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Unread 08-22-2002, 07:11 AM   #1
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Default Ambien vs. Sonata?

Camster,

M has been having some serious sleeping problems lately and was rx'd Sonata. It really seems to be helping a lot. She was told that it has a shorter half-life than Ambien and doesn't carry with it the potential for short-term memory loss. Is this a true statement? If so, I'd like to talk to my psych about the possibility of switching over at my next appt as it is a little cheaper on my insurance.

Answer when you can swing the time, no rush bud. My next appt isn't until 9/11... Hope everything is well on your end.

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Unread 08-22-2002, 11:27 AM   #2
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Default Re: Ambien vs. Sonata?

Yo Dude - When I first start "formally" seeing my pdoc I was given Starnoc™ (zaleplon - U.S. : Sonata™). I have not had to use a hypnotic regularily for over a year now. I still have ten or so Starnoc (Sonata) left, and will take one if I am ruminating on something and cannot get to sleep.

She (I am assuming a G.P. and not a therapist, or do they have prescribing previleges now? - anyway, doesn't matter) is more or less correct about the short term memory loss. Sonata has a much shorter half-life than Ambien™ (zolpidem - not available in Canada, so I have no clinical experience with it), so when "taken as directed" it does not seem to cause as much of the hangover effect as other hypnotics (ie. sleeping pills).

As for short term memory loss, it really depends upon what you mean by that. If you take 10mg to 20mg (too much) and then go out partying instead of going to bed, yeah you'll probably have some memory loss (especially when combined with alcohol). I know that neither of these are even remotely an issue for you, but I include this for others that may be reading. I think that she was referring to the morning fog experienced with most hypnotics which is called "hangover effect", when she was talking about short term memory loss.

Also, to clarify what I said about "take as directed"; if you take enough of the Sonata you will experience hangover effect because, as you know, the more of something you take the longer it takes to metabolize and the longer it takes to clear the body. This is because of the concept of "half-life". Elimination half-life (which is usually what I am referring to when I talk about half-life) is the time it takes for half of the drug to leave the body. It is not the same as the termination half-life (drug effect half-life) which is usually shorter; especially in drugs that have inactive metabolites (breakdown products). In other words, when I talk about half-life and you notice that the effect of the drug does not seem to last as long as it seemingly should, it is probably because the effect has stopped due to the metabolism of the drug, and the amount of drug left is not enough to elicit the desired effect. The drug effect may not be there, but what is left (or even what is left of the metabolites) can cause one to feel drowsy in the morning (ie. may contribute to hangover effect). Hmmm .... does that make sense?

Anyway, I digress. If you take more of the drug than prescribed (eg > 10mg/night), you may have enough residual drug &/or breakdown products (metabolites) in the morning to cause hangover effect and thus, short term memory loss. At normal doses, with a working liver and kidneys, there should be no hangover effect or morning-time short term memory loss.

The elimination half-life, as well as the termination half-life, of Sonata is approximately 1 hour. The metabolites of Sonata are inactive but do hang around for awhile. About 70% of the breakdown products are peed off in 48 hours. While I have not read of the metabolites having any sort of clinical effect, as is seen with other hypnotics, it would be folly to assume this. I guess what I am saying is don't push the dose too much over prescribed limits.

Why have I dwelled on this so long? Practical experience (did I say that out loud). I (and others that I have talked to) seem to build a tolerance to the drug very quickly, if it is used every night. Within a week I was taking 20mg a night with little apparent hypnotic effect. I was eventually waking up groggy. Whether this was due to little sleep or to hangover effect, I cannot be totally sure.

So, don't be to quick to throw away the Ambien if you are using them every night. Are you still taking 0.5mg of Xanax™ (alprazolam) at night as well? If you are, then I would blame this on the short term memory loss. You can become tolerant to the hypnotic effects of Xanax, but usually one does not become tolerant to the amnesiac effects. I hope that I am not talking out of turn by bringing up other meds you are, or were, taking. I just know your situation and drug regimen better than most others to whom I supply advice. Forgive me if I am giving away too much info in an open forum.

Okay, back to Sonata. I find that Sonata is a really good hypnotic when used occasionally. It is used for people who have trouble falling asleep. It is not so great for people who have trouble staying asleep (ie. those that continually wake up during the night). This is because the half life of Sonata is so short; it will put you to sleep, but not keep you asleep. That your body has to do on it's own.

What I would recommend that you ask your pdoc to allow you to use both the Ambien and Sonata (but not on the same night). If you manage the use of the responsibly (ie. use the Ambien for a few nights when the Sonata seems to be pooping out. Actually it is best to go without a hypnotic for a few nights in a row, if possible). Talk to your pdoc about this (or even print this out and bring it to him).

CAVEAT: I know that bptoo realizes that I do not recommend things to most people. I can in his case because I know him personally and his situation better than I know others who want advice. I just want to let others who are reading this know that I very seldom make recommendations, especially when I do not know all (or at least most) aspects of one's clinical situation. I even expect bptoo to keep me abreast of changes in his drug regimen, and the reasons the changes were made. Even then, I expect bptoo to run any of my ideas past his psychiatrist before initiating any changes. This is implicitly known by him and I, and need not be stated every time we communicate.

Ciao for now Bud! - Cam

<font color=blue>"The minute you or anybody else knows what you are you are not it, you are what you or anybody else knows you are and as everything in living is made up of finding out what you are it is extraordinarily difficult really not to know what you are and yet to be that thing." - Gertrude Stein, 1937</font color=blue>
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Unread 08-23-2002, 03:07 PM   #3
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Default Re: Ambien vs. Sonata?

From a person who has used both, sonata is "milder" and did not leave me with a morning headache and slow "start up" in the morning, my doc use to give me during the times that I was under "huge" stress plus .5mg to 1mg of ativan, made sleepless nites a dream . Sonata, when one needs, is pleasant
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