The major psychoactive ingredient in the drug Ambien is zolpidem. Zolpidem is a mild sedative drug that is primarily prescribed to help people sleep.
The drug has a fast onset of action and a relatively short half-life, meaning that it works relatively quickly and does not remain in a person’s system very long. This makes Ambien and other products with zolpidem primarily useful in helping people fall asleep or to initiate sleep. The drug is not prescribed to help people stay asleep or maintain sleep unless the drug is prescribed in a time-release form where the drug is released over a longer time period.
Some research studies suggest that Ambien can also be used as a muscle relaxant and may even be capable of controlling some seizures, although the dosage required for seizure control would be extremely high. However, the drug is not approved by the FDA for these purposes.
Zolpidem was developed as an alternative medication to more potent drugs, commonly used as sleep aids, that are more likely to cause physical dependence, such as the benzodiazepines. However, the United States Drug Enforcement Administration (DEA) classifies zolpidem products as Schedule IV controlled substances, indicating that the DEA believes there is some potential for the development of physical dependence on zolpidem and a potential for abuse of the drug. Thus, products containing zolpidem can only be obtained with a prescription from a physician; however, they are not as tightly controlled as more potent central nervous system depressants, such as opiate drugs.
The Action of Ambien
The mechanism of action of zolpidem is to increase the activity of the inhibitory neurotransmitter GABA (gamma-aminobutyric acid). GABA is the primary inhibitory neurotransmitter in the brain. When GABA is released, it results in a decrease in the firing rates of neurons within the brain and spinal cord. This accounts for its sedative effects. GABA appears to be molecularly different from benzodiazepines, but binds to the GABAA receptor, which is the same receptor that benzodiazepines bind to. Thus, it has the same general action as benzodiazepines but it is not as potent. This means that there is a potential to overdose on high doses of zolpidem products. The drug flumazenil reverses the effects of drugs that bind to GABA receptors in the brain and can be used in cases of an overdose on benzodiazepines or zolpidem products.
Sleep aids like Ambien are not designed for long-term use.
One of the reasons these drugs are only designed to be used in the short-term is that tolerance develops very rapidly and people often need significantly higher amounts of the drug in a short time to get the same effects. As a result, sedative drugs and benzodiazepines used for sleep are best used as short-term solutions while the person develops behavioral methods to help them initiate and maintain sleep. This often requires the use of behavioral therapy, relaxation training, diaphragmatic breathing, imagery, etc.
Allergic reactions that can include the development of rash, hives, intense anxiety, breathing difficulties, etc.
Mild lightheadedness and/or dizziness
Headache, nausea, and/or diarrhea
Problems with coordination and decreased reaction time
Memory issues in some individuals
Insomnia when the drug is discontinued, often referred to as rebound insomnia
In rare cases, hallucinations
Exacerbation of some pre-existing condition, such as gastroesophageal reflux disorder
Parasomnias are sleep disorders where individuals engage in activities that they would normally perform while they are awake, but they engage in these activities while they are actually asleep. Zolpidem has been implicated in some cases where people have been driving while asleep, eating while asleep, and even having sex while asleep. These cases are very rare. The most common manifestation of a parasomnia is sleepwalking.
The use of Ambien in conjunction with alcohol can increase the risk for an individual to experience a parasomnia. Misusing the drug, such as taking extremely high doses, may also contribute to the potential for this behavior.
Issues with Memory
Use of drugs that increase the levels of GABA, such as benzodiazepines and even mild sedatives like zolpidem, may be associated with problems with short-term memory in some individuals. Most often, issues with short-term memory occur when the drug is abused with some other central nervous system depressant, such as alcohol; another benzodiazepine; a narcotic pain medication; or some other sedative.
The ability to form memories depends on an increased firing rate in certain neurons in the brain. When GABA is released in massive quantities in the central nervous system, it suppresses the action associated with many different functions, particularly with the development of new memories. The massive release of GABA results in individuals being unable to fully encode new experiences, and individuals may not recall experiences that occurred while under the effects of the drug.
Zolpidem is a relatively mild sedative drug, and issues with amnesia as a result of zolpidem use alone are rare. However, elderly individuals who use zolpidem may be at increased risk for cognitive effects, including issues with memory for recent events or with forming new memories.
Individuals who have used Ambien to initiate sleep and eventually stop using the drug may find that they have very salient issues with insomnia once they discontinue their use of the drug. Rebound insomnia can often be treated with other medications and behavioral methods.
The development of psychotic behaviors as a result of Ambien use may be related to an allergic reaction to the drug, taking extremely high doses of the drug, or use of the drug in conjunction with other drugs. The development of hallucinations as a result of medicinal use of Ambien appears to be rare, but has been observed in a few cases.
Exacerbation of Gastroesophageal Reflux Disorder
People who have gastroesophageal reflux disorder (GERD) and use Ambien for extended periods of time may have exacerbations of their GERD that results in the suppression of swallowing, particularly at night. This can result in gastric acid remaining in the esophagus for longer periods of time. This condition may increase the risk for the development of esophageal cancer in some individuals.
Numerous sources, including Mayo Clinic, report that the development of physical dependence on Ambien is highly unlikely. Following the development of zolpidem, it was believed that the drug did not have a significant potential for the development of physical dependence in medicinal users, but research studies have indicated that the drug may result in physical dependence and even abuse in some individuals. Perhaps the most common long-term effect of Ambien use and abuse would be the development of tolerance and potential withdrawal symptoms.
Tolerance to drugs like zolpidem appears to develop rapidly. This is one of the reasons why these drugs are not good candidates as long-term solutions to issues with insomnia. Within only a few weeks, individuals may find that the medicinal dose they have used is significantly less effective. Continually increasing the dose of the drug for medicinal use only increases the chances that physical dependence (having both tolerance and withdrawal syndromes) may occur and may raise the potential that the drug will be misused or abused.
For most people, symptoms will typically peak within 3-5 days, and the withdrawal symptoms will resolve within one to two weeks.
Withdrawal symptoms from Ambien will often occur relatively quickly after the person has stopped using it because the drug has a relatively short half-life. Many people who experience withdrawal symptoms from zolpidem begin to experience them within 48 hours of stopping the drug. Most often, symptoms include difficulties with concentration, nausea, rebound insomnia, anxiety, mood swings, cravings for the drug, and mild confusion. Some people may experience more physical symptoms that include additional problems with headache, fever, chills, sweating, cramps, etc.
Physicians who wish to discontinue a person from Ambien will most often use a relatively brief tapering strategy where they prescribe doses of the drug in decreasing amounts over short period of time to allow the person’s system to wean itself off the drug. A formal withdrawal management program would most likely use the same approach or use a fast-acting benzodiazepine on a tapering schedule.
Abuse of Zolpidem Products
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), sedative drugs like zolpidem are commonly abused. About 1.1 million people reported misusing zolpidem products in 2015. The misuse of a drug is not necessarily the same thing as abuse of a drug. Misuse occurs when a person uses it outside its prescribed purposes in only a few instances. Abuse represents a longer trend of misuse.
An individual who develops a substance use disorder as a result of abusing zolpidem products would be diagnosed with a sedative, hypnotic, or anxiolytic use disorder, according to the American Psychiatric Association’s (APA) diagnostic criteria. The diagnosis of a substance use disorder is dependent on at least a few of the following:
Continued nonmedicinal use of a drug
Development of impairment in daily functioning or significant distress as a result of drug use
Problems controlling use of the drug
Continuing to use the drug in spite of numerous negative consequences associated with using the drug
Development of tolerance
Development of withdrawal symptoms
Individuals who abuse Ambien most likely use it in conjunction with some other drug and are generally not individuals with prescriptions for Ambien. Untreated and chronic substance use disorders are associated with numerous other physical and mental health issues, including increased risk to develop numerous diseases or disorders (e.g., cancers or cardiovascular conditions), increased risk for the development of some other psychiatric or psychological condition (e.g., depression, an eating disorder, a trauma- or stressor-related disorder, etc.), financial issues, employment issues, relationship issues, legal issues, increased mortality, and significant impairment in everyday functioning.
Other Potential Long-Term Effects Associated with Ambien
People are often encouraged not to drive the morning after using Ambien due to potential problems with attention and decreased reflex actions. Although sources such as Mayo Clinic report that the potential to develop cardiovascular issues, respiratory issues, and other health issues that often occur with chronic use of other types of central nervous system depressants is reduced for individuals who use Ambien, any individual who abuses the drug in large amounts or in conjunction with other drugs is increasing their risk for numerous other potential physical and mental health hazards. Long-term use of Ambien according to its prescribed purposes is probably not associated with increased health risks for most individuals, but chronic misuse or abuse of any drug almost always increases these risks. This includes the risk for overdosing on the drug.
People who abuse zolpidem products should seek help from a licensed mental health clinician who is trained and has experience in the treatment of addictive behaviors. Individuals with substance use disorders typically do not experience a resolution of their disorder unless they receive some form of professional intervention for their behavior and engage in a long-term recovery program