People who frequently use the medication, especially in doses that exceed recommended levels, may be at risk of developing physical dependence and withdrawal symptoms when they try to quit. Working with a physician on a tapering schedule can make the withdrawal process more comfortable. A physician may also be able to recommend techniques and habits that can help you to fall asleep without medication.
Ambien is a brand name for the drug zolpidem. It is indicated for use in the short-term to help induce sleep and is the most commonly prescribed medication for insomnia.1
Through its actions on the GABA system, zolpidem increases brain inhibition to help induce sleep.
Ambien belongs to a group of medications known as “z-drugs” because of the spelling/pronunciation of their chemical names (the other two drugs in this category being eszopiclone and zaleplon). Though they have similar mechanisms of action, these drugs are commonly used as alternatives to benzodiazepines, which were historically used to manage insomnia. Zolpidem interacts with the benzodiazepine binding site on the gamma-aminobutyric acid (GABA) receptor complex and, in doing so, increases GABA activity. GABA is a neurotransmitter that inhibits certain types of brain activity. Through its actions on the GABA system, zolpidem increases brain inhibition to help induce sleep.2,3,4
Ambien is classified as a Schedule IV drug by the Drug Enforcement Administration, which means that it has some potential for abuse and physical dependence. Data from the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that in 2017, approximately 9.5 million individuals reported using zolpidem products in the past year, and about 900,000 were estimated to have misused the drug. These numbers are lower than in 2016, when 11.4 million people used the drug and just over 1 million people misused it.1,5
Ambien’s primary effect is to initiate sleep. Potential side effects of Ambien include:3
Sleepwalking, sleep driving, and sleep eating have all been reported with people taking Ambien. In case studies, these behaviors disappeared after people stopped taking the medication.6
In addition, tolerance, physical dependence, and withdrawal may potentially develop in individuals who take Ambien for a significant length of time—though these effects may be less prevalent and milder than those associated with benzodiazepine use.2
Symptoms of withdrawal from Ambien include:2,3
Withdrawal symptoms may begin within 6-8 hours after a person stops taking the medication. The symptoms generally reach their peak intensity on the second day and fade by the fourth or fifth day.7
Individuals who abuse Ambien often use it in significantly higher amounts than prescribed, combine it with other drugs such as alcohol, and use it more frequently than it is intended to be used. This practice can lead to more serious physical dependence and a more severe withdrawal syndrome.
Ambien works relatively quickly, and it remains in the body for a short period of time. It has a rapid onset of action within 30 minutes, with peak effects reached within 1–2.5 hours for most people, depending on whether the person took an immediate- or extended-release version of the drug.2
With higher doses, it can be detected for up to 72 hours in urine and up to 48 hours in blood.
The drug has a relatively short half-life of 2.5 to 3 hours. The half-life of a drug refers to the amount of time it takes an individual’s system to eliminate half of the dose. However, elderly patients and those with liver impairment may take longer to metabolize the drug and may require reduced dosing to avoid toxicity.2
Because Ambien is metabolized relatively quickly, it is typically only detectable in urine for 24-48 hours in most individuals taking therapeutic doses. Blood tests may detect it for 6-20 hours. With higher doses, it can be detected for up to 72 hours in urine and up to 48 hours in blood. Though Ambien is relatively poorly absorbed into growing hair, one study detected it in hair up to 5 weeks after taking the drug.2,8
The above-stated detectability times are general ranges. However, there is bound to be some variation in how people metabolize different substances, which may influence their detectability. The detectability window of Ambien may be affected by numerous variables, including:
To safely and comfortably manage withdrawal, it’s best to work with a physician, who can taper or gradually lower the dose over time. Doctors and other treatment professionals may be able to recommend other changes to your routine to help promote sleep without the use of Ambien, such as by avoiding TV or smartphone use before bedtime, adjusting diet, or using relaxation techniques.9
For most people, sleep aids like Ambien are best used as short-term solutions and should be combined with therapy or other methods to help a person develop good sleep habits that help them fall asleep without the use of medications.
If you or someone you know is concerned about stopping Ambien, talk to a physician about a tapering schedule. If you are abusing Ambien, especially with other drugs, seek out a drug rehabilitation program with medically supervised detox. Medical staff can help you safely withdraw from the substances you are using and work with you to transition into a treatment program, where you can learn coping skills and relapse prevention strategies to help you avoid drug abuse in the future.
. National Institutes of Health, LiverTox. (2018). Zolpidem.
. Gunja, N. (2013). The Clinical and Forensic Toxicology of Z-drugs. Journal of Medical Toxicology, 9(2), 155-162.
. Food and Drug Administration. (2016). Ambien.
. West Virginia Department of Health & Human Resources. Substance Addiction: “A Chronic Brain Disease.”
. Substance Abuse and Mental Health Services Administration. (2018). Results from the 2017 National Survey on Drug Use and Health: Detailed Tables.
. Hoque, R. and Chesson, A. (2009). Zolpidem-Induced Sleepwalking, Sleep Related Eating Disorder, and Sleep-Driving: Fluorine-18-Flourodeoxyglucose Positron Emission Tomography Analysis, and a Literature Review of Other Unexpected Clinical Effects of Zolpidem. Journal of Clinical Sleep Medicine, 5(5), 471-476.
. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
. Villain, M. Cheze, M. Tracqui, A., Ludes, B., and Kintz, P. (2004). Windows of detection of zolpidem in urine and hair: application to two drug facilitated sexual assaults. Forensic Science International, 143(2-3), 157-161.
. Harvard Medical School. (2013). The savvy sleeper: Wean yourself off sleep aids.