Short communicationZolpidem-induced amnesia and somnambulism: Rare occurrences?
Introduction
Zolpidem tartrate is a non-benzodiazepine hypnotic of the imidazopyridine class and is very effective in inducing and maintaining sleep. It binds selectively to the benzodiazepine ω1-receptor subtype in the central nervous system but possesses low affinities for the ω2- or ω3-receptor subtypes (Langtry and Benfield, 1990, Stahl, 2002). It is characterized by minimal disruption in the sleep architecture so it does not appear to cause rebound insomnia, nocturnal awakening, or other withdrawal reactions after short term administration (Langtry and Benfield, 1990).
However, zolpidem causes decreased rapid eye movement sleep while increasing total sleep time. Incidences of zolpidem-associated nocturnal wandering and abnormal sleep behavior have previously been reported as rare side effects. Our current observational study is an attempt to review adverse effects, specifically somnambulism and anterograde amnesia, after zolpidem administration among the Taiwanese in order to determine if this is an infrequent occurrence.
Section snippets
Patients
Data were collected through extensive chart reviews of patients visiting the out-patient psychiatric services of Kaohsiung Medical University Hospital over a 2-month period in 2005. Patients treated with zolpidem for insomnia for more than 6 months were included for further interview. Patients who lived alone, had combined nocturnal use of benzodiazepines, or had past histories of eating disorders, mental retardation, dementia, attention-deficit/hyperactivity disorders, substance abuse, and/or
Results
Of the total 255 zolpidem users, 13 (5.1%) reported incidence of somnambulism or amnesic sleep-related behavioral problems. Of the 13, 6 were male and 7 were female. The average age was 42.5 years and the average dosage of zolpidem was 10.0 mg per day. Their diagnosed diseases were as follows: 2 for schizophrenia, 3 affective disorders, 3 anxiety disorders, 3 sleep disorders, and 2 adjustment disorders. The behavioral problems included 3 patients who watched television, 5 who used the
Discussion
To the best of our knowledge, zolpidem-induced amnesia and somnambulism is a rare occurrence, only 14 published case reports in English (Mendelson, 1994, Canaday, 1996, van Puijenbroek et al., 1996, Harazin and Berigan, 1999, Morgenthaler and Silber, 2002, Sattar et al., 2003, Lange, 2005, Sharma and Dewan, 2005, Yang et al., 2005, Barrett and Underwood, 2006, Kito and Koga, 2006, Najjar, 2007, Tsai et al., 2007, Sansone and Sansone, 2008.) and 2 clinical trials of zolpidem-induced anterograde
Role of the funding source
This study did not receive any financial support or funding.
Contributors
C.C. Chen designed the study and wrote the protocol. J.H. Tsai, P. Yang, C.C. Chen, W. Chung, T.C. Tang and S.Y. Wang interviewed and assessed the clinical patients. J.H. Tsai, P. Yang, C.C. Chen and W.Y. Chour managed the literature, analyzed, and wrote the manuscript. J.H. Tsai and J.K. Liu analyses the data statistically.
Conflict of interest
We declare that we have no conflict of interest.
Acknowledgment
The primary data was reported in the 19th ECNP Congress in Paris, France last 16---20 September 2006.
References (24)
Medication-associated somnambulism
J. Am. Acad. Child Adolesc. Psych.
(2005)- et al.
Amnestic sleep-related eating disorder associated with zolpidem
Sleep Med.
(2002) - et al.
Zolpidem, somnambulism, and nocturnal eating
Gen. Hosp. Psych.
(2008) - et al.
One rare side effect of zolpidem---sleepwalking: a case report
Arch. Phys. Med. Rehabil.
(2005) Memory, benzodiazepines, and anxiety: integration of theoretical and clinical perspectives
J. Clin. Psychiatry
(1993)- et al.
Cognitive effects of long-term benzodiazepine use: a meta-analysis
CNS Drugs
(2004) - et al.
Perchance to…eat?
Newsweek
(2006) Amnesia possibly associated with zolpidem administration
Pharmacotherapy
(1996)- et al.
Assessment of recovery from anaesthesia: what tests should we use?
Anesthesiology
(1987) - et al.
Assessment of a new hypnotic imidazo-pyridine (zolpidem) as oral premedication
Br. J. Clin. Pharmacol.
(1987)
Zolpidem in insomnia: a 3-year post-marketing surveillance study in Switzerland
J. Int. Med. Res.
Zolpidem tartrate and somnambulism
Mil. Med.
Cited by (52)
Medication induced sleepwalking: A systematic review
2018, Sleep Medicine ReviewsCitation Excerpt :The two post-marketing reviews of adult patients found the incidence of zolpidem-induced sleepwalking rates were 0.5% [42] and 1.1% [43]—in children the rate was 2.2% [44]. In a psychiatric sample, it was 5.1% [41]. Case reports included patients with complex medical histories or who were concurrently taking other medications [41,45,47,49–51,60–63] and patients who were otherwise healthy aside from their presenting problem [48,53,55,56].
The sleeping brain in Parkinson's disease: A focus on REM sleep behaviour disorder and related parasomnias for practicing neurologists
2017, Journal of the Neurological SciencesNon-benzodiazepine receptor agonists for insomnia
2015, Sleep Medicine ClinicsPara-suicidal amnestic behavior associated with chronic zolpidem use: Implications for patient safety
2013, PsychosomaticsCitation Excerpt :In a series of 1972 insomniac patients, adverse effects of anterograde amnesia and somnambulism were observed in 1.1% of the patients using zolpidem.10 In a single center retrospective study of 255 Taiwanese patients taking zolpidem, the frequency of amnesia and somnambulism was noted to be 5.1%.11 In another retrospective cross-sectional study of 125 psychiatric outpatients, including 67 taking zolpidem, the frequency of hypnosedative-related complex behaviors was even higher at 15.2%.
Effect of Medications and Substances on Parasomnias
2013, Encyclopedia of SleepEffect of Medications and Substances on Parasomnias
2013, Encyclopedia of Sleep