Zolpidem or Ambien is one of the most commonly prescribed medications to treat insomnia.
But is it safe?
Keep watching because we are going to go over some of the most common side effects as well
as some more rare but concerning ones that you need to be aware of if you are going to
take this pill.
Hi everybody, I'm Dr. Erik Richardson a board certified Family Practice physician.
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Today we are going to be talking about one of the most common medications that is given
to treat insomnia called zolpidem or ambien.
This is a medication that has been available since 1992 in the United States and is the
most commonly prescribed sleep medication out there, in fact over 10 million prescriptions
are written each year Zolpidem is in the category of sleep medications
called non-benzodiazepine sedative hypnotics.
They work by binding to certain areas in the brain that increase a chemical called GABA.
When these chemicals go up, it slows the activity in the brain causing you to sleep.
There are several different formulation of zolpidem.
You have the regular zolpidem that tends to last around 6 hours, a more rapid acting that
lasts up to 4 hours and a long acting formula that can last up to 8 hours.
They are effective for most people but you do need to be somewhat careful while taking
it that's why for the rest of the video I'm going to go over some important things that
you need to be aware of while taking this medication.
First of all, this medication is not approved for long term use.
Not that I don't have patients who are not on it long term, it is just that as with any
sleep aids, we always prefer to be able to find ways to get to sleep that does not require
a medication to get us there.
This is a challenging thing for a lot of people, but there are tips and tricks that you can
work on to help yourself get to sleep.
This is out of the scope of this video, but if you are looking for a direction on things
that you can do, start by searching for "sleep hygiene" online and it will pull up a lot
of things that you can try.
The main reason we want to try and limit the length of time we use this medication is that
it does have some potential for dependence and abuse.
It's not nearly the risk that you get from medications like your xanax or ativan's but
there is some small risk.
Above and beyond that, one of the biggest risks is that you become dependent on this
medication to fall asleep.
So it's always important to try and work on some of the underlying issues that are making
it difficult for you to sleep.
Another reason to try and avoid taking this all the time is that you can develop some
tolerance to the medication.
This means that you need to take higher and higher doses to get the same effect.
Taking drug holidays where go without it for several days can help with this.
And finally for those who are on it for a long time can be at risk for having some sudden
withdrawl symptoms.
After stopping it abruptly you may notice symptoms like feeling shaky, muscle cramps,
nausea, vomiting sweating, flushing, mood swings and difficulty sleeping.
If you are on it a long time and are wanting to come off, work with your doctor on the
best way to do that.
The next thing you need to be careful with this medication, is make sure you are taking
it right.
When you take this medication, you need to make sure that you dedicate enough time for
sleep.
Depending on what formulation you have you need to make sure you have at least 4-8 hours
before you need to get up.
This may be longer in some individuals, so you need to be cautious.
The main reason, is that this medication, can stay in your system and even if you are
awake can affect your ability to concentrate and react.
This is really dangerous if you try and drive or do any other activities that requires you
to be alert.
The next thing you need to be careful of, is make sure that you don't take it with any
other sedative type substances.
You should not combine it with alcohol, other sleep aids, anti anxiety medications like
xanax or Ativan or even street drugs like marijuana.
This is a mediation that can work well for most people but there are certain people who
may want to be more careful or avoid taking it all together.
We've found that those who have significant mental illness or depression including a history
of suicidal ideation should maybe try and avoid it.
Those who have severe sleep apnea or other breathing problems like asthma, chronic bronchitis
or emphysema may not do well on it.
And it really isn't something that you should be taking if you are pregnant, especially
in the last trimester as it can affect your baby.
Now, let's talk about some of the side effects that are possible while taking this medication.
Most people do just fine on it but there are some things that can happen more commonly.
Obviously this medication can cause some drowsiness.
We hope this is the case, but it can extend itself longer in some people.
Others may complain of headaches, dizziness and a drugged feeling.
WE sometimes will see diarrhea, dry mouth, palpitations, and depression.
This certainly aren't common side effects, but they are things that you should watch
out for.
Now what about more concerning effects?
Probably the most concerning one that occasionally we hear about even in the news, is some significant
problems that it can cause while sleeping.
In some people this medication can cause what we call complex sleep behaviors.
In fact this problem has actually caused them to put what they call a "black box" warning
for this medication.
A black box warning is something that the FDA uses to point special attention to a specific
serious known side effect or issue with a medication.
Zolpidem has one of these warnings.
In some people it has been seen that they can experience certain serious and possibly
life threatening behaviors.
There are reports of people while taking the medication getting up and preparing meals,
making phone calls, sleep walking or even getting out of bed and driving their cars.
In the morning they have no recollection of doing these activities.
Obviously these can be very concerning and you need to stop the medication right away
and call your doctor if you experience anything like this.
Besides these kinds of sleep issues other more serious reactions can include worsening
depression and suicidality, hallucinations, aggressive behavior, amnesia, allergic reactions
as well as dependency and withdrawls after prolonged use.
This can be a very effective medication to help you fall asleep but as you can see it
is not without risk.
These risks are still small, so we still do prescribe it but hopefully it emphasizes the
importance of trying to avoid using these on a daily basis.
They really are meant more for short term use and like any sedating medication need
to be used carefully.
Hopefully it also emphasizes the importance of working with your doctor on other options
to help with your insomnia besides depending on medication.
If you are looking for better resources to help with your insomnia, I encourage you to
go to the National Sleep Foundations website at sleepfoundation.org.
They have a lot of great resources on helping you find healthy ways to get a better nights
sleep.
Well, those are the main points that you need to know about Ambien.
Certainly there are other things that may need to be addressed in you situation, so
make sure you talk to your doctor about any of your concerns.
I am curious though for those of you watching, what are your experiences with zolpidem?
Also what other tips have you learned to help you get to sleep?
If you have any thoughts we'd love to hear about them in the comments below.
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