Ambien (generic name, zolpidem) is a sedative-hypnotic with effects similar to Valium or Xanax. Ambien is generally prescribed to people for short-term treatment of insomnia. Short-term in this context means up to five weeks.
Physicians are cautioned to seek other reasons for insomnia that last longer than this time frame. Because Ambien can mask insomnia that is caused by some physical or mental problem, it is important to seek underlying conditions if normal sleep patterns do not return.
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The Food and Drug Administration currently lists Ambien as a Schedule IV drug, meaning it is considered to have a relatively low potential for abuse. Ambien shares space on this list with benzodiazepines. Ambien has several characteristics that make it an attractive choice for the treatment of insomnia and some risks.
Advantages of Ambien
Ambien has a quick onset – about 15 minutes – and leaves the body after about 8 hours. The effects generally start falling away as soon as 3 hours with a normal dose. This means patients can use the drug to fall asleep, but probably won’t have any after-effects the next morning.
Ambien also has very few drug interactions of note. The major interaction is with other central nervous system depressants and especially alcohol. It can also be used in the elderly at a lowered dose.
Disadvantages
Doctors may overprescribe, and patients may overuse the drug. It is such an easy and quick solution for insomnia that proper sleep studies or examinations for deeper problems may never be done. The drug has been and continues to be prescribed for much longer than the short-term recommended by the manufacturer.
Ambien is habit forming. Patients may increase the dose on their own and have rebound insomnia if taken off the drug. It is also not appropriate for people who sleep less than their target number of hours. Ambien is best for getting to sleep, not for staying asleep the entire night.
Ambien causes retrograde amnesia – forgetting things that happened just before and after the drug is taken. It can cause confusion that is unrecognized in the elderly who are assumed to be losing their memory. It can also mask normal changes in sleep patterns with age.
The drug can also cause sleep-walking in some patients. This has even been blamed for one death where a patient walked off a balcony. Quite complex behaviors have been observed in people who were ‘asleep’ and yet functioned almost normally. Patients who live alone and cannot be observed should be cautioned about this. Others can have someone watch for this ‘twilight sleep’.
Ambien also shares a danger with other sleep-inducing drugs. After the drug is taken, if the patient has to stay awake, they will certainly suffer cognitive impairment. If an emergency arises, patients who have taken the drug may be unable to respond properly. Driving can be particularly dangerous in these conditions.
Ambien addiction and abuse
Because Ambien is so popular in legitimate medicine, more is available for diversion into the black market. Here the drug is used for several reasons – both as a sleep aid (popular among those undergoing withdrawal from narcotics) and as a ‘downer’ on its own.
The property of retrograde amnesia means it can be used as a date rape drug, particularly so when added to alcohol.
Addiction to Ambien is generally thought to occur as a result of medical treatment for insomnia instead of from illegal purchase. The reason is that a chronic and steady usage is required for an addiction to occur. The incentive for the addict is their need for sleep. Stopping the drug means not sleeping and improper or poor sleep can disrupt someone’s life tremendously. Suddenly stopping Ambien in someone who has become tolerant is actually dangerous and can trigger seizures. For this reason, long-term patients will be withdrawn from the drug by lowering the dose slowly over one or two weeks.
Unfortunately, Ambien is also a drug that can be used in suicide attempts (with or without alcohol). This is why finding out if insomnia is due to depression is so important before the drug is prescribed.
photo by Foxumon
