ARTICLE OVERVIEW: Ambien (zolpidem) is known to be habit forming and can induce serious withdrawal side effects upon cessation of use. In fact, zolpidem is classified as a sedative and hypnotic that provokes physical dependence after only a few weeks of daily dosing. Here, we review tapering protocols and medical treatments during detox. Then, we invite your questions at the end.
TABLE OF CONTENTS
- Why Withdrawal Occurs
- Withdrawal Symptoms
- Protracted Symptoms
- Main Treatments
- Medications that Can Help
- Safe Dosing
- Is Medical Detox Necessary?
- Detox at Home
- Safety Considerations
- Signs of a Drug Problem
- Use and Abuse
- Who Uses Ambien?
- Dependence vs. Addiction
- Your Questions
Why Withdrawal Occurs
Zolpidem is the main ingredient found in Ambien. It is a non-benzodiazepine hypnotic which binds to the benzodiazepine binding site on the GABA-A receptors in the brain. After daily dosing of Ambien for a couple of weeks or more, the central nervous system adapts to the presence of Ambien. This is a process called “dependence”, and is characterized by a set of symptoms which manifest when you significantly lower or stop Ambien dosing. These symptoms are also known as “withdrawal”.
To explain what happens in the brain, you must first understand that the brain is a “neuroplastic” organ, meaning that it adapts in order to survive. When we take sedatives like Ambien daily for a period of a few weeks or more, the brain naturally compensates for the depressant effects of the drug by creating chemicals that stimulate the central nervous system. However, when you take away the Ambien…it takes time for these “sped up” functions to return to normal. This is what’s actually happening during withdrawal: the brain returns to its natural, non-Ambien induced balance.
Some studies demonstrated that sudden discontinuation of Ambien by doses within the normal recommended range 2 to 4 weeks after treatment does not cause withdrawal symptoms. Instead, Ambien dependence and withdrawal symptoms have been reported in persons with doses between 160 to 2000 mg per day who take the medicine for four weeks, or longer.
Ambien is one of the top 3 drugs prescribed to people with sleeping disorders. However, it is habit-forming and can provoke serious withdrawal symptoms upon dose reduction.
Is difficult to know exactly how long Ambien withdrawal takes for each individual person. Ambien withdrawal symptoms start a few hours to a couple of days after your last dose of Ambien and can last for several weeks after peak symptoms have resolved. People who develop addiction to or extreme dependency on Ambien may experience a more difficult detox process than those who take Ambien for short period of time at low doses.
The duration it takes to detox and withdraw from Ambien depending on a person’s:
- Dosage patterns.
- Medical history.
- Other drugs abuse disorders.
- Total time taking the drug.
Effects of withdrawal include two subsets of symptoms: physical and mental. For example, Ambien withdrawal can trigger the resurgence of insomnia and may cause a vicious circle causing more physical problems and frustration. Some common physical symptoms may include:
- Abdominal cramps.
In addition, the process of withdrawal from Ambien can be exhausting; it can drain you mentally, triggering anxiety or panic as your body returns to a previous balance and a normal body function without the drug. Some of the mental/emotional symptoms related with Ambien withdrawal may include:
- Dysphoria (a dissatisfaction with life).
- Exacerbated insomnia.
- Mood changes.
- Disturbed sleep patterns.
- Panic attacks.
- Rebound insomnia.
As you see, there are several symptoms which may come up during withdrawal from Ambien. Even more, there are severe cases of withdrawal that can include memory loss, hallucinations, and confusion. All of these symptoms can be risky and very dangerous, and you may want to be monitored if you have been using high doses of zolpidem, or have been taking Ambien for months or years at a time.
Ambien withdrawal may be an unpleasant experience depending on the severity of past use, and it can be potentially dangerous. Still, there are clinically approved ways to treat Ambien withdrawal symptoms once you have become dependent on this prescription drug.
Always seek medical supervision when you are planning to go through Ambien withdrawal after a period of dependence. Some symptoms can be risky or dangerous.
Unlike many psychoactive drugs, little to no symptoms have been reported in the weeks and months after acute withdrawal from Ambien. In fact, no protracted symptoms have been described in revised cases after the initial period of detox has been concluded. Most people remain asymptomatic and without Ambien craving in the months and years after their treatment.
There are many options out there for detox and ways of managing withdrawal symptoms. These options can range from:
- Brief motivating contacts with doctors, such as face-to-face consults.
- Gradual dose reduction (“tapering”), with and without substitute medication.
- Inpatient to outpatient monitoring.
- Therapeutic support, for example, behavioral therapy.
So where do you start in the process?
First, you should talk to your prescribing doctor. S/He can look for alternative ways to treat insomnia while you are withdrawing from Ambien. Furthermore, treatment can include tapering or prescribing other medicines to help you sleep and make it easier to bear the withdrawal. They can also prescribe medications that treat specific withdrawal symptoms.
In addition, understanding your past medical history will play an important role in the treatment of Ambien withdrawal symptoms and will impact the effectiveness of recovery. So, keep in direct communication with your doctor to figure out a withdrawal plan together.
The next step is finding time to include support. An online forum or group meeting may help while you withdraw from Ambien, and will positively affect your progress. Talking to someone close to you or a member of a support group when you are craving Ambien can be helpful in treating psychological symptoms. Sometimes, there are quick interventions like meditation or mindfulness for sleep induction that can help minimize the effects of withdrawal.
Medications that Can Help
There are no FDA approved medications to treat addiction to prescription sedatives; lowering the dose over time must be done with the help of a health care provider. Still, there is interest in identifying possible pharmacological medicines that can help. These include:
Gabapentin has been used efficiently to assist or treat alcohol withdrawal, management of cocaine dependence as well as benzodiazepine dependence/detoxification, and has shown positive results treating Ambien dependence problems. Gabapentin is eliminated via renal mechanisms, which may be of particular utility in people with hepatic dysfunction.
Quetiapine is a second-generation, antipsychotic medication with known sedating effects. This medicine may be used in the short-term management of rebound insomnia. While zolpidem is a relatively safe drug compared to conventional hypnotics, people with substance abuse histories may be at risk for abuse. In cases of zolpidem abuse or dependence, the use of another sedating agent with lower abuse potential should be considered.
The best way to withdraw from Ambien is have your Ambien doses slowly reduced over time to compensate for withdrawal symptoms. It is important to reduce your Ambien doses slowly because when the doses are being tapered, symptoms are less severe.
While you are slowly decreasing doses, it is essential that you treat any withdrawal symptoms that may arise. This biggest one being insomnia. Look for alternative ways to help with your sleep cycles. Sometimes, insomnia is a symptom of something else. Maybe you need to decrease levels of stress in your life to help you sleep. Maybe something psychological is impacting your ability to sleep. Seeking talk therapy during this process may also help you withdrawal from Ambien.
Ambien is one of the top 3 drugs prescribed to people with sleeping disorders. The recommended initial dose is 5 mg for women and elderly persons and 6.25 mg for men. Ambien is taken only once per night immediately before bedtime with at least 7-8 hours remaining before the planned time of awakening.
In some persons, the higher morning blood levels following use of the 12.5 mg dose increase the risk of next day impairment of driving and other activities that require full alertness. Dosage adjustment may be necessary when is taken combined with other central nervous system depressants.
Is Medical Detox Really Necessary?
Each case should be individualized depending on the multiple factors that are involved with this drug. For some people, withdrawal symptoms are unbearable. For others, they are not that extreme. What is always important to take in mind is to consider this option if you feel you may need an extra help. Some of the main benefits of a medical detox are:
- Access to around-the-clock medical care.
- Emotional and psychological support.
- Tapering knowledge and general experience in withdrawal cases.
- Transitioned care to addiction rehab, if necessary.
As with most medical decisions, choosing to seek help from a medical detox is a personal choice that takes into account a health care provider’s recommendations. So whether or not you go to a clinic, always seek medical advice first!
Detox At Home
Is detoxing at home safe?
Never come off Ambien cold turkey or unsupervised. Ambien detox can be related with adverse and serious side effects. This is why any Ambien detox should always require medical supervision as in inpatient or outpatient programs. Instead, your doctor can help you first taper down your doses of Ambien over the period of a few weeks (or more) and set up an alternative plan for dealing with sleeping problems. Additionally, medical supervision helps identify and treat subjacent related problems or new problems as they occur.
Concerns about Ambien abuse, dependence, and withdrawal syndrome are increasing in the recent years due to increased number of reported cases. Perhaps this is due to lack of awareness of many physicians and persons about the potential of Ambien to create these problems. Even more, some people need to be aware of possible contraindications during this type of sedative detox.
If any of these symptoms occur, you may need special attention:
- Abnormal extroversion.
- Aggressive behavior.
- Consumption of the drug beyond the prescribed time.
- Consumption of the drug in higher doses than the prescribed.
- Depression or worsening depression.
- Dysphoria (a dissatsifaction with life).
- Mood disorders.
- Loss of personal identity.
- Persistent thinking of looking for the drug.
- Strange behavior.
- Suicidal thoughts.
NOTE HERE: In people who are diagnosed with depression AND treated with sedative-hypnotics, worsening of depression, and suicidal thoughts and actions, including completed suicides have been reported. Suicidal tendencies may be present in such persons and protective measures may be required. Intentional over dosage is more common and withdrawal requires special supervision.
Signs of a Drug Problem
Sometimes, difficulty with Ambien withdrawal can be a sign of a larger problem. Not all people who take Ambien and become dependent on it fall into this category. However, if you notice any of the following signs…it can be helpful to follow up with a doctors, psychologist, psychiatrist, or a social worker for a full assessment:
- Combining Ambien with alcohol or drugs.
- Craving Ambien.
- Difficulty quitting Ambien and staying quit.
- Taking more and more Ambien to get to sleep (tolerance).
See the Surgeon General’s Report on Facing Addiction for more screening tools for addiction.
Use and Abuse Potential
While Ambien is prescribed to treat short-term insomnia, it is not meant to be used over an extended period of time… mainly because of how Ambien works in the brain.
In the early 1990´s, zolpidem was considered to be a novel solution for the treatment of insomnia. Researchers suggested that it maintained the beneficial characteristics of benzodiazepines in terms of reduction of sleep latency and sleep maintenance without their side effects. It also was suggested that zolpidem lacked anxiolytic, anticonvulsant, and muscle relaxant action and hardly caused memory impairment and more importantly minimal abuse and dependence potential.
However, several recent publications have highlighted that the abuse potential of zolpidem was underestimated. But what is misuse? And when does normal prescription use become a problem?
Basically, people “abuse” Ambien when it´s used in higher doses than recommended. Increases in amount or frequency of dosing triggers a different kind of action on the brain and Ambien’s pharmacologic behavior becomes similar to the benzodiazepines binding to other receptors in the central nervous system.
Who Uses Ambien?
According to the Substance Abuse and Mental Health Administration’s (SAMHSA) and data taken from the Drug Abuse Warning Network (DAWN) Report:
50 – 70 million Americans suffer from chronic sleep disorders, which can affect performance on daily tasks and lead to negative health consequences.
But how many people develop a substance use disorder as the result of taking Ambien?
According to data from the National Health and Nutrition Examination Survey, 2005–2010, published in 2013 by the Centers of Health Statistics (NCHS), over the past two decades, prescriptions filled for sleep aids in the United States have increased. In fact, the number of sleep aid prescriptions has tripled from 1998 to 2006 for young adults aged 18–24.
The 2016 National Survey on Drug Use and Health (NSDUH) further estimated that 497,000 people aged 12 or older were current misusers of sedatives, which rounds to about 0.2 percent of the population. There were an estimated 23,000 adolescents in 2016 who were current misusers of sedatives (0.1 percent of adolescents), 50,000 young adults aged 18 to 25 (0.1 percent of young adults) and an estimated 425,000 adults aged 26 or older were current misusers of sedatives (0.2 percent of adults aged 26 or older).
So… if you think that you may have a problem with Ambien … know that you are not the only one. You are not alone.
Dependence vs. Addiction
In traditional diagnoses, ‘addiction’ generally referred to a person’s physical reliance on alcohol, drugs, and others substances and behaviors, while ‘dependence’ was viewed more as the psychological reliance on the addictive behavior. But let’s take a look at these distinctions a little more closely.
Physical dependence occurs in anyone who takes Ambien for a month or longer. It is predictable and expected by doctors, a state of adaptation to the presence of the drug. Ambien dependence is diagnosed by a cluster of withdrawal symptoms triggered by abrupt cessation of the drug intake, rapid dose reduction and decreasing blood level of the drug. It is not the same as addiction.
Addiction is a primary, chronic, neurobiological disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following:
- Compulsive use.
- Continued use despite harm.
- Impaired control over drug use.
Drug addiction is a treatable disease, using a multidisciplinary approach. If you think that you’ve become addicted to Ambien…please reach out for help! You are not alone. In fact, the condition is medical. It is treated medically, without judgment on your moral character.
The bottom line is this: If you think you have a problem with Ambien, you probably do. Give us a call on the number above or leave us a message in the comments below. We want to hear from you and understand how we can help.
Do you still have questions about Ambien withdrawal? Do you want to know more on how to treat the symptoms? Please ask your questions in the comments section below. We will try to respond to you promptly and personally.
Reference Sources: CDC: Prescription sleep aid use among adults: United States, 2005–2010
FDA: Questions and Answers: Risk of next-morning impairment after use of insomnia drugs; FDA requires lower recommended doses for certain drugs containing zolpidem
NCBI: A case of Zolpidem dependence successfully detoxified with gabapentin
NCBI: Quetiapine Treatment of Zolpidem Dependence
NICB: Zolpidem dependence, abuse and withdrawal: A case report
NIDA: Commonly Abused Drug Charts
PUBMED HEALTH: Using medication: What can help when trying to stop taking sleeping pills and sedatives?
SAMHSA: Emergency department visits for adverse reactions involving the insomnia medication zolpidem
All of the information on this page has been reviewed and verified by a licensed medical professional.