Ambien News

It is a truism in the medical profession that "all medications have side effects," and Ambien is no exception.

Sleep eating. Ambien’s strangest effect may be sleep eating disorder, which was first reported by Michael Silber, M.D, co-director of the Mayo Clinic Sleep Disorder Center, in 2002.

"What happens," Silber says, "is the patients get out of bed, walk to the kitchen, prepare food — often sloppily, and often with high caloric ingredients. They eat in a very sloppy way, either in the kitchen or after taking the food back to bed, and they have no memory of eating it." He explains that these patients also experience severe embarrassment, and some have significant weight gain since this is a frequent occurrence for them. (One patient did not link Ambien to her nocturnal eating until she had gained 100 pounds.)

Increased interest in this bizarre side effect of Ambien was prompted recently by New York Times articles based on studies conducted by Carlos Schenck, M.D. and staff at the Minnesota Regional Sleep Disorder Center. He believes that thousands of Ambien users in America develop sleep-related eating disorders. (Sleep eating differs from nocturnal eating disorder in which, Silber says, "People wake up hungry and, with full memory and consciousness, begin to eat.")

Silber states that sleep eating and other odd behaviors are the side effects that may result when taking Ambien, which should not be used after drinking alcoholic beverages. It should only be taken right before going to bed for a full night’s sleep. In addition, he has had many patients who, when they told their doctors they were sleep eating, received the response that such a reaction was "impossible." Silber concludes that "we have to educate doctors as well as patients."

Other serious side effects of Ambien include a fast, pounding heartbeat, unusual tiredness, mental/mood changes, memory loss and unsteadiness. In addition, several doctors and their patients feel that sleep eating is just one of many unusual reactions to the drug, ranging from barely benign sleepwalking events to hallucinations, violent outbursts, and perhaps the most unbelievable and dangerous of all, driving while asleep.

Insomnia 101.. In general, insomnia involves symptoms that include difficulty in falling asleep, waking up frequently during the night and having difficulty falling back to sleep, waking up too early in the morning, and feeling tired upon waking. Primary insomnia means that a patient is experiencing sleep problems that are not directly associated with any other health condition or problem, and reaching for a sleeping pill may seem to be a simple solution. Secondary insomnia means that a patient is having sleep problems because of significant life changes, physical or emotional discomfort ranging from stress to depression), environmental factors (noise, light, extreme temperatures), some medications, or interference with the individual’s normal sleep schedule, e.g., jet lag. Its symptoms include sleepiness during the day, general tiredness, irritability, and problems with concentration or memory.

Treatment for chronic insomnia should begin with addressing any underlying conditions or health problems that are causing it, rather than turning to a sleeping pill as a "quick fix." In this situation, behavioral approaches help the patient to change poor behaviors that may worsen the condition and learn new behaviors that promote natural sleep. Relaxation exercise, sleep restriction therapy and recondition may prove to be beneficial here.

Basic factors to be considered.. While some heavily advertised prescription drugs are effective in counteracting insomnia, none of them (including Ambien) stands out as being clearly superior or less harmful than the others. Researchers in Oregon report that the long-term safety and side effects of drugs like Ambien have never been compared, and some evidence indicates that patients may become addicted to them as well.

Timothy Roehrs, MD, director of research at the Sleep Disorders and Research Center at Henry Ford Hospital in Detroit, feels that different patients will prefer different sleeping pills, if they begin using them at all. "The pharmaceutical companies are trying to target a market niche. They’re all trying to develop the ideal sleeping pill — one that works fast, keeps you asleep all night, and wears off before you have to get up."

More specifically, Ambien, which is the most commonly prescribed sleeping pill, has a medium half-life of less than two-and-a-half hours, which means that it might not be too helpful to the insomniac who tends to wake up often in the middle of the night.

Since Ambien must be taken for a few days before any benefit is noticed, patients should take them exactly as prescribed and never discontinue them without consulting their physician. They should also note that using strong drugs in order to induce sleep often means that the body’s natural sleep cycle (circadian rhythm) is disrupted. As a result, their ability to fall asleep naturally may be lost, contrary to what they are hoping to accomplish with these pills.

Researchers also report that daytime fatigue was nearly four times as common among people taking sleeping pills as opposed to those taking a placebo, along with impaired performance in the morning.

Dangers for the elderly.. In the case of senior citizens, authorities tell us that they are more than twice as likely to experience a negative effect as they are to gain an improved quality of sleep from taking sedatives. Studies indicate that the risk of dizziness, loss of balance, falls, disorientation, headaches, nightmares and nausea was extensive enough to recommend considering non-drug treatments for insomnia for those in this age bracket. They also reveal that such drugs may increase the risk of bone fractures in elderly patients, who are particularly sensitive to their side effects. This is significant because, as a group, seniors tend to have the most sleep problems, and as a result, they are the most frequent users of this type of medication.

The solution.. Cognitive Behavioral Therapy (CBT) is a viable alternative to using Ambien, according to a study conducted by Gregg Jacobs, PhD, a psychologist at the sleep disorders clinic of Beth Israel Deaconess Medical Center. He says that CBT works better in both the short term and long term — and has no side effects..

In Jacobs’ study, CBT included four thirty-minute sessions (once weekly for four weeks, with a final session two weeks later) and a 15-minute follow-up call. Those who participated in the study were randomly selected to be treated with CBT, Ambien, CBT plus Ambien, or a placebo pill. Jacobs and his colleagues discovered that the participants slept more quickly and more efficiently after CBT than after taking Ambien. (Nearly 60% of those treated with CBT got to sleep as rapidly as those without insomnia do (in 30 minutes or less).

Richard Simon, Jr., MD, medical director of a sleep disorder center in Washington State, was surprised to find that those treated with CBT plus Ambien did not fare any better than those treated with CBT alone. "If a person comes in with chronic insomnia, it takes a while for CBT to have an impact," he says. "So we often give a sleeping pill for the first few weeks. But the Jacobs study shows that the combination doesn’t seem to add much."

Milton Kramer, MD, director of psychiatric research at Maimonides Medical Center in New York, says that the core issue in treating insomnia is effectiveness over time. "A lot of studies show CBT can be effective, and a year and a half after treatment, patients still have made gains. With sleep medications (such as Ambien) , there’s always been a question of effectiveness when treatment ends."