, she warned me of the one weird side effect she’d experienced: if you tried to resist falling asleep, you hallucinated. At eighteen, this did not seem like a bad thing. In fact, we did it on purpose that night. After building “nests” for the aliens out of my dirty laundry, I collapsed into the best night’s sleep in five years.
“Salvation, thy name is Ambien,” I thought. I went straight to the doctor for a prescription, which I continued for the next twelve years. While Ambien never stopped working for me, it did eventually become less effective. My doctor kept prescribing a higher dose to compensate. Over the next four years, I went from taking 5 milligrams a night to 35 milligrams a night, plus Valium or Sonata. I probably would have kept increasing from there, but once I turned 23 and was no longer covered under my mom’s insurance, I couldn’t afford the out-of-pocket expense for a higher dose.
I scrambled for alternatives. I went to hypnotherapy, which got me back down to five milligrams of Ambien a night. Although my doctors continually insisted that Ambien was “non-habit forming,” I found I couldn’t sleep a wink without even a small dose.
“You might experience a little kickback,” one sleep expert explained.
“You mean like withdrawal?” I asked.
“No, no, just a little kickback.”
No, no, it was definitely withdrawal. The nights I tried not to take it were spent wide awake, sweaty, and dry-mouthed.
Over the next six years, I racked up credit card debt to pay for my Ambien prescription. I even became a lab rat by volunteering in an experimental program that tested seizure medication to treat insomnia. These medications caused terrible dizzy spells, and didn’t improve my insomnia.
Eventually, I got a job with good health benefits and a new doctor. She was horrified when she looked at my history, but said it was typical. “Any solution Western medicine has ever come up with for insomnia is bullshit,” she told me while writing a script for Ambien, as there was nothing else she could do for me. “You should see if your insurance covers acupuncture.”
It didn’t, but after all the debt I’d racked up on drugs never fixed me, why not spend a little more for something that might? By then, I was almost thirty and sick of feeling like I had no control over a major part of my life—sleep. I had quit smoking, I ate a healthy vegan diet, and I exercised regularly. I cared a lot about my body, so no matter how many doctors told me it was fine, it did not feel right to pump myself full of drugs.
My Pilates teacher taught me meditation techniques to help with my insomnia, and so she was thrilled when I approached her for a referral for an acupuncturist. She told me that I would need to get off of Ambien for the acupuncture to work. We discussed tapering off, but since that had never worked for me, I decided to quit cold turkey when my prescription ran out.
That “little kickback” I had been told about meant a total of three hours of sleep that first week. I felt like a walking corpse, every part of me aching. It seemed like work to breathe, let alone think, but somehow I muddled through my nine-to-five days before my body finally crashed. By the next week I was able to sleep three hours a night, which felt like heaven in comparison.
Slowly, through weekly acupuncture treatments and daily doses of Chinese herbal medicines, I was getting a restless six hours a night, which was comparable to a low dose of Ambien.
Then I had a setback. Just before the release of my first book, a good friend of mine was killed in a motorcycle accident. I had to travel and promote myself while I was grieving—and grief for me meant lying awake all night, feeling hollow. I felt I had no choice but to take Ambien again. I stayed on it for a month-and-a-half before forcing myself to quit again. I only experienced a two-day “kickback” that time and soon I was back to my restless six hours a night.
Grateful as I was to be sleeping at all without anything stronger than herbs, my true goal was to sleep like a normal person: drifting off in no more than twenty minutes and getting seven to nine hours of solid sleep each night.
After about a year of acupuncture and herbs, my friend sent me a link to a New York Times article claiming that Cognitive Behavioral Therapy (CBT) was the only “real” cure for insomnia. While CBT Therapy would be another out-of-pocket expense, there was also an online program for only twenty-five bucks. I decided to try it.
The CBT program was broken into five one-week sessions. Each week, I was provided with information about insomnia and its causes as well as some techniques to practice. I filled out a sleep diary which required meticulous details about my sleep habits. I sent the sleep diary into the CBT doctor at the end of each week, and I would receive a reply with sleep goals for the following week.
In addition to keeping the sleep diary, I learned various “sleep hygiene” techniques, including keeping my bedroom solely for sleep and sex, limiting awake time in bed to a half hour before and after sleep, and going to bed only when drowsy. The program encouraged using meditation and relaxation techniques to counter the negative thoughts that I would experience at bedtime, replacing thoughts like “I’ll never be able to function tomorrow” with “I can handle sleep loss, especially if it only happening a few times each week.”
I had heard all of this advice before, but I had been stuck in the mentality that my problem was more severe and it couldn’t help. Once I committed to practicing these techniques as they were presented by the CBT clinicians, I found that they actually helped. By the end of the five weeks, I was falling asleep within 15 minutes and sleeping an average of seven hours a night, with only one or two nights of insomnia.
I highly recommend the CBT for Insomnia program to anyone who is struggling with insomnia or wants to stop using sleeping pills. These are some of the techniques I learned through their program:
- Go to bed at the same time each night and wake up at the same time each day. To figure out your appropriate bed and wake-up times, keep track of your sleep patterns for a week, noting when you go to bed, when you get out of bed, and estimating how long it takes you to fall asleep as well as how much sleep you actually get. Determine what your usual arising time is. Then figure out the average number of hours slept, add an hour to that (because you should not spend more than half an hour laying in bed before sleep or waking up), and count backward that number of hours to determine your bedtime. Go to bed at that time every night for one week, even if it seems like you are getting a ridiculously little amount of sleep and staying up insanely late. Continue keeping the sleep diary and after another week, take the average number of hours slept and add an hour to it. Maintain the same rising time, but adjust your bedtime accordingly. If you slept through the night most nights, this probably means you will go to bed a half-hour to an hour earlier. If not, don’t be discouraged, it will get easier. Repeat this every week until you’ve figured out your ideal amount of sleep (in other words when you add a half hour or hour, you don’t stay asleep that long). After that, if you would prefer to get up earlier, adjust your rising time by fifteen minutes each week until you’ve reached your goal.
- If you are spending more than 20 to 30 minutes tossing and turning at night, get up and read something boring until you feel drowsy. Also don’t linger in bed for more than 20 to 30 minutes in the morning.
- Keep naps to a minimum, 15 to 30 minutes in length at the same time each day, preferably before late afternoon if you must take them. Establishing a routine of meditation is even better.
- Make your room as dark as possible—mine has a black sheet tacked over the blinds—and your bed comfortable. Spend money on quality pillows. I even purchased a body pillow.
- Read and watch TV in another room. Your bed is for sleep and sex.
- Create a bedtime ritual of reading, taking a warm bath or shower, or doing something else that you find relaxing to trigger drowsiness.
- If repetitive thoughts or worrying keeps you awake, get up and write your ideas or concerns down. Better yet, make it part of your ritual to journal about your day or make to-do lists for tomorrow so you can get that out of your system.
- Be kind to yourself. Don’t beat yourself up for issues you may encounter during the day or for having a hard time sleeping at night. Clock-watching and worrying about how much sleep you might get isn’t going to help you fall asleep any faster.
I kept practicing these techniques until I was able to create a routine that fit best with my personal schedule, which meant 7.5 to 8 hours of sleep. After six months I was able to stop the acupuncture and herbal supplements altogether. In August of this year, I will celebrate four years of normal sleep. Although there has been stress and grief and loss during those years, I have managed to keep myself on track. I attend therapy to address my depression and anxiety, and I am conscious to reinforce my sleep hygiene habits during times of stress. I find that my insomnia can flare up when I’m sad or anxious, which can then lead to being overtired, which can then lead to feeling emotionally worse. Stress and anxiety and insomnia are all connected. But even though I’m still coping with the other two issues, my insomnia is now under control.