Ambien-amnesia link no surprise to doctors

Deseret News (Salt Lake City), Mar 16, 2006 by Lois M. Collins Deseret Morning News

Local sleep specialist Dr. Christopher R. Jones hasn't personally met a patient who drives while sleeping under the influence of popular sleep remedy Ambien. But in the past couple of years he's seen two cases of potentially dangerous sleepwalking, including a businessman who was taking a somnolent stroll in his pajamas through a dark alley when someone found him.

Ambien (zolpidem), a central nervous system depressant used to help people sleep, garnered unwanted attention this month with news stories about a couple of research papers showing unusual sleep actions, including walking, driving and eating, but not remembering any of it. The drug is manufactured by French company Sonafi- Aventis.

The eating aspect is well enough known that it is included as a rare side effect in the warning literature provided by the manufacturer. And the other activities while sleeping, all classified with the eating as "confusional arousals," don't come as a particular surprise to Utah doctors specializing in sleep disorders, either.

Many oft-prescribed and very helpful prescription sleep remedies "have amnesia as one of the pharmacological properties," says Dr. Robert Farney, medical director of the LDS Hospital Sleep Disorders Clinic.

The Utah doctors also note that the effects appear to be rare. A scientific paper that's being written on the sleep-related eating disorder was prompted by research at the Minnesota Regional Sleep Disorders Center in Minneapolis, which identified 32 patients who apparently binged while asleep and then didn't remember it later. Still, 26 million prescriptions were written for Ambien in the United States last year. The Minnesota researchers estimate that thousands may experience the effect, but their estimate has not been documented. And while the Mayo Clinic has seen similar cases, it has no hard number, either.

It's also unclear how many people drive while they're "sleeping" under the drug's influence. The company has staunchly maintained the drug has a strong safety profile and it has reported any case it's heard of to the Food and Drug Administration, which says in turn that it will monitor the safety reports on the sleeping aid.

Jones, associate professor of neurology and medical director of the University Sleep-Wake Center at the University of Utah doesn't prescribe many sleep medications. He prefers a behavior- modification approach to resolve sleep difficulties. The "most important and simultaneously most difficult" is managing daytime stress more effectively. Unfinished psychological business and unresolved conflicts "seem to activate the wake-up system in the brain" that can make sleep elusive and unsatisfying. And when it's clear that the stress factors are not leaving, he says, it's helpful to schedule some problem-solving time in the daytime. At night, you learn to "convince your emotion-control circuits and intuition that you really don't have to stay awake" for it because you're going to work on it tomorrow and then you can relax and sleep.

He also counsels avoiding thought-provoking activities and stress- provoking conversations at bedtime. Instead, people need a wind- down time with bedtime rituals that prepare the mind for a good night's sleep, Jones says. And he counsels people who have trouble sleeping to get more bright light and physical activity during the day. "You don't earn deep sleep by being inside in the dim light."

Farney says there's no doubt that the odd sleep-related effects of Ambien are real. But the danger is greatest, he says, when the drug is not used as intended. For instance, someone who takes the sleeping aid and then doesn't go to bed may be more at risk of a sleep-walking-related behavior.

He's seen the unusual side effects firsthand, he says, "and the exact frequency is hard to say. I don't think it's a large number."

Awareness is a big part of the solution, Farney says. When someone knows the potential exists, they can watch for it and make changes that help avoid it. He points to one of the cases that made news this week, a woman who took Ambien to sleep during the day because she worked all night. She would get up, still asleep, and eat. Once she was aware of the problem, she changed shifts and sleeps at night, Farney says.

What is a huge problem, Farney notes, is taking sleeping pills without recognizing the extent of a sleep disorder. For instance, someone may have sleep apnea that isn't recognized and the sleeping pill is not going to resolve everything.

And like Jones, Farney notes that there are other options to resolve unsatisfactory sleep, including different types of medications that don't seem to have the same effect. Other choices may make sense to someone who has a concern about what he or she might be doing while taking Ambien.

But they agree, most people who use the drug are simply sleeping under its influence.

E-mail: lois@desnews.com