Is Ambien Addictive?

Ambien, also known as zolpidem, is addictive. It belongs to a class of medicines called sedative-hypnotics.

What was once promoted as a sleep aid with less habit-forming and harmful side effects than benzodiazepines is now widely believed to have similar addiction risks.

As a “Z-Drug,” Ambien works by slowing brain activity and the central nervous system (CNS) enough to promote sleep. It’s a non-benzodiazepine that was introduced to the market to have the same effectiveness as benzodiazepines, such as Xanax, but advertised as safer and less addictive.

This, unfortunately, turned out to be false. It is now recognized that Ambien has a similar abuse potential to benzodiazepines, though typically a longer window before addiction sets in. The addictive qualities of this medication led to it being labeled as a federally controlled Schedule IV substance.

Ambien is meant for short term use only. A  physical dependence can form in as little as two weeks, even at conservative doses. Equally concerning, the Food and Drug Administration (FDA) has issued a ‘black-box warning’ —their most serious type of warning— for its reported unwanted side effects. These side effects can be potentially fatal and may occur after a single dose.

According to a study released in 2012, “Receiving hypnotic prescriptions was associated with greater than threefold increased hazards of death even when prescribed <18 pills/year.” This study included Zolpidem.

Signs you may be forming an addiction to Ambien

Insomnia is common, affecting roughly 1 in 3 adults worldwide. For those struggling to sleep, prescription sleep medications such as Ambien can help them sleep better and longer as a short-term solution.

The emphasis is on the “short” term. Ambien tolerance increases in just a couple of weeks of use. With an increase in tolerance comes an increase in dosage and a higher risk of dependence. Some people find their insomnia worsens once they’ve stopped taking the drug and are unable to sleep without it.

Over half a million people in the United States are currently abusing Ambien and other sedatives, as estimated by the National Survey on Drug Use and Health.

Signs of Ambien addiction include:

• Refilling prescriptions faster than usual
• Taking larger doses than prescribed to sleep
• Having cravings for Ambien
• Engaging in dangerous activities without any memory of it
• Spending large sums of money on the drug
• Isolating from family and friends

Habit forming, dependence, and addiction explained

Addiction doesn’t have to be linear; someone can reach the habit formation stage without developing dependence or addiction. That said, due to its high abuse potential, Ambien addiction can rapidly progress through the following stages:

Habit Forming:

• Defined as a routine or regular behavior that gets harder to give up the longer the behavior continues.

In the habit forming stage, the neurochemical response to a substance acts as a reward, stimulating the release of feel-good neurotransmitters and reinforcing the desire to repeat this behavior. Eventually, as this habit continues, a physical or emotional dependence develops.

Dependence:

• Defined by the point at which use of a substance is required to function normally, and discontinuing use may lead to withdrawal symptoms. Dependence can be physical or psychological.

Physical dependence — this occurs once the body has adapted to the presence of the drug and ceasing use leads to physical withdrawal symptoms.

Emotional dependence — widely known as “triggers,” when an interaction sets off a biochemical change in a person’s brain that strongly influences behavior to seek the drug.

At this stage, you can decide to act on the physical or emotional impulse, or ignore it, although decision making may be impaired. Choosing to stop using the drug becomes increasingly difficult.

Addiction:

• Defined as the inability to stop using a substance despite causing psychological and/or physical harm.

People who are addicted to a substance have an extremely difficult time quitting on their own and will often engage in self-sabotaging behavior in order to continue use. Getting the drug is no longer a choice, but an obligation which can lead to life-threatening consequences.

Other serious health concerns of using Ambien for insomnia

The FDA has issued a ‘black-box warning’ for Ambien. This is the most serious warning from the FDA and serves to alert doctors and patients of the drug’s life-threatening risks.

The ‘black-box warning’ reads as follows:

“Complex sleep behaviors warning: Using this drug can cause complex sleep behaviors including sleepwalking, sleep-driving, making and eating food, having sex, or other actions while not fully awake. These events may lead to serious injuries, including death. Often, people do not remember doing these things. If this happens, stop taking this drug and tell your doctor right away.”

This warning comes with good reason. According to a study released in 2012, “receiving hypnotic prescriptions was associated with greater than threefold increased hazards of death even when prescribed <18 pills/year.”

Yes, that says less than 18 pills per year. This study included Ambien.

Additional health risks associated with Ambien include:

Next-day central nervous system (CNS) depression

Sedative-hypnotic agents, including zolpidem, are CNS depressants, meaning they slow activity to the brain. This can cause drowsiness and decreased mental alertness while taking the drug and extend to the next day, especially when taking the extended-release form.

Patients taking Ambien have reported feeling fully awake despite impaired mental alertness. This can lead to impaired driving, accidental injury, and trauma, such as motor vehicle accidents, falling, bone fractures, and intracranial injuries.

Complex sleep behaviors

Some people who take Z-drugs have reported developing complex sleep-related disorders, also called ​parasomnias. Parasomnia is defined as a sleep disorder that involves unusual and undesirable physical events or experiences that disrupt sleep.

Certain prescription sleep aids, including Ambien, have led to some people engaging in behaviors while sleeping without having any recollection of it afterward. These behaviors include sleepwalking, eating, driving, cooking, and having sex while sleeping. Parasomnia can develop even in patients who don’t drink or take drugs in combination with Ambien, although it’s worth noting that such severe side-effects are very rare.

There are some factors that increase the likelihood of developing complex sleep behaviors from sleep aids. These risk factors include:

• Dose: can occur with any dose, but is more likely with higher doses
• Gender: complex sleep behaviors tend to develop more in females
• Medications: simultaneous use of serotonergic antidepressants can increase risk (e.g., Zoloft, Paxil, Lexapro)
• Alcohol use: using alcohol or other CNS depressants while taking Z-drugs can increase risk of complex sleep behaviors
• Inhibitor use: simultaneous use of CYP3A4 inhibitors can increase risk. These are antibiotics used to treat several types of mycobacterial infections
• Pre-existing condition: already having a sleep disorder, like obstructive sleep apnea or restless leg syndrome
• Incorrect administration: taking Z-drugs earlier rather than immediately before sleep
• Substance use disorder:  having an inability to control substance use

In addition, because the prevalence of sleep disorders rises with age, so do the chances of having a pre-existing condition, making age an indirect risk factor for those taking Ambien. Complex sleep behaviors aren’t the only risk factor for older adults, however.

Higher dementia risk for white seniors

It’s been reported in a study by the University of California—San Francisco that taking prescription sleep aids can increase the risk of dementia, specifically for white seniors.

Roughly 3,000 adults at the average age of 74 were monitored over the course of nine years; 20% of the group was diagnosed with dementia.

Of that group, white participants who frequently took sleeping pills had a 79% higher chance of developing dementia. Black participants who had similar habits with sleeping aids did not have a heightened risk. In fact, their risk of dementia was the same as the white participants who abstained from sleep medications.

Researchers concluded more studies are needed to investigate the underlying cause of the increased risk.

Psychiatric and behavioral effects from Ambien

Below are some of the most common psychological side-effects reported from Ambien patients, but it is by no means an exhaustive list.  For a full list of side effects, please see the documentation enclosed with your prescription, and bring up any concerns you have with your doctor.

Potential psychiatric side-effects of Ambien include:

• Hallucinations, visual and auditory
• Delirium
• Abnormal thinking
• Increased aggressive behavior
• Disinhibition
• Bizarre behavior
• Agitation
• Amnesia
• Anxiety
• Depression

These effects vary in onset, but typically occur within 15 to 30 minutes after initial dose. These side effects are reversible upon discontinuation of the drug.

Side effects from medications often affect certain groups of people more than others. Some notable risk factors for developing psychological and behavioral effects from Ambien include:

• Dose: can occur with any dose, but is more likely with higher doses
• Gender: psychological and behavioral effects tend to develop more in females
• Age: people age 65 and older have heightened risk
• Medications: simultaneous use of psychoactive medications, like opioids or anti-anxiety medications, can increase risk
• Alcohol use: using alcohol or other CNS depressants while taking Z-drugs can lead to a higher chance of psychological effects
• Pre-existing condition: already having a neurodevelopmental disorder, such as ADHD,  can increase risk
• Substance use disorder:  having an inability to control substance use and combining illicit substances with Ambien is more likely to produce psychiatric side effects.
  

Suicidal ideation and behavior

There has been a clear connection between hypnotic medication use and suicidal ideation and tendencies. Specifically, the risk of suicide increased with the level of zolpidem use in a 2016 study, affecting people with and without previously diagnosed psychiatric illness.

The reason for this increase in suicidal behavior may be related to the “dream-like” state brought on by zolpidem and other Z-drugs. This sedating feeling can cause confusion, bizarre behavior, hallucination, and/or paranoia.

The onset for this behavior is intermediate, typically occurring within the first seven days of therapy.

Some people are more prone to this risk than others. Some common risk factors include:

• Dose: can occur with any dose, but is more likely with higher doses
• Alcohol use: using alcohol or other CNS depressants while taking Z-drugs can increase risk
• Pre-existing condition: having a history of psychiatric illness including anxiety, bipolar disorder, depression, and schizophrenia can increase the risk of suicidal ideation or behavior.
  

Withdrawal syndrome symptoms

With addiction to Ambien developing in as little as two weeks, withdrawals are a common side-effect of using this drug.

Some people report transient rebound sleep disturbances, which causes longer sleep-onset and increased awakenings that can occur 1-2 days after discontinuation. In other words, their insomnia is temporarily made worse when they stop taking Ambien, although symptoms usually improve after the first 48 hours.

Other withdrawal symptoms typically occur within 48 hours of dose decrease or drug discontinuation.

Some symptoms of withdrawal syndrome might include:

• Abdominal cramps
• Anxiety
• Disorientation
• Dysphoria
• Insomnia
• Irritability
• Muscle cramps
• Restlessness
• Seizures
• Sweating
• Tremors
• Vomiting

Withdrawal symptoms generally resolve within a few weeks of drug discontinuation or with resumption of therapy.

Helpful resources if you’re struggling with an Ambien addiction

If you’re struggling with an Ambien addiction, you are not alone. In a report by the Center for Disease Control (CDC), 8% of adults surveyed took a sleep aid in the past 30 days, with 6% of adults taking sleep medications every day.

Addiction to Ambien can develop in as little as two weeks. If you find yourself struggling with an Ambien addiction, talk with a medical professional to learn about your recovery options.

Quitting the drug “cold-turkey” is not recommended and can be potentially dangerous for those who have taken the drug for extended periods of time and at higher doses. If you have a physical dependence, you can potentially experience severe withdrawal symptoms, including seizures.

There are many resources available to you if you or a loved one is  struggling with Ambien addiction. Speak directly to your doctor or contact a nearby addiction center who can offer a safe, medically supervised detox program.

If you’re unsure of where your nearest center may be, you can find out using American Addiction Centers and AddictionCenter.com.

Safer alternatives to Ambien to improve your sleep habits for good

Insomnia is real and not being able to get a full night’s sleep can lead to serious health consequences. Ambien is not your only option for insomnia.

If you’re struggling to sleep at night, our doctors at Kick can offer expert medical guidance, proven Cognitive Behavioral Therapy for Insomnia (CBT-i), and safer prescription medication such as Gabapentin, Trazodone and Cyclobenzaprine.

We recognize there isn’t a one-size-fits-all solution to insomnia. That’s why our doctors provide treatment and prescribe medications based on your personal needs after an online consultation.

In addition to our personalized treatment approach, you will also receive continued sleep coaching and ongoing medical support. Ready to learn more? See our sleep treatment options from our team of expert sleep doctors.

Frequently Asked Questions

Some answers to the most frequently asked questions about Ambien use and addiction: