Ambien is America’s most popular sleep medication. While it can be an effective medication for those who suffer from insomnia, its use comes with various risks.

What Is Ambien?

Ambien is the brand name of the drug zolpidem, a sedative-hypnotic that is used to treat insomnia and some brain disorders. Its effects are felt as quickly as 15 minutes after consumption, making it a very popular choice for people who are desperate to fall asleep. As a sedative-hypnotic, Ambien both calms people down and induces them to fall into a very deep and powerful form of sleep. It does this by slowing down brain activity to the point where a person feels incredibly drowsy and relaxed, triggering the same receptors in the brain that are activated when a person takes benzodiazepines like Valium and Xanax.

Hypnotic drugs can be habit-forming, so much so that doctors should take a number of factors into account before deciding whether or not to prescribe them to a sleep-deprived patient. The Journal of Clinical Psychiatry recommends that a doctor should first try and determine the exact cause of the person’s insomnia, then suggest alternatives that do not involve the consumption of a hypnotic drug like Ambien, before finally prescribing Ambien at the lowest effective dose, for the shortest possible period of time, and then monitoring how the person interacts with the drug.

The Unexpected Effects of Ambien

 
Ambien can cause a number of side effects, ranging from the inconvenient to the troubling. These include:

  • Headache
  • Muscle pain
  • Nausea
  • Diarrhea
  • Fatigue
  • Feeling dizzy/weak

While these effects are certainly not unique to Ambien, the Journal of Medical Toxicology mentions further effects, such as sleepwalking, sleep driving, eating while asleep, and performing other routine activities that might usually be carried out during the day, like buying groceries, making phone calls, and sending text messages and emails. This is partly because the sleep that Ambien induces is not a normal form of slumber – a key fact about Ambien that exhausted and frustrated people don’t care about, as long as they don’t toss and turn for hours anymore. The Fix points out that even the labeling on bottles of Ambien cautions users about the “strange behavior” that comes with the territory.

‘Ambien Let a Murderer Live’

 
Some of that behavior might seem amusing or novel, but with the right set of conditions, being on Ambien can be deadly – either for the person taking it or for others. That was the case of Robert Stewart who, in March 2009, went to the retirement community where his estranged wife worked in North Carolina and shot eight people to death. Injured by a responding police officer, Stewart told hospital staff later that day that he had no recollection of the shooting.

Stewart’s legal team argued that Stewart was depressed before the shooting and under the effects of antidepressants and excessive amounts of Ambien, making him a “lethal sleepwalker” who could not be held legally responsible for his actions.

The jury agreed, finding Stewart guilty of second-degree murder by way of his diminished mental capacity at the time of the killings. Stewart was sentenced to at least 142 years in prison, prompting a law enforcement resource website to claim that “Ambien let a murderer live.”

Another instance of violence related to Ambien comes in the form of a paramedic in Chicago, who took two Ambien and fell asleep. He woke up in a trance, got in his car, and struck two vehicles, breaking a woman’s arm. Upon fully waking up in hospital (and under arrest) he had no recollection of the events.

Women and the Ambien Risk

 

The trial of Robert Stewart threw a great deal of media attention on the risks of misusing Ambien. No longer was it seen as a miracle drug that would put millions of tired, stressed, and sleep-deprived people to sleep as soon as their heads hit the pillow.

Now, other stories emerged of individuals waking up and finding out they had done inexplicable things while under the influence of Ambien: eating eggs with the shells intact or a woman going on a $3,000 shopping spree while in an Ambien trance.

Women may be at particular risk for suffering the ill effects of Ambien, since women are subject to more sleep-disrupting (or sleep-depriving) hormonal cycles than men. Older women use Ambien because it helps them overcome sleeplessness associated with menopause. Furthermore, women’s bodies process Ambien at a slower rate than men’s bodies, to the point where the U.S. Food and Drug Administration recommended that doctors prescribe lower dosages of Ambien to as little as 5 mg (since Ambien is an “immediate-release” product), to ensure that patients (especially women) do not develop a tolerance for the drug.

Ambien Tolerance

 
In this context, “tolerance” refers to a person’s body acclimatizing to a drug, so much so that regular doses no longer have the desired effect. It is a risk seen with the consumption of any chemical substance, whether legal and prescribed, or illegal and recreational (or any combination thereof). In order to derive the desired effect, people have to consume increasing amounts of the drug, all the while deepening their dependence. When Michael Jackson overdosed in 2009, he was taking 10 Xanax tablets every night, down from a nightly average of 40 or 50.

Similarly, Ambien’s potency can make it a very attractive drug for people who are desperate to fall asleep and stay asleep, so much so that the Ambien becomes their primary means of sleep. Once addicted to Ambien, any other nonchemical form of inducing sleep – anything from a warm bath, to herbal tea, yoga, meditation, or relaxing nature sounds – is incapable of naturally creating a mindset of rest and relaxation, partially because the sleep Ambien induces is not a normal form of sleep, but also because of how overwhelmingly powerful it is.

Addiction

 
Ambien’s power is such that it should only be owned, and used, with a doctor’s prescription. Any use of Ambien outside those parameters – regardless of excuses, like insisting that one extra pill can’t hurt or that the person really needs the Ambien to fall asleep – suggests unilateral administration of the Ambien, which could point to addiction.

Another sign of danger is when people combine Ambien with other substances, even if the action is borne not out of a desire to use the substances recreationally, but because they believe that such combinations will help them sleep or simply help them relax. Many people enjoy a glass of wine before bed, and they may assume that the sedative properties of alcohol will go down well with their Ambien.

However, to combine Ambien and alcohol is incredibly risky because the effects of both substances will be intensified. Psychology Today explains that the sleep induced by Ambien is not normal, natural sleep (because if the people who had to take Ambien could sleep normally and naturally, they would not take Ambien). Instead, Ambien puts individuals into a state between wakefulness and sleep (hence why people on Ambien perform seemingly complex actions while still technically being asleep, such as driving a car or going through the process of shopping online). Add alcohol into the mix, and the unpredictability of what happens while in an Ambien-induced state increases exponentially. Marie Claire quotes a toxicologist as saying that alcohol tampers with the trancelike state brought about by Ambien, making it a very dangerous cocktail. Nonetheless, 60 percent of people who take medications that have negative interactions with alcohol still drink while taking their meds, most likely due to complacency.

 

The Science of Sleep

 

Most people, says Psychology Today, think of sleep as being an on/off switch, not a biological, neurological process that is still being studied and understood. As recently as 2015, researchers at the University of Southern California said that the functions of sleep are still among the “greatest unsolved mysteries of science,” and that the true nature of sleep remains unknown.

But to someone who tosses and turns for hours, unable to stay asleep for more than minutes or hours at a time, the unsolved mysteries of the science of sleep mean nothing. As sleep remains elusive, all that matters is that Ambien puts them to sleep; wine helps them relax.

Ambien brings about sleep (or, more accurately, a state that resembles sleep but really isn’t), but at the cost of wakefulness and lucidity the following day. For insomniacs, or people who are dealing with exhausting and depressing levels of stress, they may be lured into thinking that one more good night’s sleep will help them be at their best the following day. In truth, they are only increasing their bodies’ need for Ambien and increasing the effects of Ambien.

They may indeed get a good night’s sleep, but they will feel a number of deleterious side effects:

  • Fatigue
  • Difficulty controlling movement
  • Short-term memory loss
  • Inability to concentrate and think clearly
  • Bizarre and uncharacteristic behavior

Such problems are possible even with prescribed doses of Ambien. When Ambien is consumed while other chemical substances are in the body, those problems become all but certain.

A doctor will undoubtedly warn a person against taking Ambien while on another medication, or drinking alcohol while on Ambien, and the FDA-approved labeling on a bottle of Ambien will carry messages to the same effect. Those pairing Ambien and alcohol will likely do so knowing that they are not supposed to – hence why such behavior suggests an addiction.

Withdrawal

 
As with any chemical substance to which a person becomes addicted, simply discontinuing intake is a dangerous proposition, as the person’s system has become so dependent on the drug that the sudden termination can cause numerous problems. The Journal of the Association of Physicians in India reports that stopping Ambien intake after a period of time can result in seizures and other withdrawal symptoms, such as nausea, mood swings, and even hallucinations (depending on the length of the Ambien consumption, how much was being consumed, and how quickly the Ambien was stopped, as opposed to being tapered off the drug).

Black and white image of a young woman crying and covering her fTreating an Ambien dependence involves addressing the physical effects of the addiction, as well as the mental health aspects. To ensure that the discontinuation of Ambien doesn’t trigger seizures or hallucinations, a person should not attempt to go off Ambien without medical supervision. This may entail checking into a hospital or treatment facility, where trained medical staff can observe the process of weaning off the Ambien, and supply medications to ease the transition. The American Journal on Addictions writes of a 52-year-old patient who was given quetiapine to help him overcome his physical need for Ambien.

Once Ambien is purged from the bloodstream, the body will react quite negatively. Since Ambien is an immediate-release drug, the first of the withdrawal symptoms – usually muscular cramping – will be felt within 10-12 hours. Over the next two or three days, the symptoms tend to be at their worst: anxiety, muscle spasms, mood swings, intense craving for more Ambien, diarrhea, and loss of appetite. To ensure that the distress is minimized, doctors may prescribe anti-anxiety and anticonvulsant medication. For this reason, withdrawal should not be attempted without medical supervision, as the resolve to resist taking Ambien to stop withdrawal symptoms will be prohibitively low.

Ambien withdrawal symptoms generally wear off by the end of the first week after the last dose of Ambien was consumed, but this depends on the factors mentioned above: how much of the medication the person was taking, how long the person had been taking it, and other risk conditions.

Therapy for Ambien Addiction

 
Withdrawing from Ambien can be a painful and distressing experience, but it is a necessary one to prepare the person for the next stage of treatment. Addiction always has a psychological component. If left unaddressed, it is only a matter of time until the addiction rears its head again.

 

In the case of Ambien addiction, treating the mental craving for Ambien is a question of examining the person’s life to discover why such difficulty falling asleep was present, and why the situation got so out of hand that the person turned to abusing Ambien.

 
This stage of treatment is covered by psychotherapy, where a therapist works with a client to get at the issues behind the Ambien abuse. This may require a full examination of the client’s life, and past and current mental health, to understand the nature of the sleep deprivation and the factors that drove the Ambien abuse.

Sleeping without Ambien

 
Once these factors are brought into the open, the therapist and client can devise an alternative system of coping with these factors – to either overcome them outright or figure out how they work to better cope with them. This could mean switching to a lighter sleep medication, while enacting specific changes in the client’s life to make sleep come easier.

Such changes might include adhering to a very specific sleep schedule, practicing yoga, attending 12-Step meetings, and taking up meditation (or prayer) as a form of mental discipline, as did a woman who told her story about Ambien addiction to Today. These steps might seem basic, but when insomnia strikes – as it inevitably will – they can help stave off the temptation to take an extra Ambien tablet.