By Michael Breus, PhD, ABSM
There’s more news about complications that can arise from prescription sleep medication: Side effects from a common prescription sleep aid are sending increasing numbers of people to emergency departments.
The number of people seeking emergency medical treatment for the adverse effects of sleep medications containing zolpidem has risen dramatically in recent years, according to a new federal report. Zolpidem is the active ingredient in several of the most commonly prescribed sleep medications, including Ambien, Ambien CR, Edluar, and Zolpimist.
The report was issued by the Substance Abuse and Mental Health Services Administration’s Drug Abuse Action Network (DAWN), which collects information about drug-related visits to emergency departments nationwide. Their analysis included all emergency-department visits that involved adverse effects of zolpidem during the years 2005-2010. During this 5-year period, visits to emergency departments involving adverse effects of zolpidem increased significantly, rising by more than 200%. Women and older adults sought emergency treatment for adverse zolpidem effects in greater numbers overall than men and younger adults. According to the report:
- In 2010, there were 64,175 emergency-department visits involving zolpidem. Of these, 19,487 or 30%–specifically involved adverse reactions to the sleep medication.
- In 2005, there were just 6,111 emergency-room visits involving adverse reactions to the sleep drug. During the period 2005-2010, emergency department visits involving adverse reactions to zolpidem rose almost 220%.
The analysis found women were significantly more likely to seek emergency treatment for problems with zolpidem than men:
- Women accounted for 68% of emergency department visits related to adverse reactions to zolpidem in 2010. The differences between men and women fluctuated during the 5-year period, but overall women made up a greater number of the zolpidem-related emergency visits in every year but 2008.
- The number of emergency-department visits made by women involving adverse effects of zolpidem increased by 274% during the years 2005-2010. Visits by men increased 144%.
Age also was a factor, with greater numbers of cases involving older adults:
- Adults ages 45 and older accounted for 74% of all emergency department visits involving adverse reactions to zolpidem. As a comparison: this same age group accounted for 56% of emergency room visits involving adverse effects of any drug.
- Patients ages 65 and older were the single most common age group to seek emergency treatment for adverse reactions to the sleep medication: 32% of all emergency department visits related to adverse effects of zolpidem were undertaken by people in this age group.
- Patients ages 45-54 were the next largest group, accounting for 22% of all visits.
Other pharmaceutical drugs often were involved in emergency treatments related to zolpidem. Half of the emergency department visits related to adverse effects of zolpidem involved other medications as well:
- Of the total visits to emergency departments related to adverse effects of zolpidem, 40% involved the sleep drug alone.
- In 50% of the cases, one or more additional prescription drugs were involved.
- The most common prescription drugs seen in combination with zolpidem’s adverse effects included narcotic pain relievers, anti-depressants, anti-anxiety medications and other insomnia medications.
The side effects associated with zolpidem can be disorienting, scary, and at times dangerous. These side effects include hallucinations, problems with memory, excessive daytime tiredness, sleepwalking and engaging in other behaviors such as eating and even driving while not fully awake and alert. The adverse effects of zolpidem can be exacerbated when the sleep medication is combined in the body with other common prescription drugs, including narcotic pain relievers, anti-depressants and anti-anxiety medications. Alcohol, too, can have a magnifying effect on the body’s reaction to zolpidem.
Medications containing zolpidem are prescribed to millions of Americans with sleep problems, in numbers that have been rising dramatically in recent years. The SAMHSA report does not discuss reasons for the spike in zolpidem-related emergency department visits, but it’s certainly likely that the rise in the number of prescriptions may play a significant role. For all their frequent usage, we still don’t know a great deal about the health and side effects of zolpidem medications. Stories about strange and erratic behavior associated with these sleep medications have been widely reported, but research into the effects of zolpidem is just starting to accumulate.
In January of this year, the Food and Drug Administration issued a safety alert including changes to its regulations regarding zolpidem. The FDA announced it would require drug makers to cut in half the recommended dosages for women taking zolpidem, and suggested that the recommended dosage for men be lowered as well. The alert also urged medical professionals to warn all patients taking zolpidem about early-in-the-day drowsiness and impairment. The FDA’s action came about as a result of research indicating that patients—especially women—who take zolpidem at night may have concentrations of the medication in their bloodstream high enough to cause impairment in the morning for activities such as driving. The research showed that women’s bodies take significantly longer to metabolize the drug, leaving them particularly vulnerable to excessive drowsiness and impairment in the morning.
Research also has shown that older adults are at greater risk for adverse effects from sleep medications, including those containing zolpidem. The elevated numbers of both women and older adults seeking emergency treatment for problems with zolpidem appears to align with other research suggesting these groups are at elevated risk for complications from these medications. We must continue to learn more about the short-term and long-term effects of zolpidem and other sleep medications on patient safety and health.
Sleep medications containing zolpidem can be an effective short-term treatment for disordered sleep. But these medications must be prescribed with care and caution by doctors, and used correctly by patients. Prescription sleep medications such as those with zolpidem are not intended for long-term use. For most patients with sleep problems, the best long-term prescription for healthy sleep isn’t found in a pill bottle. It’s found in the fundamentals of strong daily sleep habits, and a lifestyle that promotes good sleep hygiene.
Michael J. Breus, PhD
The Sleep Doctor™