Is Ambien Safe If You Have Sleep Apnea?

It may be safe but should always be under the supervision of your doctor.

Question

I was in a car accident I went to the hospital a week afterwards after experiencing insomnia and anxiety. I asked about the insomnia and the doctor gave me a ten day prescription of generic Ambien 10 mg pills. I've avoided taking it so far. The doctor said only take it if you absolutely need to. I need a good night of rest, and I feel like I'm running out of options. What really worries me are the potential side effects and how they might affect my anxiety. I also have mild sleep apnea, which certain medicines can affect. Should I take the Ambien or not?

Asked by Marc On Sep 10, 2018

Answered by
Medical Content Reviewed By PharmacistAnswers Staff

On Sep 10, 2018

Man Sleeping In BedAmbien (zolpidem) can (and has) been used safely in those diagnosed with sleep apnea, but is recommended to be used cautiously and only under the supervision/recommendation from your doctor.


The prescribing information for Ambien states the following on the matter (1):

"Although studies did not reveal respiratory depressant effects at hypnotic doses of zolpidem in normal subjects or in patients with mild to moderate chronic obstructive pulmonary disease (COPD), a reduction in the Total Arousal Index together with a reduction in lowest oxygen saturation and increase in the times of oxygen desaturation below 80% and 90% was observed in patients with mild-to-moderate sleep apnea when treated with Ambien (10 mg) when compared to placebo. Since sedative/hypnotics have the capacity to depress respiratory drive, precautions should be taken if Ambien is prescribed to patients with compromised respiratory function... Ambien should be used with caution in patients with sleep apnea syndrome."


Ambien And Sleep Apnea

It is important to make the distinction that there is more than one type of sleep apnea and the recommendation to use Ambien can vary based on your diagnosis. The two most common forms of sleep apnea are (2):

  • Obstructive sleep apnea
  • Central sleep apnea


Obstructive sleep apnea (OSA) results from a physical obstruction (i.e. blockage) of the airway during sleep. This is most commonly caused by the tongue and soft palate closing the airway in the throat (3).


Central sleep apnea (CSA) isn't a physical blockage like obstructive sleep apnea, but rather is due to the brain not communicating properly with the muscles that control breathing (4).


Sleep apnea can cause numerous symptoms, including (3, 4):

  • Paused breathing
  • Shallow breathing
  • Reduced blood oxygen saturation
  • Next day grogginess
  • Hyper-sedation
  • Lethargy


Ambien has been studied in both cases of apnea (obstructive and central). The majority of evidence points to Ambien having a positive benefit in those with central sleep apnea. Unfortunately, evidence of benefit in those with obstructive sleep apnea is less clear.


Use of Ambien in both obstructive and central sleep apnea are discussed below.


Ambien And Obstructive Sleep Apnea

Ambien (zolpidem) has been used safely in those with obstructive sleep apnea, but as mentioned above, caution is advised, especially if you have severe symptoms.


One review study noted that Ambien did not significantly worsen many of the characteristics associated with obstructive sleep apnea (5). Specifically, Ambien:

  • Did not cause an increase in the number of breathing pauses throughout sleep.
  • DId not increase the duration of breathing pauses throughout sleep.

 

However, the study did report that in some individuals, Ambien significantly lowered minimum oxygen levels during the night when compared with placebo. This could potentially worsen certain symptoms like fatigue and next-day grogginess.


Conflicting with the results from the above study, other have reported that Ambien does not change sleep architecture, cause breathing changes or affect oxygen saturation levels (6, 7, 8). Many of these studies however were not completed in individuals diagnosed with obstructive sleep apnea or were done in those who were receiving active treatment for their apnea (e.g. using CPAP machines).


Due to the conflicting data, it would be prudent to discuss the use of Ambien with your doctor if you have been diagnosed with obstructive sleep apnea. There doesn't appear to be a large risk of severe adverse effects in most (e.g. respiratory failure) but there could some residual problems with sedation and lethargy.


Ambien And Central Sleep Apnea

The evidence for Ambien (zolpidem) use in those with central sleep apnea is far more positive than for obstructive sleep apnea. In fact, many studies show improvement in central sleep apnea symptoms, most likely due to the fact that in CSA, there is no physical airway obstruction, but rather is the result of communication dysfunction between the brain and our breathing mechanism.


One study reported the following findings (9):

  • Ambien decreased instances of shallow/labored breathing.
  • Ambien improved sleep continuity and decreased subjective next-day sleepiness.
  • Ambien caused no change in oxygen saturation levels.


In fact, the guidelines from the American Academy of Sleep Medicine lists Ambien as a possible effective treatment option (10):

"The use of zolpidem (Ambien) and triazolam (Halcion) may be considered for the treatment of primary central sleep apnea syndromes only if the patient does not have underlying risk factors for respiratory depression."

However, Ambien is only considered as an alternative or last line treatment option in the guidelines due to incomplete evidence for benefit.


Additional Information On Ambien

  • Ambien is most often recommended to be taken only "as needed" and does not need to be taken consistently for effect.
  • It is only FDA approved for the "short-term" treatment of insomnia (clinical studies showed efficacy for up to 35 days) (1).
  • While Ambien is not contraindicated in those with anxiety conditions, anxiety is listed as a possible side effect of Ambien (1).
  • Ambien is not associated with rebound insomnia after discontinuation (11).


Final Words

As discussed above, Ambien (zolpidem) may be an option to help you get a good night sleep if you have been diagnosed with sleep apnea, but there is incomplete evidence for a definitive recommendation. It is important to discuss the potential risks and benefits with your doctor and be under their supervision if therapy is initiated.

About the Pharmacist

Dr. Brian Staiger Pharm.D

Dr. Brian Staiger is a licensed pharmacist in New York State and the founder of PharmacistAnswers.com. He graduated from the University At Buffalo with a Doctor of Pharmacy degree in 2010. He has been featured in numerous publications including the Huffington Post as well as a variety of health and pharmacy-related blogs. Please feel free to reach out to him directly if you have any inquiries or want to connect! He's answered thousands of medication and pharmacy-related questions and he's ready to answer yours! Brian.Staiger@PharmacistAnswers.com Office: 716-389-3076

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