Some sleep aids may boost memory by changing sleep

When I perform sleep studies on my patients, one way I have of knowing that a patient is in a certain stage of sleep is by one of their brain wave patterns. One such pattern that is commonly associated with light, non-dream sleep is sleep spindles. Sleep researchers have discovered that certain disorders that can affect memory, like Alzheimer's and schizophrenia, have a reduce amount of sleep spindles. And certain medications can increase the number of spindles. So researchers did a test to see if taking one of these medicine to increase the spindle frequency improved memory. One of the medications was Ambien. The results showed an increase in spindles and an improvement in verbal memory. And the improvement was better than plain sleep. This is exciting, as it may allow us to improve memory in certain people.

FDA recommends lower dose of Ambien for women

This article discusses recent news release that the FDA is lowering its recommended dosage of Zolpidem in women. Zolpidem is active ingredient in Ambien. FDA says women can not metabolize the medicine at full strength quick enough, and still have high levels in their bloodstream when waking in the morning. This could lead to motor vehicle accidents. The FDA is not saying women on full strength Ambien have to have their dose reduced, or that women will not be allowed to take full strength. Just that these patients on Ambien should give themselves plenty of time in bed so that the medicine is fully metabolized and they are safe to drive.

Ambien increases risk of falls in hospitalized patients

Here's another article about Ambien and increased fall risk. This study was done at Mayo, where Ambien was associated with a significantly increased risk of falls in hospitalized patients. Mayo has decided not to use Ambien anymore in their hospitalized patients, and instead, use a drug free approach. Details were not given about that approach, and hopefully they will have success. Poor sleep quality during hospitalization can be a challenge, and I am not sure standard behavioral therapies used on an outpatient population would work during an acute hospitalization. More studies will be needed for sure.

Australian Olympic Committee bans prescription sleeping pills

This article describes how the Australian Olympic Committee (AOC) is banning prescription sleeping pills for Australian Olympic athletes. Per the article, the AOC is concerned about addiction to the sleeping pills after a retired Olympic swimmer, Grant Hackett, said he became addicted to a form of Ambien, called Stillnox.

I'm not sure how banning the use of these prescriptions during the games will prevent athletes from using them after the games are over. Most people who use these medications do not become addicted to them. If the medications improve sleep, this may actually improve athletic performance, as I discussed in a previous blogpost.

Zolpidem use, Balance and Cognition upon awakening

In the January 13th issue of the Journal of the American Geriatrics Society, there is a study about the effects of Zolpidem on balance and cognition upon awakening. Zolpidem is the active ingredient in Ambien and Ambien CR. This study involved 12 older patients (average age 67 years) and 13 younger adults (average age 22 years). All participants were healthy, physically active, and mentally sharp. Balance was assessed by the tandem walk test, where participants walk on a six-inch beam. Cognition was tested by assessing short term memory and processing speed. The researchers studied balance and cognition right before bedtime and 2 hours after falling asleep after the participants took 5mg of Zolpidem. Researchers also studied balance and cognition after all of the participants went to bed two hours later, to study the effects of partial sleep deprivation without taking Zolpidem.

The results showed that 58% of the older adults and 27% of the younger adults had balance problems after taking 5mg of Zolpidem. Cognition was also impaired in both groups, but the decrease in cognition was more pronounced in younger adults than older adults.

This study underscores the importance of using caution with sleeping pills because of the risk of falls in elderly patients that use these medications. The fact that younger adults had more severe cognitive changes is also important. Five milligrams of Zolpidem is the recommended starting dose for patients older than 65, but 10mg is the more common dosage in younger patients. I wonder if the cognitive changes would be more pronounced at the higher dosage in younger adults.