Wednesday, August 25, 2010

Ambien and sleepwalking

A reader recently described getting out of bed and walking one night after she had used Ambien (also called zolpidem) to help her sleep. In fact, it is now fairly well accepted that Ambien and other sleeping agents can cause “sleepwalking.” A lot of interest was given to a report from Dr. Mark Mahowald that he and colleagues had a series of patients who seemed to not only sleep walk but also to eat while taking Ambien—with no memory of it. Certain types of eating in the night (sleep-related eating disorder) seem to be a type of sleepwalking during which the person gets out of bed and eats but has no memory of it. The eating is different from “having a snack” to aid in getting back to sleep in that this eating is more compulsory and sometimes strange—like biting an onion. Most of us who have been seeing patients with sleep problems have examples of Ambien producing many types of behavior which can be problematic because the person is, well, basically, half asleep. I have a lady who drove her car for over an hour, and then woke up having parked it and had no memory whatsoever of how she got there. I have another young woman who flooded her bathroom quite severely after apparently taking a bath but leaving the water on. So, it pays to remember that sleeping pills can have side effects, especially if someone is alone and might stumble out of bed or into a car (eg Patrick Kennedy). When starting on sleeping pills you should begin with the lowest doses and increase if necessary. You should be sure that you are in a safe place (not sleeping on the balconey), not mix with alcohol and take the pill only right before going to bed. Used carefully, for many people, Ambien is a very safe sleeping pill. J. Steven Poceta is a licensed practitioner of neurology and sleep disorders who has been engaged by Revolution Health. No information in this blog is intended to diagnose or treat any condition. The opinions expressed here are my own and do not necessarily reflect those of Revolution Health.

Steve Poceta MD

3 comments:

  1. Oh snap. I didn't know you had a blog too. Love Ambien.

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  2. Ambien is great.. the only time i've had those kinds of things happen is with a dose higher than 5mg, when taking it with alcohol, and/or I was already extremely tired. Ambien can cause short term memory loss and most of the time I believe people are completely competent so there is little danger except for loss of inhibition and falling asleep. The example you gave of someone leaving water running is a perfect example - they should not have taken the ambien before taking a bath. The woman basically became so sleepy she crawled into bed and fell asleep with the water running.. This kind of situation could happen with or without Ambien.
    One helpful note MDs should advise their patients: Break up the ambien and take small pieces (quarters would be nice). If after 15 mins you are not asleep, take another small piece.
    If ambien were sold in 1mg dosages and it were prescribed/advised in the above manner, there would be far fewer (if any) strange incidents. As noted, prescribe the lowest dosage but ambien lowest dosage is 5mg. The widely 'recommended' 10mg to new patients is too much.
    p.s. Ambien CR is the wrong solution for an artificial problem. Consider the added psychological benefit of taking smaller doses multiple times. Each additional small dose a patient takes will give a placebo boost. Most patients might end up at a 2mg total dose (3 or 4 is still fine and is still less than current 'normal' dosages). They may even self-determine what dose they need and take 2 (of 1mg) at a time at night. This is still safer than a person deciding they need an additional dose one night and taking two 5mgs or two 10mgs (this is not uncommon i'm sure and probably accounts for some of the reports).

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  3. I have been taking Ambian for a couple of months. it works great, i go right to sleep, wake up refreshed. But,I have also made and received phone calls late at night I don;t remember. Scary stuff, be careful.

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