Ambien Question
I’ve had a couple of different medically trained people inform me that Ambien is only “designed for short term use” and is generally prescribed because insurance companies prefer it to be used based on cost.
I’m “lucky” that I had an adverse reaction to the drug so I was moved onto something “better”, however it makes me concerned that so many people take Ambien on what appears to be a long term basis.
What are your thoughts on the subject?
I am going to apologize now for what is most certainly going to become a miniature rant on medication.
Ambien is a non-benzodiazepine hypnotic, and is suggested for short-term use, just like every other hypnotic or sedative ever made. They are all recommended for short term because they all have potential for abuse, and many are thought to further disrupt your sleep cycle over time.
As a newer drug, Ambien is actually more expensive than most of the old-line sleepers. One of the reasons it is prescribed a lot is because it is newer. Just like most people, doctors like to use the newest, shiniest, most promising things they find. This is, in my opinion, partly due to pharmaceutical companies beating us over the heads with their newest drugs, but also because the newer drugs tend to have fewer side effects, or at least they are presented that way. Another reason Ambien is popular is there is purported to be less risk of abuse compared to other sedatives and hypnotics. It is thought to be less addictive, and the odds of having to keep increasing your dose to get the same effect are lower than with things like Valium or Halcion.
Ambien does have weird side effects in some people. It can cause sleep-eating and other sleep behaviors that don’t typically occur in people who aren’t taking this type of medication. Sleep and insomnia are complicated, and not completely understood yet, so trying to fix problems with sleep can be pretty difficult. There are also reports that coming off of Ambien after taking it for an extended period can cause real problems in some people, including seizures if you don’t wean off and just suddenly discontinue.
Knowing all of the above, though, Ambien does have fewer potential problems than some of the older drugs, and many people have insomnia that just doesn’t respond to things like sleep hygiene or even “more natural” supplements like melatonin (see table below). Torturers use sleep deprivation as a tool, as do brain washers. Insomnia is a serious problem. So if you are one of the people who suffers from ongoing sleep issues, drugs like Ambien can be a real godsend.
I think the key is to work with your doctor and be honest about your situation. Try sleep hygiene first. Deal with any issues that can cause secondary sleep problems, such as chronic pain, depression, or anxiety. If you still have difficulty sleeping, Ambien is a decent drug for a lot of people. You have to be aware of its limitations as with any drug, and if it doesn’t work for you, try something else.
I can go on and on about this or any drug, but philosophically we have problems in the US related to medication use. We over prescribe, but we also demonize. Modern medicine and modern pharmaceuticals make our lives longer, healthier, and give us better quality of life. But we have this love/hate relationship with them. We think we should be able to muscle on without taking anything. We have this idea that drugs aren’t natural, and natural is better. But arsenic is natural, and so is suicide related to untreated depression and insomnia.
I don’t advocate unnecessarily taking medication, but I don’t think it helps when we develop unreasonable fear and hatred of meds, either. There are trade offs for everything in life, including nearly any medical treatment or lack thereof. Read up on any medication prescribed for you. Research every diagnosis you are given. You don’t have to be in health care to do this. Keep open communication with your health care providers and work as a partner in your own care. You owe it to yourself to be as informed as possible.
FDA-Approved Hypnotics for Insomnia
Duration Agent Trade Name Dose Half-life Comments
Benzodiazepine
Long acting
Flurazepam Dalmane 15-30 mg 48-120 h Do not use in older adults due to long half-life
Quazepam Doral 7.5-15 mg 41 h Do not use in older adults due to long half-life
Intermediate acting
Estazolam ProSom 1-2 mg 10-24 h Sleep maintenance
Temazepam Restoril 7.5-30 mg 3.5-18 h Sleep maintenance
Lorazepam* Ativan 0.5-4 mg; 1 mg in elderly 12-20 h May be used if duration of action meets patients needs
Short acting
Triazolam Halcion 0.125-0.5 mg 1.5-5.5 h Caution, rebound anxiety; not first-line agent
Nonbenzodiazepine
Intermediate acting
Eszopiclone Lunesta 2-3 mg; 1 mg in elderly and hepatic impairment 6 h Sleep onset and maintenance
Short-to-intermediate
Zolpidem Ambien 5-10 mg; 5 mg in elderly or hepatic impairment 2.5 h Primary use, sleep onset
Zolpidem ER Ambien CR 12.5 mg; 6.25 mg in elderly or hepatic impairment 2.8 h Primary use, sleep onset and maintenance
Short acting
Zaleplon Sonata 10 mg, 5 mg in elderly or hepatic impairment or use with cimetidine 0.9-1 h Primary use, sleep onset; maintenance up to 4 h
Melatonin Receptor Agonist
Short acting
Ramelteon Rozerem 8 mg 1-2.6 h Primary use, sleep onset
* Not FDA approved for sleep
Table from Primary Insomnia: Treatment and Medication on Medscape.
NOTE: Medscape requires a sign-in, but it is free and an excellent source of current, reputable medical information.
