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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.
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.
Due to these side effects, it is imperative that Ambien be taken immediately before going to sleep.
Listed below are real examples of when an individual did not go to sleep after taking Ambien
Because of Ambien’s strong amnesiac effects, these individuals remembered nothing about the events.
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.
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.
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.
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.
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.
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.
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.