By The Recovery Village Ridgefield
Editor Jonathan Strum | Medically Reviewed By Dr. Trisha Sippel, PhD
Last Updated: May 30, 2023
Editorial Policy | Research Policy
Ambien (zolpidem) is a non-benzodiazepine hypnotic that is commonly prescribed to help with sleeping problems. It is also associated with substantial dependency and addiction concerns. Ambien overdoses can be lethal, and they typically occur with co-use of other drugs or alcohol.
How Do Ambien Overdoses Occur?
Ambien is in a class of drugs known as “z-drugs,” which includes zaleplon (Sonata) and eszopiclone (Lunesta). Z-drugs are central nervous system depressants that act by enhancing brain neurotransmitters called GABA. This leads to reduced brain activity (depression), which is why these drugs are good at promoting sleep. When misused, however, Ambien and other z-drugs can have dangerous consequences, including respiratory depression and coma.
Lethal overdoses from Ambien alone are uncommon. Most prescription doses fall between 5–10 mg. Lethal overdoses of Ambien alone tend to be greater than 4,000 mg, but profoundly negative effects begin to occur at the 400–600 mg level. Ambien overdose deaths are generally associated with polysubstance use (often alcohol, cough medicines, opioids or illicit drugs). When co-used with other drugs, a lethal Ambien dose has been reported to be as low as 1,100 mg.
Ambien Overdose Symptoms
Common psychological symptoms associated with sub-lethal amounts of Ambien (less than 400 mg) include:
- Profound drowsiness
Physical symptoms may include:
- Respiratory depression
- Cardiovascular toxicity
Ambien overdose is a medical emergency. If you suspect an overdose, call 911.
What Happens if You Overdose on Ambien?
Ambien overdose leads to significant repression of normal brain function, particularly in brain regions that are responsible for breathing and normal heart function. Immediate symptoms of Ambien overdose include profound drowsiness and lethargy, and symptoms may progress to include:
- Altered breathing (respiratory depression, leading to a lack of oxygen in the brain)
- Reduced heart function (cardiovascular toxicity, leading to loss of oxygenated blood throughout the body)
Risks of Overdose
When used as directed and without other drugs or alcohol, Ambien poses a low risk of overdose. However, daily Ambien use for even a few weeks can lead to dependency issues. Overdose risk is greatly increased when Ambien is co-used with alcohol, over-the-counter drugs, other prescription drugs or illicit drugs.
Ambien Overdose Statistics
The number of Ambien-involved emergency department (ED) visits approximately doubled between 2005–2010. Of these visits, females were significantly more likely to report overdoses than males.
Most emergency department visits involved people between 45–54 years old (31%), with people aged under 34 (23%) and people aged 35–44 (21%) being the next most common. In addition, nearly 60% of ED visits for Ambien overdose were associated with other drugs or alcohol. These statistics show how important it is to avoid using Ambien with other substances.
Ambien Overdose Deaths
Deaths caused by Ambien alone are rare. A lethal dose of Ambien is above 4,000 mg, which is approximately 400–800 times the average prescription dose. Deaths are most commonly reported with co-use of illicit drugs, prescription pain relievers, other z-drugs, benzodiazepines or alcohol.
Although not necessarily related to overdoses, it is worth noting that Ambien and other sleep medications are associated with an increased risk of suicide and suicide attempts. People who have previously been diagnosed with major depressive disorder should use extreme caution when taking Ambien, other z-drugs and benzodiazepines.
Ambien is notorious for causing complex sleep behaviors like sleepwalking, sleep-eating and sleep-shopping. Complex sleep behaviors can be lethal. For example, Ambien has been associated with people getting into their cars and driving while asleep, with deadly automobile accidents being recorded in a few cases. Similarly, people who have taken Ambien have died due to drowning, hypothermia and poisoning.
Ambien Overdose Treatment
Ambien has a short half-life of 2.6 hours, so it is rapidly metabolized. Treatment for Ambien overdose is largely supportive, but a drug called flumazenil may be administered in extreme cases.
Flumazenil competes with Ambien for binding sites in the brain, which reduces Ambien’s effectiveness. However, in the case of polydrug overdoses, flumazenil may make matters worse. In addition, people who have a history of seizure disorders should not be given flumazenil.
Ambien Overdose Prevention
The best way to prevent Ambien overdose is to only use it in the short-term (only when absolutely needed). It should be taken as directed and without alcohol, cough medicines, over-the-counter drugs, prescription drugs or illicit drugs.
Ambien and other z-drugs were initially seen as safe and relatively risk-free treatments for insomnia. However, increasing evidence shows that z-drugs can have significant negative outcomes, even when taken as prescribed. Misuse of Ambien can cause profound physical and psychological effects, including long-term damage due to respiratory depression or cardiovascular toxicity.
Research has also identified Ambien as a drug that should be avoided by people who have major depressive disorders. Even in people without a prior diagnosis of depression, Ambien use is associated with a significant increase in suicide attempts or completions. Ambien should be used in prescribed doses, rarely and with caution.
Ambien overdose can be a medical emergency. If you suspect an overdose, call 911.
If you or a loved one is concerned with Ambien use or misuse, call The Recovery Village Ridgefield today. We can provide you with treatment options that can help you overcome Ambien dependency as well as help you develop effective drug-free sleep habits. Contact us today to learn more about treatment plans that can work well for your situation.
Our Recovery Advocates are ready to answer your questions about addiction treatment and help you start your recovery.
Matheson, Eric; Hainer, Barry L. “Insomnia: Pharmacologic Therapy.” American Family Physician, July 2017. Accessed July 31, 2019.
Gunja, Naren. “The Clinical and Forensic Toxicology of Z-drugs.” Journal of Medical Toxicology, June 2013. Accessed July 30, 2019.
Proctor, Ashley; Bianchi, Matt T. “Clinical Pharmacology in Sleep Medicine.” ISRN Pharmacology, November 2012. Accessed July 30, 2019.
The Substance Abuse and Mental Health Services Administration. “Emergency Department Visits Attributed to Overmedication That Involved the Insomnia Medication Zolpidem.” The DAWN Report, August 2014. Accessed July 30, 2019.
McCall, Vaughn W.; Benca, Ruth M.; Rosenquist, Peter B.; Riley, Mary Anne; McCloud, Laryssa; Newman, Jill C.; Case, Doug; Rumble, Meredith; Krystal, Andrew D. “Hypnotic medications and suicide: risk, mechanisms, mitigation, and the FDA.” American Journal of Psychiatry, July 2017. Accessed July 31, 2019.
Kripke, Daniel F. “Greater incidence of depression with hypnotic use than with placebo.” BMC Psychiatry, August 2007. Accessed July 31, 2019.
Young, Kelly. “Insomnia Drugs Get Boxed Warning for Complex Sleep Behaviors.” New England Journal of Medicine – Journal Watch, May 2019. Accessed July 30, 2019.