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Does the Sleep Aid Zolpidem Impair Driving the Next Day?

Dr. Dalrymple questions the evidence against a drug he uses himself.

by
Theodore Dalrymple

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August 13, 2013 - 4:00 pm
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For most of my life I have had no difficulty in sleeping, rather in staying awake. But whether because of a physiological ageing process, or of a guilty conscience aware of a life of cumulative sin, I now experience periods of insomnia. Occasionally I do what I once swore as a young man never to do: I take sleeping tablets.

My favourite, to the exclusion of all others, is Zolpidem (Ambien). It does not leave me feeling groggy, as do other hypnotics, but rather as near to daisy-freshness as I ever feel early in the morning. Imagine my alarm, then, when I saw an article in a recent New England Journal of Medicine that suggested that the drug of my choice might make me a dangerous driver the following day.

Zolpidem is short-acting, which means that it is metabolised and cleared from the body quickly. Some people therefore find that they wake in the middle of the night when they have taken it (previous studies suggest that Zolpidem’s main advantage over placebo is in getting people off to sleep quickly). Having woken in the night, and finding difficulty in returning to sleep, some people are tempted to take more of the drug. Indeed, the manufacturers – the largest company listed on the French stock exchange – have thoughtfully manufactured a lower-dose pill for precisely this situation.

But simulated driving tests done on people after they have woken in the morning having taken Zolpidem demonstrate that they perform less well than people who have taken nothing. This is so even when people claim to feel no after-effects of the drug at all: in other words, they are not the best judges of whether or not they suffer such after-effects. The commonly-heard refrain, principally from middle-class hypochondriacs, that “I know my body” is not true in all, perhaps in many circumstances.

However, the article does not address certain important questions concerning the effect on Zolpidem on driving the following day. The first is that while Zolpidem may reduce performance on simulated driving tests, it is known that insomnia itself does likewise. So the question is not whether Zolpidem affects driving tests, but whether it affects driving tests among those who suffer from insomnia and who take it. In such circumstances, it is conceivable that it improves performance.

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All Comments   (9)
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I take a different form of the drug from a different company that may not be readily available in the US. It is Stilnox CR made by Sanofi Aventis in France . Same Zolpidem Tartrate, but in a 12.5 mg slow release form. I've found I can take less of it - like cut it in half - and it still puts me to sleep and keeps me asleep. I'm one of the ones that wake up and can't get back to sleep even on a higher non slow release dose. I've also used Melatonin as Liberty Clinger suggests and it works too. Prescription only and $50 a bottle, so I tend not to buy it. I had a general anesthetic about a week ago and I'm still being real careful about driving. If Stilnox is impairing function much I'd be surprised. I find even if I have to use a whole tablet it really knocks me wobbly and impairs my walking. I once took it by mistake with my other meds and drove home. When it hit me I started hitting the curb. It was iron will and focus time, but it was difficult. I'll never do that again and that I think is where the danger is. I think some exercise - say a 10 min walk - would tend to finish off the dregs in the morning. It certainly beats the benzos as a sleeping pill.
35 weeks ago
35 weeks ago Link To Comment
Why not use OTC melatonin instead of Zolpidem? Melatonin is less expensive and does not require a doctor's prescription. Melatonin's half-life is one hour compared to Zolpidem's two hours, making it even less likely to cause problems with sleepiness or driving performance the next morning. Deep sleep, known as N3 sleep, is that stage of sleep which is "restorative," that is to say it is the stage of sleep which best eliminates sleepiness the following day, and so that is the sleep stage which would most improve cognitive function and driving performance the next day as well. As we age N3 sleep diminishes, so the perfect sleeping pill would possess a short half life, so as to avoid a "hangover" the next morning, and would increase N3 sleep. Not only does melatonin have a shorter half-life than Zolpidem, it increases N3 sleep whereas Zolpidem does not. So, I recommend a 3mg dose of Melatonin 30 minutes before bed and a half tablet for nighttime waking when there is trouble getting back to sleep.

Melatonin is the body's natural sleep hormone which is secreted by the brain's pineal gland starting about two hours after sunset. By taking a melatonin tablet as a sleep aid you are simply adding a bit to what Mother Nature is already providing for your sleep. I believe melatonin can rightfully be called God's or Mother Nature's sleeping pill.

36 weeks ago
36 weeks ago Link To Comment
I take zolpidem also, 10 mg, and I feel alert and refreshed next morning too. Not so with melatonin, for some reason. It leaves me feeling groggy the next morning, even though, by all accounts, it shouldn't. Same with Benadryl, though I understand why that drug would affect one poorly.
Nope, I've never had a problem with zolpidem at all. No amnesia as has been reported by some, either. If I get up to get a drink of water, or let a dog outside, I always remember the next day. I do think it's mainly a matter of people not using the medication as directed that gets them into trouble. Just my humble, personal opinion.
35 weeks ago
35 weeks ago Link To Comment
Whatever works best for you as an individual is what you should use, so in your case keep using zolpidem.
35 weeks ago
35 weeks ago Link To Comment
True, and since it does give you more N3 sleep, be aware that you may have vivid dreams. Another tip for better sleep: when you wake up in the morning, go and look at the sun in the Eastern sky. This resets your body clock to tell it when day and night is--if it's confused about that, you can get insomnia.
35 weeks ago
35 weeks ago Link To Comment
Dreaming occurs during REM sleep. In addition to the benefit of increasing N3 sleep, melatonin also increases REM sleep, so that is where vivid dreams may come in, but that is not a negative unless the dreams cause frequent arousals from sleep which is not usually the case. Unlike melatonin zolpidem slightly reduces REM sleep, an effect which is probably inconsequential.


35 weeks ago
35 weeks ago Link To Comment
My car was hit a few months ago by a woman who literally was looking right my car and didn't see it. I could watch it because I was at a stop light when I was hit. In dealing with her after the accident I would swear she was on 'something' but it wasn't alcohol or pot (those I can detect pretty easily).

I wonder how many others are driving around on either prescription painkillers and other drugs that will impair their ability. It's troubling, dangerous (and expensive).
36 weeks ago
36 weeks ago Link To Comment
Drugs, legal and illegal, are a safety problem for people on the roads but so is sleep deprivation.

My brother and I came VERY close to being killed when a minvan rear-ended us as we were stopped to make a left-hand turn across traffic. The driver hit us full speed, pushed us across oncoming traffic which only narrowly avoided hitting us and we nearly hit a very large lamp post dead center. The only thing that saved us was that the collision broke a leaf spring that bent down and acted like an anchor to slow us down. (The ditch we passed through also helped.) Fortunately, our pickup's gas tank did not explode as had happened in a similar accident a few months before at the same gas station and my brother and I had only minor injuries.

When we spoke to the driver of the other vehicle, he freely volunteered that he had fallen asleep at the wheel and never touched the brakes. There were no skid marks on the road. He and his family were coming from a Bible camp and had apparently been so enthused that they hadn't slept much that weekend. The road was a public highway and the driver must have been doing at least 50 mph when we were hit.

We'd passed the driver a few minutes earlier when we'd noticed him driving erratically thinking that passing him would be safer that following him. We hadn't anticipated that he would actually rear-end us a few minutes later while we prepared to turn to buy gas.

35 weeks ago
35 weeks ago Link To Comment
Although at least one study showing next day cognitive changes noted that they occurred in the (cough, cough) "elderly." Not in younger subjects such as Dr. Dalrymple, of course.
36 weeks ago
36 weeks ago Link To Comment
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