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Is Intermezzo the right kind of sleep medicine? (11/29/11)

November 29, 2011

Music for the Sleepless, or Disharmony?

It’s not every day the FDA approves a new drug – especially a new sleeping pill.  Intermezzo is a term that refers to a separate piece that plays in between acts – especially in a musical performance like opera. And now it’s being repositioned to name a “new” kind of sleeping pill – one used  in the middle of the night.

Yet Intermezzo is not a new drug, and may create more of the problem it’s supposed to solve.

Old Wine in New, More Expensive Bottles

What is Intermezzo?  Nothing more than smaller doses of the old generic sleeping pill zolpidem (ambien.)  Zolpidem is very popular – especially among women – and is famous for provoking bizarre sleepwalking for those who don’t immediately get into bed.

Intermezzo will come out in two doses – 1.75 mg – recommended for women – and 3.5 mg – for men.  The lowest available dose of zolpidem is 5 mg.  People wanting intermezzo can get generic zolpidem from their doctors and cut the pills into thirds.  Voila – an old drug has become a new one – at what will presumably be far less cost.

Assuming the cost of using is worth it.

How Is Intermezzo Meant To Be Used?

Only in the middle of the night for people who cannot get back to sleep and have four or more hours of expected sleep yet to come.

That’s a problem.

One of the banes of insomniacs is clockwatching – looking at the clock throughout the night.  Most insomnia doctors and researchers will tell you that clockwatching is a great way to keep people up all night.

Not only do insomniacs who watch the clock keep themselves awake – through also get more aroused and sleepless. And clockwatchers often find themselves waking up in the middle of the night at exactly the same time  – night after night.

They’ve reset their biological clocks – and caused themselves to wake up.

Use of Intermezzo will pretty much guarantee clockwatching – how else will you know you still “have” at least four or more hours of required sleep to go? (OK, you might program your cell phone in some interesting way, but most won’t.)  And people will become conditioned to wake themselves up – to consume a pill.

The FDA’s four hour rule is presumably there so too much of Intermezzo (zolpidem) won’t be sticking around sedating people when awake. Don’t expect that rule to be followed in practice.

At least the weird sleepwalking produced by bedtime zolpidem ingestion may prove less troublesome  with low dose intermezzo.  People are not as prone to do something besides sleep between 1 and 3 AM.

Alternatives to Intermezzo

Lots of people wake in the middle of the night – pretty much all of us.  Most times we don’t know that.  Sleep itself causes amnesia, and our awakenings are so short we don’t recall them.

But if you do fully wake in the middle of the night there are plenty of alternatives to taking a pill.

Like reading and music.

Unlike when using Intermezzo it’s best not to look at a clock at night but to set an alarm and treat every moment before that alarm as sleep time.  Sleep is non-linear; deep sleep and REM sleep may make you feel far more functional than stage 1 sleep, and your biggest REM period is usually right before you wake.

So if you can’t sleep after what you estimate is 5-10 minutes, get out of bed.  Go to a different room or at least a chair – don’t condition yourself to staying in bed if you’re not sleeping.

Next, read or listen to music.  There are many playlists to help you sleep.  Middle of the night books should prove neither boring nor enthralling.  Poetry knocks out many; history works for more than a few, as do travel books, art history, books on music, autobiographies and memoirs. When in doubt, read a book you should have read in high school – but didn’t.

Bottom Line

By encouraging clockwatching and conditioning drug use during the middle of the night, Intermezzo may provoke more chronic insomnia than it will treat. Low dose zolpidem may work for some, especially shiftworkers.  But there are plenty of alternatives for middle night insomnia before you reach for a sleeping pill – and they’re much safer.
Rest, sleep, Sarasota Sleep Doctor, well-being, regeneration, longevity, body clocks, insomnia, sleep disorders, the rest doctor, matthew edlund, the power of rest, the body clock, psychology today, huffington post, redbook, longboat key news

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