Brief Answer:
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Detailed Answer:
Hello Diane,

As one who struggled with sleep problems, I can relate to this.

The first red flag I noticed in your history is that you take Ambien. While Ambien can work great for some people, it is really only meant to be taken occasionally, not daily. And I know from personal experience and that of patients, while Ambien can work well for some people, it can also really mess a person up. People can have problems for months after discontinuing it. Ambien is very short acting and when it wears off can then cause agitation or nervousness, and then a person gets into a cycle of not being able to sleep. The Xanax you take may be masking some of that agitation/wakefulness.

Xanax is generally for short term use, too, and as a benzodiazepine, it can be dependency forming. But it does not typically mess people up the way Ambien, Sonata, or other very-short acting sleep medications do, and many people do use Xanax or Ativan on a nightly basis without problems. I am not as concerned about the Xanax.

For ongoing sleep problems, I recommend medications that are not specifically for getting a person to sleep fast (i.e. sleep meds such as Ambien etc). Instead, there are meds that have longer half-lifes that might help. If you were my patient I would strongly advise you wean off of the Ambien by going down to 5 mg for 7-10 days and then discontinuing it. But you will need something else in it's place. Keep in mind you may have some Ambien withdrawal symptoms. Also, it can take months to reset after using a number of medications similar to Ambien (Sonata, Lunesta, etc).

Here are some suggestions:
1. Trazadone: This antidepressant has soporific (sleep inducing) effects. Start with a low dose as it may make you sleepier during the day, initially.

2. Clonazapam: This is a long-acting benzodiazepine that generally calms the system down like Xanax can, but it is longer acting. However, it is dependency forming because it is a benzodiazepine. Still, it can be helpful and you can eventually get off of it slowly.

3. Amitriptyline (Elavil): This is lower on my list because it is a tricyclic antidepressant and some people experience more side effects on it than with other meds. But it can help sleep architecture, is good for preventing migraines, and nerve pain so it has it's merits. Again, I would start with a very low dose and increase gradually as needed and tolerated.

4. Gabapentin (Neurontin): This is in the class of anti seizure medications, but it also has soporific effects. It generally has a lower rate of side effects. The sleep inducing effects may not be as pronounced as with the other meds listed above, but that varies from one person to the next. Start with lower dosage and go up.

5. If all else fails: A very low dose of olanzapine (in the class of atypical antipsychotics) can work great. For bipolar, the dose is in the range of 15 mg but for sleep, 2.5 mg may work.

The medications I listed above would be taken scheduled rather than as needed.

Rather than a psychiatrist, you might consider going to a sleep specialist.

If you have not had thyroid blood work done, be sure to have a TSH and thyroxine level measured just to make sure thyroid problems are not contributing to this.

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