Is it healthy to cycle through sleep medication?

This question was asked in Pine Point, Maine on 02/08/2013.
I work night shift 7 p.m. to 7 a.m. 4-5 times a week. I take Ambien when I wake up at noon so I can go back to sleep. When I notice the Ambien not working as well I will change to Sonota for a few days then back to Ambien. My doctor has allowed me to do this for years but now says he isn't comfortable with it because he couldn't find anything in "up to date" so he didn't feel comfortable. I first heard of this at a conference for sleep professionals by a sleep doctor. My doctor said if I find the names of doctor /references who prescribe something like this he'd reconsider. This has been working for 2 years and for some reason he feels now is the good time to stop. Might I add the pharmacist keeps questioning my doctor even after my doctor said it was alright. The pharmacist seems to have always had an issue with this on some level. I read online and it doesn't seem uncommon. I need help please! I do not take the medications together!

Doctors Answers (5)

Jana P. Kaimal, MD, FCCP
Answered on: 4/5/2013 7

Consider seeking the advice of a qualified sleep specialist. There may be alternatives to your current treatment regimen.

J. Douglas Hudson, MD, DABSM
Answered on: 2/18/2013

Shift workers often suffer from a syndrome which creates excessive sleepiness and/or wakefulness at the wrong time. To continue working in this fashion it often requires medication to promote either sleep or wakefulness. Alternating sleeping aides is often a good idea to reduce the development of tolerance. It seems as though you have been successful with this approach. An example, the FAA now recognizes that pilots who flight irregular schedules benefit from taking FDA approved sleep aides if taken many hours ahead of flying to eliminate hangover effect and to keep their sleep cycles as near normal as possible. Ambien CR studies were done which found that subjects who took the drug for a year had no problems with addiction, etc. Regular Ambien failed to do such a study and was always listed as being for short term use. Personally, I see no reason to differentiate the two and would support you continuing with your plan until you are no longer working shifts. Taking a stimulant to stay awake would also be acceptable if needed.

Jeannine Louise Gingras, MD
Answered on: 2/8/2013 4

Without seeing you as a patient. I cannot really comment. Shift work disorder is difficult tonnage and often requires thinking outside the box!

Courtney Whitney, DO
Answered on: 2/6/2013 1

It would be most ideal to sleep without the aid of meds, but sometimes they are essential/helpful. I am not aware of a problem with altering these meds. They have a similar mechanism of action (GABA receptor). These medications have not been studied for long term use so we are not sure if there is potential harm. The primary problem is insomnia (possibly due to shift work) that is now likely also complicated by hypnotic dependence. Consider Cognitive and Behavioral Therapy for Insomnia (CBTI).

Robert C. Jones, M.D.
Answered on: 2/6/2013 1

Shift Work Syndrome is very difficult to treat, but you have found the means to keep it under control. After you've acclimated to your Ambien and it's not as effective, you've had a "drug holiday" from it by using the Sonata. Since they both work slightly differently to produce sleepiness, alternating them is a very effective treatment. I had to do this for patients with Restless Legs Syndrome prior to the advent of Dopamine Agonists. Your Doctor has been keeping track of your usage of medication to avoid any abuse of them. Since you have been responsible I see no reason to change what's been effective. Going to other treatments for preventing Shift Work Syndrome may not work! If it ain't broke don't fix it! I would highly recommend to continue your current schedule of treatment.