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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 31329
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I have taken 12.5 mg of Ambien CR four years now only

Customer Question

I have taken 12.5 mg of Ambien CR four years now only getting about three hours sleep then I'm awake, last night I added 20mg of melatonin and slept for six hours is it safe to do every night
JA: What medications do you take daily? Are you allergic to any medications?
Customer: melatonin and slept for six hours is it safe to do every night
JA: Anything else in your medical history you think the doctor should know?
Customer: Also take Pantoprazole DR 40mg one a day and Bupropion XL 300 mg one a day
Submitted: 1 month ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 1 month ago.

I am Dr. Arun and will be helping you today.

If you take Melatonin for about 1-2 weeks; it is safe. But taking it for long duration can be habit forming and you may be dependent on it for sleep. So avoid it for long duration and use it intermittently (instead of continuously).

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

Expert:  Dr. Arun Phophalia replied 1 month ago.

Treating sleeplessness (insomnia) is a big challenge as the available medications are associated with several side-effects. Herbal medicines are being looked at as an ideal replacement for these medications. Among the ethnobotanicals used for sleep disorders, only Valeriana officinalis and Ziziphus jujuba have been evaluated for pharmacological or clinical efficacy against insomnia.

A physical illness is uncommon with the sleep issue. An off and on sleeplessness need to dig the cause for underlying anxiety, depression or other related issue. A thorough evaluation by the history is done to reach to a conclusion. Accordingly the medical treatment is commenced. The precipitating factors can be;

1) depression,

2) anxiety,

3) sleep-wake schedule changes,

4) medications,

5) other sleep disorders,

6) medical conditions

7) work-related issues

8) family problem,

9) health events.

All these in isolation or in combination play problems in sleep issues. Good sleep cycle, handling the specific problem, counseling, cognitive-behavioral therapy, medications are employed for the treatment.

Following measures are helpful;

1) Avoid if you do;

a) caffeine or alcohol use,

b) environmental noise,

c) inappropriate room temperature,

d) watching TV in bed.

e) avoid large meals in dinner.

2) Relaxation techniques

3) Acupressure and acupuncture.

A study comparing zolpidem with CBT showed continued efficacy for the patients treated with CBT. Please see the reference;

Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW. Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med. Sep 27 2004;164(17):1888-96. [Medline].

Dietary measures which are useful:

1) Avoid caffeinated beverages in the late afternoon or evening.

2) Avoid alcohol in the evening.

3) Avoid large meals near bedtime.

Acupressure on the Shenmen points of both wrists significantly decreased insomnia, with the benefit persisting for up to 2 weeks afterward. Please see the reference;

Sun JL, Sung MS, Huang MY, Cheng GC, Lin CC. Effectiveness of acupressure for residents of long-term care facilities with insomnia: a randomized controlled trial. Int J Nurs Stud. Jul 2010;47(7):798-805. [Medline].

The following is the guideline when using medications:

1) Try the lowest dose of the medication.

2) Use the medication for not more than 2-4 weeks in a single stretch.

3) Medications with a rapid onset of action, such as zolpidem or zaleplon, are preferable when the problem is falling asleep.

4) If the problem is staying asleep, temazepam, estazolam, flurazepam are more useful.

5) If one is depressed, an antidepressant with sedative properties, such as trazodone, mirtazapine, or amitriptyline, may be preferable.

It is privilege assisting you.

Please let me know if you have further queries or unanswered questions.

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Thank you.

Wishing you all the very best in life.

Expert:  Dr. Arun Phophalia replied 1 month ago.

Thank you for the opportunity to answer completely your Question. Please make sure to rate me because that is how I am credited and paid for my work.

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Thank you.

Expert:  Dr. Arun Phophalia replied 1 month ago.

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Expert:  Dr. Arun Phophalia replied 1 month ago.

Hope you are doing very good.

Please let me know if I can help you further.