Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN
Written By: Phillippe Greenough
Article Updated: 01/25/2021
Number of References: 32 Sources
While it may not be commonly used as a recreational drug, Ambien is still abused. More than that, it is possible to become addicted to Ambien and to experience withdrawals if use is stopped suddenly. While this is rare, and not much research has been done yet on Ambien addiction and withdrawal, this article is aimed at gathering what is known regarding the symptoms of Ambien withdrawal. Here we will discuss the way Ambien works, the symptoms of withdrawal, the timeline involved, and some effective treatments.
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The timeline for Ambien withdrawal has not been well described due to the relative rarity of Ambien addiction. That being said, there are case reports in the medical literature that can help us describe this timeline in detail. Additionally, with classic benzos, there is substantial variability in the withdrawal timeline between individuals, and since Ambien works in a roughly similar way, this variability may also apply to the Ambien withdrawal timeline.
The active ingredient in Ambien, zolpidem, has quite a short half-life of around 2.5 hours and is metabolized rapidly. While there are many contributing factors that affect the withdrawal timeline, Ambien’s half-life may be contrasted to the classic benzo half-lives of 11 hours (Xanax), 13 Hours (Ativan), and ~35 hours (Klonopin). This indicates a shorter withdrawal period than with the classic benzos, although this may not translate due to the differences between Z-drugs and benzos regarding their specific neurological interactions. Due to the lack of well studied and documented Ambien withdrawal timelines, what follows is a generalization based on case reports.
A broad generalization of the week-by-week Ambien withdrawal timeline may look something like this:
Due to its short half-life, someone who was a regular and heavy user will begin to experience Ambien withdrawal symptoms within 8 hours of the last drug use. Some of the most common symptoms during the first two weeks of Ambien withdrawal may include:
Dangerous symptoms do not usually occur in moderate users, however, the risks rise dramatically as the amount of Ambien regularly used increases. Seizures are very rare in light-to-moderate users, but in those who used large amounts of Ambien, or used it for long periods, the risk of seizure becomes appreciable. In general, the acute phase of withdrawal exhibits both physical and psychological symptoms and these will be at their most severe in the days or weeks shortly after Ambien use has ceased.
By the start of the third week, the physical symptoms are often fully resolved. Insomnia may still be present, but it is usually much improved from the previous weeks. Cravings may actually begin to intensify during this time and as the memory of the discomfort of withdrawal begins to fade, the desire to use Ambien again may be heightened. Depression and anxiety are usually still at a high level, and social anxiety may be especially pronounced. This specific type of anxiety is usually present from the beginning, although it may not be until someone feels well enough to go out that they notice this symptom.
The fourth week should show some significant improvement from the first week. While psychological symptoms are often still disruptive, the physical symptoms, including insomnia, are much improved if not resolved completely. Even though the most physically difficult and uncomfortable stage is in the past, this does not mean that the struggle is over. Most relapses happen either during or shortly after acute withdrawal, and if someone hopes to stay clean, they will have a much better chance if they get further treatment and care.
Some of the more common symptoms of the third and fourth week of Ambien withdrawal may include:
While these may be some of the same symptoms from the first two weeks, there are usually reduced in intensity. They will continue to subside, but this may take some time to become noticable.
Even after the acute and most intense symptoms subside, the post-acute phase can exhibit more minor symptoms that may persist for weeks, months, or even years. These symptoms are strictly psychological, but may still be very disruptive and mentally uncomfortable. It should be mentioned that severe depression can lead to suicidal ideation or suicide attempt, and this can obviously produce physical problems even though the causes are psychological.
Some of the post-acute symptoms of Ambien withdrawal include:
Again, while these symptoms may not be as intense as in the acute phase, they may still be very disruptive to someone’s continued sobriety. The persistence of these symptoms and their slow resolution can be very demoralizing, but they will fade with time. Obtaining professional psychiatric and therapeutic care during this period can go a long way towards improving the subjective experience of these symptoms, and helping someone cope with their effects. While these treatments may improve the symptoms, the only way to be certain that these symptoms will improve is through continued abstinence from Ambien and other drugs.
The symptoms of Ambien withdrawal can vary greatly between individuals, both in intensity and duration. This has to do with multiple factors, some of which are based on choices such as Ambien use habits, while others are genetic and beyond someone’s control. Depending on the person, someone may recover quickly and completely within weeks or months, while others may have severe, lingering symptoms for many months or even years.
Some factors that contribute to both the intensity and duration of Ambien withdrawal symptoms include:
The single largest contributor to the intensity of Ambien withdrawal symptoms is the amount of Ambien someone used regularly. The more that someone uses Ambien, the more GABA downregulation will occur. The more downregulation occurs, the more intense the withdrawal symptoms will be once they stop using the drug. This affects the acute and short-term symptoms of Ambien withdrawal directly and can indirectly impact the post-acute, long-term symptoms as well. The largest contributor to the duration of post-acute withdrawal symptoms is the length of time that someone used Ambien. The neurological remodeling that occurs after downregulation has begun is an exceptionally slow process; both slow to perform and slow to reverse. The longer someone uses Ambien, the more complete this process becomes. When someone stops using Ambien, it can take quite some time for remodeling to reverse and return their brain to return to pre-Ambien function.
Someone’s age has an effect, although the real contributor is liver function. As someone gets older, liver function tends to decline and is a normal part of the aging process. The vast majority of Ambien metabolism occurs in the liver, and impaired liver function can increase the half-life of Ambien, sometimes by a substantial amount. The longer the half-life of the drug, the longer the withdrawal duration will be. At the same time, a long half-life leads to less severe withdrawal symptoms, so while symptoms may persist for longer, they will be less intense.
The existence of co-occurring mental health issues can worsen the subjective experience of the symptoms of Ambien withdrawal. Since depression and anxiety are such common symptoms, if someone were to have a pre-existing disorder involving either of these symptoms then they would experience worse depression or anxiety during withdrawal.
Genetics certainly plays a role in addiction, although as it relates to the symptoms of Ambien withdrawal, it is a very indirect influence. Someone with a genetic predisposition for addiction may be more likely to take more Ambien more regularly than someone with no such predisposition. This, in turn, would lead to worse withdrawal symptoms. While very indirect and tangential, the influence may still be present.
When taken as prescribed, Ambien rarely produces withdrawal symptoms even after prolonged use. That being the case, those who abuse Ambien often need to take substantially more than therapeutic doses to produce euphoria. It has been documented that several people who abused Ambien were taking between 100 to 120 times the prescribed dose per day. In these amounts, Ambien is capable of producing withdrawal symptoms, possibly of life-threatening severity.
Ambien is a member of a group of drugs known as non-benzodiazepine hypnotics along with several other newer sleep aids. While these medications produce effects somewhat similar to those of benzodiazepines (benzos), they are chemically unrelated. The benzo class includes medications like Xanax, Klonopin, and Valium, and while they may produce roughly similar effects as Ambien, they are distinct classes of drugs. Also known as “Z-drugs” Ambien and similar sleep aids work by increasing the effect of the neurotransmitter GABA which is a major inhibitory neurotransmitter in the brain.
The way Ambien works is similar to classic benzos in that it stimulates the GABAA receptors at ω subunits. These have also been referred to as “benzodiazepine receptors” as this is a part of the mechanism through which benzodiazepines exert their effects. Ambien, while binding to these receptors similar to benzodiazepines, is very selective in its binding and preferentially binds to ω-1 and ω-2 receptors. This leads to a similar effect of sedation but results in a distinct pharmacologic profile. For example, while benzos are potent anticonvulsants all across their dosing range, Ambien only exhibits anticonvulsive and muscle relaxant activity at extremely high doses.
When someone takes Ambien repeatedly, tolerance to its sedative effects on cognition can develop through a process known as downregulation. Due to the increased impact of GABA due to Ambien use, after a time, the brain will begin to reduce its sensitivity to GABA in an attempt to compensate and maintain balance and effective function. This initially produces tolerance to the drug, and continued use will result in dependence. Additionally, once downregulation has begun, a further, more comprehensive process of neurological remodeling begins. This is the brain’s attempt to better function in a GABA-downregulated environment. While downregulation can begin fairly soon and produce tolerance, sometimes as soon as just a few weeks of use, the remodeling process is much slower and will take time to produce noticeable effects.
Even though Ambien withdrawal symptoms are not usually dangerous, the relative rarity of this withdrawal syndrome leads to a lot of unknowns regarding the exact risks involved. Due to this, if someone is expecting to undergo Ambien withdrawal, it is highly recommended that they enter an Ambien detox center. These programs can reduce the risks of dangerous health complications through medical monitoring and medications. Furthermore, they can reduce the psychological discomfort through therapies while also helping someone develop new, healthier coping skills. Finally, the various connections that these facilities have with their local recovery communities can help someone build a solid foundation in recovery and form friendships with others who have been through the same struggle and made it out the other side.
There are several other drugs that can produce uncomfortable or even dangerous withdrawal symptoms. We have more in-depth withdrawal guides for drugs such as:
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