the Risks and Effects of Sleep Medications

The severity of sleeping pills?

Hello, doctor: I recently checked the sleep medication I am currently taking, which is called "Shu Meng Mian" in Chinese.
It seems to be associated with sleepwalking and amnesia, and it appears to be classified as a drug on the internet.
Is it really that serious? What should I be aware of while taking it? Thank you.

Meizi, 40~49 year old female. Ask Date: 2015/09/14

Dr. Wu Enliang reply Psychiatry

Hello, this medication is known as Zolpidem, which is a prescription drug and not classified as a controlled substance.
It must be prescribed by a physician.
The dosage for adults under 65 years of age is one tablet per day.
For adults over 65 years or those with hepatic impairment, the recommended dosage is half a tablet per day, with an increase to one tablet only in very rare cases.
In all situations, the dosage should not exceed one 10 mg tablet per day.
There is no relevant data available, so its use in children is not recommended.
Usage: During the treatment period, efforts should be made to shorten the duration of treatment, ideally to a few days, and not exceeding four weeks.
For occasional insomnia, treatment may last 2-5 days (e.g., insomnia caused by travel).
For transient insomnia, treatment may last 2-3 weeks (e.g., insomnia related to significant events).
For occasional or transient insomnia, prescriptions can be written for continuous treatment based on the patient's symptoms or for use as needed.
Some cases may require continuous treatment for more than four weeks, but this should only be considered after careful reassessment of the patient.
Recent case reports have indicated that Zolpidem may lead to misuse, dependence, and withdrawal phenomena, with some studies suggesting that its reinforcing effects and potential for abuse are similar to those of benzodiazepines.
There are calls to reassess the risks of dependence associated with this medication.
Regarding side effects, initial studies and recent literature indicate that Zolpidem may cause hallucinations, confusion, agitation, sensory distortion, dizziness, headache, drowsiness, fatigue, delusions, abnormal thinking, tearfulness, unsteady gait, amnesia, sleepwalking, nightmares, delirium, seizures, nausea, vomiting, diarrhea, muscle pain, and other side effects.
If any of these side effects occur, the medication should not be used further.
In summary, this medication can be used occasionally but is not recommended for daily long-term use due to a high risk of dependence.
If any severe side effects (though uncommon) occur, it should not be used again.
It is advisable to discuss with your physician how to use this medication correctly.

Reply Date: 2015/09/14

More Info

When it comes to sleep medications, particularly Zolpidem (known as "舒夢眠" in Chinese), it is essential to understand both the benefits and the potential risks associated with their use. Zolpidem is a prescription medication primarily used for the short-term treatment of insomnia. While it can be effective in helping individuals fall asleep, it is not without its side effects and risks.

Understanding Zolpidem and Its Effects
Zolpidem belongs to a class of medications known as non-benzodiazepine hypnotics. It works by enhancing the effects of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain, which promotes relaxation and sleep. However, its mechanism of action can lead to various side effects, some of which can be quite serious.

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Common Side Effects
Some of the common side effects associated with Zolpidem include:
- Drowsiness or sedation
- Dizziness
- Headaches
- Nausea
- Fatigue
- Memory issues, including amnesia
- Sleepwalking or engaging in other activities while not fully awake (known as parasomnia)
These side effects can vary in intensity from person to person. For instance, while some individuals may experience mild drowsiness, others may find themselves engaging in complex behaviors while asleep, such as cooking or driving, without any recollection of these activities the next day.

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Serious Risks
There have been reports linking Zolpidem to more severe side effects, including hallucinations, confusion, and even suicidal thoughts in some cases. The risk of dependency and withdrawal symptoms is also a concern, particularly with long-term use. Although Zolpidem is not classified as a controlled substance like benzodiazepines, its potential for misuse and dependence has led to increased scrutiny.

Usage Guidelines
When using Zolpidem, it is crucial to follow your healthcare provider's instructions carefully. Here are some important considerations:
1. Dosage: The typical dosage for adults is 10 mg taken right before bedtime. For older adults or those with liver issues, a lower dose of 5 mg is recommended. It is essential not to exceed the prescribed dosage, as higher doses can increase the risk of side effects.

2. Duration of Use: Zolpidem is generally recommended for short-term use, typically no longer than 4 weeks. Prolonged use can lead to tolerance, meaning higher doses may be needed to achieve the same effect, increasing the risk of dependency.

3. Avoiding Alcohol: Alcohol can exacerbate the sedative effects of Zolpidem and increase the risk of adverse effects, including respiratory depression and impaired motor function.

4. Monitoring Side Effects: Be vigilant about any unusual behaviors or side effects. If you experience sleepwalking, memory loss, or any severe reactions, contact your healthcare provider immediately.

5. Discussing Alternatives: If you find that Zolpidem is not suitable for you due to side effects or concerns about dependency, discuss alternative treatments with your healthcare provider. Cognitive-behavioral therapy for insomnia (CBT-I) is an effective non-pharmacological approach that can help address the underlying causes of insomnia.

Conclusion
In summary, while Zolpidem can be an effective short-term solution for insomnia, it is essential to be aware of its potential side effects and risks. It is not classified as a controlled substance, but it does carry the risk of dependency and serious side effects, including sleepwalking and memory issues. Always consult with your healthcare provider to ensure that you are using this medication safely and effectively, and consider exploring alternative treatments for insomnia if necessary. Your health and safety should always come first.

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