Written by Ross Phan, PharmD, BCACP, BCGP, BCPS | Reviewed by Christina Aungst, PharmD Updated on April 26, 2022
Key takeaways:
- While it’s normal to experience sleeping difficulties every now and then, some people have chronic (long-term) insomnia that doesn’t go away.
- There are a number of medications, including zolpidem (Ambien), that can help relieve your sleeping problems.
- Zolpidem (Ambien) is a common medication used for sleep problems. But it is not without side effects, which can include drowsiness, falls, and abnormal thinking or behavioral changes.
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Many people experience insomnia (sleeping difficulties) every now and then. Factors — like stress — can cause short-term insomnia. But for some people, insomnia can become a chronic (long-term) issue that happens at least 3 nights per week for a minimum of 3 months.
Adults typically need around 7 hours of sleep every night. But approximately one-third of adults in the U.S. routinely sleep less than that. Having insomnia can negatively impact your quality of life. In fact, not getting enough sleep is linked to a number of other medical conditions — like depression, heart disease, and obesity.
There are medications — like zolpidem (Ambien) — that can help relieve insomnia problems. But they are not without side effects.
In this article, we’ll discuss Ambien’s side effects, how long its side effects last, and possible long-term effects.
What are the side effects of Ambien?
If you’re taking zolpidem short term (less than 10 nights), common side effects may include:
- Dizziness
- Drowsiness or sleepiness
- Diarrhea
If you’re taking zolpidem long term (between 28 to 35 nights), you might experience dizziness and have a feeling of being drugged.
Severe side effects are also possible with zolpidem. Some serious side effects may include:
- Abnormal thinking or behavioral changes
- Mood changes
- Slowed concentration
- Lung-related effects
- Abnormal sleep-related behaviors
- Discontinuation (withdrawal) side effects
We’ll go into more detail about some of these side effects below.
1. Drowsiness
The FDA warned that people should not drive or engage in other activities that need complete mental alertness the day after taking zolpidem ER (Ambien CR).
Ambien CR is an extended-release version of Ambien. It can cause next-day drowsiness or sleepiness in up to 15% of adults. Since you’re less likely to be fully alert when feeling drowsy or sleepy, Ambien CR’s prescribing information also recommends against driving.
2. Impaired driving and car accidents
So, the FDA warned people against driving. But how likely are you to get into a car accident while taking zolpidem?
Regardless of whether you’re new to zolpidem or you’ve taken zolpidem for more than 1 year, a 2015 study suggests that you’re roughly twice as likely to get into a car accident. This risk peaks to more than five times as likely between 1 to 4 months after starting zolpidem.
While taking zolpidem, the amount of medication in your body has a similar driving risk as a blood alcohol concentration (BAC) of 0.06% to 0.11%. With the U.S. legal alcohol limit being 0.08%, driving while taking zolpidem is much like driving while intoxicated.
3. Hallucinations
Hallucinations have been reported in people taking zolpidem, especially those taking zolpidem ER. They can last up to 7 hours. And they might be more likely to occur if you take zolpidem along with an SSRI (selective serotonin reuptake inhibitor) antidepressant, like sertraline (Zoloft) or fluoxetine (Prozac).
Instead of hallucinations, some people might have other side effects, such as mood changes and abnormal thinking or behaviors. For example, one individual reported feeling an “Ambien high.” While taking zolpidem, they may appear more sociable and talkative, which is out of character for them.
4. Falls, hip fractures, and brain bleeds
Zolpidem has CNS-depressants effects. The CNS stands for central nervous system, which includes the brain and spinal cord. Suppressing the CNS might make you feel clumsier. You may also feel drowsy and less alert. These side effects also raise the likelihood of falls in people taking zolpidem.
And these falls may result in brain injuries and hip fractures in those taking zolpidem. This is especially true for people 65 and older.
5. Upper respiratory tract infections
People taking zolpidem are roughly twice as likely to develop any type of infection, including lung infections. But more studies are needed to assess how zolpidem might cause an infection.
6. Impaired memory and Alzheimer’s
Older adults have a particularly high risk of side effects from zolpidem. Some of these can include memory impairment and delirium (confused thinking). A 2017 study from Taiwan showed that those who took zolpidem for a relatively high number of days in a year (more than 180 days) had a greater risk of Alzheimer’s disease compared to those who took zolpidem less than 28 days out of the year.
7. Abnormal sleep-related behaviors
People who committed violent crimes after taking zolpidem have sometimes blamed their actions on sleepwalking or other side effects of zolpidem as they testified in court. While violent crimes are extreme, abnormal sleep-related behaviors are possible with zolpidem. This is a concern given its widespread use.
Examples of other reported sleep-related behaviors, include sleepwalking, sleep driving, and having sex while sleeping.
8. Emergency room visits
Between 2009 and 2011, zolpidem accounted for about 12% of adult emergency department (ED) visits for adverse drug events related to mental health medications. Of these visits, about 21% involved adults 65 years of age and older.
9. Cancer and death
Zolpidem is linked to a higher risk of cancer, death, or both. This higher risk was found with other prescription sleep aids, too. In a 2012 study, the higher risk of death appeared even in people who took zolpidem at a rate of less than 18 doses per year over a 2.5-year time period.
In another 2012 study, people taking slightly more than 5 mg of zolpidem per week were more than six times as likely to have cancer.
10. Nausea the next day
A possible side effect of zolpidem includes nausea. Nausea might be a result from experiencing dizziness with this medication.
While dizziness is a common side effect of zolpidem, people tend to experience it more with the zolpidem ER version. This also matches with more reports of nausea with zolpidem ER.
Nausea, however, can also be a symptom of a severe allergic reaction. And it can be a symptom of abruptly stopping zolpidem after long-term use, too. If you suspect that you’re having a severe allergic reaction or withdrawal symptoms, get medical help right away.
11. Not approved for long-term use
It surprises many people to hear that zolpidem is not approved for long-term treatment of insomnia. In fact, it’s best to talk with your healthcare provider if your insomnia isn’t better within 7 to 10 days of taking the medication. Your ongoing insomnia might be a symptom of another medical condition.
How long do Ambien (zolpidem) side effects last?
If you only used zolpidem as a short-term medication, then some of its side effects might only last for 5 hours. But it might take at least 8 hours to be fully alert enough to perform activities, like driving.
But after 2 weeks of taking zolpidem, your body might become used to its effects. If you’ve taken zolpidem as a long-term medication, don’t suddenly stop it. Keep in mind, withdrawal symptoms can last from several days to a few weeks. In general, however, symptoms start to improve about 4 to 5 days after stopping the medication.
If you would like to quit taking zolpidem, talk with your healthcare provider. They can help make this process safer and more comfortable for you.
What are the long-term effects of Ambien (zolpidem)?
Long-term side effects of zolpidem may include:
- Abnormal sleep-related behaviors
- Accident- or fall-related injuries
- Cancer and death
- Infections
- Memory problems
- Overdose risk
- Substance use disorder (SUD) risk
- Withdrawal symptoms
If you have questions or concerns about zolpidem’s side effects, talk with your pharmacist or healthcare provider.
The bottom line
Although it’s normal to have some sleep problems once in a while, some people have long-term insomnia that won’t go away. Fortunately, there are a number of medications available, like zolpidem, to help treat sleeping issues.
Zolpidem is a common sleeping medication that can help with insomnia. But it’s not without side effects. These can include drowsiness, falls, and changes in behavior and mood. If you have any questions or concerns, talk with your pharmacist or healthcare provider.
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