Zolpidem: The Effect on Sleep

Today’s the media offers many opinions when it comes to sleep. They touch on sleep quality, how to get to sleep more easily, and how sleep affects the body. Many of the claims expressed by the media are opposing. A controversial issue that has become more apparent today is the use of medication to facilitate sleep. Zolpidem, which also goes by the trade name Ambien, is a commonly used sleep aid for adults. Zolpidem gets a lot of negative press because of the potentially dangerous side effects. While under the influence of Zolpidem, people have committed crimes, said things they don’t remember, and have driven without being aware (Pressman, 2018). “Sleep walking” can also occur after taking zolpidem. A recent incident involving TV star Roseanna Barr and her malicious statements while taking zolpidem has given these concerns more publicity. However, zolpidem helps millions of people get the quality sleep that every person needs to function properly throughout the day. The question remains; is zolpidem safe to take as a sleep aid?

Ambien in the Media

In May of 2018, Roseanne Barr, best known for her television sitcom “Roseanne,” used Twitter to post racial slurs regarding Valerie Jarrett, a former government official under Barack Obama. This behavior resulted in the remake season of “Roseanne” being cancelled at her own expense. Her apparent reasoning behind the tweet was her use of zolpidem. Barr also describes in several articles how she often does “odd things” while under the influence of zolpidem at night and has problems remembering her activities (Zauzmer, 2018). The statements made by Barr has resulted in zolpidem being discussed in the media at an all-time high. Thousands of people with insomnia look to zolpidem as an easy solution for their sleepless nights, but there are concerns that negative aspects might outweigh the positive ones.

Ambien and Sleep Disruption

Zolpidem is a hypnotic drug that selectively acts on neurotransmitters in the brain. If your brain awakens while you are in a certain stage of sleep, specifically non-REM sleep, sleep-walking might occur. This is a common complaint regarding Zolpidem. In a study by Suzuki, Hibino, Inoue, Mikami, Matsumoto, & Mikami (2016), they found that after switching to suvorexant, another drug to treat insomnia, the sleep-walking stopped completely. In older adults especially, sleep-walking can be dangerous or cause injury. Frey, Ortega, Wiseman, Farley, & Wright (2011) explored cognitive and motor functioning after treating participants with zolpidem while also taking account of sleep inertia. The study included twelve older adults and thirteen younger adults and took place in a sleep laboratory. Baseline testing was first performed on all subjects without the use of zolpidem.

One group was then administered 5-mg of zolpidem approximately 10 minutes before scheduled sleep and one group was given a placebo. Two hours after administering the medication, they tested the participants on cognitive function and walking stability; this method stems from when users of zolpidem generally awaken and might experience complications. Once awakened, they were instructed to walk along a balance beam in tandem. It was considered a failure if the participant stepped off the beam because of imbalance. They also completed Stroop Color Word Tasks for cognitive measurement. After the study, they concluded that zolpidem significantly impaired cognitive and motor function as seven of the twelve adults stepped off the beam, and all participants did significantly worse on the cognitive test. However, zolpidem did improve the ability to fall asleep as the placebo group stayed awake two hours after their scheduled sleep time. In the conclusion, the authors explained, “Because impaired tandem walk predicts falls and hip fractures, and because impaired cognition has important safety implications, the use of nonbenzodiazepine hypnotic medications may have greater consequences for health and safety than previously recognized,” Frey et al. (2011)

Ambien and the Stages of Sleep

Arbon, Malgorzata, & Dijk (2015) compared how melatonin, temazepam (Restoril), and zolpidem (Ambien), target your GABA and MT1/MT2 receptors. Receptors are what control your brain activity and natural melatonin secretion during your sleep cycle. Before the study, the researchers knew that zolpidem targeted specific GABA receptors while melatonin supplements target MT1 and MT2 receptors. What they didn’t know was how zolpidem affected your slow-wave activity (SWA) during nocturnal non-rapid eye movement (NREM). They used sleep EEGs measured in hertz and polysomnography to measure change in sleep phases in the sixteen participants. Slow wave sleep is extremely important for cognitive functioning, primarily memory consolidation. It is often referred to as sleep dependent memory processing. In the end, they found that zolpidem reduced SWA significantly. Because slow wave sleep is so important, reduced slow wave sleep, or deep sleep, over several nights could have detrimental effects on your brain, particularly in memory (Roth, 2009).

Effectiveness of Zolpidem as a Sleep Aid

Although zolpidem proves to be dangerous to some, it has become a phenomenon in the world of sleep. In one large-scale study by Perlis, McCall, Krystal, & Walsh (2004) they evaluated the impact zolpidem has on people with insomnia who meet the DSM-IV criteria for insomnia. They had an experimental group and a placebo group. Over twelve weeks, participants recorded their medication use as well as their sleep times in sleep diaries. Overall, the participants that took zolpidem experienced nearly 50% decrease in sleep latency, number of awakenings, and time awake during the night. They also experienced a 27% increase in total sleep time. All of the participants improved their sleep quality across the board.

However, a case study by Keuroghlian, Barry, & Weiss (2012) based on a physician who participated in shift work, highlighted some of the concerns of zolpidem use. The physician, a 34-year old male, had a history of drug and alcohol abuse. He was a resident in a teaching hospital, and he would often work 30 hour shifts at a time. He used zolpidem due to his sleep-wake disruption. After one shift, the physician experienced a grand mal seizure. Because the physician had a history of alcohol use, psychiatrists noted that alcohol and zolpidem together cause additive affects and concluded that the seizure was due to withdrawal of zolpidem. Most adults indulge in alcoholic beverages periodically, and adults are the primary users of zolpidem. Many of the “bad press” incidents associated with zolpidem may be due to these additive affects. Ambien alone has proven to be effective in helping healthy patients with insomnia, but for people who already have other mental diagnoses or substance abuse history, zolpidem is not necessarily a safe option.

Conclusion

Based on the research produced by these studies, I believe that Ambien is an effective sleep aid, but there are risks associated with it. Sleep waking at night when you are under the influence of zolpidem can be particularly dangerous, especially in the older patient population. After reading the articles about the Roseanne Barr incident and then reviewing the scientific literature, I can conclude that there might be some gaps in the research looking at the safety of zolpidem as a sleep aid. It seems evident that certain people, such as heavy alcohol users, may not be good candidates for this medication as a sleep aid. Some of the studies I discussed show that other medication such as suvorexant and melatonin may be safer and can help with the onset of sleep and reduce awakenings throughout the night.