Medical Journal: 8/31/18

After-action report on Ambien:

Image result for new yorker back to the old drawing board

Feeling reasonably sleepy and comfortable, I decided to try to get off without a sleeping potion. So I took my usual bedtime zinc and magnesium (to prevent cramping), and benzonatate (cough suppressant), 1000 mg. of Tylenol, flushed the nasal passages with saline, then used Flonase in hopes of keeping them reasonably dry over night, spayed the throat with phenol and such on a lozenge, turned off the light, and tried to go to sleep. In the back of my mind was the thought that if I wasn’t worried about sleeping –having the Ambien as a back-up –the not-worrying might let me sleep.

No such luck. The throat was a little bit uncomfortable, and (perhaps due to the Flonase) I kept sniffling and swallowing, and sleep was just not a happenin’ thing. So I took one 12.5 mg. zolpidem (Ambien) extended-release tablet, read for a few minutes to let it start working, and turned off the light again. Mistake! Propped up to read, I was fairly comfortable. But as soon as I got horizontal, I felt queasy: not nauseated enough to worry about vomiting, but distinctly uncomfortable. Sitting up all the way brought the queasiness down to a tolerable level, but when I tried to calm myself down with deep, slow breathing –my go-to approach –I found it impossible. It was as if there was something wrong with the diaphragm and the muscles of the chest; I couldn’t expand enough to get a good breath in, and couldn’t contract enough to force the air out. That left me breathing quickly and shallowly just to get enough oxygen. I tried standing and then walking; I think the walking helped a bit, but only a bit.

Now, this is not a problem I have. Back when my back was giving me trouble, I had some New-Agey breath training. So I can –do, when I’m trying to manage my mood –inhale for thirty seconds and then exhale for thirty seconds, sometimes one nostril at a time. So being reduced to about a two-second inhale-and-exhale was pretty seriously scary, and of course I wondered if something was going on with the heart. I even toyed with the notion ofheading in to an ED, but that seemed like an over-redaction and as likely to make things worse as to make them better. I couldn’t really focus enough attention to read, so I just sat in a reclining chair and breathed for a while. (15 minutes? An hour? Time flies when you’re having fun.) At some pointI fell asleep sitting up –as I had two nights earlier –was down for probably a couple of hours, woke up, seemed to be breathing normally, went to bed, slept well, woke up alert at about 10:30. I still can’t do a full thirty-second inhale –the chest muscles just don’t want to cooperate –but otherwise feel no after-effects.

In the meantime, I’m looking for Plan B as a sleeping solution. If anyone is in the market for 29 Ambien XL in mint condition, no reasonable offer will be refused.


3:30 pm. Talked to Dr. Weiss. In retrospect, it might have been better to start with half an Ambien. But given the experience, no point trying it again. Will switch to 0.5mg lorezepam (Ativan), which is short-acting. I’ll start with half of that, and take the other half as booster if I wake up in the middle of the night.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact:

6 thoughts on “Medical Journal: 8/31/18”

  1. Wow, that sounds awful. I’m glad you have access to a recliner. I think everyone should have one. I don’t get why people think they are for fogies. It can’t all just be from Archie Bunker can it?

    I don’t want to interrupt, but I suppose you’ve already eliminated pot as an option? I used to know this guy who had serious back issues and he told me there were so many kinds, you could find one for almost anything, and it wouldn’t necessarily get you high. I have no idea if that’s true though.

    I’m glad this is over! It is awful not to be able to sleep. And I feel for people who don’t have the IQ or the patience to learn about drugs. Wait, that’s me! ; )

  2. All of this sounds ever so exhausting! As it happens, I make and sell organic latex beds (a late career after 25 years of writing); that means that, as a professional obligation, I’ve been inhaling everything I can find about sleep issues. I also have had many battles of my own with sleep. So let me hand you all 2-3 grams of potentially-useful knowledge I possess:

    1. Flonase, insofar as I understand it, is not like Afrin and other traditional nose sprays. It’s designed to be taken daily for months. If you find it provides quick action, more power to you. I’d just say don’t take it right before bed. Try taking it 2-3 hours beforehand so that any drainage is finished before lights out.

    Instead of Flonase, I use Afrin, which may not be superior in any respect. And I have self-imposed rules: one squirt only, in one nostril only. I alternate nostrils day by day. I never use it more than 4 days in a row, then take a 1-3 day break. Done this way, it works like a charm and I have never had rebound, loss of effectiveness, or nasal damage.

    2. I absolutely swear by Breathe Right strips (which are available in no-name generics these days, also). Any night I can get through without drugs is a good one, and these often make that possible. No side effects, reasonably cheap, easy to use, surprisingly effective even if not a cure-all.

    3. 1,000 MG of Tylenol is a lot, isn’t it? I hope you’re getting periodic blood tests on liver function, and staying away from even the most benign alcoholic beverages. Tylenol can destroy your liver in the wink of an eye.

    4. Sure, recliners are all fine and good. But you might want to consider investing in an adjustable bed. Not cheap, and awful heavy if you ever need to move it. But it can provide benefits that differ — and in some respects are superior — to a recliner. If this interests you, write me back channel and I’ll give you some tips on getting a decent one at a decent price (you are a moderator, right? So you can check my Log-In info for my real email address. You have my permission to use it. Or post here and I’ll figure out how to respond to you directly).

    5. I tried Ambien or something similar; it was horrible stuff and I quit pretty quickly. My uncle took it and one day drove his car over the sidewalk and down some park steps during a blackout. He dropped the drug immediately. I also used to take Ativan. It works great. It is also addictive and can have rebound. It sometimes made me dopey the entire next day. So use it very, very carefully. I don’t remember the specific dosing now, but I used to always take just a half-pill, never for over 3 nights in a row and then followed by a couple of nights without it.

    As a general principle, I dislike ALL sleep drugs. I think the sleep quality they provide is mediocre.

    6. Have you tried melatonin before bed? My experience was: it worked to ease me off to sleep quickly, but lasted only for 2-3 hours. THEN, the next day, I would need to take naps repeatedly. Dopey, but even worse than with the Ativan. On the other hand, YMMV, and in the grand scheme of things it’s a pretty benign OTC drug.

    I don’t suppose I need to say a word about basic sleep hygiene, right? I will anyhow. You know to keep the teevee out of the bedroom, avoid all blue lights in the evening, hit the hay about the same time every night, make sure the room is on the cool side, invest in insulated windows if outside noise is a problem, do a deep breathing-relaxation routine just before bed, avoid eating 2-3 hours before bed, etc.? Yes?

    Good luck with it all.

    1. Very interesting, I had never heard of alternating nostrils. Is Afrin dangerous, or do you do that just to avoid “rebound” somehow, and how come alternating works? Is it just bc you are getting less of the medication overall?

      I have a very short attention span for medication information and I either try to avoid taking things, or just sort of wing it. I wish there were an easy way to get good information. Ha! I don’t even know if I’m supposed to eat eggs anymore or not. Apparently we are all supposed to go and get two blood tests to figure that out, while wolfing down eggs between to see if we’re sensitive. Who has that kind of time?

      It is hard for me to imagine what could be better than a really good recliner, but at the same time, I want to believe it too, you know? The romance of sleep. Ahh.

      1. Good questions. Every time I ever told a doctor that I used nasal spray regularly, due to night time congestion from allergies, he or she recoiled in horror and promptly wrote me a script for something intended for long-term daily use (Flonase being one of those, before it was available OTC). I dutifully filled the prescriptions and used the medications. They worked great for a few weeks, and then they didn’t work at all. The Afrin, by contrast, ALWAYS works.

        The one doc who took time to explain it to me said that Afrin and comparable drugs cause minor addiction, rebound effects, and — used continuously — can cause tissue damage in the nasal passages. So I tried to figure out the least amount I could get away with. Limiting it to one nostril per night certainly does that, and one squirt seems sufficient. And (after all) I only need to have one side or the other clear to sleep okay. The instructions on the bottle are to use two sprays per nostril, up to 3x a day, for up to 3 days running. So that would be 36 squirts of the stuff in three days, versus 3 squirts with my method. (I realize some people need it all day, but I can generally do well enough when I’m up and about; it’s only when I try to sleep that the congestion becomes maddening).

        A great recliner is a thing of joy, to be sure. There’s one that is explicitly advertised as the “best sleeper recliner” in big full-page ads at Archaeology and Smithsonian. But I find that no matter how comfortable to start, I get a back ache if I stay in one too long. And, remember, they’re invariably padded out with oil-based polyurethane foams that off-gas all kinds of nasties for years (I sell 100% natural latex mattresses for a reason: superb support AND they’re absolutely toxics-free). So that’s a two-fer to explain my bias against recliners, but — as always — your mileage may vary.

        1. So, this is getting into a sensitive area perhaps … but have you got pets? It sounds like Afrin really may not be safe. I don’t know about you, but I’d sacrifice quite a few IQ points in order to keep my sense of smell (which in dry air is hardly there at all already). Honestly, who would even notice? Plus I think brains are overrated. They don’t make one a good person. Maybe even tend the opposite way.

          I know full well some of the things I should be doing to have less congestion. I have to throw out a lot of my cr*p, and shower at night more consistently.

          Your point about latex is a good one. I do worry about off-gassing and I do need a new mattress. I don’t think I want one that is too squishy though. And I doubt I could afford organic bedding. Come to think of it … I have a topper and nooooo idea what it was made of. Hmm.

  3. I’ve got no pets, but were circumstances different I’d get another cat. I do love cats. The bit about showering at night, versus in the morning, is valid. I hardly ever do, however. As for too much stuff: I’ve turned into a minor (and frequently hypocritical) advocate of the simplicity movement. And it’s true, I can attest personally: the more junk you lose, the fewer allergens running amok.

    I don’t think Afrin, used as directed, is particularly dangerous.Used as I do, it is certainly very safe. And, I am pretty sure my sense of smell has never been affected by it.

    A good latex mattress should NEVER be squishy, unless that’s explicitly what you wanted and it was made that way from the get-go. My most popular model has a firm 6″ core with a very soft 2″ topper, all inside the organic cotton cover. Not squishy. But I can make ’em even firmer if desired. You in the S.F. Bay Area? I’m in Santa Cruz, if you want to actually see one. If you’re off somewhere else in the country, I can back-channel you some rules of thumb so you don’t get sandbagged while buying a new mattress from one of the usual suspects.

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