Ambien is out

Insomnia is a serious problem for millions of Americans. Older adults often have difficulty getting to sleep, and many rely on sleeping pills. Unfortunately, benzodiazepines like alprazolam (Xanax) and z-drugs like zolpidem (Ambien), zaleplon (Sonata) and eszopiclone (Lunesta) have been linked to dementia. [For details, see the articles by Billioti de Gage et al, BMJ, Sep. 27, 2012;  Zhong et al, PLOS One, May 27, 2015 and Schroeck et al, Clinical Therapeutics, Nov. 2016.] If Ambien is out of the question, how else can a person get the ZZs he or she needs?

How Does a Doctor Decide Ambien Is Out?

Q. I am a 77-year-old man who has been taking zolpidem (Ambien) for 15 years so I can get the sleep I need. Now, however, I have a new primary care physician who will not renew my prescription because “it is not within the guidelines for those 65 and older.”

I have explained to the doctor that I need this medicine to fall asleep. Moreover, in the 15 years I have taken it, I have never, ever, had a side effect. Until just three months ago I worked a job that required me to wake at 5:40 in the morning and I still had zero side effects.

My doctor is adamant, however, and has prescribed trazodone, which is apparently within the guidelines. However, I read the warnings that come with the prescription and found that those with kidney disease should not take trazodone. I have Stage 3 kidney disease. Can you suggest another sleep aid that is not hazardous to my remaining kidney?

Older People Have Special Needs:

A. Zolpidem is on the Beers list of drugs that are often inappropriate for older people. Experts revise this list every few years to help keep doctors from making things worse by prescribing drugs that affect older people badly. (You can learn more from our Guide to Drugs and Older People.)

Is Trazodone Safer?

We’re not sure that trazodone is safer, however. The FDA has never approved this antidepressant for treating insomnia. It can cause next-day drowsiness, dizziness, confusion, dry mouth, blurred vision, unsteadiness and headache.

Getting Off Zolpidem Requires Patience:

Once your doctor decides Ambien is out, you may need several weeks of gradual dose reduction to phase off zolpidem to avoid rebound insomnia. Cognitive behavioral therapy for insomnia helps without side effects. Don’t overlook tai chi, a moving meditation that can be useful.

Non-drug options include dietary supplements such as melatonin, 5-HTP or tryptophan. There is evidence that tart cherry juice can help people fall asleep more quickly and sleep longer (Pigeon et al, Journal of Medicinal Food, June 2010).

You can find details on these and other sleep aids in our Guide to Getting a Good Night’s Sleep. This 22-page online resource is available at www.PeoplesPharmacy.com.

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  1. Wendy A.
    Texas
    Reply

    It is horrible for “government” studies to control people over 65. I have been taking ambien for almost 10 years-take 5 mg. when needed. Never any side effects. Trazodone has bad side effects, and some of the others are anti-anxiety medications. Could it be the zolpidem is so inexpensive that the industry feels like it is not make the money they want to make off of us and giving us more expensive alternatives that don’t work as well? Scary that we are losing control of our own lives.

    • susan
      tulsa
      Reply

      It isn’t horrible when they know what the consequences can be; it’s their job to regulate drugs. my mom was 80 years old when she took ambien. It led to psychotic episodes and a 2-week stay in hospital. Thank God my dad said no when they wanted to put her in a psych ward. She’s fine now, but it was a horrible experience. It is not an uncommon experience in older people either. Ambien is also known to cause unconscious activity and many people have gotten into vehicles and driven, unaware of their actions, and caused accidents. My friend was hit by a man on ambien and nearly died. Another man in my hometown jumped off a patio after taking ambien. It’s a bad drug. I understand the suffering of insomnia, but find something else – especially if you’re older.

  2. Tim
    warren,oh
    Reply

    I often read, here and on other medical websites that CBT can be a good alternative? Well, maybe if you are cognitively intact, but many, including my mother who is 91, has dementia and has a terrible time with sleep. CBT is not really an option, and people who think this can work for people who no longer have a properly functioning hypothalmus, just don’t get it.

  3. Lind
    NC
    Reply

    My dr will no longer prescribe ambient because I am over 65. I have severe insomnia all my life. The last 15 years were great taking ambien. Have tried several different drugs. Some help me sleep, but I feel like crap all day. I think this is age descrimanation. I don’t drink or take any anxiety medicine. Slept good, functioned good. now I just feel awful and tired depressed. This has been going on for closed to a year. I also suffer from sleep paralysis. What can we do. We are not individuals anymore. We are older and “they” don’t care. Discrimination law suite anyone? Do you know I did not think of my self as old till this happened. Now I do!

    • susan
      Reply

      It’s not a question of discrimination, it’s a question of practicing good medicine. They know that ambien has a much greater chance of causing an adverse reaction in older people than in younger ones; that’s a FACT. My 80 year old mom was one who had a very bad reaction. When she was in hospital, the doctor there was very angry that her doctor had prescribed it. Don’t be upset and defensive about it. Be grateful you have an ethical and responsible doctor, and find something else to help you sleep.

  4. Cindy M. B
    Seattle, WA
    Reply

    I am now 69 (thank goodness don’t look it at all) and I do take Ambien now and then on special occasions, like having to get to bed very early or being in a sleepover with rowdy friends on a ski trip or whatever. I’ve had no problems or side effects whatsoever except for ONE episode of sleep-eating some years ago, nothing serious.

    Now, if Ambien is truly being linked to Alzheimer’s, I want to know about that and will study up on it. But I find that many meds are being denied to “older” folks for things like statistics on fall-risk and such, which absolutely do not pertain to me. I’d also want to find out if taking one 5-mg Ambien every 2-3 weeks would still increase the risk for Alzheimer’s or not.

    With many meds, there’s a “therapeutic window” that must be reached for any bad stuff to happen; though with other meds, it’s like littering… every little bit hurts to a certain extent. I wish article authors would be more clear about this when discussing medication risks.

  5. Janice
    Reply

    I had taken Ambien 10 yrs ago at 58 yo. It worked ok but as dr said, I was ‘sleep eating’ meaning waking several times a night and snacking. I was prescribed Restoring. This worked great and took that for years. I went to a new doctor, he said no more! Older people get crabby! Well that’s not true for me. Another Dr for seniors prescribed Zolpidem, generic of Ambien. It doesn’t work well but it’s better than nothing. Chamomile tea, warm milk with real vanilla helps. I’m 68 yo and still have insomnia, so did my dad and my son does as well. Hereditary?? Hmm could be!

  6. LF
    Reply

    Oh boy. Insomnia seems to be one of those problems that doctors just don’t know how to treat. Yet untreated, insomnia itself can cause many of the cognitive problems doctors worry about when prescribing sleeping medications.

    I took Ativan for 15 years without any problems. It allowed me to sleep almost every night and made it possible to work. I have no trouble coming off it when my new GP refused to prescribe it(I tapered slowly over three months and it was painless).

    Of course, after that I was stuck. Years later, I’ve been through a few things that worked for a while but I always end up in a state of exhaustion from severe insomnia.

    However, if you have not tried Mirtazapine (Remeron) ask your doctor to prescribe it. It worked incredibly well for me for almost 6 months (and then it pooped out on me). It had virtually no side effects.

    Trazodone for me is a bust. It doesn’t work well, if at all, and it comes with some truly nasty side effects. That’s what I’m using right now, and it’s time to taper off it.

  7. GT
    San Antonio, TX
    Reply

    I recently had this same conversation with my doctor after my 65th birthday. The CMS (Centers for Medication and Medicaid Services) has recently added a mandate that affects the Star Ratings of medical providers. Specifically, in an effort to rate physician performance, 15 individual measures of quality have been put in place for Medicare Part C/D providers. Among these medication safety and adherence measures is one that deals with “High Risk Medications”. Unfortunately, the CMS is using the American Geriatrics Society’s (AGS) ‘Beers Criteria’ (Beers List) for potentially inappropriate medication (PIM) use in older adults as the basis for what is considered high risk. This is in stark contrast to the Beers List’s developed use as a tool for physicians to use when considering treatment options. It was never intended as a black and white ‘do not prescribe’ list, as patient needs/considerations can vary greatly. The AGS has been quite vocal in this regard.

    Nonetheless, the CMS has inappropriately applied this standard, and Medicare Part C/D insurance providers are mandated to consider a physician’s use of Beers List medications when establishing the Star Ratings that affect physician compensation. Specifically, a physician’s overall Star Rating will be negatively affected when that physician prescribes Beers List medications for any patient in excess of a 30 day supply per year.
    As a result, physicians find themselves in a bind. Unless their practice is willing to accept less from Medicare Part C/D insurance providers because of resulting lower Star Ratings, they must stop prescribing Beers List included medications for their 65 and over patients, whether or not those medications are the best (or only effective) option for the particular patient.

    I will take it a step further. I have prescription coverage through a pension plan that is not associated with either Medicare Part A/B. However, my physician’s practice has become reluctant to make that distinction since there is so much to lose if the CMS and it’s Medicare Part A/B providers fail to make the distinction when reviewing the practice’s prescription data.

    Two medications on the Beers List have been godsends for me, and I have been using them, as needed, for several years, under my doctor’s supervision. But now, because I had a (65th) birthday, I am effectively being denied their use. Where is the good logic in that? What on earth is the CMS thinking (or not thinking)?

  8. Suellen
    Miami, Florida
    Reply

    You can’t switch to tart cherry juice from AMBIEN after 15 years and expect to sleep!!!!!! For some people ambien is a great drug ( unfortunately you become dependent on it and cannot sleep without it). Betty Ford anyone??

  9. Pat
    Durham, NC
    Reply

    With respect to your piece, “If Ambien is out….”, a life style change worked for me. I am 90. While I had little trouble falling asleep, once I had been awakened by the need to use the bathroom, I had trouble getting back to sleep. Neither Xanax nor melatonin helped. I then read an article that commented that life style was often the problem: going to bed too soon after leaving the dinner table; too much alcohol; snacking after leaving the dinner table. I now retire no earlier than 31/2-4 hours after leaving the dinner table; have no more than 1 glass of wine at dinner; and never snack after dinner. Result: a dramatic improvement.

  10. Charles
    Portland
    Reply

    Finding the side effects of Ambien to be too intolerable, I started taking a 5-HTP pill, and a Schiff Melatonin Ultra pill at bedtime. It has worked beautifully, with no morning grogginess. If I have more stress than usual, I’ll also take a magnesium gel cap with the pills. I get a great night’s sleep with this routine.

  11. Betty
    Reply

    Thank goodness they re-made a m b i a n and it works better now. It is’t so god-awful powerful.

  12. Robin Alsop
    OK
    Reply

    I am a 59 year old female and took Ambien 10mg for 14 years in order to get sleep. A new doctor said I need to get off Ambien because of the link with Alzheimer’s. Over the course of 6 months, I reduced from 10 to 5mg, then to 2.5mg, and finally none.

    It was scary, because I equated being able to get to sleep with taking that little pill. While I was in that dose reduction period, I started taking tart cherry capsules, one upon arising, and another one late in the evening, about an hour before bed. I also added a magnesium supplement to my morning supplement regimen.

    Coincidentally, I started getting hormones (estrogen AND testosterone) in the form of pellets, for post-menopausal symptoms. It takes me 10-30 minutes to go to sleep, and I awaken 2-3 times a night, but generally, I feel rested in the morning, so I think my sleep is good. And I dream!

  13. Linda
    South Dakota
    Reply

    I accidentally found that food preservatives give me terrible insomnia. When I removed all preservatives I began sleeping all night for the first time in many years. It’s a simple thing to try for anyone who has trouble sleeping.

  14. Tracey R
    Bluffton, SC
    Reply

    Get a new doctor and try CBT for insomnia. After 10+ years on Ambien, CBT-I worked wonders for me. (I subscribed to a 5-week, on-line program for under $80.). I still take an OTC, low-dose melatonin sleep aid. And for trips out-of-town when my routine is interrupted, I may take a 1/2 dose of Ambien. But give CBT-I a try. I did, on the recommendation of People’s Pharmacy, with great results.

  15. Marie
    Pa
    Reply

    I had been taking ambien for over 15 years and my new dr will not renew my prescription because of my age,71….. she prescribed trazadone, which I took for 2 days without any help sleeping. After reading it was basically for depression I stopped taking it. I take cymbalta and dont feel I want to take an additional med for depression….as a result I have not had a decent nights sleep for the last 2 1/2 weeks and feel exhausted. I never had any reactions from ambien and feel this should be my decision if I want to continue taking it or not.

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