Please read the Medical Disclaimer before preceding.
While I am not any sort of medical professional, I am something of a scientist. I do have two science degrees, one at the undergraduate level and a masters. They may be in business, but I did graduate summa cum laude, mainly because I read everything I could get my hands on, including the assignments. But I also studied aerospace engineering for three years before I realized what I really wanted to do was fly, not be an engineer.
How one goes from studying to being the best pilot in the universe… the best navigator on Earth… Ok, Ok! The best navigator in a couple of Air Force competitions I won. There, now, back to Ambien. But I’m a pilot, too, and a good one. 😉
Ambien is a great drug, but it’s largely misunderstood, even by doctors. I’m not going to cover all the historical, chemical, and pharmacological details you can read about on Wikipedia. Instead, I’m here to reveal a course of therapy which I have learned first-hand works quite well while minimizing dependance on ambien along with its side effects.
The second time I took ambien was as an aviator in Iraq. We were given a whopping 3 tablets, 5 mg each, per month, to help us with flip-flopping sleep schedules. The problem is, I was in the midst of severe chronic insomnia due to a divorce that was initiated six months earlier. In order to be safe while flying, I didn’t need ambien three times a month. I needed something nearly every night.
As it turns out, the tablets we were given were somewhat triangular in shape, with rounded edges. I could easily clip off a third of the tablet — 1.67 mg — which might be…
Yes. It was just enough to have an effect. While it wasn’t enough for slam me into the deep sleep required to switch my sleep schedule by 12 hours, it was enough for me to keep up with mild changes in sleep schedules caused by well-managed flight operations.
I could do this.
I’d already discovered melatonin, and had figured out that more is not better with that drug, either. In fact, a number of studies had shown that any dose of melatonin over 500 ug began showing significant side effects, including vivid dreams which interfere with sleep, while any dose over 1,000 ug (1 mg) begins working against one getting to sleep. One brand who’d been making melatonin for years still sold a low-dose 300 ug tablet, which was perfect for what I needed.
So, why not combine them?
I discussed it with my flight surgeon around day one in theater, and within 24 hrs he reported back that there were no contraindications or competition between the two substances, so he said, “give it a go.”
It worked, perfectly.
We flew every other day, so by taking only a third of the 5 mg ambien tablets, those three tables could be stretched to 15 days. The night before I flew, I’d take 300 ug of melatonin and 1.67 mg of ambien. I went to sleep easily and slept like a baby, very well-refreshed, and without the thick-headed side effects of taking the entire 5 mg tablet. On nights when I wasn’t flying the next day, I was usually quite tired from the long day’s missions and just took the melatonin, if anything at all.
LESSON LEARNED #1: With melatonin, more is not better. 300 ug works just fine for a 200 lb man.
LESSON LEARNED #2: Hard work and routine physical exertion is a great soporific! (sleep aid)
The other thing I learned about ambien is that it’s effects last longer than the literature seems to suggest. Even while taking just a third of a pill, I could still tell it was effecting me some 10 hours later. You really need to give your head time to clear if you’re taking a normal, 5 mg dose.
LESSON LEARNED #3: Plan to take ambien and go to sleep at least 10 hrs before driving or operating heavy machinery, and at least 12 hours before engaging in any serious responsibilities like driving a bus or driving a train. As for flying… “For the past couple years, the FAA has approved the use of one prescription sleep medication, Ambien (zolpidem), by virtue of its short half-life (2.5 hours) and safe side-effect profile. Its minimum “no fly” waiting time is 24 hours” (Source: http://www.airspacedoc.com/how-pilots-can-safely-and-legally-use-antihistamines-and-other-sleep-inducing-medications/). If I recall correctly, the Air Force only had 6 hour period of no-fly after taking up to a 10 mg dose. That seemed to be very aggressive, and I recall fellow crew members reporting serious grogginess even at the 10 hour point on 5 mg. The FAA’s 24 hour “no fly” period, on the other hand, seems to be way too conservative, more like lawyers got involved and are trying to eliminate all possibility of lawsuit rather than find a solid solution to people’s insomnia. On further checking, I found at least one Air Force reference: https://www.315aw.afrc.af.mil/Portals/13/Users/096/96/96/Aircrew%20Medication%20List%20June%202017.pdf
LESSON LEARNED #4: Never violate regs! If they’re lax, then don’t even violate the spirit of the regs, even if you’re following them to the letter. If they’re too restrictive, well, take that up with the governing bodies.
The first time I took ambien was about six months prior, immediately after receiving the divorce papers. I didn’t sleep for a week. When I did sleep, it was because of the ambien, and for five straight nights on 5 mg per night. That ended the dose, and then, once again, I didn’t sleep for three straight days. The doctor tried a second time, with the exact same dosage and duration, despite the fact I told him the ambien was knocking me out and I was groggy for 12 hours. Two big, glaring clues the doctor missed.
LESSON LEARNED #5: With ambien, you probably do not need as much or as often as you or your doctor thinks you need. Find a minimum dose and minimum dosage cycle that’s right for you. Even at minute doses, if you use it every day, you will quickly develop both tolerance and dependence. It’s better to do your best to take a small dose only when you absolutely need it. It will also be more effective that way.
Then, the doctor did something extraordinary: He put in my medical records, “Does not respond well to sleep medications” and “Do not prescribe sleep medications.” Fortunately, the in-theater flight surgeon either didn’t see that or he ignored it, as the every other night 1.67 mg ambien + 300 ug melatonin combination we’d hit upon worked like a charm. Unfortunately, or rather quite notoriously, the doctor back in garrison was a raging control freak with the rank to back it up, and after I returned from deployment, the next three years of my life were a living hell because he denied me any and all sleep meds for 34 months. I finally managed an end run through mental health (their doctors can prescribe sleep meds, too, but didn’t fall under the dictator doc’s command). Problem solved:
LESSON LEARNED #6: If your current doctor can’t break free from straight-jacketed, 20-year-old thinking, SWITCH DOCTORS. You deserve FAR better than the nice but inept control freak I was saddled with back in garrison.
Finding the sleep you DESERVE can be a long, tough road. Ambien can be very effective, if used intermittantly and in doses lower than normally recommended and prescribed. It’s effectiveness may be improved with small (less than 500 ug) doses of melatonin. Routine moderate exercise can significantly improve one’s ability to fall asleep and stay asleep.
Good luck, good night, and sweet dreams!!!