Insomnia can be a very frustrating condition, and it can have far-reaching negative effects on your quality of life. When changing your habits and lifestyle aren’t enough to help you, medications, such as Ambien (zolpidem) may be prescribed by your doctor. While the Food and Drug Administration (FDA) has approved Ambien as a safe and effective treatment for insomnia, recent research has raised some questions about its use. Consider the following when weighing the pros and cons of Ambien.
Emergency room visits due to Ambien have increased dramatically.
A recent report noted that between 2005 and 2010, the number of people taking Ambien who ended up in an emergency room increased by almost 220 percent—from 6,111 visits to 19,487. In addition, the report found that 74 percent of the visits were made by people at least 45 years old, and that 68 percent of the ER visits were made by women. The sedative effects of zolpidem can be harmful when combined with other drugs, particularly anti-anxiety medication and pain relievers. In fact, the researchers found that 50 percent of all emergency room visits in 2010 were related to people combining other medications with zolpidem, and in 37 percent of the cases, it was taken with a medication that depresses the central nervous system.
FDA reduced dosage recommendations for Ambien.
In January 2013, the FDA required zolpidem manufacturers to reduce the recommended dose of the medications associated with the active ingredient. Those medications include, Ambien, Ambien CR, Zolpimist, Intermezzo and Edluar. New evidence showed that blood levels of zolpidem the next day can still severely impair alertness and the ability to perform tasks in some people, including driving or handling machinery.
Women take longer than men to flush the medication from their system. Therefore, the FDA has reduced the dosage for women taking instant release drugs from 10 mg to 5 mg, and for extended-release drugs from 12.5 mg to 6.25 mg. The FDA also encouraged doctors to prescribe the same dosage to men. The FDA also warned that morning drowsiness and reduced alertness is not exclusive to zolpidem, and that many other insomnia drugs carry the same side effects.
Ambien can cause behaviors that aren’t remembered in the morning.
Ambien can cause people to do strange things in the middle of the night and not remember it the next morning. These include sleepwalking and binge eating at night, as well as short-term memory loss. Other people have reported driving their cars, having sex and making phone calls while asleep. The manufacturer has dismissed such events as very rare side effects, but does not have statistics to show how rare.
But Ambien can be safe if used correctly.
Although the above concerns are legitimate, taking Ambien responsibly and as prescribed can be a safe and effective way to treat insomnia, according to Dr. Sam Fleishman, president of the American Academy of Sleep Medicine and Medical Director of Cape Fear Valley Sleep Center. He says the FDA’s recent dosage change for Ambien, “certainly makes us pause and take a step back, but there are a number of people who take Ambien and don’t have a problem.”
The problem, says Dr. Fleishman, could be that doctors and patients aren’t having the right conversations about taking the medication.
“There needs to be an ongoing conversation between the doctor and patient on how to use the medication, including what time they take it and what else they are taking it with,” he says, “Those questions are not being asked on a regular basis.”
How and when a person takes Ambien can cause some of the strange behavior that has been reported, according to Dr. Fleishman. For instance, if you take the drug, but don’t go to sleep right away, you might have conversations you don’t recall the next day, or eat in the middle of the night.
But, Dr. Fleishman says driving while asleep is a very rare occurrence.“Most episodes where that has occurred, people have combined it with alcohol or other substances.”
Dr. Fleishman says women, the elderly and smaller individuals are more likely to experience next-day impairment due to Ambien because they can’t metabolize the drug as quickly. But he says most patients have no problems. While he acknowledges that we shouldn’t discount the recent research, he says it’s important to remember that Ambien has been widely prescribed for 17 years.
“Ambien still has a lot of benefit and value, but we need to be more thoughtful about using it.”
People taking Ambien should see their sleep problems improve within seven to 10 days, and if they do not, they should contact their doctor. In addition, Ambien should be taken only for short periods of time, two weeks or less. Taking it longer can create a dependence, or addiction.
In addition, for those who have taken Ambien for longer than two weeks, it’s important not to suddenly stop taking it, as severe withdrawal symptoms can occur. For those who have taken the drug for less than two weeks, it may be difficult to get to sleep the first couple nights after stopping Ambien. But this is normal. The ability to fall asleep without medication should improve by the third night. Anyone experiencing any strange activity or side effects,should talk to their doctor immediately about whether to discontinue taking the medication.
Nordqvist, C. (2013, May 3). "Emergency Visits Due To Ambien Skyrocket." Medical News Today. Retrieved from http://www.medicalnewstoday.com/articles/260084.php
Nordqvist, J. (2013, January 10). "FDA Reduces Dosage Recommendations Of Sleeping Pills Containing Zolpidem." Medical News Today. Retrieved from http://www.medicalnewstoday.com/articles/254816.php
Nordqvist, C. (2006, March 16). "How Many Ambien Patients Get Up At Night And Remember Nothing?." Medical News Today. Retrieved from http://www.medicalnewstoday.com/articles/39759.php
American Society of Health-System Pharmacists, Inc. (2013, February 15). “Zolpidem” MedlinePlus. Retrieved from http://www.nlm.nih.gov/medlineplus/druginfo/meds/a693025.html