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

Medically reviewed on Jan 06, 2017 by C. Fookes, BPharm

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 9 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, Intermezzo and Zolpimist.

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. Although addiction centers report 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). Other reported activities have included eating, walking, making phone calls, or having sex after taking Ambien and later having no memory of the activity.

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. Always wait until you are fully awake before you do anything that requires you to be alert.

5. Women More Susceptible To Effects Of Zolpidem

Zolpidem (Ambien) is broken down (metabolized) in the liver to an inactive form, but the enzymes responsible 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 subject to abuse 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 Use The Microwave) 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. Potentially full of dangers, talk to your doctor if friends or family report this kind of behavior happening to you.

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 be far from safe, and there's no guarantee they actually contain the right ingredient.

In 2007, the FDA described several instances where individuals who ordered Ambien or other similar drugs 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, sleep deprivation 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 actually developing or worsening 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. 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 - not a true condition or illness. Use of sleeping pills should always be 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? Recent loss of a loved one, a job change, or a marital dispute? Do you keep the TV on in your bedroom? A victim of late-night computer use? Are you getting any exercise? All of these can affect your ability to rest soundly. 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 CR Product Labeling. Sanofi. Octoner 2014. http://products.sanofi.us/ambien_cr/ambiencr.html#S5.8
  • Centers for Disease Control and Prevention (CDC). Insufficient Sleep Is a Public Health Epidemic. Sept 3, 2015. http://www.cdc.gov/features/dssleep/
  • Ambien Addiction and Abuse. Addiction Center. Updated Dec 18, 2015. 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.
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