The Ambien Defense
[Guest post by DRJ]
Earlier this week, the Wall Street Journal Health Journal reported that the side effects of prescription sleep aides like Ambien and Lunesta may be as significant as those of earlier generation sedatives such as Halcion, which has been banned in some countries. Side effects include amnesia, confusion, agitation and other behavior disturbances:
“One woman woke up with a paintbrush in her hand, having painted her front door in her sleep. People have set fire to their kitchens while trying to cook, cursed their bosses on the phone and crashed their cars into trees — all in a sleeping-pill-induced haze and with no memory afterward.”
Experts aren’t sure why some people seem more susceptible than others, but they speculate that “sleep medication may act on brain circuits unevenly, leaving the parts that govern ‘automatic’ behaviors like eating and driving active while shutting down the centers of judgment and control.”
Cases in which defendants have successfully asserted a sleepwalking defense to criminal charges are few and far between. In this 2005 Canada case, a defendant was acquitted of rape after asserting the sexomnia defense – a genetic condition that combines sleepwalking, sexual acts and alcohol. And in this 2005 UK case, a defendant escaped rape charges by asserting the defense of “automania” (sleepwalking with sex). A defendant in this 2002 Massachusetts case asserted a sleepwalking defense but jurors stated he was acquitted on other grounds.
The reluctance to assert and recognize a sleepwalking defense may change as a result of this report, not only because it validates that some people are more susceptible to sleepwalking but also because there are so many people taking these drugs.
In addition, as noted in this 2006 report in CHEST – the journal of the American College of Chest Physicians (for specialists in pulmonology, critical care, sleep medicine, and related disciplines) – it is estimated that 2% of the population suffers from violent behaviors while sleeping, including incidents of murder, suicide, and sexual offenses. Thus, I suspect it won’t be long until we see more defendants asserting this defense, perhaps successfully.
In any event, if you take sleep aides, experts offer this advice: Don’t take sleeping pills when you are solely responsible for small children. If you do take them, unplug your phone because the ringing may prompt an episode of sleepwalking. Hide your car keys and, if all else fails, put an alarm on your bedroom door.
That should be enough to keep you up all night worrying.
— DRJ
I’ve actually advocated this for a long time. Ambien has been notorious for this among nurses since it came out around 15 years ago (I think, that’s when I first gave it anyway.)
I’ve got at least a dozen stories about patients doing crazy things after taking Ambien. That’s from before I started working psych.
Stashiu3 (460dc1) — 5/9/2008 @ 8:25 pmYou’re ahead of the curve, Stashiu3, and there are undoubtedly some tort lawyers who would love to have your input.
DRJ (a431ca) — 5/9/2008 @ 8:33 pmI found the Budweiser method worked well on most occasions, but adding pills to the mix could help to achieve a near comatose state which could cause uneasiness to observers.
daleyrocks (906622) — 5/9/2008 @ 8:50 pmThe people who need Ambien to go to sleep are abnormal to begin with. Who knows what more an extraneous chemical will do to them?
nk (8f20b5) — 5/9/2008 @ 9:09 pmSleepist!
daleyrocks (906622) — 5/9/2008 @ 9:54 pmShort-term use of sleep aids can be very beneficial for many conditions. Sleep hygiene (no caffeine after 5pm, no reading/watching TV in bed, no naps, etc… all the things you can do behaviorally) is important, but is sometimes not enough.
I noticed the problem with Ambien back in 1993 I think… the first time I gave it to a patient. A retired general with cancer was in a 4-person room and woke up in the middle of the night, stood in his bed, and began urinating everywhere… including towards the others in the room. He didn’t have an IV running, but he certainly had a very large and full bladder, much to the others dismay. When all the call-lights went off at once we went down there and shortly had things cleaned up and under control. I had one of my techs stay in that room the rest of the night in case the general became confused again, but that was it for the night.
In the morning, he didn’t remember anything about it at all. (Yes, we moved him into another room that day anyway… the others in the room seemed to accept that it wasn’t intentional, but we felt it best to move him away.) Since then, I’ve always been very careful to emphasize to my patients that Ambien can work great, but some people can become very uninhibited and amnestic while using it. If you are a nurse and find a patient walking the halls naked, it’s usually a good idea to see if they’ve taken Ambien.
Stashiu3 (460dc1) — 5/9/2008 @ 10:13 pmWe had a gentleman here that worked for the local cable company and, while on Ambien, bounced the company van off of a couple of cars and finally got pulled over. The cops called his wife who came to get him and he didn’t remember a bit of it the following morning. It happens.
Pablo (99243e) — 5/10/2008 @ 3:35 amIn the morning light, my comment #4 sounds, and is, crude. I apologize for it. Please allow me to restate it.
For some people, their insomnia may be only a part of a more serious sleep disorder and Ambien or other sleeping aids may aggravate it and not ameliorate it.
nk (8f20b5) — 5/10/2008 @ 7:50 amHmmm… I read it that way the first time nk, so I guess I’m rude and crude as well. 😉
Stashiu3 (460dc1) — 5/10/2008 @ 8:41 amOr maybe we just have the same friend — Jack Daniels? 😉
nk (8f20b5) — 5/10/2008 @ 8:57 amHaving been a person whose biological clock did not seem to meet my need for rest since childhood, I can tell you that chronic insomia is not fun.
I have been on Ambien for over four years and have had none of the problems that seems to be discussed here. It has, and continues to be, a great resolution to a severe problem.
For any drug on the market that helps millions, you can find a handful of patients that it has adverse affects on. So if you want to bash simple aspirin, you can.
retire05 (0379ce) — 5/10/2008 @ 9:01 amAmbien can be great for some people because it has a short half-life and less of the “hangover” effects of other sleep medicines (even Benedryl). I assume they’ve done sleep-studies and such to check for sleep-apnea and other correctable conditions if they’ve let you keep taking it for four years. It seems to be the perfect medication for you which is great, because as you said, chronic insomnia is not fun (sucks buttermilk through a straw is what Gram would say).
Although not technically a Benzodiazepine, it is so similar to one that we use the same reversal agent in an overdose. Many of the military pharmacies treat them the same. It is very unusual to keep someone on them regularly for more than a couple of months at most. I’m very glad it works for you. You are the rare exception rather than the rule.
Stashiu3 (460dc1) — 5/10/2008 @ 9:24 am#12, how do you know that I am the “exception” rather than the “rule”? Have you conducted studies? Do you have studies to show that Ambien produces adverse side affects in most patients?
It seems to me there are less problems with the drugs than there are with criminal lawyers who will say anything, do anything to get their clients off.
Or famous U.S. Congressmen who hail from a prominent family that wants to use a drug as his excuse for being as useless as his other family member.
retire05 (0379ce) — 5/10/2008 @ 10:50 amThe information comes from the drug manufacturer itself and is readily available to health professionals, retire05.
nk (8f20b5) — 5/10/2008 @ 11:00 amStashiu3 is a health professional and when the drug company says “short-term treatment” I trust his interpretation of “two months”.
nk (8f20b5) — 5/10/2008 @ 11:04 am#9 Stashiu3:
Maybe we should start a club.
EW1(SG) (84e813) — 5/10/2008 @ 11:07 amI read NK’s #4 and got the “crude” form, but I just chalked it up to him being drunk… 🙂
Scott Jacobs (d3a6ec) — 5/10/2008 @ 11:19 amAt my house. Jack Daniels, Jameson’s, bitter European beers, wine and grappa. I like sausage, bacon and mushrooms on my pizza but we can always order half-side toppings if you guys like something else. If we need Ambien after that, we’ll have three-layer chocolate cake.
nk (8f20b5) — 5/10/2008 @ 11:20 amI am never drunk, Scott. Just pleasantly inebriated.
nk (8f20b5) — 5/10/2008 @ 11:23 amretire05,
I wasn’t attacking you by any means. There truly are medications that normally cause quite a few problems, both short- and long-term, that end up being so perfectly suited for an individual that it’s appropriate for them to stay on it indefinitely.
You’re lucky to have found the one like that for you and I’m glad your doctor has sense enough to keep you on it. There are more than a few who would refuse just because it’s not “standard practice”. I, and many nurses I’ve worked with, have noticed this problem with Ambien from experiences with many patients. It just needs a better protocol for use. I’ve always suggested extra precautions to my patients who are using it for the first time because this can be so dangerous. As nk said (so crudely, heh), people are taking this because they’re already messed up (in the sense of being unable to sleep)… if they weren’t, they wouldn’t need it.
Stashiu3 (460dc1) — 5/10/2008 @ 11:39 amOr unpleasantly, depending on how your posts come out. 🙂
Scott Jacobs (d3a6ec) — 5/10/2008 @ 11:47 amI read NK’s #4 and got the “crude” form, but I just chalked it up to him being drunk…
The site needs somebody to act like a thoughtless jerk like that since Christoph isn’t commenting anymore.
daleyrocks (906622) — 5/10/2008 @ 11:49 amI went to the doc to get a physical and some shots before going to the middle east. He gave me a scrip for ambien ‘to help me sleep on the plane ride’. Didn’t need or want it, but got it anyway to see what it did. When the warning label says do not mix with alcohol, DO NOT MIX WITH ALCOHOL. Unless you like having the weirdest, scariest, uncontrollable double vision imaginable. Which is disconcerting when nightclubbing in downtown Cairo. But it does help you sleep…
model_1066 (ea1605) — 5/10/2008 @ 12:48 pmNot to mention the risk of getting raped, robbed, or depressing your respiratory drive to the point where you stop breathing.
*sarcasm on
Other than that, everyone should ignore warning labels… it’s not like they’re rules or anything.
/*sarcasm off
Stashiu3 (460dc1) — 5/10/2008 @ 1:04 pmStrangely,I’ve never heard any bad stories from Pts to whom I’ve given it.I generally prescribe half a pill(5 and 10 cost same).There was a case in the 80’s near where I did my internship-the halcion defense- where a man claimed halcion ‘made ‘him drive from Kazoo to Battle Creek and Kill his wife.Got trashed in court.
corwin (73e4d9) — 5/10/2008 @ 1:06 pmI agree with 23;do not mix with alcohol.And I wonder about how many do.I’ve read the “Chest’ article,and I find it “Twaddle” as John Watson,MD
exclaimed to Holmes
Hey doc, how are ya? I can’t say I’ve heard much about 5mg, but most docs I’ve worked with are giving 10mg to 20mg, sometimes with instructions that they can take another 10mg or 20mg in four hours if they’re still having trouble. That’s the high end (to say the least), but I’ve seen problems with anything over 5mg.
I like the idea of titrating up if needed, but with a couple of weeks minimum between dose changes. I believe patients have to get used to the medicine before knowing how it’s going to work for them. The best use (in my opinion) is in helping people get to sleep… not forcing them to sleep, especially at first. I’d be interested to know what you think.
As to the CHEST article, I think twaddle is an excellent description. It reads like they had their conclusions before gathering their data.
Stashiu3 (460dc1) — 5/10/2008 @ 1:18 pmMixing sleeping pills with booze:
Another Drew (8018ee) — 5/10/2008 @ 3:59 pmSee “Judy Garland”!
Tylenol PM works pretty good for me.
kishnevi (202292) — 5/10/2008 @ 4:32 pmMy sister-in-law had the classic Ambien oddness, including sleepwalking, talking, ordering porn on the Internet, etc. She stopped taking it when the box arrived on her doorstep.
Now, I take Lunesta and while I sometimes don’t remember everything clearly that happens just before the lights go out, I think that’s just because it makes me so sleepy. As someone who has suffered from insomnia since boyhood, Lunesta has given me consistent, sound sleep for the first time in my life, with no adverse side effects.
Now, where’s some wood I can knock on?
Pious Agnostic (f22b64) — 5/11/2008 @ 3:32 pmSQUAWK SQUAWK WHENS I SEE THAT GREEN MOTH COMMIN IMS GOING TO EATS IT SQUAWK SQUAWK SQUAWK
krazy kagu (4c262b) — 5/13/2008 @ 8:57 amI am a 3rd shift worker and I take ambien to go to sleep when I need to be back awake on day shift.
The only thing I can warn about is…make sure you take it with a partner that you can trust. My husband has told me about sexual experiences and complete conversations he has had with me while on ambien. I DO NOT remember ANYTHING! But I trust him. Just be careful who you are with…
jeanneh8 (e6654b) — 10/20/2008 @ 4:19 pm