Necessary Evil to Combat Severe Tinnitus — Long-Term Ambien (Zolpidem) Use

Hi everyone,

Thanks for being such a great community!

Most of what one will read online about long term sleeping pill use is very negative.

However, since my tinnitus got worse four months ago, on many nights it seems to either be a choice not to sleep, or to take an Ambien and sleep. If I try to do without, I'm just kept awake for hours by the tinnitus sound. I used to be able to use masking sounds, but the "new tinnitus" just reacts to or competes with any and all sounds.

I find the anxiety *about* having to take Ambien / Zolpidem (or sometimes Zopiclone) can become as big an issue as anything else. It seems an unnecessary extra burden? Of course, I would prefer to learn to sleep with this tinnitus (or for the tinnitus to go be gone forever!), and understand that, taken every night, these strong hypnotics loose their power - but while natural sleep seems impossible, should I just take the stuff and stop worrying about it? Panic can rise in me during the day around the fact I am using sleeping pills, which does not seem helpful. On other occasions I manage to see it as "no big deal" and life is less difficult.

It's about quality of life and staying alive - I don't want to just indulge and do recognise the negatives of relying on anything like this to sleep. At the same time, as I know many here know, tinnitus changes things and means you take actions you would never consider before. I wish a doctor could work out a more imaginative "plan" with me where I could cycle between meds and options, rather than just talk about the dangers of relying on pills (which I understand and agree with - whilst being aware I'm in a different predicament.) Currently I don't need to take Ambien every single night in a row, but probably a number of nights a week. 5 mg-10 mg does the trick, though sometimes a glass of wine is added if things are very loud. Is anyone else in this boat? Anyone else done this for a while and managed to make it work (as much as one can make things work)? I kind of need some reassurance...

Again, I would rather not have to do this. But being driven loopy by severe tinnitus and no sleep seems a worse alternative.

(If anyone has "learned" to sleep with very loud tinnitus, I of course would love to hear about that too! With the “old tinnitus” I had going on I could usually sleep fine without any meds for many months, but this seems impossible, no matter what sleep hygiene I practice. But maybe a positive attitude about this - believing the brain can sleep to such sounds through hearing of such successes - will be helpful.)

Thanks again. This really is SO challenging!!

 

Hello. I really apologise for bumping my own thread, but I would love it if anyone could answer. All I hear online and from doctors I talk to is horrific warnings about long-term Ambien use. But severe sleep deprivation long term can't be good either. Has anyone here had to work out strategies to use prescription sleep aids long term? Any alternative takes? Thank you so much!

(Of course, I'd much rather learn to somehow sleep to these tinnitus levels.)

 

I can only relate my experience. This is not a recommendation really.

When I couldn’t sleep I chose medication in the end. I tried multiple natural sleep aids and then several prescription sleep aids before landing on Clonazepam. I took it for a year and a half. As you say, it began to become less effective. Also, in that time my tinnitus began to improve and got to a level I was able to sleep with naturally. I decided to taper and did a long very slow taper.

I measured the pills on a postal scale and shaved off thousandths of a mg every few days. It took me 4 or so months to taper. Ultimately, I had very few issues. Some anxiety attacks and a little bit of trouble sleeping periodically. Everyone’s experience with these things is so different it’s hard to tell what’s best.

Perfect example of that being that I tried Zopiclone before Clonazepam. I had horrible side effects. My tinnitus became the loudest it’s ever been while taking it, 10/10 suicidal level jet engine. I developed a head bob that progressively became worse over a matter of only days. My legs would literally “walk” themselves. I could take one step and then just let my body do the rest and it would walk me to another room. It was crazy. I felt like I was not in control of myself while I was on it. Again, I took it for less than a week. I quit cold turkey. To this day I still have a very mild head bob. I can definitely believe the stories of people sleepwalking on it and driving or whatever.

I never mixed alcohol or other medications with the Clonazepam. Maybe that helped with my minimal side effects and uneventful taper. Who knows. I also never exceeded my dose. My prescription was for 1.5 mg a day. I only used 1mg daily. Probably 3-4 times in the year and a half I would take the extra .5 mg if I was having a particularly bad day.

I now take a few mg of Melatonin a night to help and I’ve also found it makes my tinnitus lower. If it didn’t also lower my tinnitus I wouldn’t take it daily. Most nights I don’t even need it to sleep.

 

I took Ambien before, but not for tinnitus. It was for severe insomnia and crippling anxiety. I didn't even know about tinnitus at that time.

Weird vivid dreams tbh, I took it for about a month or two. No side effects after. I'm not sure for how long you want to try that, but I hope that Zoloft might be the best for you.

 

Robert,

Short answer: I don't think they are a good idea, definately not long-term. Maybe my story will help.

Personally I have developed a fear of most drugs, even though I have taken a BP drug every day, which may have caused my issue, but I am worried about going off of it too. But several doctors have told me I am depriving myself of better sleep without an anti-depressent, which I am told is the go to method now for sleep issues, not Ambien. And that could be the marketers at work, I don't know. Talk to your doctor about that.

I used Ambien on must-have nights in the first 1.5 years. Most nights I just bare-knuckled it, sleep or not. Eventually I completely dropped it 3 years ago. I didn't like being knocked out, not knowing what transpired other than being in bed, and I wasn't even sure I got good sleep.

At that 1.5 year mark I also tried CBT for sleep. She had me journal my sleep, or lack there-of, and ecventaully created a plan: no food/drink 4 hours from bed, no screens 1-2 hours, and start sleep evey night and wake up at same time. The idea is that your body will develop the habit, no matter what is going on.

Yes, I could have done this on my own, but I didnt, and in the end I think it saved me. I also exercise every day, even though I don't want to with the ringing going on. If not exercixe, walk, chores, play with your dog, etc.

I have also carried this idea that I wlll eventually have to go to anti-depressents, so I will have a couple days where I may go into a sleep-crisis mode. That happaned about 2 months ago and I had a Trazodone prescription filled. This is the 4th time I have done this, and yet again I fell back into a decent sleep pattern without taking them, and in fact, this last time I am sleeping better than I can recall. Go figure.

You may not want to follow my example. You may want to look into taking another drug. I have simply refused to do that. Maybe I would be better off doing it, and this fear is unjustified. All I know is that as of now things are ok.

Cheers.

 

I just saw that you are a musician. I was a drummer for several years. Just think about it, with all the practices and live shows, there must have been 100's of them where I didn't use earplugs. Now I play acoustic guitar but I also am trying keys a bit. No drums but maybe one day.

And re-reading the other parts of your post, yes, you are correct, try not to fill your head with anxieties if you can help it. I do sleep with this crazy noise. There are some people on here who say the noise even helps them to sleep.

 

It's better to use atypical antidepressants like Mirtazapine or Trazodone for sleep.

If you live in the US, you can also get Dayvigo, which is a dual Orexin receptor antagonist and it's supposed to be better than it's predecessor Belsomra.

If you live in the EU you'll have to wait some months until the EMA approves Daridorexant, which is supposed to be the best sleep drug ever invented.

 

I used Zopiclone for a few days and it not only made me feel worse, but I remember clearly it increased my sound sensitivity quite noticeably.

I was on Mirtazapine for over a year, but I can state it didn't help with my sleep either.

I couldn't sleep normally for about a year and four months. I would just accept this miserable state as a new normal, because no med, including benzos or supplements, would work for me. My anxiety was on suicidal levels.

What I did know along the way, is that taking drugs won't solve my problem, so I had to ride it out until I found some supplements that worked and got off the pharma crap. But I'm certain that my body first needed the time to get somewhat used to the tinnitus, so the anxiety was lower, then supplements started to work.

I'd say, sure, in crisis situations you can take something now and then, but long term benzo / AD use will mess up your brain plasticity, which you need for coping.

So, especially when you're 4 months into the worsening, I wouldn't hook myself onto these heavy meds. I think you need to somehow ride out the worst and find a natural long term stuff. In my case Inositol really helped and a few other things.

 

I would actually say that being sleep deprived is better than being drugged up by Ambien or Zopiclone. Because when you take that crap, you won't get quality sleep either plus you are messing up your brain with those chemicals too. Benzos were not designed for long term use, they are emergency drugs.

I don't know if you don't sleep at all, but I slept about 2 hours per night and it sucked big time, but I kind of survived. I clearly remember waking up by tinnitus in panic after an hour sleep, laying down for 5 hours then getting another hour or so. In the morning I felt better than when I took meds and would wake up feeling like the worst hangover + some other weird feeling in my head.

Now, if I get anxiety during the night, I take l theanine, valerian and crank up my masking tape.

The problem with any psych meds for sleep is that it's not sustainable. Okay, it helps you tonight, this month, maybe for a few months, then boom. It stops working and you are on square "minus one". You go to the pill pushing doctor and he puts you on another drug in addition. Rinse and repeat.

I know how it feels though, I am talking from my first hand experience. I literally slept 2 hours per night on average for 6 months. Then, like 3 hours per night etc. So, don't panic if it takes long. I first thought my brain would shut down due to sleep deprivation, but I managed somehow.

 

Thank you so much for all your responses. Very helpful. There is much to ponder here, and I have taken on board what has been said. I actually had a strong sense that simply accepting a lack of sleep might actually be an option (for however long that will be), but because of the emphasis that we “must” get a certain amount of sleep, and how unpleasant it can feel, I was scared away from such an option. However, I actually had an elongated period of very severe insomnia a few years before the February 2020 tinnitus (and then this 4 month worsening), and realised towards the end of that that much of the problem was again, worry *about* the lack of sleep more than the actual effects of the lack of sleep itself. (As mind-bending as such a lack of sleep can be.)

The NHS and doctors’ approach didn’t help, because the emphasis was for me to “fix” it. Of course I understand this, tried my best to adhere to all the protocols, and I’m sure it works for some - but for me it increased the worry and obsession and trying to obey all these rules made sleep even harder. It was only when I took my wife’s advice (as well as the advice of a more unusual doctor) and really practiced not caring that I felt a bit better. And then, by taking an “accepting” approach, sleep did slowly come back! I should have remembered this experience (though it feels so lame to have got better only to have tinnitus come and introduce a new problem to that mix.)

Sure, it does feel utterly crap not to sleep. But actually, I am remembering that on some nights when Ambien wasn't taken or wine drank - even with 0 hours sleep - I actually had a better, less anxious day than I expected. Of course one has to be very strict and refuse anxious thoughts continuously and much more deliberately, and I absolutely am not saying it is easy, but I am saying it could be less severely anxiety-ridden than I was expecting.

So I think I will go more in that direction, thanks to the advice of this thread. And if it all gets too much, some wine on its own can’t be the worst thing in the world. Also, if there is 0 hours on a bad night, it can be the case that there is many more hours on another night, maybe even the following. And then back to 0 and so on.

PS - Mirtazapine didn’t seem to work for me on the previous bout of pre-tinnitus insomnia, and I put on quite a bit of weight (was not at large before that... hah), but I’m open to trying other drugs listed here. And that brand new sleeping aid does look very interesting and promising.

And yes @Paul1980, I am a musician. Somehow I managed to do a 4 hour HBO soundtrack composing job on the initial bout of tinnitus, but this is more challenging! Even now, though, there are occasional less haywire days where a bit of quiet music making (not so much listening) is possible.

 

I was also convinced that 8 hours sleep a night is a must for everyone. But it looks like scientists are debating this. It's very individual and while having a night sleep is something I have always cherished (and when tinnitus took it away I was stressed about the same thing as you right now), I noticed that it's still possible to function on low amounts of sleep. I had a colleague who has had severe insomnia for years and a few years back got tinnitus from a concert. He also slept like an hour or two per night. And he was high functioning IT engineer.

So, see it as a temporary pain, which needs time to heal. When you break your leg, you don't start taking morphine right away. Just wait things out naturally, however painful it may not be. Then you can try natural remedies which you can take forever.

 

Robert,

I tried Mirtazapine for two nights (7.5 mg) and I didn't sleep any better. It just made me feel like a zombie for two days, and I wonder if it made my tinnitus worse.

Did the Mirtazapine affect your tinnitus? What dose did you take?

Thanks,
Bruce

 

I brought up Dayvigo to my psychiatrist as a potential sleep aid as I’m trying to get off my Clonazepam and my Trazodone is no longer very effective. She had never even heard of it. She tried to prescribe me Elavil, which I won’t take due to all the cardiac side effects. It seems like we’re damned if we do and damned if we don’t.

 

Hi,

I’m interested in knowing about your taper, specifically your use for postal scale. All I have is a pill cutter and so I have to try to guess an estimate. Can you tell me a little bit more about how you used the postal scale?

Thanks,
Danielle

 

Which country are you based in? Dayvigo is available in the US and Japan only.

Daridorexant will be available this year in the EU if EMA approves it.

 

I didn’t “hold” at any point really. I used a nail file and shaved off .001-.002 of a pill every day. I measured this with the postal scale. Since my scale wasn’t 100% accurate I could only say for certain that every 2-3 days I’d shave off as much as I was trying to because there would be slight variations in weight each time I weighed the pills.

My dose was in .5mg pills so two pills was heavier than a single 1 mg dose of Clonazepam. So for a single 1 mg pill I’d have shaved half as much, as I believe the Clonazepam weighed the same even if the concentration of the benzo is different. Don’t quote me on that though.

So basically a micro taper every single day till I was completely off. Make sure your scale weighs thousandths. Pretty sure all postal scales do.

 

US.

 

I don’t think I am smart enough to do that!

 

Then your doctor isn't up to date with the latest developments because Dayvigo has been available ever since 2019...

I'd suggest you either get another doctor, preferably a young one who's more open minded, and push for the prescription of this drug because it's the best for insomnia right now in the market.

 

Tapering is intimidating in my opinion. I felt intimidated to begin with. In my opinion, this method is actually pretty easy, especially compared to others I researched.

What part is confusing you? I’d be glad to elaborate further.

 

I was definitely half joking, but the weighing and shaving part. But I think I’ll order a postal scale. I have plenty of mail files. Right now I just cut it in half and cut it in quarters and then whittle down 1/4 two around 1/8 to 1/ 16th and take that. I’m coming off of 1 mg. Not super scientific.

I just ordered Magnesium hoping that will help me sleep.

 

I am in agreement with that.

 

Danielle,

I took Amitriptyline (Elavil) for 25 years, prescribed for Chronic Fatigue Syndrome, which I have had for 32 years (I'm now 59).

I took 10 mg in the morning at breakfast, and then 10 mg before bedtime. Eventually, by 2015, I stopped taking it (by then I only took 10 mg at bedtime).

In March 2020, my CFS came back with a vengeance after having been largely in remission for nearly 30 years.

So I started up on Amitriptyline, again, starting with 10 mg at dinner, then up to 20 mg.

I can say that Amitriptyline knocks you out at 20 mg. I would sleep about 4 hours, get up to use the toilet, then go back to sleep for another 3+ hours. Some nights I would get as much as 9 hours if I was really tired.

In July of last year, I weaned myself off of it very slowly over the course of a month. I wish I hadn't, as I haven't slept well, since that time, and I don't sleep much at all, with this latest tinnitus spike due to Paxil poisoning.

My side effects were dry mouth (big time), and a slightly elevated heart rate that got better as I adjusted to the medication. The big thing for me, though, was that I felt a bit dull, with memory issues (I wasn't as sharp).

I will say that if I can't find a proper sleep med to knock me out, I will likely try Amitriptyline, again, as sleep is so crucial, especially for tinnitus. My tinnitus (and hearing) is getting progressively worse due to chronic insomnia, these past two months.

I hope that helps, in some way.

Best,
Bruce

 

Thanks Bruce. I already have an elevated heart rate for reasons I don’t know. Blood pressure is good. And the heart rate already runs at 100 so I can’t take anything that would risk raising that any more.

 

I guess we all continue on in the quest for good sleep, Danielle...

Thanks for your reply.

 

The hyperacusis started in July of 2020. The tinnitus became noticeable in December of 2020.

I took Zolpidem (10 mg and, on occasion, 12.5 mg extended release) for several months and then developed the hyperacusis. I am still taking it but only 2.5 mg each night.

I have wondered if it caused the hyperacusis. The Zolpidem has never really improved my sleep but I have continued to take it due to my concern with rebound insomnia. My other theories are 1) anxiety and/or depression with sleep deprivation caused by the pandemic and other changes in my life 2) an aging auditory system damaged by decades of playing very loud live music 3) taking Lexapro for no more than a week at only 2.5 mg (which is very unlikely). I did take the Lexapro just before the hyperacusis started but it is probably just a coincidence.

 

I have taken 45 mg of Mirtazapine for at least three months. I gradually increased it to this dosage My tinnitus seems to be more intense since December, but I do not necessarily think that the Mirtazapine has caused it. It has been a problem since before I started taking it. I have not really experienced any side effects, but it has not helped improve my anxiety and/or any depression. I am not comfortable trying an SSRI because of the possible side effects (including insomnia and an increase in anxiety).

 

I guess it is hard to know, definitively, whether a medication will increase tinnitus. My hunch about my own tinnitus increasing is that it's a ramification of my lousy sleep patterns, these last 9 weeks. Solve the sleep issue and hopefully the tinnitus may get a bit more manageable.

 

My other theory is that the pandemic has put me in a perpetual “fight or flight” mode which has caused the tinnitus and hyperacusis to come to the surface. I was also taking Zolpidem (and still do in a much lower dosage) when it first started and wonder if that caused it. I was experiencing a lot of anxiety and sleep deprivation during the onset of hyperacusis and tinnitus. My sleep is better but would still like at least another hour of sleep on a consistent basis.

 

I take 1 mg of Clonazepam, 20 mg of Melatonin and 45 mg of Mirtazapine every night and have for months. Without it, I would get no sleep at all. I do what I have to do and have come to peace with it, healthy or not.