2-Minute Neuroscience: Zolpidem (Ambien)

Zolpidem, better known by the brand name Ambien, is a medication primarily used to treat insomnia and other sleep-related problems. In this video, I discuss the safety and effectiveness of zolpidem as well as how it works in the brain to promote sleep.

TRANSCRIPT:

Zolpidem, better known by the brand name Ambien, is a medication primarily used to treat insomnia and other sleep-related problems. Studies have found zolpidem to be effective in reducing sleep latency, or the amount of time it takes someone to fall asleep, as well as in increasing total sleep time. Zolpidem belongs to a class of medications known as non-benzodiazepine hypnotics, sometimes called Z-drugs because many of the first of these drugs to be sold had names that started with the letter Z.

Similar to the benzodiazepines, zolpidem exerts its effects by increasing activity at receptors for the neurotransmitter GABA. GABA is primarily an inhibitory neurotransmitter, and increasing GABA activity can promote sleep as GABA can decrease activity in parts of the brain that promote wakefulness. Unlike benzodiazepines, however, zolpidem is thought to selectively bind to specific GABA receptor subtypes that are especially involved in sleep-inducing effects.

While zolpidem has been found to be effective and safe in the short-term management of sleep problems, the drug can also cause tolerance, dependence, and withdrawal symptoms when someone stops taking it, even when taken as prescribed at typical doses. Additionally, while most of the side effects of zolpidem, such as next day drowsiness, are common side effects of sleep medications, some zolpidem users have reported sleepwalking, sleep eating (which involves getting up and eating without waking), and even more dangerous activities like sleep driving, while under the influence of the drug. And due to various concerns, such as potentially impaired metabolism of the drug, an increased risk of falls, and an increased risk of cognitive impairment, zolpidem may pose more problems for older populations. Thus, despite its effectiveness, zolpidem should be prescribed cautiously and used only for as long as is absolutely necessary.

REFERENCES:

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Fitzgerald AC, Wright BT, Heldt SA. The behavioral pharmacology of zolpidem: evidence for the functional significance of α1-containing GABA(A) receptors. Psychopharmacology (Berl). 2014 May;231(9):1865-96. doi: 10.1007/s00213-014-3457-x. Epub 2014 Feb 22. PMID: 24563183.

Gunja N. In the Zzz zone: the effects of Z-drugs on human performance and driving. J Med Toxicol. 2013 Jun;9(2):163-71. doi: 10.1007/s13181-013-0294-y. PMID: 23456542; PMCID: PMC3657033.

Huedo-Medina TB, Kirsch I, Middlemass J, Klonizakis M, Siriwardena AN. Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration. BMJ. 2012 Dec 17;345:e8343. doi: 10.1136/bmj.e8343. PMID: 23248080; PMCID: PMC3544552.

Matheson E, Hainer BL. Insomnia: Pharmacologic Therapy. Am Fam Physician. 2017 Jul 1;96(1):29-35. PMID: 28671376.

Salvà P, Costa J. Clinical pharmacokinetics and pharmacodynamics of zolpidem. Therapeutic implications. Clin Pharmacokinet. 1995 Sep;29(3):142-53. doi: 10.2165/00003088-199529030-00002. PMID: 8521677.

Wong E, Nguyen TV. Zolpidem Use in the Elderly and Recent Safety Data. Prescription Pad. 2014 Feb;10(2):140-141.

[rutegerd]

I have been on most of the Z drugs for over a decade now. The sleep eating is super real. You eat like a horse and don't remember. Sleep driving. They help you get to sleep, but you have to be aware of what they can do.

[ssskillzzz]

Have taken Ambien for a decade. I haven't had too much of a tolerance buildup and I describe it like this. If I don't lay down to go to sleep, I will still be asleep soon, regardless of if im still up around and talking.

[BroBromans]

Best sleeppil on the market and nice trips lool

[satoru.nakata]

one of the common side effects of zolpidem many people recall is 'they ran naked down the streets' and they had no memories of that incident, their known ones told them about that.

[margueriteoreilly]

I remember my doctor giving me them...got me to sleep....and back in to routine after a couple of weeks then straight off them...

[ericamurphy]

Been on for 9 years and it’s hard to get the pharmacy to understand I have a very low quality of life without it. It is worth the risks for me 😊 I have no negative sides just better mental health

[mizulightblue]

My dad is taking Zolpidem since nearly 2 decades now. His doctor also increases the dosis, because of the intolerance that he got from it.

[stevevorass]

20 years and counting for me.. I hate how hard it is to get refills!

[orpheus]

Does Zolpidem pose any long-term cognitive impairment? I couldn't find a consensus in the literature available but I can be mistaken.

[icyrunner]

Can you do a video on allopregnanolone? And other neurosteroids? I think that would be fascinating

[Monica-]

I've taken zolpidem off and on for over 15 years. I've taken so many OTC and other prescriptions. It's been a life saver, but ready to transition to something else that is not prescription. I

[StdsRbop]

The warning in this video on tolerance & withdrawal feels a bit overblown. You can be on 10mg for decades and get the same effect every time. And if you come off of it, you sleep will suck especially bad for several days but then go back to your previous baseline. Idk if I would call this a "withdrawal"

[greasyhandshake]

I usually just punch myself in the head until the anxiety attacks go away and it allows me to sleep. Melatonin, gaba, benadryl, and L theanine don't work anymore. Nothing except punching myself so hard I can't even open my jaw the next morning. I bet ambien might work for a bit. It'd be nice if I could afford to see a doctor

[rabbit]

I’v been trying different sleeping medication, only Z drugs works so well, I need quick fell asleep not helps me sleep longer .
next no drowsiness.

but with alcohol …did happen dangerous activity, and I don’t remember anything, it’s really sacred .
I ‘v been taken on and off 15 years, trying to cut down then start a lot’s suicidal thoughts…
but I need to sleep ..

[thomaslau]

Insomnia is like a punishment given by God.

[gimpimp]

How about describing the neurology rather than the cost benefit of using it. For instance, if it sometimes is correlated with sleeping walking why. Or since it’s used for sleep describe in the 2nd minute how this influences parts of the brain relative to sleep.

[Dale-TND]

30mg sublingual... lets get this show on the road.