Q. Please send me any information you have on sleep. I suffer with insomnia, as do my friends. We have all tried zolpidem. It sometimes helps me drift off to sleep but it doesn’t last more than a few hours. After that I am like a tree full of owls again, wide awake.
Over-the-counter sleep aids don’t work at all or cause the men in my group discomfort from prostate problems. We would like to know more about Sonata, Rozerem and other sleep aids.

A. Part of the problem may be the generic formulation of zolpidem (Ambien). Many readers report that certain generics are less effective than others.
Zaleplon (Sonata) is a short-acting sleeping pill that can be helpful for people who wake in the early hours of the morning. If they have at least four more hours to spend in bed, it can help them fall back to sleep.
We are sending you our Guide to Getting a Good Night’s Sleep for more information on zolpidem, zaleplon and ramelteon (Rozerem) plus non-drug approaches. The sedating ingredient in OTC sleep aids, including drugs like Tylenol PM or Advil PM, is diphenhydramine (Benadryl). It can cause problems for men with enlarged prostates.

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  1. PF
    Reply

    I originally tried the real Ambien, which put me to sleep within 15 minutes, in bed, and stayed there. Then the generic switch started. I tried Apotex, Dr Reddys Lab, Teva, Mylan, Qualitest, Aurobindo, Torrent and two others. With the exception of Apotex (which worked as well as Ambien) none of the others put me to sleep.
    Many times I would be up for hours, and impaired, instead of being safely asleep in bed. The doctor had to prescribe two of the generics to make up for their poor performance, even that didn’t work. One of the brands did not kick in for four hours and then made me sleep until 10:30 am . That would have been a disaster for someone who had to wake up at 6:30 and be alert enough to drive a car.
    There is a document on the internet, IF YOU CAN FIND IT, a patent application for Ambien. It is rather long but explains all of the different forms of zolpidem tartrate there are. Form A, Form B, Form C, etc. They come in crystalline and anhydrous, and they come with 3,5 and 7% moisture content. Zolpidem tartrate tends to want to break down into zolpidem free base (which is not bioavailable). The form, the crystalline and anhydrous and the moisture content all influence this problem. Ambien is made with the best ingredients to prevent breakdown to free base form. Also they found that the amount of pressure that the tablets were made under influenced breakdown to free base.
    Ambien was researched for all these qualities because they had a reputation to maintain. The generics don’t have any incentive to use the best combination of qualities of the ACTIVE ingredient. And I don’t think the maker of Ambien was required to tell the other companies how much pressure to make their tablets under. I am not against all generics, I always buy generic tylenol, ibuprofen, sudafed, antihistamines, naproxyn.I have generic Flonase, tramadol and aspirin. No problem. But the zolpidem is just too specific. Real ambien is very safe, but the generics are causing impairment without sleep.

  2. Joseph A.
    Reply

    When you say “one each Citracel and magnesium” are referring to one pill each? Do Citracel and magnesium come in pill form?

  3. BJB
    Reply

    generic Unisom works for me as long as I don’t have any caffeine after noon, most of the time. Lunesta worked a little. Ambien didn’t work at all. Melatonin works a little some times. Tryptophane didn’t work at all. It amazed me to find out how some of us are so sensitive to caffeine. I read if you go without any for two weeks or more, you can sleep. I tried it once, but still didn’t sleep the way we need to sleep. I wish you all something we all need, a good nights sleep!

  4. Dallee
    Reply

    My doctor recommended 100 mg thiamine (B-1) to improve sleep — works like a charm.

  5. CR
    Reply

    I can sympathize, KLB, because, although I’m a guy, I’ve also had insomnia since early adolescence. Docs do their best to understand, but are terrified (by the DEA) from “over-prescribing” hypnotics (with justification, I admit: c.f. Marilyn Monroe, Michael Jackson, Anna Nicole Smith). However, I’ve been through everything from chloral hydrate (there’s one that dates me!), to Seconal/Nembutal/Tuinal; Placidyl (great for VERY short term use, but now unavailable); Quaalude (the “gold standard” of hypnotics; too bad it got the party drug rep and was made Schedule I); through Ambien/Sonata/Halcion.
    While the last three are all still available (Sonata is NOT available in generic form, and VERY expensive), and work fairly well, I tried Rozerem and found it worked incredibly well for me. However, there appears to be a HUGE variability in its effectiveness in the patient population. BUT, it worked not only wisely, but too well: while it put me to sleep within 20-30 mins and lasted a good 7-8 hours, I found that I had a “hangover” from it that lasted virtually the entire next day. This was not a one-time experience, either; I tried it numerous times and had the same result each time.
    I finally was forced to give up, and I returned the unfinished portion (of the second refill; I really tried it a LOT) to my pharmacist because I couldn’t stop trying to get it to work “right”. However, because of the great variability in patient response, you might find that it works like it did for me (hypnotic-wise), but without the next day’s drugged feeling. I’m on Medi-Cal, and Rozerem is the only newly-approved (non-generic) hypnotic that they pay for without a whimper.
    If Medi-Cal pays for it, any health insurer should pay for it without even a prior authorization. Can’t hurt to try.

  6. Paula
    Reply

    I take an occasional ambien, 10 mg split in two. I do not have any side effects – only restful sleep for about 7 hours. I’m 86 years old.

  7. MSB
    Reply

    I’ve suffered from Insomnia for 20+ years. To break my Ambien habit this works for me:
    1 each Citracal and Magnesium 400
    2 pills Valerian Nighttime Natural Sleep Aide (contains Valerian & Lemon Balm)
    I take them about 45 min. before bedtime.
    Have been doing this for 6 months now with great results.

  8. John A. Saylor M.D.
    Reply

    You have a sleep disorder distressed reader almost monthly. Your advice is usually very satisfactory, however, there is always the problem of unintended consequences, side effects or of failure. I discovered an almost failproof sleep aid with absolutely no unintended consequences or side effects except increased facility in a foreign language.
    Most readers have had some exposure to a foreign language, but little proficiency. To fall asleep they need only start reading a story, novel or news report in that foreign language. Unless they are extremely proficient they will necessarily consult their foreign dictionary for several words of each page. That process is considerably fatiguing. The concentration on the subject mater will drive away the sleep disturbing thoughts. Voila! Sleep is assured. Many or most restless sleepers will waken repeatedly during the night. A return to the fatiguing and distracting gimmick of translation will work within 15 to 30 minutes every time.
    John A. Saylor, M.D.

  9. KLB
    Reply

    From childhood, I’ve struggled and suffered with insomnia. At 56, I’m just completing my first year without a menstrual period, and hormone fluctuations have added to my sleep misery. I’ve tried just about everything; after fairly good results from Ambien CR, I switched to the generic due to the financial consequences when my insurance would no longer cover the prescription at all. I’ve found the generic form doesn’t do the job. There isn’t even much difference in effectiveness at twice the normal dosage.
    I plan to ask my doctor to let me try Rozerem when I see him in January. I once took Trazadone, but having to eat late at night created more problems. Amitryptiline once helped, too, at a low enough dosage (~20 mg) that didn’t set off the dry mouth or constipation of the more common, higher dosage.
    For years, I’ve used high doses of generic Benedryl (100 mg), but as my doctor has warned me on many occasions, along with Ambien (prescription or generic), it has a strong impact on short-term memory. I never had much trouble when I took Ambien alone, but I definitely can do things I’m unaware of at the time with the combination (eating, sending garbled e-mail, cutting my hair!).
    Since I live alone with no one to stop my odd behaviors (and fearing they’ll escalate to driving or something equally dangerous), I’ve attempted to reduce the diphenhydramine. Getting to sleep can be nearly impossible for hours once I get down to 50 mg.
    It got so that almost no matter what I take, my sleep continued to deteriorate. I’ve even started on natural progesterone at a prescription level, to hopefully tame that aspect of insomnia. Recently I went to a sleep disorder doctor, expecting to have a sleep study even though I have no symptoms of sleep apnea or narcolepsy.
    I got told to take a week to cut the diphenhydramine by 50% (been there, done that, as I said), and to take another week to cut the alprazolam I also use (at .50 mg) by 50%, then come back and see him. Riiiigggghhhht. And no sleep study.
    I was diagnosed in the late 90’s with Chronic Fatigue Syndrome and around 2000, with fibromyalgia. Both conditions are integrated with insomnia; kind of a “chicken and egg” thing. I have little pain with the FM compared to most who have it, unless I have an especially bad night sleep-wise. My cortisol production is also off-track by about 10 hours, and I take NAC and phosphatidyl-serine to try to correct this.
    Anyway, I’ve upped some of the natural supplements I take, and most nights now, I get 3-5 hours of virtually uninterrupted sleep. After that, it’s off and on, semi-dream state. I think I felt better physically when I woke up every hour or two, though psychologically, it was very difficult.
    Here’s what I’ve found helps to some extent — maybe somebody will see something that hasn’t occurred to them to try, and will be helped.
    Zolpidem (gen. Ambien) = 10 mg
    Alprazolam (gen. Xanax) = .50 mg
    Diphenhydramine (gen. Benedryl) = 100 mg
    Magnesium = 200 mg
    GABA = 3000 mg
    5-HTP (an enteric-coated formula, which makes it semi-time-released) = 200-400 mg (I used to take large quantities of l-tryptophan, but since it’s still a bit suspect, I switched to 5-HTP, which is its precursor)
    l-theonine (amino acid that’s know for its calming action) = 2000 mg
    SAM-e = 400 mg
    Sometimes I also take passion flower and/or skullcap. I’ve taken valerian root in a formulation that includes these herbs, along with magnesium and, I think, kava kava.
    My latest find is termed a sleep apnea product, from Nature’s Rite in Colorado. It’s an 1100 mg capsule that includes lobelia, meadowsweet, chamomile, crampbark, and thyme. I usually take two capsules, occasionally four (at which I definitely feel more relaxed and typically do a lot of yawning, which feels great!). Only the cost keeps me from regularly using it at the higher dosage, which despite what the label says, my holistic M.D. said was safe to use beyond the two capsule limit/day. However, I’ve learned that lobelia can be toxic.
    I do all the obvious things: not much caffeine, and none much past lunch time; bedroom is dark, cool, and quiet; pets don’t sleep with me; don’t do anything that winds me up late in evening; etc. I even use affirmations and other aspects of cognitive behavior therapy to encourage better sleep. You name it, I’ve probably tried it. Very, very frustrating, to say the least.
    Good luck to fellow sufferers, and hopefully, something in my post will help at least a little bit for someone.

  10. Mongoose
    Reply

    Hi,
    Although not intended to be a sleeping pill per se’ melatonin does a reasonably good job for occasional use. I recommend you confer with a physician before engaging in long term use. I use it to mitigate jet lag (crossing many time zones), and, for that, it works quite well after 1 or 2 days. Upon arrival in the new time zone (ie. across the International Date Line), I take one tablet 30 minutes before bedtime (bedtime appropriate to the new time zone). Melatonin causes sleep to be more productive. It reboots the body to conform to the new time zone (CTRL-ALT-DELETE, reboot). It’s been useful for changing to night shift, and sleeping in the daytime; again 30 minutes prior to the new bedtime. It wears off after 4 hrs, but it’s easy to continue sleeping anyway.
    Caveat, if you take one and decide not to go to sleep, and you get behind the wheel, you’re gonna doze off and have a wreck.
    Again, no matter what, talk to a physician, or medical professional, before taking melatonin (even though it’s over-the-counter)!
    Enjoy!
    The Mongoose

  11. Greg Pharmacy Student
    Reply

    In pharmacy school we all learned that every new problem in an elderly person should be considered a medication side effect until that has been ruled out. More medications are not always the right answer.
    Ambien CR, which is now available generically, might be a benefit if you are waking in the middle of the night.
    I hope it’s not terribly common to have problems with generic medications. Reporting a problem to your pharmacist or doctor rarely results in the proper regulatory body, the FDA, being notified.
    If you have a problem report to the FDA at: https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm Or call: 1-800-332-1088
    Be prepared to pay extra for name brand.

  12. MDF
    Reply

    I have started using some of the herbal formulations that I found at Wal-Mart and the ones I have tried have worked. Valerian Root also may work for some people, and is often found in such herbal formulations.

  13. MS
    Reply

    I have had consistent, good results with the following “cocktail”:
    1. One “Unisom” (or the Kroger equivalent)
    2. 1,000 mg. calcium citrate & 500 mg. magnesium
    3. 200 mg. Vitamin B-6

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