“Sleep-driving” while under the influence of Ambien has captured wide attention and continues to be an alarming problem. Ambien (zolpidem) is one of the new “Z” drugs used as sleeping pills that are popular in commercials and doctors’ sample cupboards. But alternatives exist (most obviously the other Z’s - zopiclone/Lunesta, and zalepron/Sonata).

There have been newspaper reports of individuals arrested while sleep-driving, people who took Ambien at bedtime and didn’t even wake up during the arrest process. Like Devin Dove, who remained asleep until he woke up in a hospital bed and was handed a ticket for DUI by a nurse. The previous night he’d had no alcohol, no drugs - only his prescribed Ambien - and no recollection at all of driving or leaving his bed. Just waking in the hospital. He is concerned about others avoiding similar situations and the legal troubles that can follow.

Dove is expressing his feelings with Ambien Outrage, a web site that gathers stories from other victims, shares resources, and is intended to form a community. He’s putting out a call to all who’ve experienced sleep-driving, sleep-eating or more, to contact him and share your stories.

Although he is upset about his own case, what outrages Dove the most is that the FDA approved the drug and keeps it on the market after so many reports of sleep-eating, sleep-driving, sleep-arson, etc. in an automatic semiconscious state. In the legal system, somnambulism is a tricky legal point. The defendant can’t be held responsible since he had no plan, no motive and …

There are some nice guided progressive relaxation audio files on a web site that, although it’s promoting a drug, does also provide some useful tips on managing insomnia. It’s important to be aware that sleeping pills can be dangerous and generally aren’t helpful except short-term. Instead, sleep management establishes new behaviour instead of the behaviour of swallowing a sedative.

To stress the point, a recent study in the Journal of the American Medical Association (JAMA) indicates that therapy, in particular CBT, is more effective than medication for insomnia. A controlled trial in Norway comparing zopiclone (Lunesta) to placebo and a therapy intervention that included “information on sleep hygiene, sleep restriction, stimulus control, cognitive therapy, and progressive relaxation technique” measured the quality and quantity of sleep. After six weeks the CBT group reduced wake time by 52% compared to 4% with zopiclone, and quality of sleep was significantly improved. Six months later, the therapy’s effect was still beneficial while the drug had no lasting effect.

Learning to relax is one key part of sleep hygiene, and progressive relaxation is a well-established technique. Listen to the embedded audio files here.

The type of lighting in your home may be a contributing factor to insomnia as well. This new JAMA study did not look into that angle. Bright light therapy for seasonal depression is proven effective, but reverse applications for insomnia and mania have scant research.

The FDA has announced it will require makers of certain sleeping pills to warn consumers about serious side effects including allergic reactions and sleep-driving. Somnambulism (sleep-walking) incidents involving complex tasks like driving, preparing and eating food, and having sex while asleep, with no memory of the tasks when awakened, have made the news in recent years. Now the FDA wants consumers and doctors to have direct warnings on labels and in brochures.

The Z-drugs are a class of drugs called pyrazolopyrimidines, the best-known being zolpidem (Ambien), eszopiclone (Lunesta, Imovane), and zalepron (Sonata). Considered better than addictive depressant drugs like Valium, they’ve become popular. But Z-drugs, in particular Ambien, have become notorious for bizarre and dangerous side effects like sleep-driving and sleep-eating.

Somnambulism does occur on its own, most commonly in childhood. There are centuries-old reports of sleep homicides and somnambulism is an established - if controversial - legal defence. Why Ambien in particular is linked to it, and why certain other drugs may or may not be, is unknown. Some sedating medications - including benzodiazepines - are actually used to treat somnambulism.

The FDA’s list of sedative-hypnotic drugs to carry the new warning include Seconal, a powerful barbituate rarely prescribed anymore, Halcion, an addictive benzodiazepine in use since the 1970s, Rozerem, a new drug that affects melatonin and is chemically dissimilar to all the other drugs on this list, and the Z-drugs. Somnambulism, especially sleep-driving, isn’t usually associated with the older drugs or Rozerem, and in a PubMed search I …