I have a friend who has end-stage brain cancer. In order to prolong her life, she has been undergoing high dose radiation therapy, which is taking a terrible toll on her body. She barely has the energy to get out of bed, partly because when she is in bed she cannot sleep, something that is critical for people who are that ill.
MAKING THE RIGHT CHOICE REQUIRES ACCURATE INFORMATION
I asked if she was taking a sleep aid. Yes, she was, but the melatonin (1) wasn't working very well. When I suggested Ambien she told me that her doctor offered it, but she declined because it was too dangerous because of all the sleepwalking it causes, and also the possibility of addiction (2). In this case, she was making a poor choice, depriving her body of the sleep, because of overblown fears about the medicine. The fears were based, perhaps entirely, on sensationalist press coverage (3).
While stories of people who took an Ambien (generic name zolpidem) having "sleep-sex" or eating a whole package of Oreos without knowing it make great news, they are misleading because they imply that these strange side effects are common. They are not. A literature search shows that Ambien induced sleepwalking is rare.
A 1995 article in The International Journal of Sleep Medicine described a three-year study of insomniac patients who took Ambien. The study was conducted by Sanofi, the makers of the drug. Here are the highlights:
- A multicenter, post-marketing trial conducted in Switzerland over a three-year period.
- 525 Physicians surveyed.
- 1972 Patients included in the study, representing about 1% of all Ambien use in Switzerland.
- A total of nine patients (0.5%) suffered from somnambulism (sleepwalking).
- Of the nine, five (0.3%) discontinued use of the drug.
In other studies:
- Complex sleep-related behaviors (CSBs) (4) were studied in 125 patients previously diagnosed with anxiety, depression, and similar disorders. About 15% of this population has Ambien-related CSBs, but this was found in patients that took high (> 10 mg/day) doses.
- In a post-marketing study of 96 patients, there was only one reported case of sleepwalking (5).
That's about it. The rest of the Ambien sleepwalking papers I came across were case studies of one or two people. These may be interesting but tell us nothing about how often it occurs.
Ambien, and other drugs in the "Z class" were invented to provide a safer alternative to Valium (See Need Some Zzzs? How Good Are The 'Z' Sleeping Pills?). And they are safer, but, like every other drug, they are imperfect. But these imperfections have been greatly amplified by the press, which has resulted in incorrect information being spread around. My friend needed sleep, yet was too scared to take something that would work and this was causing her health to worsen.
Just another example of how inaccurate sensationalized news coverage will beat sound science in the ratings game (6).
1. Melatonin, a human hormone, is sold over the counter in pharmacies and also at supplement stores. It seems to work for some people, but, even though it is being used as a drug, it is not approved as a sleep aid (or for anything else). It is sold in pills that contain between 1 and 10 mg of melatonin. What's the right dose? No one knows. Is it safe? Depends on the dose. Do you see the problem of unregulated drugs being sold next to vitamins?
(2) The anti-opioid hysteria has contributed to this fear; it is dead wrong. The addiction potential to Ambien is far lower than that of opioids or benzodiazepines. Yet some people with terminal illnesses worry about addiction. Worse still, chronic pain patients have told me that the fear of addiction rears its head in hospitals. Some doctors worry about addiction for people with only a short time to live. Madness.
(3) I suggested that she was worried about the wrong risk; sleep is of far greater benefit to someone so ill than the remote risk of a sleepwalking incident. She now sleeps through the night and feels better.
(4) Complex sleep-related behaviors were defined as "somnambulism with object manipulation, sleep-related eating, and other amnestic sleep-related behaviors."
(5) Sauvanet JP, Maarek L, Roger M, Renaudin J, Louvel E, Orofiamma B. Imidazopyridines in sleep disorders. New York: Raven Press, ; 1988. Open long-term trials with zolpidem in insomnia. In: Sauvanet JP, Langer SZ, Morselli PL, eds; pp. 339–49.
(6) ACSH gets no funding from Sanofi-Aventis or any other drug company.