Ambien Side Effects: Memory, Depression, and More
Ambien, the brand name for zolpidem, is a sedative-hypnotic medication commonly prescribed for the short-term treatment of insomnia.1 While effective, Ambien does have risks, including the potential for next-day drowsiness, misuse and dependence. Ambien use can cause several side effects—some of which are relatively benign while, although rare, others can lead to serious injury or even death. Additionally, the use of Ambien with other substances, especially opioids and other central nervous system (CNS) depressants, like alcohol and benzodiazepines, can be dangerous and potentially life-threatening.1
Continue reading to understand how Ambien works; its potential side effects and risks, including complex sleep behaviors, its addictive potential, and signs of misuse and overdose. Additionally, get a better understanding of the how to stop if you or a loved one struggle with Ambien, sedative, or other prescription drug misuse.
What is Ambien?
Zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta) are three non-benzodiazepine prescription sedatives collectively referred to as “z-drugs.” All three work as CNS depressants and all three belong to the DEA Schedule IV controlled substances list, which means there is currently a medical use in the United States, but the drug may lead to limited physiological dependence.1-3
Ambien is intended for short-term use and the drug label cautions that treatment should be “as short as possible.” The risk of dependence of z-drugs like Ambien increases with longer-term usage (more than 10 nights). Combining Ambien with opioids or other CNS depressants—including alcohol and benzodiazepines—and taking higher doses of the drug can result in potentially dangerous symptoms of oversedation.1 In fact, case reports suggest that Ambien may have some misuse potential when taken at higher doses, even among individuals with no prior history of misusing drugs or alcohol.4
Ambien Side Effects
The side effects of Ambien may range from mild symptoms such as drowsiness to more severe symptoms that should be discussed with your doctor, including complex sleep behaviors, suicidal thoughts, and significant next-day impairment.
Serious Side Effects and Potentially Dangerous Adverse Effects
Ambien has many potentially serious side effects that can lead to adverse outcomes and warrant notifying a doctor immediately. These include experiencing complex sleep behaviors, significant next-day impairment, abnormal behavioral changes (e.g., depression and suicidal thoughts and actions), and overdose. A person’s risk of experiencing potentially dangerous adverse effects are greater with longer-term use, use at higher doses (particularly for women and adults over the age of 65), and with concomitant use of opioids, benzodiazepines, or other CNS depressants (including alcohol).1,5
Complex Sleep Behaviors
While Ambien and other z-drugs were originally marketed as being safer and less addictive than other sedative-hypnotics, reports of complex sleep behaviors caused the U.S. Food and Drug Administration (FDA) to add a boxed warning to the Ambien label in 2019. It states that complex sleep behaviors—such as sleepwalking, sleep-driving, sleep-cooking, and engaging in other activities while not fully awake may occur—and carry a risk (though rare) of serious and potentially fatal injury to oneself or others. The FDA also added a contraindication, which means individuals who have experienced complex sleep behaviors in the past should not take Ambien or any of the z-drugs and should inform their prescriber. Complex sleep behaviors can occur at therapeutic doses of zolpidem with or without another CNS depressant or alcohol.1,6
Even before the boxed warning, the FDA lowered the recommended dose for all zolpidem products due to next-day impairment. Additionally, the FDA suggested that individuals taking the extended-release zolpidem (Ambien CR) not drive or participate in activities that require complete alertness the day after taking the sleep medication since zolpidem levels can remain high enough to impair them—even the next day.7
The risk of experiencing next-day impairment is highest for those taking controlled-release zolpidem (Ambien CR or generics), and higher for women, since zolpidem is eliminated more slowly in women than it is in men.8
Depression and Suicide Risk with Ambien
Research indicates that the use of Ambien and other sedative-hypnotic medications may worsen depression or suicidal thoughts and behaviors in primarily depressed individuals.1 Thus, the drug’s FDA label cautions that individuals with depression should be prescribed the lowest number of tablets to avoid intentional overdose.1
It’s important to note that, in general, behavioral therapy is the mainstay of treatment for insomnia, and pharmacological interventions should be considered only when necessary.9
Overdose is possible if zolpidem is used alone or in conjunction with other substances and can lead to coma or even death. The likelihood of experiencing an Ambien overdose is higher when the drug is taken in higher doses or if it is taken with opioids or another CNS depressant (e.g., benzodiazepines, alcohol, other z-drugs). Symptoms of potential overdose may include:1
- Impaired consciousness.
- Extreme sedation.
- Severe respiratory depression (i.e., slowed, shallow, or irregular breathing).
Ambien Misuse, Addiction, and Withdrawal
In 2020, approximately 803,000 (0.3%) adults aged 18 or older reported misusing zolpidem products.10
Although it’s rare, use of Ambien can lead to physiological dependence.1 Dependence is a physiological adaptation of the body to a substance, meaning the body becomes so used to the drug being present in the system that when an individual decreases their use significantly or quits altogether, withdrawal symptoms surface. The risk of dependence increases the longer a person takes Ambien.1
When an individual becomes dependent on Ambien and they abruptly stop taking it or drastically reduce their dose, they may experience withdrawal symptoms. This is not common, and in clinical trials occurred in 1% (or less) of individuals who stop their use of the drug—but case studies and anecdotal evidence suggest that rate is likely higher. Withdrawal symptoms may include:1,11
- Trouble sleeping.
- Panic attack.
- Abdominal pain.
- Uncontrollable crying.
- Stomach cramps.
How to Safely Use and Safely Stop Ambien Misuse
Individuals should adhere to the dose, duration, and other instructions provided on the Ambien drug label and those given by their healthcare provider. Any abnormal behavior, specifically complex sleep behaviors, suicidal thoughts, or significant next-day impairment should be reported to your doctor as soon as possible.1
Additionally, individuals should avoid consuming alcohol or taking opioids and other CNS depressants (benzodiazepines, other z-drugs, or other prescription sedatives) with Ambien.
If you or a loved one struggles with Ambien misuse—or other sedative or prescription drug misuse—it might be time to seek treatment.
If you’re ready to stop, it’s a good idea to talk to your doctor, but you may also benefit from medical detox, especially if your misuse of Ambien takes place in conjunction with additional substances, such as alcohol, opioids, or other sedatives. Withdrawal symptoms resulting from one or more CNS depressant substances can be extremely unpleasant and potentially dangerous.12
While detoxification can stabilize a person as their body rids itself of a substance, it’s generally not sufficient to support long-term abstinence, and is considered a first step in a more comprehensive treatment plan, which benefits many people in their recovery efforts.
Addiction treatment typically includes individual and group counseling, behavioral therapies, and education to help you identify the emotions, thoughts, and behaviors that led to substance misuse and teach you strategies to aid you in identifying triggers, developing coping techniques, preventing relapse, and remaining substance free.