Astonishingly, there are approximately 100 million Americans who suffer from a sleep disturbance, an alarming number when one realizes that this statistic refers to a basic life necessity. In some patients, the root cause of the problem is a medical condition such as sleep apnea, while in others the underlying issue is psychological stress. Nevertheless, irrespective of the primary cause, most patients with a sleep disorder resort to taking medications that help them cope with their sleepless nights. Among the available prescription drugs formulated for insomnia, zolpidem (aka Ambien) has become a favorite. The FDA (Food and Drug Administration) approved this medication in 1992 and since then, its use has skyrocketed. At one point, it became the top selling sleeping aid, generating two billion dollars per year in revenue. Its popularity is not unfounded, given that zolpidem is both an effective and fast acting drug. However, zolpidem is associated with a number of serious adverse effects, which led the FDA to amend their dosing recommendations in 2013. Yet, despite these revisions, significant deleterious effects continue to occur, and patients taking this drug should be aware of what these are.
Zolpidem is classified as a hypnotic drug and it works by stimulating the GABA receptor, a site containing the gamma-aminobutyric acid neurochemical which slows down activity in the central nervous system. This medication is known to induce sedative effects, but it also serves as a muscle relaxant and as an anti-epileptic. The commonly prescribed short-acting drug begins to work within 30 minutes of ingestion, and the overall drug effects can last 6-8 hours. The drug is generally given to those who have trouble initiating sleep, given that there are better drug alternatives for patients having issues with sleep maintenance. Zolpidem is associated with numerous side effects, which include: headaches, nausea, vomiting, dizziness, sleepiness, amnesia, hallucinations, poor motor coordination, altered thought process, impaired judgement, euphoria, dysphoria, and disinhibition. It’s important to note that patients taking zolpidem may develop drug tolerance and dependency, a process which can occur within a few weeks. Consequently, if the drug is abruptly stopped, patients may manifest rebound insomnia, delirium, and seizures.
Elderly patients should be cautious when taking zolpidem, given that the drug’s side effects can be amplified in this subgroup of patients; a problem that oftentimes leads to an increased risk of falls. Furthermore, patients who are planning to drive in the morning should be extra careful, because the symptoms of sleepiness and impaired cognition can extend into the next day (as evidenced by the numerous car accidents in which zolpidem was found to be a culprit). Still, if the decision is made to take this drug, patients should start with the lowest possible dose and only take the drug for a short period of time (no more than 12 weeks). Of course, it’s always best to focus on non-pharmacologic treatment. Therefore, partaking in good sleep behaviors, such as avoiding caffeine, alcohol, nicotine, and large meals at bed time, will improve the chances of falling asleep. Moreover, staying away from smartphones and the television prior to bedtime, will guarantee the body an enjoyable and refreshing period of proper sleep.