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
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