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Don't Sleep On It: 10 Things You Didn't Know About Ambien

Medically reviewed by Carmen Fookes, BPharm. Last updated on May 6, 2021.

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1. Sleep Problems Common. Sleep Aid Use Increasing.

Sleep deprivation is no joke. Numerous motor vehicle crashes, industrial disasters, and medical errors have been linked to insufficient sleep. Sleep problems often stem from stress, pain or medical conditions that may not always respond to lifestyle changes recommended to improve sleep.

So maybe it's no surprise for you to hear that more than 10 million prescriptions are written for Ambien (zolpidem) or Ambien CR every year. Ambien is a sedative, also called a hypnotic, that is used to treat insomnia. Other brands of zolpidem include Edluar and Zolpimist (oral spray).

2. Not A Benzodiazepine But Has Benzodiazepine-Like Effects

Although Ambien belongs to a different class of medicines than older drugs historically prescribed for sleep (such as benzodiazepines), it works in a similar way.

Both benzodiazepines and zolpidem (Ambien) are thought to enhance the effects of a specific neurotransmitter called GABA. However, Ambien only induces sleep whereas benzodiazepines also work as anticonvulsants and muscle-relaxants.

Even though Ambien is not as habit-forming as benzodiazepines, it is still addictive. Ambien is also a lot shorter-acting than most benzodiazepines, although some side effects may stick around.

3. Original Doses Packed Too Big A Punch

The FDA regularly monitors prescription drug information and makes label changes based on reported side effects.

In 2013, the FDA ordered Sanofi-Aventis, the manufacturers of Ambien and Ambien CR, and all other manufacturers of zolpidem to change their dosage recommendations.

This was in response to over 700 reports of zolpidem-related driving accidents, including drowsy-driving and sleep-driving (patients getting out of bed while not fully awake and driving). People also report eating, walking, making phone calls, or having sex after taking Ambien and having no memory of doing so.

4. Long-Lasting Forms: Impaired Alertness Still High

Ambien CR has two layers.

The first layer dissolves quickly to send you off to sleep. The inner layer dissolves more slowly, and helps you stay asleep. But this inner layer can also mean blood levels of the drug are still high enough the next morning to impair your ability to drive or operate machinery.

Impairment with Ambien CR is increased with higher dosages; when taking it late at night with less than 7 to 8 hours of sleep left; in women; and if taken with narcotic pain medicines, antidepressants or alcohol. If you still feel drowsy the next day after taking Ambien CR, talk to your doctor about reducing the dosage or alternative sleep medications. Do not attempt to do anything that requires alertness if you are not fully awake after taking Ambien CR.

5. Women More Susceptible To Effects Of Ambien

Zolpidem (Ambien) is broken down (metabolized) in the liver to an inactive form, but the liver enzymes responsible for this process are more active in men than in women.

Some scientists believe the faster rate of zolpidem metabolism in men may be due to the enzyme-enhancing effects of testosterone. This means that Ambien's effects are more likely to last longer in women. In fact, plasma levels of zolpidem can be up to 50 percent higher in women.

As a result, recommended initial doses of Ambien in women are 5 milligram (mg) for the immediate-release form and 6.25 mg for Ambien CR. Seniors also have a reduced ability to metabolize Ambien and should also take lower initial dosages.

6. Not As Addiction-Free As Once Thought

When zolpidem (Ambien) was first discovered, scientists thought it unlikely to cause tolerance, dependence, or be misused like benzodiazepines. Unfortunately, if you've been taking moderate-to-high doses of Ambien for long periods of time, you may struggle with medication withdrawal symptoms when you try to quit.

Symptoms can include shaking, stomach cramps, vomiting, nervousness, and panic attacks. Ambien is designed for short term use only. Taking it at higher than recommended doses for long periods of time increases your chance of addiction.

7. Things That Go Bump (Or Tweet) In the Middle Of The Night

Parasomnia is the medical term given to an activity someone might perform while they are technically asleep.

These range from sleep-walking, hallucinations, cooking meals, binge eating, cleaning the house or even driving the car while in an altered state of consciousness. The next morning, the person has no idea of what went on the night before.

Drugs such as Ambien (zolpidem) reportedly induce this side-effect more than benzodiazepines do. So much so, that the terms "Z-drug Zombie" or "Ambien Zombie" are in common usage.

While research has shown that some people are indeed prone to occasional parasomnias after taking Ambien, these are more of a physical rather than a cognitive nature. Some celebrities have tried to blame Ambien for their bilious comments or statements; a notable example being Roseanne Barr's inflammatory comments about Valerie Jarrett, a former senior adviser to former President, Barack Obama. As the manufacturers of Ambien succinctly put it, "Racism is not a known side effect of any Sanofi medication".

8. Prescription Medicine. Prescription Needed

Ambien is a controlled, prescription drug which means on-line sales of the drug without a prescription are illegal. Plus, drugs bought over the Internet might not be from a registered manufacturer, and there's no guarantee they actually contain the right ingredient.

In 2007, the FDA described several instances where individuals who ordered Ambien received a product containing haloperidol, a powerful antipsychotic. After ingesting the counterfeit product, some of these people experienced difficulty in breathing, muscle spasms and muscle stiffness requiring emergency treatment. Ask yourself...is it worth it?

9. Making You Feel Worse, Not Better

Depression is a serious condition that can cause lack of sleep. In some people, insomnia occurs before symptoms of depression. In others, symptoms of depression occur before the onset of sleep problems. As a result, many people with depression take sedatives such as Ambien.

However, sedative use is associated with a higher chance of developing depression, or worsening existing depression. Alcohol use, which should be avoided when taking Ambien, can compound this risk. Report any new or worsening symptoms of depression to your doctor. Ambien may not be the right sedative for you.

10. Taking A Sedative? Accidents Can Happen

Taking Ambien occasionally to help you sleep is generally safe...as long as you stay in bed! But what if you need to get up in the middle of the night to go to the toilet? What if you wake up earlier than usual and get out of bed or go to work?

Chances are, you will still be drowsy from the drug's effects, and you are more likely to fall, break a hip, hit your head, or have a car accident, especially if you are of an older age. In fact, use of Ambien and other sedatives can double the risk of a car accident or other serious injuries. Sleeping pills should not become a regular habit - and be especially careful when you do use them.

Fight Back: Other Ways To Combat Insomnia

Lack of sleep is often a symptom of an underlying problem. It is not really a condition or illness in its own right. Sleeping pills should only be used as a last resort.

Think about your caffeine use, is it too much? Monster-sized energy drinks or triple venti lattes may be the culprit. What about life situations? Do you keep the TV on in your bedroom? A victim of late-night computer use? Are you getting any exercise? Have you recently lost a loved one, had a job change, or a marital dispute? All of these can affect your ability to rest soundly.

Consider doing yoga, a meditation course, or downloading a sleep App, such as Calm, Simple Habit, or Insight Timer. Your mind at night is a reflection of your mind during the day and finding ways to unburden it during the day of stressful thoughts can help with your sleep at night.

See other ways you can address lack of sleep and think about joining the Drugs.com Insomnia Support Group to ask questions and voice concerns.

Finished: Don't Sleep On It: 10 Things You Didn't Know About Ambien

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Sources

  • Ambien (zolpidem) [Product Information] Drugs.com https://www.drugs.com/ambien.html
  • Ambien Addiction and Abuse. Addiction Center. April, 2021. https://www.addictioncenter.com/sleeping-pills/ambien/
  • FDA. Questions and Answers: Risk of next-morning impairment after use of insomnia drugs; FDA requires lower recommended doses for certain drugs containing zolpidem (Ambien, Ambien CR, Edluar, and Zolpimist). December 2014. http://www.fda.gov/Drugs/DrugSafety/ucm334041.htm
  • Lin F-Y, Chen P-C, Liao CH, Hsieh Y-W, Sung F-C. Retrospective Population Cohort Study on Hip Fracture Risk Associated with Zolpidem Medication. Sleep.2014;37(4):673-679. doi:10.5665/sleep.3566. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4044749/
  • Cubala WJ, Landowski J, Wichowicz HM. Zolpidem abuse, dependence and withdrawal syndrome: sex as susceptibility factor for adverse effects. Br J Clin Pharmacol. 2008;65:444–5.
  • Olubodun JO, Ochs HR, von Moltke LL, et al. Pharmacokinetic properties of zolpidem in elderly and young adults: possible modulation by testosterone in men. Br J Clin Pharmacol. 2003;56:297–304.

Further information

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