In regard to sleep, the media offers many opinions that touch on sleep quality, how to get to sleep, and how sleep affects the body; most of the beliefs in the media are opposing. A controversial issue that has become more apparent today is the use of medication to sleep. Ambien, or zolpidem as the generic name, is a common sleep aid in young and older adults. Ambien gets a lot of negative press around it in regard to the drug being dangerous, and most speculations include negative connotations of the medication. People often “sleep walk” while under the influence of Zolpidem at night; some people have committed crimes, said things they don’t remember, and have driven without knowing (Pressman, 2018). On the other hand, Ambien helps several thousands of people get the quality sleep that every person needs to function properly throughout the day. Once the article involving Roseanne Barr releasing the malicious statement came to light, the publicity around Zolpidem has changed now that it is being more openly discussed; the main concern raised is if Zolpidem is safe to take as a sleep aid.
Ambien in the Media
Roseanne Barr, best known for her television sitcom “Roseanne,” used twitter to post racial slurs regarding Valerie Jarrett, former government official under Barack Obama, in May of 2018. This behavior resulted in the remake season of “Roseanne” being cancelled at her own expense. The apparent reason behind the tweet was her use of Zolpidem. Barr also describes in several articles how she often does “odd things” while under the influence of Ambien at night without remembering anything (Zauzmer, 2018). This statement made Ambien discussed in the media at an all-time high. Thousands of people with insomnia look to Ambien as an easy solution for their sleepless nights, but the negative aspects might outweigh the positive ones.
Ambien and Sleep Disruption
Zolpidem is a hypnotic drug that is selective in what neurotransmitters it acts upon in the brain. If your brain awakens while you are in a certain stage of sleep, specifically non-REM sleep, sleep-walking might occur. This is a common complaint regarding Zolpidem. In a study by Suzuki, Hibino, Inoue, Mikami, Matsumoto, & Mikami (2016), they found that after switching to suvorexant, another drug to treat insomnia, the sleep-walking stopped completely. In older adults especially, sleep-walking can be dangerous or cause injury. Frey, Ortega, Wiseman, Farley, & Wright (2011) explored cognitive and motor functioning after treating participants with zolpidem while also taking account of sleep inertia. The study included twelve older adults and thirteen younger adults and took place in a sleep laboratory. Before testing them under the influence of zolpidem, they did baseline tests without the medication. One group took 5 mg of zolpidem approximately 10 minutes before scheduled sleep; the placebo group stayed awake two hours after their scheduled sleep time. Two hours after administering the medication, they tested the participants on cognitive function and walking stability; this method stems from when users of zolpidem generally awaken and might experience complications. Once awakened, they attempted to walk across a balance beam tandemly; a failure of the test means the participant stepped off the beam because of imbalance. They also completed Stroop Color Word Tasks for cognitive measurement. After the study, they concluded that zolpidem significantly impaired cognitive and motor function as seven of adults stepped off the beam on zolpidem, and all participants did significantly worse on the cognitive test. In the conclusion, the authors explained, “Because impaired tandem walk predicts falls and hip fractures, and because impaired cognition has important safety implications, use of nonbenzodiazepine hypnotic medications may have greater consequences for health and safety than previously recognized,” Frey et al. (2011)
Ambien and the Stages of Sleep
Arbon, Malgorzata, & Dijk (2015) compared how melatonin, temazepam (Restoril), and zolpidem (Ambien), target your GABA and MT1/MT2 receptors; these receptors are what control your brain activity and natural melatonin secretion during your sleep cycle. Before the study, they knew that Zolpidem targeted specific GABA receptors while melatonin medications target MT1 and MT2 receptors. What they didn’t know was how zolpidem affected your slow-wave activity (SWA) during nocturnal non-rapid eye movement (NREM). They used sleep EEGs measured in hertz and polysomnography to measure change in sleep phases in the sixteen participants. Slow wave sleep is extremely important for cognitive functioning, primarily memory consolidation; it is often referred to as sleep dependent memory processing. In the end, they found that zolpidem reduced SWA significantly. Because slow wave sleep is so important, reduced slow wave sleep, or deep sleep, over several nights could have detrimental effects on your brain, particularly in memory (Roth, 2009).
Effectiveness of Zolpidem as a Sleep Aid
Although zolpidem proves to be dangerous to some, it has become a phenomenon in the world of sleep. In one large-scale study by Perlis, McCall, Krystal, & Walsh (2004) they discuss the impact zolpidem has on people with insomnia; they used experimental and placebo groups, and all of the participants met the DSM-IV criteria for insomnia. Over 12 weeks, participants recorded their sleep in sleep diaries. In the experimental group, they also recorded the use of zolpidem, as needed, each night. Overall, participants experienced nearly 50% decrease in sleep latency, number of awakenings, and time awake during the night. They also experienced a 27% increase in total sleep time; all of the participants improved their sleep quality across the board. In a case study evaluated by Keuroghlian, Barry, & Weiss (2012) based on a physician who participated in shift work, the perspective opposes the previous article. The physician, a 34-year old male, had a history of drug and alcohol abuse. He was a resident in a teaching hospital, and he would often work 30 hour shifts at a time; he used zolpidem due to his sleep-wake disruption. After one shift, the physician experienced a grand mal seizure. Because the physician had a history of alcohol use, psychiatrists noted that alcohol and zolpidem together cause additive affects and concluded that the seizure was due to withdrawal of zolpidem. Most adults indulge in alcoholic beverages periodically, and adults are the primary users of zolpidem. While comparing the latter study and this case study, most “bad press” around zolpidem can most likely be due to additive affects. Ambien alone has proven to be effective in helping healthy patients with insomnia, but for people who already have other mental diagnoses or substance abuse history, zolpidem is not necessarily a safe option.
Conclusion
Based on the research produced by these studies, I believe that Ambien can be safely used, but there are risks associated with it. Especially with older adults, waking in the night when you are under the influence of zolpidem can be dangerous. After initially seeing the media article about Roseanne Barr and then conducting research, I can conclude that there might be some gaps in the research associated with zolpidem and safety in using it as a sleep aid; there is, however, sufficient data to prove that certain people are not good candidates for the medication as a sleep aid. Some of the studies I discussed show that medication such as suvorexant and melatonin are safer and help with the onset of sleep and reduce awakenings throughout the night.