Ambien is a nonbenzodiazepine hypnotic sedative medication used as a short-term insomnia treatment.
By binding to the GABA receptors in the same way as benzodiazepines, this prescription drug helps to put the brain into a state where the user can fall asleep. Ambien does not induce sleep or force sleep specifically, which is why it is considered a hypnotic.
How People Are Introduced to Ambien
Insomnia is a chronic lack of sleep that can have many root causes. Stress or anxiety can lead to sleeplessness, whether it is caused by a change in environment, work, or personal stress. Depression, a mental condition, can cause insomnia. Medical conditions like chronic pain, difficulty breathing, gastrointestinal reflux disease (GERD), or others can cause a person to wake up frequently or be unable to fall asleep. Some prescription medications, especially stimulants, along with caffeine, nicotine, and alcohol, can all prevent a person from being able to sleep or prevent them from sleeping enough. Getting older changes how the brain functions in small ways, and a side effect of that can be insomnia.
According to an article on hypnotic medications in the Journal of the American Medical Association (JAMA), 10-15 percent of US adults experience chronic insomnia, while 25-35 percent experience occasional insomniac periods. Many of these adults seek help to treat the condition, because it can be debilitating.
Ambien received approval from the Food and Drug Administration (FDA) in 1992, and it has become one of the most popular sleep aids on the market since then. According to pharmaceutical research firm IMS Health, in 2007 alone, pharmacists filled 54 million prescriptions for Ambien and other sleep aids – a 70 percent increase since 2002. Because it is prescribed so often, many people are exposed to Ambien use. This is one of the factors that has driven the high rate of abuse.
People who struggle with insomnia do, in most cases, experience relief from the condition when they take Ambien as prescribed. This medication does have legitimate clinical uses that are therapeutic in nature, but it can also be abused. There are many reasons that a person can become addicted to Ambien and begin abusing this prescription medication.
Signs of Ambien Addiction
Ambien is intended for short-term relief of insomnia. Because insomnia can trigger further stress, which can lead to further inability to sleep, this medication is an important step in overcoming larger issues that can cause insomnia. By prescribing this drug for less than two weeks, doctors can be sure that their patients get the sleep they need, but they do not come to rely on the drug to sleep. Many doctors who prescribe Ambien state that they do not believe this powerful hypnotic drug is addictive when used as prescribed. Once a person has taken Ambien, they may feel like they need the drug to get rest. This is one of the first symptoms of addiction, and unfortunately, it can go unnoticed.
There are many signs of addiction. A few physical symptoms of sedative intoxication and abuse include:
- Unsteady gait
- Slurring speech, as if drunk
- Inability to concentrate
- Memory problems or amnesia
- Slowed or shallow breathing
Addiction to prescription drugs can also lead to behavioral changes. Some of these changes include:
- Stealing drugs from friends or family
- Forging prescriptions or lying about prescriptions to get more
- Doctor shopping to get multiple prescriptions
- Mood swings, irritability, depression, anxiety, or other emotional changes
- Poor decision-making
- Rebound insomnia
- Appearing “high”
- Aggression or irritability when questioned about medication
Ambien can lead to withdrawal symptoms. Sometimes, these symptoms occur even when used as directed, but they are more likely to appear in people who have taken Ambien longer than two weeks or who have used high doses of Ambien. Withdrawal symptoms include:
- Abnormally high aggression
- Agitation and anxiety
- Rebound insomnia
- Loss of personal identity
- Strange behaviors
- Depression, or worsening depression
- Suicidal ideation
Causes of Ambien Addiction
Benzodiazepines have been found to be addictive, and hypnotic medications like Ambien were introduced to the market in part because they should be less addictive than Valium or Klonopin. However, Ambien and similar medications act on GABA receptors in similar ways as benzodiazepine medications. These effects can, for some people, be addictive; when a person craves the effects of a medication, this can lead to abuse. Medical researchers have often found that benzodiazepine receptor agonists like Ambien and benzodiazepines are abused for nonmedical reasons, especially by people who have a history of substance abuse.
Physical dependence on a drug is different than addiction, but it can be a side effect of drug abuse or sustained drug use. Ambien has a high risk of physical and emotional dependence, as well as a high risk of physical tolerance. When the body needs medication to feel normal, that is a symptom of dependence; when the body needs more of the medication to get the same effects, that is a symptom of tolerance.
Because Ambien has a high risk of physical tolerance as well as dependence, it is rapidly becoming one of the most abused drugs in the country. People who take Ambien may rapidly feel the need to up their dose to beat their insomnia. They may not always discuss this problem with their doctor, or their doctor may not monitor the individual appropriately for symptoms of tolerance, dependence, or abuse.
- Statistics on Addiction and Abuse
According to the Substance Abuse and Mental Health Services Administration’s studies, since 2005, the number of emergency room visits due to Ambien’s side effects has risen 220 percent. According to the National Institute on Drug Abuse, in 2004, there were 13,000 emergency department visits due to Ambien; that number increased to 28,000 in 2008.
- Women accounted for two-thirds of these visits. Statistically, women are more likely to report insomnia and receive prescriptions to treat the condition.
- People over the age of 65 made up one-third of hospital visits due to adverse Ambien reactions. This is, in part, due to changes in metabolism as a person ages, so older adults are more sensitive to Ambien’s effects.
- Half of the visits involved Ambien abuse in some form, combinations of other medications with Ambien, particularly alcohol and opioid painkillers, but also anti-anxiety medications or other insomnia medications. These combinations could occur accidentally, if the patient fails to accurately report all their medications, or if the doctor fails to take all other medications into account. However, prescription drug abuse is an increasing problem in the US, and the number of Ambien-related ER visits is a sign of this growing issue.
There are a few demographic groups who are more likely to abuse Ambien or become addicted to this medication: teenagers and older adults.
Although Ambien is not recommended for use by people younger than 18 years old, a research study found that many teenagers have received prescriptions for Ambien, other sleep aids, and benzodiazepines. The study, published in the journal Psychology of Addictive Behaviors found, through an online survey of 2,700 middle and high school students in Detroit twice a year between 2009 and 2012, that 9 percent of these students had received legitimate prescriptions for Xanax, Klonopin, Valium, Ambien, Lunesta, or Restoril. During the course of the study, students who stopped receiving prescriptions for these medications were 12 times more likely to illegally obtain these medications – stealing others’ prescriptions, or purchasing them illegally. This early exposure can increase the likelihood of drug addiction and abuse later in life.
SAMHSA reported in 2011 that 3 percent of adolescents abuse anti-anxiety and sleep medications. A Drug Enforcement Administration report found that 17 percent, or one in five, teenagers reported using prescription medication for recreational purposes or to get “high.”
On the other end of the age spectrum, older adults are also very likely to abuse Ambien. A study conducted by the Centers for Disease Control looked at information on Ambien between 2005 and 2010, and found that 7 percent of Ambien use in a one-month period came from adults ages 80 and up. People in the 50-59 age group represented 6 percent of use in the past month. The National Sleep Foundation conducted a survey in 2007 and found that postmenopausal women made up 41 percent of users of sleep medications in a group of women ages 18-64 who were surveyed on such use. They were more likely than other age groups to use Ambien multiple times a week, which indicates potential dependence, abuse, or addiction.
Women are also at greater risk of abusing Ambien than men. The CDC report found that 5 percent of adult women filled Ambien prescriptions, compared to 3 percent of men. Non-Hispanic white people were more likely to take Ambien, which increases their chances of becoming addicted or dependent.
- Side Effects of Ambien Abuse
One of the most dangerous side effects of Ambien, whether the medication is taken as prescribed or abused in larger doses for recreational reasons, is the high risk of performing activities while asleep. The most common are sleep eating, sleepwalking, having sex while asleep, or sleep driving. Ambien carries a strong warning from the FDA that mentions these potential side effects and suggests that they are more likely to occur if Ambien is taken after drinking alcohol or taken in doses larger than prescribed.
Recreational use of Ambien is much more likely to lead to dangerous, unconscious activities. While sleep eating and sleepwalking may not be inherently harmful, there are many reports of people injuring themselves and others because of sleep driving, or falling off balconies or walking into traffic while sleepwalking. The Huffington Post investigated reports of sleep-driving in particular, and found that stronger warnings about Ambien’s risks were not issued by the FDA until years after the medication had been on the market. Since then, the regulatory agency has also lowered the recommended dose to help prevent some of these dangerous side effects.
Another side effect is grogginess or drowsiness the next day. Warnings from both the manufacturer and the FDA recommend that 6-8 hours be set aside for sleep induced by Ambien, which helps relieve some of these issues upon waking. However, especially when a person first begins taking Ambien, drowsiness the next morning can impair their ability to drive or concentrate at work. For people who abuse Ambien, larger doses can lead to more severe impairment the next day.
Other long-term side effects of using Ambien at the prescribed 10 mg include:
- Changes to the central nervous system, such as headaches, dizziness, or hallucinations
- Cardiovascular effects
- Gastrointestinal distress
- Rashes on the skin
- Respiratory problems
- Musculoskeletal pain
- Blurry vision or tinnitus
- Liver damage
- Dependence and tolerance
There are many health risks involved in abusing Ambien. While side effects, dependence, and tolerance are bad enough, people who abuse Ambien also have a greater risk of death compared to people who do not take this sleep aid. A study published in the British Medical Journal found that people who took Ambien, Sonata, Lunesta, Valium, Xanax, and similar GABA receptor agonists had double the risk of dying, compared to the control group. The researchers controlled for factors like alcohol, nicotine, and other drug use, along with psychological factors like insomnia or depression.
Another investigation, published in London’s Daily Express, found that taking 60 Ambien pills per year increased the risk of heart attack by up to 50 percent. Yet another study found that taking sleep aids was as risky as smoking cigarettes.
Get Help for Ambien Addiction
Long-term, untreated drug addiction of any kind can have serious physical and mental health consequences. Addiction is a disease of the brain, but with help, the abuse of harmful substances can be stopped. It is important to talk to a doctor and loved ones to get the support needed to overcome this problem. A doctor can recommend treatment plans, including inpatient or outpatient rehabilitation. Support from family members and friends also helps a great deal.
A treatment program will likely involve tapering the Ambien dose until the person does not physically need the medication anymore. Reducing dependence is the first step, but not the only one. Psychological treatment of underlying mental or emotional health issues that contribute to addiction helps the person learn triggers for use and how to manage those triggers. With comprehensive addiction treatment, long-term recovery is possible.