Ambien Addiction and Withdrawal: Tapering and Treatment Options
When you have insomnia, you're never really asleep, and you're never really awake (from the movie Fight Club).9
For those that can't sleep, Ambien, used intermittently and at therapeutic doses, isn’t too dangerous.
At higher doses though, things change. It starts to light-up a wider array of benzodiazepine receptors and it starts to feel a lot more like a typical benzodiazepine, like Valium or Xanax.
Basically, at higher doses, it gets you high.
So when you take higher doses for a while, it’s easy to grow both physically dependent and addicted, and once dependent and addicted you’ll need to:
- Taper down slowly to minimize withdrawal symptoms
- Get some form of addiction treatment, to learn to manage cravings and avoid relapse
Read on to learn about the withdrawal symptoms you can expect and about how to minimize withdrawal symptoms through one of three tapering and detox methods.
Ambien Addiction = Benzo Addiction
According to the Council for Information on Tranquilizers, Antidepressants and Painkillers (CITAP) – Ambien (zolpidem) and other drugs of the Z class are simply benzodiazepines by another name.1
Though they look different chemically, at high doses they act similarly in the brain - and the withdrawal management, tapering and treatment recommendations for Ambien addiction and benzodiazepine addiction are essentially the same.
Ambien Withdrawal Symptoms
If you’ve been using this medication daily for longer than 2 weeks, you should not stop using suddenly. Stopping suddenly is hard on the body and generally results in very unpleasant withdrawal symptoms.
Typical Ambien withdrawal symptoms include:
- Shakiness and tremor
- Bouts of depression and crying
- Anxiety, nervousness and panic attacks
- Lightheadedness and flushing
- Nausea and vomiting and other digestive complaints, like stomach cramping
- Muscle cramps
- Insomnia (having a hard time falling or staying asleep)
- Seizures (more rare)2
Due to the very real risk of seizures, once dependent, you should never stop using Ambien very suddenly, nor should you reduce your daily dosage too quickly.3
Once dependent, to quit Ambien, you must choose one of the following three primary options:
- Taper down slowly off Ambien
- Switch over to a longer acting benzodiazepine like diazepam (at an equivalent dose) and then taper down from that
- Detox off Ambien in an inpatient facility while receiving a continuous flumazenil infusion
In most cases, doctors will advise that you slowly taper down your dose, or switch to an equivalent dosage of a longer acting benzodiazepine, like diazepam, and then taper down from that.4
Straight Ambien Taper
The simplest method is the straight Ambien taper.
You should consult with your doctor when making a tapering plan, but don't get pressured into a rapid reduction - after all, what's the hurry? Consider taking your time and know that spaced gradual reductions cause fewer withdrawal symptoms and less rebound insomnia.
As a conservative starting point, you might consider a 10% reduction every 2 weeks. Or, you can try a slightly more aggressive tapering plan, such as reducing by 10% per week, knowing that you can always slow things down if it becomes unmanageable.
Tip for Success – Stay in control of the process and the pace. It’s your body and you know what’s manageable and what’s not. Don’t let an outside ‘expert’ impose a schedule that doesn’t work for you. It’s OK to pause reductions during times of great stress or when withdrawal symptoms get too severe - but try to avoid retreating to a higher dosage after a reduction. For the best chances of success, you can slow down, but never go backward.
Switching to and Tapering from Longer Acting Benzodiazepines
Ambien is a fast acting sedative, with a half life of roughly 2 hours (a little less for children and a little more for elderly users). After taking Ambien your blood plasma levels will peak at approximately 2 hours post ingestion.5
Although fast acting sedatives work great to get you sleeping quickly and alert by morning, they result in highly variable plasma concentrations - and this isn’t ideal for a tapering situation.
As an alternative, you can switch from Ambien to an equivalent daily dosage of a long-acting benzodiazepine, like diazepam, without feeling any withdrawal symptoms. Once stabilized on this longer-acting medication, you can start tapering off just as you would for a straight Ambien taper.
Tapering from a medication with a longer half life results in more stable blood plasma concentrations. This is a good thing because:
- Stable plasma concentrations eliminate the intoxicating highs and the worst of the lows (withdrawal symptoms). You need to learn to live without the highs and you won’t mind minimizing the lows.
- You taper slowly to give your brain a chance to heal and adapt. Stable blood plasma concentrations facilitate this healing.
To maximize your odds of tapering success, consider:
- Waiting until a period of low work/life stress to start your tapering regimen - Since withdrawal symptoms can include low mood/anxiety, insomnia, fatigue, etc. you probably don’t want to tackle the first days of tapering during an especially busy or chaotic time of year.
- Consider taking some time off work for the first few days or week or so, to get used to the tapering experience while minimizing demands on your time and energy.
- Tell a few close friends and family about your tapering regimen. You’d be wise to make use of their support and they may appreciate an explanation for what might otherwise seem like unusual behaviors.
- Consider joining an in-person or online support group or community of others also tapering from Ambien or benzos.10
Before you start read our complete guide to tapering off benzodiazepines
In extreme cases, such as when a person can’t or won’t taper, there is always the option of hospitalization and rapid detoxification with a continuous flumazenil infusion.
Flumazenil works as a benzodiazepine agonist (among people with benzodiazepine tolerance). When administered continuously, it allows for the abrupt discontinuation of Ambien and a rapid detoxification.6
Controlling Withdrawal Symptoms with Medications
In some cases, your doctor may prescribe medications during tapering to help alleviate symptoms of withdrawal, such as to:
- Help minimize the risk of seizures
- Help with rebound insomnia
- Reduce palpitations
- Reduce the severity of psychiatric withdrawal symptoms, like
anxiety or depression7
Psychosocial Addiction Treatment
People addicted to Ambien have 2 problems.
- They are physically dependent on the medication
- They are addicted to the feelings it provides (the high)
A successful tapering regimen gets you past your physical dependency, but it doesn’t do anything to treat your addiction to getting high – for this you require addiction treatment.
Brain Changes = Cravings
By getting dependent and addicted to Ambien you change your brain in 2 fundamental ways:
- Your dependency alters the functioning of your benzodiazepine/GABA systems. You remedy this by slowly tapering down and allowing your brain the time it needs to heal and revert back to a ‘normal’ state of functioning.
- Your addiction alters the structure and functioning of a number of neural systems, such as executive functioning (thinking, planning, impulse control etc.) memory and reward systems.
Though a slow taper reverts your GABA/Benzodiazepine systems back to normal, it does not heal the many brain systems altered by addiction – these changes are long-lasting or irreversible.8
And one consequence of these lasting brain changes is the experience of persistent cravings.
Because of the way addiction hijacks the functioning of the brain’s reward, thinking and memory systems, a wide array of situations and stimuli can trigger intense cravings, for long after you quit, without you even realizing what triggered your sudden urge to use.
Examples of situations and states that can trigger cravings include:
- Anger or stress
- Environmental cues that remind you of drug use
- Certain moods, such as feeling celebratory or bored
- Social cues (for example, running into a friend you once used with)
So, for long after you quit, you keep experiencing cravings, and if you fail to resist your cravings just once, you can easily fall right back into active use and addiction.
It’s not an easy thing to overcome, and that’s why addiction treatment can help a great deal.
Addiction treatment teaches the skills you need to minimize your exposure to situations that trigger cravings, how to deal with the cravings that do arise, how to develop a support network, how to handle life stresses and even how to handle yourself should you ever slip-up and fall back into use.
You can get addiction treatment:
- From a therapist or substance abuse counselor
- Through an intensive outpatient program
- By going to rehab or enrolling in a day treatment program
- By joining a therapy group
And you can further increase your odds of success by participating in a community self-help support group, like NA.
- Z-Drugs: Council for Information on Tranquillisers, Antidepressants, and Painkillers
- Medline: Zolpidem
- Zolpidem Seizure Risk
- Detoxification of High-Dose Zolpidem Using Cross-Titration with an Adequate Equivalent Dose of Diazepam.
- NHTSA: Zolpidem
- Dependence on Zolpidem: Two Case Reports of Detoxification with Flumazenil Infusion
- Manging Zolpidem Dependence
- NIDA: Principles of Addiction Treatment
- Fight Club Quotes
- Stopping Zolpidem
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