Open thread Nov. 18, 2022 Dan Crawford | November 18, 2022 8:36 am “Open thread Nov. 15, 2022,” Angry Bear, angry bear blog Comments (27) | Digg Facebook Twitter |
I have come to believe that prescribing Zolpidem/Ambien ought to be reallocated mostly to the realm of psychiatrists — because psychiatrists have the training — and the inclination — to do the necessary work up and careful follow up — and primary doctors, more and more clearly in my hearing, definitely do not.
The clear trend in the “physical illness” medical field – I hear about it over and over – is of medical doctors zapping long running prescriptions for Zolpidem without so much as a five minute, intelligent discussion about how much the withdrawal of their sleeping crutch may upset and or even upend patients’ whole ways of life.
Logically, one would think that interruption of a long running, successful treatment for a seriously debilitating “condition” (we don’t use the word “illness” here) should necessitate a careful work up and follow up.
It is not like there seems available any routine Zolpidem substitute, like switching from antibiotic to antibiotic. Therein lies the patients’ dreaded rub. Candidate substitutes all seem to introduce serious (yucky feeling) drug hangovers for maybe the first half of patients waking hours. Alternately, patients can spend all their waking hours in a sleep deprived haze (w/o drug).
I mostly need help getting my last two hours of sleep. I take a 3-4mg dose cut from a Zolpidem tablet after the first five hours and wake up 2 hours later bright eyed and bushy tailed – zero, ZERO, drug hang over.
Five minutes after I wake up I feel perfectly fit to drive a car. Logistically perfect. Doctors will fret that the “hypnotic” is still in your blood stream even if you cannot sense anything like that – causing you to make mistakes even if you feel perfect.
After trying one Zolpidem “substitute” (Mirtazapine) I made one major driving error and had to concentrate hard to avoid two others — two days after I downed it! But, intellectually I had no problem knowing I was doing some things very wrong. Ditto, if I drive on five hours sleep — I am definitely aware that I am a bit short on patience and judgment. 12 years on Zolpidem; I have never received any “intellectual” message that I am driving incorrectly because of the drug.
So a close look at me, anyway, would seem to obviate extra driving accident concerns.
Even if Zolpidem doubled my accident risk – on the road or slipping and breaking my knee in the kitchen – I prefer that to enduring a drug hangover half the day (from a “substitute”) or to living in a sleep deprived daze all day – every day of my life in my case. I know; I recently did four miserable months alternating between all day sleepiness and half day gradually shedding the feeling of being hit by a truck. That half day was what I lived for.
My OTC “substitute” was Diphenhydramine (Benadryl) – recently reported to bestow the maximum risk of developing dementia.
But, this is the caliber of workup and follow up detail that psychiatrists are primed to ferret out.
Memory loss? Zolpidem doesn’t make you forget anything you have learned already – or anything new about how things work together. Less than 1% of users have clinically significant memory loss (whatever that means).
Somebody should do a study of 1000 insomnia patients who have been bumped off Zolpidem (most, probably without discussion) – and 1000 who had their dose halved (probably from 10mg to 5 mg) – to see how deep an effect this may have had on their lives, up close and personal.
But, this is the caliber of follow up that psychiatrists are primed for. (Did I say that already?)
In one internet conversation, a patient was panicking. He had previously been out of work for three years because he couldn’t sleep. Now, after a year and a half on Zolpidem, his doctor was leaving and he was afraid he couldn’t get his prescription renewed (I’ve been there). Do you think his doctors realized that they were denying him everything else in his life – job, ability to raise a family, pay for entertainment – to make him safer from slipping and breaking his knee in the kitchen? Did they think all that through?
I have seen one chart (link below) that shows annual Zolpidem prescriptions have dropped from 45 million to 10 million from 2012 to 2020. Does that mean that 35 million Americans are now walking around in drug hangovers for hours, or in a sleep deprived hazes all day – in insomnia periods? Could that be? (The chart is at the end of a blog post mostly on another topic.)
I am nothing if not grandiose. I envision the day when everyone can go down a checklist that identifies whether or not they likely have what is known as insomnia – and 50 or 60 million patients are taking Zolpidem.
I really have no idea what other people are up against, so take this with the understanding that I know I may be ignorant of what is very real to you and others.
I don’t sleep all night. ( old age, mostly,…me and my dogs). i am told it is common. on the other hand i don’t have to go to work the next day.
but for what it is worth, i find i can get up in the middle of the night, several times, or just stay up. and i have no problem functioning (as much as my life requires), though i do seem to need a nap about four o’clock in the afternoon. about an hour suffices, and i probably go to bed earlier than i used to. So,what’s the point of this?: I’d rather be drug free and work out my own solution–so far so good–to the problem.
no guarantee this will work for you. but maybe worth a try. (it takes a little will power to get past the first few minutes of “rather be in bed,” but it helps to do a few chores that don’t take much intellectual energy..like taking the dog out, or washing the dishes.
but you are right about doctors, just ike judges they get jaded and don’t think they need to think any more.
two more that might help. i know the first works. i don’t know about the second because i can never try it:
get as much physical work or exercise as you can. work is better.
avoid tv or computer screens, especially before bed.
Merrick Garland to Name Special Counsel for Trump Investigations
NY Times – just in
NY Times: The attorney general named Jack Smith, the former head of the Justice Department’s public integrity section, to the job just days after former President Donald J. Trump announced that he would seek the White House again in 2024. …
Who is Jack Smith?
NY Times – just in
… Mr. Smith served from 2010 to 2015 as chief of the Justice Department’s public integrity section, which investigates politicians and other public figures on corruption allegations.
Two of Mr. Smith’s more notable corruption cases against high-profile political figures had opposite results. His team initially won a conviction against the former Gov. Robert McDonnell of Virginia, a Republican, but the Supreme Court overturned it.
It also won a conviction of former Representative Rick Renzi, Republican of Arizona, who was sentenced to three years in prison. (Mr. Trump pardoned Mr. Renzi among a flurry of clemency actions in January 2021, in his last hours as president.) …
The Mystic of Mar-a-Lago
NY Times – Nov 18
This is as good an explanation as any of what being a Bad Boy president is all about.
What the World Needs Now Is Love
what the world needs now is enough love to finance a better place for the victims of the Russian invasion of Ukraine. we need to get those poor Ukraine people to a better place, to a NATO Nation, but relieve the overcrowding in the NATO Nation by getting more NATOnian people into the US. Love is a small price to pay. We can do it. And when the NATOnians arrive we have 10 million job openings waiting for them.
I promise that you will never regret
I think you are probably right. I would point out that Ukranians have essentially the same culture as Americans, and not being racially identifiable should be acccepted more readily than the other immigrants we are afraid of.
This may be instructive.
cross-cultural differences between Americans and Ukrainians
(Personally, I have at times believed that Russians and Americans have a lot in common also, but sort of like opposite sides of a coin perhaps, both being ‘bulls in a china shop.’)
Anyway, it would seem that Ukrainians have more in common with Russians.
Wikipedia: Kievan Rus’, also known as Kyivan Rus’ was a state in Eastern and Northern Europe from the late 9th to the mid-13th century. Encompassing a variety of polities and peoples, including East Slavic, Norse, and Finnic, it was ruled by the Rurik dynasty, founded by the Varangian prince Rurik. The modern nations of Belarus, Russia, and Ukraine all claim Kievan Rus’ as their cultural ancestor, with Belarus and Russia deriving their names from it. At its greatest extent in the mid-11th century, Kievan Rus’ stretched from the White Sea in the north to the Black Sea in the south and from the headwaters of the Vistula in the west to the Taman Peninsula in the east, uniting the East Slavic tribes. ..
Unfortunately, Ukraine came to be known (by Russia) as ‘Little Russia’.
What the Unusual Midterm Elections Mean for Climate Action
NY Times – Nov 17
Elon Musk Reinstates Trump’s Twitter Account
NY Times – Nov 20
Mr. Musk, who had asked Twitter users about whether to bring back the former president to the service, said, “The people have spoken.” …
(I’m off Twitter, as of last night.)
Despite voter-approved anti-gerrymandering reforms, Ohio GOP still draws lopsided map
NPR – Nov 21, 2021
Ohio Gov. Mike DeWine, a Republican, has signed into law a congressional map that creates 15 new districts in the state, but anti-gerrymandering advocates are slamming the map saying it was drawn to keep a Republican stronghold in Ohio.
The plan has 12 seats that either heavily favor or lean in favor of Republicans. That’s 80% of the districts in a state that voted for former President Donald Trump with 53% of the vote in 2020.
Voter rights groups say Republican lawmakers went out of their way to carve the map in a way that gives them an advantage.
“It is full of weird shapes and squiggly lines,” says Jen Miller, executive director of the League of Women Voters of Ohio. “Maps don’t look like this unless you’re trying to secure a partisan outcome rather than fairly representing voters.” …
The midterms and Trump’s return show why we need a third party
Boston Globe – Nov 14
(This appeared in the Globe last week. The link above is probably not free.)
(Well, good luck with that. The GOP shows no signs of doing away with itself, let alone changing for the better. Eventually, by some odd chance, enuf of them will become enlightened & join the Dems, and/or the GOP will go the way of the Whigs.)
“For the first time in history, roughly half of Americans now say they are political independents, rather than Democrats or Republicans.”
Support for Third US Political Party at High Point
Gallup – February 15, 2021
Sixty-two percent of U.S. adults say the “parties do such a poor job representing the American people that a third party is needed,” … Support for a third party has been elevated in recent years, including readings of 60% in 2013 and 2015 and 61% in 2017.
Meanwhile, 33% of Americans believe the two major political parties are doing an adequate job representing the public, the smallest percentage expressing this view apart from the 26% reading in October 2013. …
(Obviously, this is not exactly new news.)
The political future of the US seems to depend on which party (old or new) can seize or summon the loyalty of the ‘masses’ (*), presumably the working class. It’s not really clear which party has the greater claim at this point. Since the GOP mainly seems to represent wealth & capitalism, one might think the answer is clear, but that doesn’t explain Trumpism. The Dems may be left as the party of suburbia & academia, if not intelligentsia. Of course, global climate change or world/nuclear war might change this picture drastically.
* most of the voters.
Remembering of course, that for the time being, US political sentiments are apparently driven mostly by the notion of a diminishing white majority, on the part of the diminishing white majority.
“The Dems may be left as the party of suburbia & academia, if not intelligentsia.”
Personally, I think most non-white voters will stick with the Dems, and the Dems are counting on this.
NY Times – Nov 21
What Will Russia Without Putin Look Like?
Inside the Saudi Strategy to Keep the World Hooked on Oil
NY Times – Nov 21
In a First, Rich Countries Agree to Pay for Climate Damages in Poor Nations
NY Times – Nov 19
Ukraine War Continues to Slow Global Growth, New Report Says
NY Times – Just in
Confronting the Crisis