The Centers for Disease Control (CDC) estimates that approximately 35% of Americans receive less than seven hours of sleep daily and one in four Americans will develop acute insomnia at least once every year.

An Overview

Ambien is a prescription-only sleep aid belonging to the non-benzodiazepine, sedative hypnotic class of sleep medications known as “z-drugs.” It is approved by the FDA (Food and Drug Administration)to treat insomnia characterized by difficulty falling asleep. Due to its habit-forming nature, it should not be taken long term (> 6 weeks) due to the potential for dependence and addiction.

Originally developed as a safer alternative to benzodiazepine drugs such as Xanax (alprazolam), Valium (diazepam) and Ativan (lorazepam), Ambien carries significantly less risk of seizures upon withdrawal as compared to benzodiazepines, however seizures can still occur. It was also marketed as being less addictive than benzodiazepines as it takes longer to develop tolerance and dependence. Research has shown that Ambien carries less potential for rebound insomnia upon discontinuation than benzodiazepines. While safer than benzodiazepines, Ambien still carries a significant risk of addiction and dependence, even in those without a history of substance abuse.

Side Effects

• Hallucinations: false visual or auditory sensations that appear real
• Psychosis: a loss of contact with reality associated with difficulty determining what is real and what is not real
• Amnesia: the inability to remember events that have occurred while under the influence of the drug

Due to these side effects, it is imperative that Ambien be taken immediately before going to sleep.

Real Life Stories of Ambien Gone Awry

Listed below are real examples of when an individual did not go to sleep after taking Ambien

• An airplane passenger removed all his clothing and ran up to the first-class aisle completely naked
• A man had experienced hallucinations of pirates in his bedroom. Upon waking up the next day he noticed a small fire had been started in the corner of his room
• A woman spent $2,980 on an Ambien-induced online shopping spree

Because of Ambien’s strong amnesiac effects, these individuals remembered  nothing about the events.

Tolerance and Dependence

If Ambien is taken longer than the recommended maximum of six weeks, dependence and tolerance can develop, even in those who began taking the drug for a legitimate medical purpose. Tolerance occurs when the dose of Ambien that helped an individual get to sleep is no longer effective, necessitating an increase in the dose to achieve the same effect. Dependence can also occur, where sleep is difficult to achieve without Ambien and withdrawal symptoms are experienced upon discontinuation. Discontinuation may result in withdrawal symptoms such as depression, anxiety, sweating, and abdominal/muscle cramps. Withdrawal symptoms will generally peak 3-5 days after discontinuation and subside after 1-2 weeks.

It is important to note that while tolerance and dependence will develop in those who take Ambien for a prolonged period, this does not imply Ambien abuse, as dependence and tolerance will occur regardless of whether the drug is being abused. Some individuals will intentionally abuse the drug, either taking more than what was prescribed, obtaining the drug illegally without a prescription and/or taking it in a manner not consistent with how it was prescribed such as crushing or snorting it.

More Addicting Than Previously Thought

While Ambien was originally developed as a less addictive alternative to benzodiazepines, a growing body of evidence has suggested it may be much more addictive than previously thought, with the potential for abuse and addiction being as severe as its benzodiazepine counterparts. Research has shown that both Ambien and triazolam, a benzodiazepine also FDA-approved for the treatment of insomnia, showed a similar degree of “drug-liking,” a measurement of a drug’s potential for abuse.

Addiction Treatment

Ambien addiction is a serious problem; those seeking addiction treatment require the assistance of a healthcare professional such as an addiction specialist. In most cases, the goal is discontinuation of Ambien to eliminate reliance on the drug to fall asleep. In order to accomplish this goal, a taperprogram is often used, where the dose of the drug is decreased slowly over time. By tapering off Ambien, the body can slowly adjust to reductions in dose. This is required because reducing the dose too quickly can result in withdrawal symptoms such as insomnia, anxiety, sweating and drug-craving.

Users may attempt to quit Ambien by going “cold-turkey,” where they suddenly and completely stop taking the drug after prolonged use. It is critical to note that this practice is extremely dangerous, as seizures have been reported upon discontinuation of high-dose Ambien. Rather, a safer and more effective way to detox from Ambien is to consult with a qualified addiction specialist in a treatment center who will develop an individualized taper regimen to slowly wean off the drug, minimizing withdrawal symptoms.

The Taper Timeline

How long a taper will last is highly dependent on the individual and includes factors such as the Ambien dose, length of Ambien use and the ability to tolerate withdrawal symptoms upon dose-reductions.

• Gradually decrease the number of days per week the individual takes Ambien. Example: take six tablets per week for two weeks, then five tablets per week for two weeks.
• Slowly taper by reducing the dose by 10% every week
• Slowly taper by reducing the dose by 10% every other week
• Quickly taper by reducing the dose by 25% every week until able to quit completely

The important thing to remember is that tapering is not a race; every individual will respond differently and there is no advantage to getting off faster.

Managing Withdrawal Symptoms

Even with a slow taper, withdrawal symptoms may be experienced. Below are some drugs that may be used to manage the withdrawal symptoms experienced when discontinuing and/or tapering Ambien.

Valium (diazepam) As A Tapering Tool

Some treatment options for Ambien addiction may involve the use of a long-acting benzodiazepine such as Valium to taper. It may seem strange that a benzodiazepine would be used in the treatment of Ambien addiction, considering it was discussed earlier that benzodiazepines are more dangerous than Ambien. The rationale for their use is due to the drugs’ half-life, a measure of how long a drug stays in the body. In general, the longer the half-life of a drug, the longer it takes until withdrawal symptoms start and the less severe they are. Ambien has a half-life of approximately 2.6 hours while Valium has a half-life between 20-50 hours depending on age. Because Valium and Ambien work similarly on a chemical level, Valium can be used to “replace” the Ambien, reducing the intensity of withdrawal symptoms and their time to onset.