OT Disputing medicine charges

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Let's not forget that people are individuals and that medications affect different people differently. I took Ambien CR for quite a number of months. It worked very well in general. I (maybe I was an exception) had no sleepwalking problems (witness available). However, it wasn't cheap, and I was disgusted about my dependency. Then the regular generic didn't work for me. It took about 2-3 nights of real sleep problems and I was back to my usual sleep problems from before Ambien. Not weeks or months. I wish there was something better to keep my brain from waking me up all the time. Valerian is something I have been administered a few times as a young adult, but Dad was real careful about it, and regarded it as sort of an opiate, although Wikipedia doesn't say so.
All medications have side effects. So does living <grin>.
--
Best regards
Han
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People who can fall asleep easily (me) are often very unsympathetic to people who need masks, earplugs and every light in the house turned off before they can fall asleep (my wife). Then there's entire class of people who can fall asleep easily enough, but once awakened can not fall back asleep. I sadly believe that unless you've experienced a sleep disorder close up, it's very hard to be sympathetic to how lack of sleep can seriously degrade your QOL (Quality of Life).
Sleep disorder clinics wouldn't be springing up like wildfires if most people could fall asleep without problems. I haven't checked lately, but I believe sleep aids are one of the mostly widely prescribed drugs in the US. If you count antidepressants that also have a anticholinergic (sleep inducing) effect, they easily are the numero uno. Throw in the self-medicators who use pot, alcohol or natural remedies to get to sleep, then the scope of the problem is mind-boggling.
When my wife started taking Halcion and then Ambien, the change in her happiness level was unmistakable. People become habituated to these meds because life is just so much easier to deal with when you've had a good night's sleep. Making anyone who needs medication to help them sleep feel like opiate abusers is really unfair. Modern man lives in a state of hyperstimulation and some can cope naturally better than others.
-- Bobby G.
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Is she still taking ambien? How long has she been taking it? How much sleep does she get, and how is she doing in general?
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Anticholinergics are not used for their sleep-induction attributes and the word does not mean "something with a sleep-induction effect". It's true however that in some people drowsiness is a minor side-effect of the anticholinergics such as those used for COPD or for over-active bladder. Anticholinergics block the acetylcholine receptors but have no direct hypnotic or narcotic effect.
I would also dispute that most modern antidepressants are used as sleep aids or in fact induce sleep at all. Perhaps if you go back to the tricyclics there's some drowsiness side effects but the Prozac class (SSRI's) and bupropion are actually stimulants.

IMO (and experience) most sleeping problems can be cured by resisting the regimen of sleep timing: go to bed when you're tired not because you have to get up early in the morning. If you can't sleep or you wake and can't get back to sleep get up and tire yourself out. Of course this is all very easy to say but not so easy to implement especially if you're gainfully employed.
Pot and alcohol are very poor choices. The sleep quality is almost never good. A warm glass of milk or hot chocolate is a much better choice.
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snipped-for-privacy@nowhere.gov wrote

http://en.wikipedia.org/wiki/Anticholinergic
Anticholinergic drugs are used in treating a variety of conditions: a.. Gastrointestinal disorders (e.g., gastritis, pylorospasm, diverticulitis, ulcerative colitis) b.. Genitourinary disorders (e.g., cystitis, urethritis, prostatitis) c.. Respiratory disorders (e.g., asthma, chronic bronchitis) d.. Parkinson's disease and Parkinson-like adverse medication effects e.. Sinus bradycardia - Hypersensitive vagus nerve f.. >>> Insomnia, though usually only on a short term basis. I'm working off 30 year old memories from when I dated an MD. She would prescribe 10mg of doxepin to elderly patients, mostly in nursing homes, because in those sub-clinical dosages they would not gain much anti-depressant effect but it would make them sleepy and was largely compatible with other medications they were likely to be taking. Doxepin (aka Sinequan) is a trycylic. That's when I first learned the word anticholinergic. I'll readily admit it wasn't what I really wanted to say, now that I've read up.

I know a lot of doctors that prescribe them for people with problems sleeping, perhaps as a placebo, perhaps hoping that their lack of sleepiness at night is related to depression or lack of substantial daytime activity. When you start trying to account for all the off-label uses of modern meds, it gets pretty fuzzy out there. It seems the favorite off-label drug these days in Neurontin. So much so it's makers have been fined by the FDA twice for big bucks for pushing off-label usage. Neurontin is for treatment of epilepsy, but I know people who are taking it mainly to knock them out at night. Prescribing SSRI's for daytime use could easily result in a patient being sleepier than normal at night because they've been artificially stimulated during the day. So yes, I would agree the newer anti-D's don't induce sleep directly, but can easily end up having that effect eventually. (-:

And in the end, it comes down to the person. Up until my thirties, I could fall asleep in a noisy squad room without a problem. My wife has always been awed and jealous of my ability to normally be asleep within 5 minutes of hitting the pillow. But as I mentioned in another post, task me with briefing a room full of three star generals and I will not be able to get to sleep without a pill now. Maybe it was just that until I was thirty, there really wasn't anything to worry about.

I agree they're poor choices, but whether they're bad choices or not, I'd say that millions if not tens of millions of people use either or both as sleep aids. Unfortunately, we're reaching a point where pharaceuticals cost more than alcohol or street drugs, especially for the uninsured. It seems the price of most meds has double since the donut hole ridden Medicare Drug act was passed. )-: A joint or a shot of vodka per night has to be cheaper than brand name sleep aids when you factor in the doctor visit. Most people don't care if it's bad quality sleep as long as it's sleep.
-- Bobby G.
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You are the first person I have ever met that has taken it for several months without experiencing withdwarals and extended insomnia. I have talked to many people who have taken ambien regularly, and *none* of them were able to quit without extensive and severe insomnia. You are more than an exception, you are very unique!
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Thanks!! Of course, I knew I was unique, but I do appreciate your confirmation! <grin>
I can only relate what I experienced. Getting off wasn't that easy, but it certainly didn't take more than a few days. But then, I quit smoking cold turkey too. Twice. Last time was November 16, 1976. Haven't smoked since.
--
Best regards
Han
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Good for you!!!! I wish I could have stopped my mom from smoking. )-: It eventually killed her. My sister still smokes and she's smart enough to know better. I'd have to say nicotine is as addicting as any sleep aid and worse, you can get it anywhere. My wife only uses Ambien occasionally now, and that's when she's got a trip or a big presentation or something that's out of the ordinary that she will worry about no matter how much she's planned. On those occasions, she considers Ambien a godsend. I don't recall her having any real problems quitting, although I did get her a sound machine that generates a dozen different sounds (seashore, brook, rain, railroad, etc) that has been very helpful in getting her to fall asleep.
-- Bobby G.
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If addiction to nicotine is really the problem (often not the case as shown by the fact that the following frequently doesn't work) she should try an electronic cigarette. Much much cheaper than actually smoking and doesn't include the nasty products of combustion of tobacco. In fact nothing is burnt at all. You get your nicotine depending on the dose you choose as a super-high level (36mg) down to no nicotine. For most people the super-high will have you feeling as though you've just smoked a pack without stopping. Usually you'll feel nauseous. Pick a normal level (11mg or 18mg) to start. It allows you to effectively continue smoking without the bad effects. IOW it's not a smoking-cessation remedy. Unlike the vastly over-priced OTC pharmaceuticals you don't have kow-tow to the touchie-feelies and you can have all the other benefits of smoking (something in the hand, the sucking, the ritual of preparation, etc).
Because of the political-incorrectness it's impossible to do a reasonable study but some people find that they still crave the cigarette even though they have an on-demand ingestion of nicotine at at least replacement level and in "burst mode" like you'd get with a normal cigarette. This shouldn't happen if the problem with cigarettes is nicotine or even in the mannerisms of smoking but no one wants to do a reasonable study.
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I based my comment on how difficult it's been for people I know to quit. Part of the problem is that unlike heroin, you can walk along the city streets and a) see people smoking, b) smell people smoking and c) see a dozen places to buy cigarettes. The deck, until recently, has been very heavily stacked against the smoker who's trying to quit. At least with heroin, you have to go seek it out - you're not bombarded with cues that lead back to the habit. Maybe it all comes down to one of the chapter headings in my old, old abnormal psych textbook, taken from an old Spanish proverb:
"Habits are first cobwebs, then chains."
-- Bobby G.
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On 3/8/2011 5:31 AM, Han wrote:

Well, to sorta bring this back on topic for AHR, from my youth spent swinging a hammer and a shovel on construction sites, I have found the best sleep aid is intense physical exhaustion. Since I got me one of those cushy inside jobs, and drive a desk for a living, I also sometimes can't get to sleep. I just don't worry about it too much. Laying there in the dark, very still, also lets the body recharge, sort of, and more often than not I eventually do fall asleep.
--
aem sends...

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<stuff snipped>

Some of us are getting too damn old to swing a pickax anymore and it's a proven fact that the older you get, the harder it is to fall asleep. (-: For some people, lack of sleep is like a feedback loop. The longer they stay awake, the more they worry which then adds to the issues keeping them awake.
I can recall the night before a super big briefing at OSD. I could close my eyes and see myself in the middle of carousel of horses, each one representing a possible "point of failure." Did I check the video projector? Did I put the latest version on a Bernoulli (tells you this was "back in the day!") Did I make sure all the proper clearances were in place? Etc, etc. Just whirling around and around in my head. Transcendental meditation helped, but a .5mg Halcion was as certain as the sunset to stop the worry horses in my head. Some people can just turn that sort of worrying off, others can't. I think it's as simple as that.
-- Bobby G.
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Ditto for me too...On those occasions I can't sleep I just put on a boring show and relax in the recliner till I fall asleep...It also saves the wife from my tossing and turning...When I worked construction I could fall asleep at the kitchen table after supper some nights...Same for when I was in the service..I could fall asleep in the back of a truck bouncing down the road..LOL..
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tryptophan for some of his druggies. His theory was that they needed to take SOMETHING, because they weren't in control of themselves. He chose tryptophan because, as he said, it is cheap, safe, and if you OD the only major side effect is that you get extra nervous around Thanksgiving-grin. Never did see anything he wrote up on this idea, though.
--
"Even I realized that money was to politicians what the ecalyptus tree is to
koala bears: food, water, shelter and something to crap on."
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On 3/8/2011 7:40 AM, Kurt Ullman wrote:

It's my understanding that it only takes the tiniest dose of melatonin which I have used before but not lately. The tryptophan and the B vitamin seemed to work for me back in the 80's when I used it but it was banned from OTC sales in 1989 because of a contaminated batch out of Japan which caused a blood disease for a number of people. I didn't know until yesterday that the ban was lifted in 2002 and that tryptophan is now back in some health food stores. I'll have to try it again.
TDD
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talking 4-6 weeks before you even think about it increasing dose let alone taking someone off. Same with many kinds of high blood pressure. There are all sorts of things from stress, to how much caffeine, to heat in the room that cause sleep problems. If you tried just once or twice, I wouldn't think that was a good test as opposed to a week (or more). The precribing information for Ambien (wasn't that what you were talking about) says specifically re-evaluation should come if not resolved in 7-10 days.

--
"Even I realized that money was to politicians what the ecalyptus tree is to
koala bears: food, water, shelter and something to crap on."
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wrote:

weeks. Three nights I found myself wide awake before dawn and I took another one. One thing that aggravates my situation is that I have the strong urge to urinate about once an hour.
My bottom line is that the replacement doesn't work as well. I realize they can't reuse the pills, but I also have 90 day supply of pills I can't use either.
Your message gave me a thought. Because I have to order meds 90 days at a time, the pharmacy should send an evaluation script when making a change before committing to 90 days. My insurance pays 75%. I am stuck with 2 months of bad product.
I know "they" say generic is the same thing, but it most certainly is not.
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About the only thing the FDA makes generic prove is "bioequivalency". They can take as few as 10 or 20 healthy volunteers, give them the meds, take their blood and as long as blood levels are roughly equivalent to the original, they are good to do. THey do have a fairly wide equivalent window, don't remember what it is any more. There have been some problems documented with generics. One medication the stuff making up the pill was different from the original and interfered somehow with the pill's usefulness. It is not unheard of for the bioequivalency window to be wider than the therapuetic one so you might not get enough or even OD depending on the particular batch.
--
"Even I realized that money was to politicians what the ecalyptus tree is to
koala bears: food, water, shelter and something to crap on."
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On 3/7/2011 3:21 PM, Kurt Ullman wrote:

Chuckle. Had my quack change my BP scrip to allow generic, since the pharmacist said there was now a generic available at the same dosage level at a much lower cost. Picked it up, looked at it, and asked pharmacist if he had made a mistake. It was the exact same brand-name med I had been taking, at 1/3 the price. The company now also sells it as a generic, to discourage the other companies from poaching. Same pill, same color, same control number and brand name printed right on it. But unless the patient thinks to ask, or their pharmacist tells them (kudos to my local RiteAid), they and their insurance company will go on paying for the full-price version. I can see why the drug company does it- the marginal cost of each pill is trivial for them- rather than lose the sale entirely, better to sell it at a discount and still make SOME profit on it.
--
aem sends...

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<stuff snipped>

I've had them do that to me, too. I freaked. The generic/brand name battle is an interesting one.
Brand name companies have been known to make payments to companies to NOT make generics.
http://www.insidecounsel.com/Issues/2009/October-2009/Pages/Pay-for-Delay.aspx
-- Bobby G.
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