Like most drugs, if you’re looking for signs someone has a problem with Ambien, it’s important to understand this: If they’re taking it, they may have a problem.
Granted, not everyone who takes Ambien — the brand name of the drug zolpidem — becomes addicted to it, and like other drugs that can be abused, it has a legitimate medical purpose. The value of a good night’s sleep can’t be overstated, and it’s little wonder that those who find themselves without it go to great lengths to get it.
Consider this: According to a 2018 study by the University of Pennsylvania School of Medicine , one in four Americans experience acute insomnia every year, and 25 percent of those individuals develop persistent poor sleep patterns or chronic insomnia.
That doesn’t even begin to address the other 89 distinct sleep disorders, according to the International Classification of Sleep Disorders , but all generally present with the same set of symptoms: “excessive daytime sleepiness, difficulty initiating or maintaining sleep, or abnormal movements, behaviors, and sensations occurring during sleep. The cumulative effects of sleep loss and sleep disorders have been associated with a wide range of deleterious health consequences including an increased risk of hypertension, diabetes, obesity, depression, heart attack, and stroke.”
Sleep is critical for our health and well-being. And medicine has a place in promoting such health benefits. However, the most widely prescribed medication for insomnia, Ambien, carries with it certain risks for abuse and addiction, and understanding the signs someone has a problem with Ambien is valuable information to have in order to help such individuals — many of whom may not even realize they have a problem.
So, What Is Ambien?
According to MedlinePlus , a publication of the U.S. National Library of Medicine, “Zolpidem belongs to a class of medications called sedative-hypnotics. It works by slowing activity in the brain to allow sleep. Zolpidem comes as a tablet (Ambien) and an extended-release (long-acting) tablet (Ambien CR) to take by mouth. Zolpidem also comes as a sublingual tablet (Edluar, Intermezzo) to place under the tongue and an oral spray (Zolpimist), which is sprayed into the mouth over the tongue.”
According to a 2017 article in the peer-reviewed journal SAGE Open Medicine , zolpidem “was initially approved by the Food and Drug Administration (FDA) in 1992 in an immediate release (IR) formulation under the trade name Ambien,” manufactured by the company Sanofi-Aventis of Bridgewater, New Jersey, “for the short-term treatment of insomnia.” From the beginning, the company issued warnings about patient impairment the next morning and the variability of side effects, and doctors were encouraged to individualize medication regimens rather than adhere to a standard set of prescription protocols.
Over the next several years, “further variations in morning psychomotor impairment were discovered” through additional studies, and in 2005, a modified-release formula of Ambien was released “for the treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance.” The company Purdue Pharma received approval for a lower-dose tablet (brand name: Intermezzo) in 2011 “for patients who had difficulty falling back to sleep after waking in the middle of the night,” and interestingly, the dosage recommendations varied according to gender because of “data that showed that women, when given the same dose as men, had higher serum concentrations and lower clearance of zolpidem compared to men.”
Those findings led to safety concerns by the FDA, which conducted driving studies that found “the degree of impairment in patients with serum zolpidem concentrations … was similar to that observed in patients with blood alcohol concentrations (BACs) considered illegal for driving.” Those findings led the FDA to require a labeling change in 2013 that reduced the recommended dosage for women.
According to The New York Times , prescriptions for sleep medication like Ambien grew from 5.3 million in 1999 to 20 million in 2010, and last year, due to increasing reports of problems associated with Ambien and similar drugs, the FDA opted to give the medications a “black box warning”  — a “type of label is the strongest that the agency issues, calling attention to side effects that can lead to serious injury or death.”
Signs Someone Has a Problem With Ambien: How Does It Work?
According to a 2014 article in the Huffington Post , until Ambien was approved in 1992, the go-to sleep aid was a drug called Halcion, which had raised concerns because of potential mental and emotional disorders associated with it, including psychosis and addiction. As a sleep aid, “Ambien works by activating the neurotransmitter GABA and binding it to the GABA receptors in the same location as the benzodiazepines such as Xanax and Valium. The extra GABA activity triggered by the drug inhibits the neuron activity that is associated with insomnia. In other words, it slows down the brain. Ambien is extremely effective at initiating sleep, usually working within 20 minutes.”
Like dopamine, the chemical released in a torrent by the activation of drugs like heroin and opioids, GABA — gamma-aminobutyric acid — is one of the brain’s neurotransmitters “involved in many functions in both the central and the peripheral nervous systems … (that) belong to the family of amines or amino acids,” according to a page dedicated to brain function by McGill University : It’s “an inhibitory neurotransmitter that is very widely distributed in the neurons of the cortex. GABA contributes to motor control, vision, and many other cortical functions. It also regulates anxiety.”
According to the United Kingdom’s University of Bristol School of Chemistry , “GABA’s natural function is to reduce the activity of the neurons to which it binds. It inhibits nerve transmission in the brain, calming nervous activity. This can make a person feel more tranquil and give him or her sense of wellbeing.” It’s what’s known as an “inhibitory neurotransmitter,” which encourages neurons not to “fire,” or send an electrical impulse. In this manner, it “has a calming or quieting influence,” according to the University of Bristol: “Without GABA, nerve cells fire too often and too easily. Anxiety disorders such as panic attacks, seizure disorders, and numerous other conditions including addiction, headaches, Parkinson's syndrome, and cognitive impairment are all related to low GABA activity.”
The science journal Nature, in a 2016 paper , lays it out in complicated terms, but the gist of Ambien’s effects are these: Although it’s not a benzodiazepine, it binds to GABA receptors in the same way, which leads to “a structural change to the protein complex resulting in an increase in GABA potency … like many benzodiazepines, zolpidem exhibits sedative and hypnotic effects via α1 containing receptors, but unlike benzodiazepines, zolpidem reverses cognitive and motor deficits in neuropathological states, improves motor function in patients with Parkinson’s disease, progressive supranuclear palsy and stroke.”
As a prescription medication, Ambien has proven to be a godsend to many individuals who suffer from insomnia. The academic medical research center Penn Medicine, associated with the University of Pennsylvania, touts both its benefits  — fast-acting (“generally within 30 minutes”), shown to improve the sleep process, improvement of sleep problems within seven to 10 days of taking it — and its potential drawbacks:
- Side effects: “From dizziness, to constipation, to uncontrollable shaking. Some side effects, such as rash, chest pain, or difficulty breathing can become serious medical concerns that require immediate care. Rarely, Zolpidem can cause unusual nighttime behaviors, such as night-eating or sleep walking.”
- Next-day impairment: “Taking more than the prescribed dosage, or taking zolpidem and then not getting a full night's sleep (about 7 to 8 hours), can cause problems the next day, like difficulty driving, daytime drowsiness, dizziness, blurred or double vision, reduced alertness, or prolonged reaction time.”
- Drug interactions, including the concern that “alcohol can make these side effects worse.”
- Dependency: “The drug can be habit-forming, meaning you eventually will have trouble sleeping without it.”
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So How Is It a Recreational Drug, and What Are the Signs Someone Has a Problem with Ambien?
When it comes to substance abuse, it may seem odd, if not downright skeptical, that individuals would choose to recreationally consume a drug designed to make you sleep. It’s important to understand, however, that GABA receptors play a role in the continued use of other addictive substances, such as alcohol. The function of GABA receptors is enhanced by alcohol, according to a paper in the British Journal of Pharmacology : “short-term alcohol consumption increases GABAA receptor function, while prolonged drinking due to counteradaptative processes has the opposite effect,” and the same holds true for Ambien.
But why? Why does it feel good? The National Institute on Drug Abuse details a 2012 paper  on the addictive nature of benzodiazepines — which Ambien mimics — that provides some clues: “In normal animals, the firing rate of interneurons decreased in response to the drug, while that of dopamine-producing neurons increased.” In other words, the study offered a “chain of proof” that despite acting on GABA receptors, drugs like benzodiazepines and Ambien can also release dopamine, the “feel-good” chemical that’s central to the reinforcement and reward pathways that play a central role in addiction: “Benzodiazepines’ newly discovered mechanism for producing reward is comparable to those of opiates, cannabinoids, and GHB. Each of the four drugs reduces an inhibitory influence on dopamine-producing cells, thereby promoting dopamine spikes.”
So what are the signs someone has a problem with Ambien? Some aren’t so obvious, and others are downright alarming. How so? Consider the anecdotal stories of those who have no memory of their actions while under the influence of Ambien. The website Healthline asked for reader contributions  to a compilation of Ambien horror stories, and the submissions ranged from the bizarre (“I drove my car to the store and bought whipped cream all in my sleep,” “bought a $2,000 guitar amp online”) to the frightening (“I have a huge hole in my septum I dug thinking spiders had gone up my nose”).
According to a report from ABC News , while less than 1 percent of individuals in studies have reported activities like “sleep-driving, sleep-walking, preparing and eating food, talking on the phone, having sex and having hallucinations while not fully awake … the FDA received more than 700 reports of Ambien-impaired driving,” although “it was unclear what dose or time the medication was taken and if alcohol and other drugs were involved.” And given the number of prescriptions for Ambien — 38 million written between 2006 and 2011, according to Huffington Post  — 1 percent of that total (380,000) is still a large number of individuals who have issues.
That said, the signs someone has a problem with Ambien include:
- A big one: Taking Ambien even if you don’t have problems sleeping, or for other problems. In 2008, Glamour writer Laurie Sandell detailed her own Ambien addiction , which began with insomnia but soon became a solution for anxiety of any kind: “For as long as I could remember, I'd been afraid of flying … one day, as I was white-knuckling it through a patch of turbulence, I remembered the Ambien in my overnight case. I'd been taking it every night to sleep — why not to fly? I popped a pill and my fear melted away entirely. I woke up five hours later, just as the wheels touched down on the tarmac. After that I never wanted to fly without Ambien in my system again.”
- Taking more than prescribed: As is the case with most drugs, those who take Ambien can build a tolerance to it, meaning they have to take higher dosages to get the same effects, often at the expense of specific warnings by physicians. That can lead to running out of the medication before it’s time for a refill, which can lead to “doctor shopping” — obtaining prescriptions from multiple physicians (which, incidentally, is illegal).
- Forgoing social activities, hobbies or even work and school to take Ambien: If someone is constantly talking about how they “need sleep,” to the point that they’d rather ditch recreational gatherings or skip work and school in order to get it, could it be because they have a problem?
- Odd, unexplainable, out-of-character behavior: In recent years, Ambien has become a popular scapegoat for a number of unfortunate incidents. Actress Roseanne Barr blamed Ambien for a racist Tweet in 2018 (“I was ambien tweeting,” she later wrote. “Not giving excuses for what I did but I’ve done weird stuff while on ambien.”)  Other high-profile Ambien incidents, according to Time magazine: “Rep. Patrick Kennedy crashed his car in 2006 while under the influence of Ambien, and Charlie Sheen, who called Ambien ‘the devil’s aspirin,’ blamed the drug for a 2010 hotel rampage.”
- Health problems: Long-term Ambien use can present a myriad of issues, and the sudden cessation of it after prolonged use can cause a number of withdrawal effects, including “shakiness, lightheadedness, stomach and muscle cramps, nausea, vomiting, sweating, flushing, tiredness, uncontrollable crying, nervousness, panic attack, difficulty falling asleep or staying asleep, uncontrollable shaking of a part of your body, and rarely, seizures.” 
- Your life is unmanageable. The traditional definition of addiction and alcoholism comes down to this, which is why it often doesn’t matter what or how much an individual uses: If their lives have been built around a particular substance to the point that other areas are suffering, then it’s a problem.
Ambien can and does work wonders for vast numbers of Americans, but it’s also a pharmaceutical drug that carries with it certain risks. Any drug that affects the brain chemistry can lead to a potential for abuse, and while you may not see overt signs someone has a problem with Ambien, that doesn’t mean it hasn’t become one. Caution is warranted by those to whom it’s prescribed, and those who have a propensity for addiction and alcoholism should be especially aware that it can and does lead to problems.
If it does, however, the same tools used by drug and alcohol treatment centers for other substances of abuse can also work for those who have a problem with Ambien.