Let's get real about Zolpidem and Insomnia

 I believe the reason insomnia sufferers clamor for (not just prefer) Zolpidem (Ambien) is because it is the one prescription sleep drug – that doesn't feel at all like a drug.  No hours of lingering numbness (OTC  antihistamines), no all day yucky feeling (most or all other prescription drugs) – nor all day, sleep deprived, brain fog (no medicine at all).  

You can cut a 10mg into thirds and take one third to catch the last two hours of sleep (my most regular use) and wake up bright eyed and bushy tailed – no drug after haze whatsoever.  
    
Why, then, does the whole medical profession, lately, seem down on Zolpidem?  My doctor cut me off after 12 years on it (with different prescribers), my brother’s doctor cut him back from 10mg to 5 mg, my brother’s 60s age friend had hers cut off completely.  A Zoom call nurse practitioner from Minded refused me down because of my age.

Doctor’s lately arriving qualms: reports of (maybe doubled) household falls and traffic accidents, memory impairments, weird sleep walking.
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Me – slips and falls: if you break out the numbers, most of the serious damage comes from traffic accidents.  At my age (78) my mother was still bringing home the first place trophies from the amateur ballroom dance contests.  A lot of deep athletic ability in my family.

Me – driving: 28 years driving taxicabs in New York, Chicago and San Francisco.   Enough said?

Me -- memory: Zolpidem doesn't make you forget what you already know, doesn’t make you forget how processes work that you newly learned, may inhibit ability to make new memories of simple facts (what movie you watched Sunday).  “Clinically significant" harm visited upon less than 1%.  After 12 years on the drug, if it causes me any impairment, any damage should have been visited very long ago.  
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Today, 38 million Americans take Zolpidem (85% of all sleep med users).  What is the medical profession going to do, take them all off Zolpidem just as they get old enough to need it the most – condemn them to an old age of hours of daily antihistamine numbness, all day yucky drug left-over, or 19 hours or more in sleep deprived fog?

Sensible legal goal, once patients get it nailed down (in court?) -- If a patient refused a new improved fracture cast, leaving only an old model wrap an option, a doctor could not ethically refuse to offer the old style -- drug ditto: doctors should not be allowed to refuse Zolpidem if it is the only sleep aid patients will accept – not if the patient would be better off with Zolpidem than without it.  Goal #1!

Why do doctors today feel so ethically free to abandon insomniacs -- who will accept only Zolpidem – to no treatment at all?  

I suspect it has to do with the incorporality of insomnia – it fails to light up their “midbrain radar" (that even migraine headaches show up on).  They can’t measure it, can’t weigh it, can’t take its temperature, can't sew it up, no idea where to put it back.  :-)

I recommend that insomniac patients make journals, day-by-day of their struggles living without Zolpidem – with or without substitutes.  30 day, 60 day, 90 day journals – will hopefully get past physicians' motivation-gates -- with the tale that insomniac patients have a deeply unhealthy condition that MUST be dealt with.

Typical trouble day: At 10:30AM, will need to drive mother downtown.  No antihistamine in the middle of the night (main effect lasts 4 hours, unsafe driving, hours longer).  Zolpidem would act for 2 hours after first 5 hours sleep (25 minute wait, 45 minutes sedated—can think if I wish to, 50 minutes more coming out of it), waking fit as a fiddle.   Couldn’t sleep -- took Trazodone, barely able to drive, barely safely.

Once we nail down patients' legally and ethically entitled choice – not to exist in an antihistamine numbness or a permanent drug hangover or no drug at all brain fog – because the medical profession is afraid we might slip and fall – then, we can spread the word to every civil law firm in the country – and get our lives back!!!

PS  My extra hours-numbing, OTC substitute -- Diphenhydramine: https://www.medicalnewstoday.com/articles/288546#Taking-anticholinergics-for-more-than-3-years-linked-to-higher-dementia-risk