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

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  1. minerva
    united states

    Not giving Ambien to people over 65 who have no side effects from it is just cruel.
    Many have/had cancer and must take anti-hormonals, which contribute to insomnia.
    Falling down from lack of sleep is more probable for most than random side effects.
    This policy really must be reconsidered.

  2. Dave
    Portland, OR

    After reading all this, it appears that it does not matter what patients think. I have tried two different medications, and here it is 2 A.M. I still cannot sleep. Ambien worked for 15 years, no side effects, always slept well. New medications, CPAP, and nothing, still cannot sleep.

    It’s nice that some board can sit in a room somewhere and decide that a pill is not good for me just because I am over 65.

    I am 75, still working, and need my sleep. I am not depressed, suicidal, or any of the other things that are described on the pills they are trying to give me now. Ambien worked for me. I was satisfied with it, got the sleep I needed and felt good the next morning, no side effects. I just want to sleep.

  3. Dave
    Portland, OR

    I am 75, my Doctor of 27 years, prescribed Ambien for 15 of those years, just retired, the new Doctor will not prescribe Ambien and is sending me to a “Sleep Study”. I am still working, never had any side effects from Ambien, have tried others and feel bad the next morning.

    Ambien should be treated like any other medication, if you have a reaction, don’t use it, that should not prevent those that do not have a reaction from using it.

    The only other medication I use is maybe 3 Aspirin in one day

  4. D

    I understand the risks for my 82 yr old Mom. So do my brother, sister, and sister-in-law who is a PA. But when do the risks of no sleep outweigh the risks of the medicine? She’s tried everything mentioned in this article. All she wants is to sleep. The insomnia is beginning to effect EVERYTHING! She feels horrible. Pain levels have increased. Everything is magnified by not sleeping. At this point, we are all asking that she be prescribed the medicine. We will sign a waiver. She just needs sleep….

  5. Sissy
    Bracey, Va

    I have Chronic Kidney Disease
    I have type 2 diabetes mellitus with stage 4 chronic kidney disease
    Essential hypertension

    Polyneuropathy associated with underlying disease

    I will Start Peritoneal Dialysis
    any information you can give me would be Great.
    I have always had insomnia. I tried other things before my Doctor prescribed it for me 2 years ago. I was thinking all this time I had suffered from Insomnia and this wonderful prescription of ZOLPIDEM TARTRATE 10MG has given me my life back. I have a box filled with sleep aids, I can not take, They messed up my sinus .. You can get Sleep AID’s they are dangerous for me to take. Of all the bad things to take and do They take away something that would really Help me. finally, I get something that I don’t have to stay awake dwell on knowing I am at the End Of My Life. I have never taken illegal drugs in my life. What is an answer for people like me?

    • Peggy

      My psychiatrist of 25 years is retiring in 6 weeks. That event alone is weighing me down both physically and emotionally! I am worried about how I will endure that last last “goodbye”. Right now all I can feel is grief, fear and emptiness. I have been on Ambien for almost a year, and even getting him to prescribe it for me was like pulling teeth! I am on other medications for major depressive disorder, anxiety, seizures and movement disorder. Right now, my biggest fear, aside from ending all those years of care, is that my new psychiatrist, whom I don’t have yet, will end the Ambien! What can I do?

  6. Jonathan
    Victoria TX

    This feels like the government taking more control of citizens lives when each patient should be evaluated for their needs. How does someone look to their twilight years knowing they are not eligible for medicine that will help them sleep.
    It reminds me of prohibition with these kind of controls. It only creates a black market for the products being controlled.

  7. Wendy A.

    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

      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.

      • Peggy

        Just because your mother had a bad experience with Ambien, doesn’t make it a “bad drug”! Everyone is different and has different needs.

      • Ann
        HOUSTON, TX

        This is bs not everybody has bad reactions to Ambien. I have taken it for at least 10 years & have not had one reaction or experience you describe! I have tried the prescriptions they are suggesting for a substitute & one caused my vision to be so bad I could not see to read! The next one Trazadone makes my hands shaky, my legs feel like lead when I ge up at night, I have hallucinations & I stagger! None of this with Ambien! Why can’t seniors be allowed to make their own de isions regardingntheir own health? We are not children or stupid!

  8. Tim

    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.

  9. Bob

    For years I’ve taken Ambien with no side effects. It’s a very effective drug that has allowed me wonderful sleep night after night. Now that my PCP has retired and her replacement will not renew my prescription I’m having sleepless nights and groggy days. I assume the medical profession prefers sleep-deprivation over perceived risks of Ambien. I disagree.

  10. Lind

    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

      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.

      • Ann

        Obviously you do not have a problem with insomnia! Just because a few people have a problem with Ambien does NOT mean everyone does! I am allergic to penicillin, Levaquin caused me unbelievable joint & tendon pain. There are several other meds that cause me trouble but I am not advocating they be taken away from people that these meds help. It just doesn’t make any sense to me.

  11. Cindy M. B
    Seattle, WA

    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.

    • Barbra W
      United States

      This is age discrimination. What is wrong with taking an individualized approach to medications. I’m 62 my Dr. took me off ambian placed me on melatonin which is not very effective for me, but that may not be true for all people. I don’t like having a Dr. dictate my life. I have never abused nor experienced side effects from ambian.

  12. Janice

    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!

  13. LF

    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.

  14. GT
    San Antonio, TX

    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)?

  15. Suellen
    Miami, Florida

    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??

  16. Pat
    Durham, NC

    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.

  17. Charles

    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.

  18. Betty

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

  19. Robin Alsop

    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!

  20. Linda
    South Dakota

    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.

    • Salvatore

      How long until you noticed a difference?

  21. Tracey R
    Bluffton, SC

    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.

  22. Marie

    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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