Good Dr. Z / Evil Dr. Z

Dear George,

When our former family practitioner retired after 45 years, I switched over to Dr. Z, one of his younger colleagues.  That seemed to go well, at least for a while.  Dr. Z struck me as knowledgeable, laid back, helpful.  Then things got more shaky with my Ambien sleeping pill prescription.  Each time I wanted it refilled, I had to engage in a new round of conflictful negotiations.  Dr. Z says he doesn’t like Ambien, prefers not to prescribe it, and doesn’t want me walking onto the expressway at night in front of a semi.  Though  I appreciate the sentiment, I never worry about semis.   I did get more nervous last year when Medicare said that I was authorized to receive Ambien for twelve more months.  Now the twelve months are nearly up, and, when I asked Dr. Z last week if he could get a new authorization, he said that, because of my age, federal guidelines prohibit him from writing an Ambien prescription for me.  I might have imagined it, but he seemed to have a demonic look in his eye.   I get intensely annoyed by federal guidelines that prohibit this or that because of my age.  I calmly explained to Dr. Z. that Ambien is a wonder drug, and, just because I can’t imagine getting to sleep without it, that doesn’t make me an addict.  Dr. Z was unbudgeable.  He said that he wanted me to try Draxamyl* instead.  Seeing no other option, I begrudgingly said o.k.   

It turns out that Draxamyl wasn’t even developed for sleep problems.  According to the info I got with my Rx, it’s designed to treat “depression or other serious mental illnesses.”  Apparently it helps some chronically depressed persons sleep better, but there’s little evidence about non-depressed people.  According to the pharmacy info, Draxamyl has various possible side effects.    These include: nausea, vomiting, nightmares, suicide, trouble walking, constipation, panic attacks, unusual bruising, tremors, worsened depression, violent behavior, 6-hour erections, mania, eye pain, hallucinations, diarrhea, trouble sleeping, and a few dozen more.  I can’t believe that Draxamyl is a better choice than my beloved Ambien.  

I did start taking Draxamyl several nights ago.  The first night was un-thrilling.  I lay there in a heightened state of awareness till 3 a.m., then finally got up and took an Ambien.  Ambien, of course, worked perfectly.  The subsequent nights were up and down.  Sometimes I slept through the night; sometimes I woke in the early morning hours and had trouble getting back to sleep.  So far I haven’t noticed violent behavior or hallucinations.  I guess I’ll keep trying Draxamyl.  However, I am thinking of outwitting the evil Dr. Z by not taking any sleeping pill at all.  Google, it turns out, has a lot of good tips about how to go to sleep and stay asleep without medication.  Here are a few that strike me as promising**:   

• Go to bed and wake up at the same time each day.
• Get up earlier in the morning (so you will feel more tired at night).   
• Eliminate coffee, cigarettes, and alcohol in the evening.  
• Limit naps during the day.   
• Exercise regularly (but not immediately before bedtime). 
• Don’t watch TV, listen to the radio, or use the iPad in bed.
• Don’t eat or drink right before bedtime.
• Keep your bedroom cool (60-67 degrees) and free of distractions (e.g., light, noise). 
• Don’t let your pet sleep in bed with you.   
• Get all your worrying done before bedtime (e.g., after dinner, review the day and make plans for the next day). 
• Focus on your breath (in, out, in, out).  
• Try progressive muscle relaxation (start at one end of the body and work up or down, clenching and then releasing each section of muscles for all-over relaxation.   
• Keep a Sleep Diary to help identify patterns or issues with your sleep habits.  
• If you can’t sleep after 20 minutes, go to another room and do a relaxing activity such as reading or listening to music.    

I’ve never done well on most of these things.  Katja and I watch Frasier on Netflix for an hour before we turn the TV off to go to sleep.  Most days I don’t exercise enough to make myself tired, and I’ve taken to napping more often than I used to.  I’m inconsistent in my waking time, and I rarely get up early in the morning.   Sometimes I like to drink wine in the evening.  I go to bed obsessed with writing poetry in my mind.  If I do wake up in the early morning hours, I go straight to the computer.  Our thermostat is set for warm temperatures, the streetlights shine through our blinds, and Katja plays music on the radio.  All in all, I’d say everything I do is antithetical to good sleep.  So all I need to do is make massive changes to my entire life style.  I can do that.  I think I’ll start in the spring.  I’ll show that Dr. Z.    

Love,

Dave

*”Draxamyl” is a pseudonym.  The side effects listed for my prescribed drug are real.  

**Sources of sleep tips: webmd.com, greatist.com, people.well.com, sleepfoundation.org, vanwinkles.com