“Risks associated with sleeping pills have been known for some time…this study show some compelling real-world consequences.”
~Michael Grandner, instructor in Psychiatry at the University of Pennsylvania in Philadelphia
One of the most popular sleep medications is zolpidem, commonly recognizable by the brand name Ambien. In 2012, for example, zolpidem was prescribed almost 44 million times in the US alone. Ambien in particular has been singled out as a potentially problematic drug.
In 2013, the US Food and Drug Administration mandated several changes, including:
- A requirement calling for significantly lower doses on all Ambien products – in some cases, a reduction by half, citing concerns about continuing next-morning impairment.
- Label changes
- A recommendation that driving should be avoided up to a full day after taking Ambien CR extended-release
Why the recommendations? Although all medications can produce side effects of varying levels of severity, Ambien can cause adverse reactions serious enough to warrant real concern.
The most serious side effect caused by Ambien are “blackout episodes” where the person taking the medication it engages in strange behaviors – not only sleepwalking, but shopping, eating, sexual activity, and most dangerous of all, driving while still asleep.
The unremembered behaviors can be bizarre. There are examples of people trying to eat buttered cigarettes, salt sandwiches, or massive quantities of junk food. There is even an instance where a woman unconsciously ate so many candy bars and Popsicles that she gained over 100 pounds before her sleep eating was linked to her Ambien use.
“I had one patient who found a tub of margarine on his kitchen counter the next morning. It was half-gone with a spoon stuck in it,” says Dr. Cramer Bornemann.
The affected person would usually have no recollection of their actions during the blackout. The most famous example of this was former US Congressman Patrick J. Kennedy, who crashed his car into a Capitol Hill barricade in 2006 while under the influence of Ambien.
When asked about the incident, Kennedy said, “I simply do not remember getting out of bed, being pulled over by the police, or being cited for three driving infractions.”
A medication guide for Ambien blatantly reads –
“After taking Ambien, you may get up out of bed while not being fully awake and do an activity that you do not know you are doing. The next morning, you may not remember that you did anything during the night.”
The list of high-profile instances of Ambien intoxication/abuse is extensive –
- Lindsay Lohan calls Ambien the “trigger” that sent her to rehab for the first time.
- NFL great Junior Seau took Ambien for years before taking his own life. His toxicology report showed that Ambien was the only drug in his system.
- TV personality Tila Tequila was addicted to snorting Ambien.
- Grammy and Oscar-winning rapper Eminem entered rehab in 2005 for sleeping pill addiction, including Ambien.
- Golfing great Tiger Woods allegedly used Ambien recreationally with his mistress.
The rate of blackouts and bizarre behavior was so high that in 2006, Susan Chana Lask, a New York attorney, filed a class-action lawsuit against the French pharmaceutical company Sanofi-aventis, the maker of Ambien.
The lawsuit alleged that more than 1000 people were directly damaged or injured as a result of using Ambien, saying that the company did not “adequately and sufficiently” warn the public, patients, or even physicians about possible side effects.
When describing the stories of people acting bizarrely or unconsciously, Lask even coined a name for the people so affected – Ambien zombies.
A Frightening List of Dangers
Other possible severe side effects of Ambien include –
- loss of coordination – In 2012, the Mayo Clinic made the announcement that it would discontinue prescribing Ambien to patients, because the drug made them four times as likely to be in danger of falling, correlating with more falls than insomnia, delirium, mental impairment, or age.
- suicidal thoughts – Even on Sanofi-aventis’ own website, it lists among the possible side effects “…worsening of depression, and suicidal thoughts or actions.”
A 2012 review of unnatural deaths in Australia where zolpidem was present revealed that 60% were suicides.
- hallucinations – In the most severe cases, Ambien can cause visual and auditory hallucinations strong enough to show visions of people who aren’t there and to hear voices that aren’t there. These delusions have been known to last up to seven hours.
- violence – The Primary Care Companion for CNS Disorders has reported Ambien use that was linked to uncharacteristically violent acts. There are instances of people killing their spouses on the same night that they took more than 5 mg of zolpidem.
- cancer – The British Medical Journal Open published a report saying that users of Ambien and similar sleeping pills have a risk of cancer that is 35% higher than that of non-users.
All factors combined, how hazardous is Ambien?
An 2009-2011 analysis of the medical records from 63 participating representative hospitals across the nation showed that zolpidem tartrate, the main ingredient in Ambien, was linked to 12% of all emergency room visits – 1 in 8. Among older adults, that ratio increases to 1 in 5.
Even worse, the risk seems to be increasing. According to the Substance Abuse and Mental Health Services Administration, emergency room visits related to Ambien nearly doubled in 2009-2010 from just four years earlier.
Almost half of those visits were serious enough to warrant admission to a hospital, and a quarter required treatment in the Intensive Care Unit.
All told, people who use Ambien and other sleeping pills have a risk of early death that is nearly 5 times as great as that of non-users. Researchers working at nonprofit health system Scripps Health in San Diego estimated that in 2010 alone, the use of sleeping pills may have been a contributory factor in up to half a million deaths in the United States.
Even individuals who just take two pills a month can increase their risk of death threefold.
“What our study shows is that sleeping pills are hazardous to your health and might cause death by contributing to the occurrence of cancer, heart disease, and other ailments.”
~Daniel F. Kripke, Professor Emeritus of Psychiatry, University of California at San Diego
A Popular Drug of Abuse
Ambien is one of the most-prescribed drugs in the United States, accounting for over $2 billion in yearly sales, so it should come as no surprise that it is also one of the most abused. The National Survey on Drug Use and Health reports that more than 500,000 people abuse or misuse Ambien and other sedatives.
Many chronically restless people turn to it as a last resort, but Ambien has a unique effect for a sleeping pill – it is very effective for helping someone fall asleep, but it is very ineffective for helping someone maintain that sleep. Also, as with all drugs, it is possible to develop a tolerance for Ambien, thereby lessening its efficacy over time.
This is not supposed to be a problem, because Ambien is intended to be a short-term solution for temporary sleeplessness. Used over a long period, Ambien can be habit-forming.
This combination sets the stage for an easy descent into addiction and misuse.
When the prescription period is over and the doctor wants to stop the medication, the desperate sleep-deprived person feels that they need to do whatever it takes to keep up their supply of Ambien. This is when they start “shopping” doctors to find one who is more amenable to writing ongoing prescriptions or worse, start going to multiple doctors to obtain multiple prescriptions.
This becomes dangerous because now, freed from the constraints of legitimacy, the person will begin to “self-medicate”, deciding for themselves the dosages and the frequency of the Ambien that they take. Invariably, they take too much too often.
If that person also uses alcohol or prescription opiate painkillers, the combined effect can be fatal – death by asphyxiation.
Alternately, some individuals – especially young people – abuse Ambien for recreational purposes, rather than as a sleep aid. Prescription drugs like Ambien are second only to marijuana in terms of rate of abuse by high school seniors, according to the National Institute on Drug Abuse.
Teens who abuse Ambien typically crush the pills and then snort them, or take extremely large doses orally. They start to feel and overall sensation of complete relaxation and disconnected apathy, accompanied by an overwhelming feeling of silliness or euphoria.
Because the drug is habit-forming, people attempting to stop using Ambien can suffer a host of highly-unpleasant withdrawal symptoms that make regaining sobriety extremely difficult. Most physicians will advise “tapering down” the dosage under medical supervision.
Ambien dependency can develop in as little as two weeks, and when the drug is discontinued, the body literally doesn’t know how to act. Acute withdrawal symptoms can begin to manifest in as little as four hours after the last Ambien dosage has worn off. Some of the symptoms of Ambien withdrawal include:
- worsened insomnia
- irrational fear
- rapid mood changes
- nausea and vomiting
- extremely vivid and frightening nightmares
Ambien abuse is particularly problematic because most people who abuse it will rationalize their behavior, saying they are only trying to find something that will help them sleep. They don’t realize that the Ambien that they have come to depend upon is usually only prescribed for a few days – two weeks at the most.
During that period, they should have been working with their physician to come up with alternate strategies designed at curbing their insomnia and giving them the relief they were seeking.
The bottom line is this – Ambien and other such sleeping medications are far more dangerous than most people realize, so if you or someone you care about is misusing or abusing Ambien, it is a matter of life and death that you/they seek professional supportive help as soon as possible.