About 50 to 70 million people in the United States suffer from chronic sleep disorders.1 Medications like Ambien can help conditions like insomnia and the inability to stay asleep.
Insomnia symptoms may include:
Difficulty falling asleep at night
Waking up during the night
Waking up before 7 or 8 hours of sleep
Not feeling well-rested after sleeping
Feeling tired the next day
Feeling depressed or anxious
Problems paying attention
Difficulty focusing on tasks
Making more mistakes than usual
Having more accidents than usual
Continuous worries about sleep
Ambien (generic name: zolpidem tartrate) is an FDA-approved drug used in the short-term treatment of sleeplessness. Zolpidem is also sold under the brand names Ambien CR, Edluar, and Zolpimist. Zolpidem is also known as a Z-drug because it is in a group of other drugs that start with the letter Z that are prescribed for insomnia.2 A list of the 300 most commonly prescribed medications in 2017 ranked zolpidem at number 50.3
People who take Z-drugs like Ambien for too long or at doses that are too high can easily become dependent.2 About 1.4 million Americans reported misusing prescription sedatives at least once in 2015.4 The most common reason (73%) they gave for their most recent incidents of misusing sedatives was to help with sleep problems.4
73% of Ambien Misuse Was Due to Sleep Problems
There have been reports of abuse of, dependence on, and withdrawal symptoms due to Ambien. The risks for Ambien abuse, dependence, and addiction are higher for people with a history of:5
Addiction to drugs or alcohol
Abuse of drugs or alcohol
DEA (US Drug Enforcement Agency) Schedule I medications have a high potential for abuse and a high risk for dependence. As the drug schedule numbers increase, the potential and risks decrease.
The DEA classifies zolpidem as a non-narcotic controlled substance.8 Despite its being a Schedule IV drug, people should be cautious when taking zolpidem.
There are several street names for Ambien:
Emergency room visits related to zolpidem overmedication rose for both men and women from 2005 to 2006 and 2009 to 2010.
In 2010, women (68%) and people between the ages of 45 and 54 represented the largest segments of zolpidem-related emergency room visits involving overmedication.
In 2010, more than half (57%) of emergency room visits related to zolpidem overmedication involved other medications combined with zolpidem.
In 2010, almost half (47%) of emergency room visits involving zolpidem overmedication resulted in hospital admission or hospital transfer. Of these, 26% of these admissions were too critical or intensive care units.
These numbers only include people who had legitimate prescriptions for zolpidem. It excludes people who took zolpidem that was not intended for them. The figures also excluded visits where an illicit drug was also detected or where there had been a suicide attempt. Therefore it is possible that many more people sought medical help for zolpidem-related emergencies but were not included in this survey.1
Ambien may cause a severe allergic reaction. People experiencing any of the following symptoms should stop taking the drug and seek emergency medical help right away:6
Swelling of the throat, face, lips, or tongue
In 2013, the FDA issued safety warnings for people who take zolpidem extended-release (Ambien CR) in dosages of 6.25 mg or 12.5 mg.1 The warning stated that they shouldn’t drive or do any activities that require complete mental alertness the day after taking zolpidem. This is because extended-release zolpidem can stay in a person’s system at high enough levels the next day to cause impairment. The FDA warning also stated that women are more vulnerable to these risks since females eliminate zolpidem from their bodies more slowly than males.
Ambien is especially effective for people who have difficulties with falling asleep. Ambien has been proven effective in reducing the time it takes people to go from being fully awake to sleeping. Research studies showed that Ambien was able to keep producing these results for about 4 to 5 weeks.6
The recommended initial dose is 5 mg for women. For men, it’s 5 or 10 mg. Ambien should be taken only once right before bedtime. People who take Ambien should sleep at least 7 to 8 hours before they plan to wake up. If the 5 mg dose is not effective, it can be increased to 10 mg.6
The misuse of a drug like Ambien is defined as taking the medication without a prescription, or more often than prescribed, or at higher doses than prescribed.
Some of the reasons that American adults abuse sedatives like Ambien include:4
To relax or relieve tension
To feel good or get "high"
To help with feelings or emotions
To see what the drug is like
To increase or reduce the effects of other drugs
One of the short-term effects of Ambien is complex sleep behaviors.6 These types of behaviors can manifest as sleepwalking, sleep-cooking, sleep-eating, sleep-driving, and doing other activities while the person is not fully awake. Other complex sleep behaviors, such as making telephone calls or engaging in sex, have also been reported.
Complex sleep behaviors can happen as a result of the first dose of Ambien or any dose after that.6 There is a severe risk of injury or death to the person taking Ambien and to others during complex sleep behaviors. When individuals are under the influence of Ambien, they typically don’t recall the complex sleep behavior(s) they had engaged in.
For some people, taking a higher dose can result in higher blood levels upon awakening. These higher blood levels increase the risk of driving while impaired. They also make any activity that requires full alertness more risky.
Ambien, like other sedative-hypnotic drugs, has depressant effects on the central nervous system. If Ambien is taken by people who also take other central nervous system depressants, such as opioids, benzodiazepines, antidepressants, or alcohol, it will increase the risk of central nervous system depression. This can cause slowed breathing or heart rates, which can be fatal.
Delayed reaction times
Blurry or double vision
Impaired driving after taking Ambien and then awakening6
Feeling detached from one's mind or body
Seeing and hearing things that are not there (hallucinations)
Even when people take the prescribed doses of zolpidem, some may still find it hard to fall asleep. When they can’t sleep, or their sleep is interrupted, individuals may take more of their zolpidem medication than recommended.1 Between 2009 and 2010, about 42,000 people went to a hospital emergency room because they overmedicated on zolpidem.1
Ambien overdose can be fatal. Other signs of a zolpidem overdose include:
If someone has overdosed on Ambien, it is important to seek medical help right away.
Some individuals can become dependent on zolpidem after just several weeks. It is common for people to continue taking Ambien past the recommended time period, going on for a few months or even permanently. One signal of possible dependence on Ambien is that it seems to stop working.2
Someone who feels that Ambien isn’t working for them any longer, or who finds themself taking more of the medication than prescribed, should contact their doctor or a treatment center. Tapering down under medical supervision is a good option for stopping using Ambien. A doctor or a drug treatment center can help with this process. People should not stop taking the drug abruptly on their own, as this can cause withdrawal symptoms.
Just as with any other sedative-hypnotic drug, withdrawal signs and symptoms can happen after someone abruptly stops taking Ambien. Withdrawal symptoms can include:9
A mild sense of unease
Abdominal and muscle cramps
Rare withdrawal symptoms can include:
Tapering down the dose of Ambien under the supervision of a doctor or a treatment center is typically the first step in breaking the cycle of Ambien abuse or addiction. Therapeutic support is also a critical factor in successful recovery from Ambien use problems.
Someone who experiences moderate to severe withdrawal while tapering down from Ambien may need medical detoxification. Medications will be administered to treat withdrawal. Most medical detoxes for anyone with moderate to severe withdrawal symptoms typically take place in an inpatient rehab setting. If the patient’s general condition is stable, and they have mild symptoms, they may be able to detox in an outpatient setting. An assessment by a doctor or treatment center can help find the best path forward to recovery.
Tapering down and detox are not standalone treatments. Therapies are needed to address the mental and physical causes and results of Ambien abuse or addiction. Long-term addiction treatment can result in more effective recovery with a lower risk of relapse.
Treatment for Ambien abuse and addiction can include cognitive behavioral therapy (CBT) given in individual or group sessions. CBT is a short-term, practical therapy that teaches specific strategies and skills to reduce drug use. This type of treatment focuses on patterns of cognition (thinking, reasoning, judging) and resulting behaviors that are negative or harmful. CBT then works to change the beliefs and thoughts that lead to unhealthy behaviors. The goal is to teach positive and healthy ways to deal with stress and other causes of substance abuse.
CBT helps participants identify problems that can lead to drug use, such as stress or sleeplessness. It also helps individuals look at where their coping skills are lacking. Therapists address these issues by using role-playing and modeling. CBT also teaches relapse prevention skills to help patients identify and avoid triggers. It emphasizes personal responsibility for one’s recovery.
CBT can also be an effective treatment for insomnia for people who took Ambien initially for sleep issues. Known as CBT-i (cognitive behavioral therapy for insomnia), this type of therapy aims to correct any behaviors that are backfiring and making it harder to fall or stay asleep. One of the most significant advantages for people who attend CBT-i is that they can learn how to handle their sleep problems without medications.
CBT-i looks at the issues surrounding insomnia and concentrates on resolving them. For example, a person may suffer from anxiety. Anxious thoughts and feelings can hyperstimulate the person, making it difficult for them to fall or stay asleep. In this type of case, CBT-i addresses the anxiety the person is experiencing and focuses on resolving it.
CBT-i also looks at the coping behaviors a person is using that may be doing more harm than good. Examples of these include taking daytime naps, drinking coffee, taking nicotine or stimulants to stay awake when needed, and spending too much time in bed. These types of coping mechanisms disrupt the natural sleep cycle and make insomnia worse. As insomnia worsens, the bedroom and sleeping take on negative associations, making restful sleep even more difficult.
CBT-i aims to break these unhealthy cycles so a person can get restful sleep without sleeping pills. CBT-i specifically looks at what a person does while in bed and what to do when sleep doesn’t come. It helps patients to restrict naps and change thoughts about sleep.
Motivational interviewing (MI) is a form of behavioral counseling for the treatment of problems due to prescription drug abuse. MI is a counseling style that aims to motivate participants to reduce or stop drug use and get further treatment. MI counselors understand that sometimes it is hard for people to change, even when they know what they are doing is terrible for them.
Many clients in therapy are resistant to change because some parts of them want to hold on to their problematic behaviors because of what they represent to them (e.g., continuing to abuse zolpidem because it helps them with insomnia or because they use it as a coping mechanism). However, they also know that the adverse effects (health, legal, or relationship problems) won’t stop until they change. MI helps clients work through these uncertainties and conflicts to make them more receptive to the idea of changing.
Good sleep habits which can help prevent insomnia and promote sound sleep include:
Keeping bedtimes and waking times consistent, even on the weekends
Staying active to help promote a good night's sleep
Checking any medications to see if they could contribute to insomnia
Avoiding naps or keeping them short
Reducing or eliminating caffeine and alcohol
Not eating or drinking large amounts before bedtime
Keeping the lights low for a few hours before bedtime
Doing some meditation or relaxation techniques before bedtime
Making the bedroom comfortable and inviting for sleep
Keeping the bedroom temperature cool and comfortable
Not using the bedroom for other activities, using it only for sleep or sex
Creating a relaxing bedtime ritual to do each night before retiring. For example, someone might read a book, listen to soft music or put on white noise, take a warm bath, or have a small glass of warm milk or a cup of calming tea.
If someone is struggling with Ambien abuse or addiction, they need to seek professional help right away. The risks of misusing Ambien are high, and it can also be fatal. Recovery is possible with the right support.
A person struggling with these issues should talk to a doctor, a mental health counselor, or a treatment center. These professionals have the education, training, and experience to help guide patients to the best treatment options so they can stop the suffering caused by sleeping pill abuse and sleeplessness. With the right help, the cycle can be broken. A healthy and revitalized life with restful sleep is possible.