Five or maybe even seven years ago, a primary care doctor prescribed Lunesta to help me sleep. Insomnia has been an issue for me since early adulthood, perhaps even as a child – I’ve always been a night owl. But with the onset of fibro in about 2001, my quality of sleep became dreadfully poor. Even if I managed to get to sleep by 11 p.m., I’d be awake by 2 a.m. and up for at least a couple of hours. That made getting to work at 8 a.m. an increasingly difficult challenge. (I used to joke with co-workers that I was never meant to sleep.) Lunesta gave me a way to get some sleep and at least hold down a job.

What I didn’t know until years after that first dose is that Lunesta was never intended for long-term use, and anything more than two weeks is considered long-term. What I also didn’t know, until just a couple of months ago, is that Lunesta (eszopiclone) is psychologically and physically addictive, with detox symptoms that can include severe anxiety, muscle spasms, nausea, vomiting, tremors, weird dreams and sweats. Detox centers that traditionally focused on alcohol and opioid withdrawal are now making beds available for those detoxing from sleep drugs.

Shame on me for failing to do my research. Shame on the doctor who gave up on me and on continuing to look for alternatives.

I’m convinced the doctor didn’t prescribe out of malice; I remember more of a sense of hopelessness. His attitude was that fibro is something you’re stuck with and there isn’t much you can do. You will never sleep better, so using a drug like Lunesta was fated. Dangerous sleep with an addictive drug was better than no sleep at all. (BTW, I no longer work with this doctor.)

The one time I’d tried to end Lunesta on my own was disastrous. Within 24 hours I had all the side effects mentioned above. I was miserable and began taking it again.

The unexpected turn happened this year when my new primary told me that guidance from the CDC, SAMHSA (Substance Abuse and Mental Health Services Administration) and other federal entities included increased warnings against co-prescribing benzodiazepines and opiates. (Lunesta is technically not a benzo, but performs chemically in a similar fashion.) To rightly limit liability to her practice, my primary let me know she would no longer prescribe Lunesta as long as I was still being treated with opioids for pain. (A pain provider prescribes Nucynta for me. It is also technically a synthetic opioid, but as with the eszopiclone/Lunesta, it functions in such a similar way to opioids that there is no real distinction.)

It was devastating news and left me with a Hobson’s choice: I either live in pain but with some sleep; or I can have pain relief without sleep. Awful.

The difference this time is a doctor who truly cared enough to create a ‘weaning’ plan, using a bridge drug (Trazodone) that could help with sleep. While not nearly as powerful as Lunesta, Trazodone is a much less dangerous drug, although I may have to detox from it later.

I’m in the final stages of releasing Lunesta from my body. Today, I’ll drop down to 1/4 of a 3mg tablet and continue that for two weeks, then stop the drug completely. The Trazodone does seem to help, although it is not nearly as effective. I’ve had to concede to the likelihood that I truly have a sleep-phase disorder as diagnosed last year by a sleep specialist. More about that in another post.

Here are the key points from my experience:

• If your pain is managed with opioids, say ‘NO,’ when a doctor offers eszopiclone or zolpidem (Ambien).
• If you’re already on a sleep med in addition to pain meds, find a good doctor or detox center to help you withdraw. Don’t try to do it on your own.
• Speak up, with your own doc and in general. The current prevailing media conversation – enhanced by continued pronouncements by the federal government – is that opioids are bad. Period. We need to engage in a much more nuanced conversation that takes into account the fact that many of us, when prescribed opioid medication for relentless non-cancer pain, are following doctor’s orders and playing by the rules. I suspect the majority of us fall into that category, yet we’re being penalized by a system that tries to fit everyone into the same, one-size-works-for-everybody solution.

I’d love to hear your experiences, thoughts and options that have worked for you as you travel this very difficult path.