Called a “z-drug” after the active ingredient zolpidem, brand-name Ambien is a prescription sleep aid that is classified as a sedative-hypnotic drug, similar in action to benzodiazepine drugs. Benzodiazepines impact levels of the neurotransmitter gamma-aminobutyric acid (GABA) in the brain. GABA is a chemical messenger that slows down hyperactive nerve firings, lowering anxiety levels, reducing muscle tension, and helping to induce sleep.
Ambien is meant to be taken to help with difficulties falling and staying asleep, but only as a short-term solution. Regular and long-term use of Ambien can cause the brain to become dependent on the drug and stop producing GABA in healthy levels without it. When a dependence has formed, withdrawal symptoms may occur when the drug isn’t present in the bloodstream. The US Food and Drug Administration (FDA) reports the following as potential side effects of Ambien withdrawal: flushing, nausea, lightheadedness, crying uncontrollably, sleep difficulties, nervousness, vomiting, abdominal cramps and pain, and panic attacks.
The Indian Journal of Pharmacology publishes that zolpidem withdrawal symptoms generally begin within 48 hours of stopping the drug. Since Ambien withdrawal may be similar to that of benzodiazepine drugs, it may also follow the withdrawal syndrome for these drugs. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that the average duration for benzodiazepine withdrawal is 1-4 weeks.
These drugs should not be stopped suddenly, or “cold turkey,” as this can cause the brain to suffer a kind of “rebound effect” wherein seizures, insomnia, and even delirium are potential dangerous side effects. Ambien serves to suppress functions of the central nervous system and keeps certain nerves from firing. When the dampening effects of the drug are suddenly lifted, the brain can go into overdrive trying to overcome this sudden change. Instead of stopping use suddenly, it is usually recommended that Ambien dosages be tapered down slowly to avoid possible complications.
Detox is the process of expelling toxins from the body, and it can be accomplished in a variety of settings. Individuals may attempt to detox at home, through an outpatient program, or in an inpatient medical detox facility. In general, home detox is not recommended for Ambien since the side effects can be potentially dangerous if not properly addressed. Both outpatient and residential detox programs can provide varying levels of support, depending on a person’s individuals circumstances and needs. Medical detox provides the most comprehensive, and safest, level of care during Ambien withdrawal, using supportive and pharmacological methods to manage difficult withdrawal symptoms.
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Duration of Ambien Withdrawal
Ambien withdrawal is individual in nature and will not be exactly the same for any two people. Several factors are involved in determining the severity and duration of Ambien withdrawal, including:
- How long Ambien was taken: Individuals taking it for longer periods of time are likely more dependent on the drug than those who haven’t been taking it as long.
- Dosage levels: The more Ambien a person takes each time influences how significant the dependence level is and therefore how intense withdrawal may be.
- Method of use: Individuals taking Ambien as directed are less likely to suffer from severe withdrawal symptoms than those who abuse the drug, particularly those who alter it and take Ambien in a manner other than as intended (e.g., chewing it or crushing the tablets to smoke, snort, or inject the powder).
- Biology and genetics: A person’s metabolism, age, gender, race, and family or personal history of addiction can all play a role in the severity of drug dependence and therefore the withdrawal syndrome for Ambien.
- Environmental aspects: High levels of stress and episodes of trauma can negatively impact Ambien withdrawal.
- Co-occurring disorders: Individuals who also suffer from a mental health disorder or medical condition may experience more intensified withdrawal symptoms or a longer withdrawal syndrome.
- Polydrug abuse: Using alcohol or other drugs in conjunction with Ambien can contribute to a longer and more significant withdrawal period.
In general, for someone who is less dependent on Ambien and does not have any mitigating environmental or biological factors at play, withdrawal side effects will be milder than for someone who is more heavily dependent on the drug and who has additional complications to consider. A general Ambien withdrawal timeline may look like this:
- Days 1-2: A kind of hangover effect may occur, leaving individuals feeling mentally “cloudy” and fatigued with difficulties focusing, learning, and remembering things; headaches; and impaired alertness.
- 48 hours after last dose: Withdrawal symptoms begin in force with “rebound” insomnia, psychological and physical side effects manifesting.
- Days 3-7: Side effects likely peak during this time, reaching uncomfortable levels, and cravings may become intense as well.
- Weeks 2-4: Symptoms start to taper off and subside.
- Beyond the first month: Some of the cravings and emotional side effects may linger; however, the bulk of Ambien withdrawal symptoms usually dissipate.
Some people who are significantly dependent on Ambien may experience protracted withdrawal, which is when withdrawal side effects and cravings continue for an extended period of time, up to several weeks or months after stopping the drug. According to SAMHSA, symptoms of benzodiazepine protracted withdrawal (which may also be the same for Ambien) can appear and disappear at random and in varying intensity levels. Symptoms include cravings, difficulties feeling pleasure, fatigue, and cognitive deficits, and they may mirror symptoms of psychiatric disorders, such as schizophrenia, obsessive-compulsive disorder (OCD), generalized anxiety disorder, panic disorder, or agitated depression. Symptoms of protracted withdrawal differ from rebound symptoms that can occur after stopping Ambien. These symptoms likely continue to wane over time; however, they can be minimized with professional help.
Safety of Medical Detox for Ambien Withdrawal
Ambien withdrawal can be unpredictable, both physically and emotionally. Seizures, tremors, heart palpitations, sweats, and jitters have been reported during zolpidem withdrawal in the journal The Primary Care Companion for CNS Disorders. Psychiatric reactions are possible during Ambien withdrawal as well, potentially causing hallucinations, paranoia, panic attacks, suicidal thoughts and behaviors, anxiety, and depression. These complications are serious enough to deter people from stopping the drug suddenly and without proper supervision.
Medical detox can establish individuals on a safe tapering schedule to slowly lower the dosage of Ambien in a safe and controlled manner. This will help to avoid potential negative reactions. Both medical personal and mental health providers can provide 24/7 monitoring, support, encouragement, and care during medical detox.
Pharmacological tools, such as additional medications or even substitute medications, may be beneficial in helping to manage side effects of Ambien withdrawal during detox. For example, quetiapine, an antipsychotic drug has shown promise in helping to treat Ambien withdrawal symptoms, the American Journal on Addictions publishes. Anti-seizure medications may be beneficial as well.
SAMHSA reports that nearly 8 million American adults suffer from both addiction and a mental health disorder, according to information gathered in a national survey in 2014. The presence of co-occurring disorders can add to emotional distress during Ambien withdrawal. During medical detox, an individual’s personal safety, as well as the safety of those around them, can be protected.
The goal of detox is to give the brain and body time to process Ambien out of the body safely. A medical detox program generally lasts 5-7 days on average, helping to manage the most acute withdrawal symptoms and promoting a stable foundation for follow-up care with a comprehensive addiction treatment program. Full withdrawal from Ambien may take weeks or months, depending on the tapering schedule, but therapy and full addiction treatment will begin and continue during this time.