Doctors prescribe Ambien, generic name zolpidem, for the treatment of insomnia, a condition chiefly defined by the inability to fall and stay asleep. Ambien interacts with specialized sites in the brain called omega-1 sites. These sites are nestled within the pockets of yet larger receptor complexes known as GABA-A receptors, which are expressed on the surface of neural cells. Via the omega-1 sites, Ambien binds GABA-A receptors and amplifies the function of the endogenous brain chemical GABA like a volume tuner. Drugs that potentiate GABA, in particular the benzodiazepines, have been traditionally used to address sleep difficulties in the general population. However, Ambien presents a number of strengths relative to these classic drugs, showing better specificity of action, faster onset and less addiction potential.
Receptor Specificity
Traditional benzodiazepines bind to multiple GABA receptor sites in the brain. According to Drs. Ramakrishnan and Scheid of the University of Oklahoma Health Sciences Center in an article published in 2007 in "American Family Physician," this promiscuity produces secondary effects unrelated to sleep onset and maintenance. For instance, benzodiazepines impact the actual architecture of sleep, which is how easily one moves from one sleep stage to the next, and how long one spends in each stage. By contrast, Ambien exhibits significantly fewer off-target effects on native sleep structure.
Rapid Onset
As a class, the benzodiazepines have very different rates of action and half-lives. Short-acting drugs like estazolam, triazolam and temazepam show peaks of action at best within one hour of administration and extremely diverse half-lives that can range from several hours to as long as a day. On the other hand, Ambien begins to show peak activity within 15 minutes of administration and has a half-life truncated to about two hours. Ultimately, this means that patients can take the drug later in the evening without compromising attention or alertness the next day.
Lower Abuse Potential
Individuals taking benzodiazepines for more than a few months of time are susceptible to developing long-term psychological and physical dependence, signaled most clearly by escalating drug tolerance. Addiction potential occurs greatest in elderly patients undergoing palliative care, or in those being treated for pain in conjunction with insomnia. Noteworthy, a withdrawal syndrome can also manifest in benzodiazepine-dependent individuals who have suddenly discontinued drug treatment, characterized by increased agitation and anxiety, sleeplessness and impaired memory. While Ambien has not been closely studied in this regard, existing work suggests that low doses of the drug do not produce overt tolerance.
