Americans Are Taking Too Much Ambien?>

Americans Are Taking Too Much Ambien

by Keng Lam, MD  

Zolpidem, also known by the brand name Ambien, is one of the most prescribed sleeping pills. The drug acts on the central nervous system, and its manufacturer recommends it only for short-term use and at the lowest dose possible. Otherwise, during the time (usually seven or eight hours) after you have taken the medication, there would be a higher risk of developing abnormal behaviors, like sleep walking, and mental impairment, such as lacking necessary alertness to drive a car. Furthermore, the FDA labeling states that when combined with other brain depressants, such as benzodiazepines (commonly used for anxiety and sleep) and opioid painkillers, zolpidem has the potential to decrease heart and breathing rate.

In July 2018, JAMA Internal Medicine published a study that described how Americans take zolpidem. Using self-reported data from the US Medical Expenditure Panel Survey, the investigators identified 3.8 million adults who had been prescribed this drug in 2015. In analyzing the data, they found that more than 68 percent of users were taking zolpidem for longer periods (more than three prescriptions or 61 days of supply) than recommended. That’s troublesome because zolpidem, a controlled substance, has the potential to produce dependence (the habit of relying on it) and tolerance (the need for increasing dosage to achieve the same effect). Many of them took doses that are higher than recommended. And more than 25 percent of Ambien users also took opioids, and 20 percent also took benzodiazepines, other worrisome statistics.

In addition, the researchers found that most of users over the age of 65 were taking the zolpidem at doses higher than recommended (usually no more than 5mg per day, which is also the maximum dose advised for all women). Seniors are more sensitive to brain depressants like zolpidem, raising a serious safety concern. That’s why the American Geriatrics Society recommends that seniors try to avoid this such sleeping pills, because the potential harms usually outweigh the limited effectiveness—or at take them only under careful medical supervision.

Bottom line: Overall, I find this study important because it highlights the unsafe use of zolpidem and the need for better education for both consumers and providers. Sleeping pills may sometimes be helpful in the short term, but they are not a solution for persistent insomnia. You have many other treatment options.

For more information on insomnia and sleeping pills, see The Trouble with Sleeping Pills and Solving Your Sleep Problems, and A Better Treatment for Insomnia (about cognitive behavioral therapy).