Do Prescription Sleep Medications Cause Sleepwalking?

Sleepwalking is a rare adverse effect of sedative-hypnotics.

Posted Jun 01, 2015

People often associate prescription sedative-hypnotic sleep medications like triazolam (Halcion), eszopiclone (Lunesta) and zolpidem (Ambien) with sleepwalking (somnambulism). In fact, the greater media often dramatizes accounts of people who drive cars, prepare meals or wander the house after taking these drugs. Fortunately, although it does happen, sleepwalking and other unusual sleep behaviors attributable to these medications are rare. By way of example, let's take a look at one of the most popular sedative-hypnotics out there zolpidem (Ambien) and its link to sleepwalking.

Zolpidem is a non-benzodiazepine sedative-hynotic mediation.  It binds to GABAA receptors, which are the major inhibitory receptors in the brain. Zolpidem has actions similar to benzodiazepines like clonazepam (Klonopin), lorazepam (Ativan) and so forth.  During clinical trials of this drug, withdrawal was observed among fewer than 1 percent of participants after 48 hours of discontinuation. Moreover, unlike benzodiazepines, accounts of tolerance, dependence and abuse secondary to zolpidem are less frequent.

Zolpidem works by helping people with insomnia fall asleep more quickly and sleep longer. In its sleep actions, zolpidem is just as effective as the benzodiazepines, a class of drugs zolpidem was intended to replace for use in those with short-term insomnia.

Zolpidem is absorbed from the GI tract, and after hepatic or liver metabolism, about 70 percent of the drug makes it into your system. In those with liver problems (think cirrhosis) more of the drug makes it into the blood; thus a lower dosage is usually prescribed. Similarly, in elderly people or those with kidney problems, lower dosages are typically prescribed, too. 

Here are some of the more common adverse effects of zolpidem:

  • dizziness
  • drowsiness
  • diarrhea
  • grogginess
  • headache
  • fatigue

More infrequently, zolpidem can cause certain psychiatric adverse effects including:

ostill © 123RF.com
Source: ostill © 123RF.com

Although rare, here are some partially awake and complex sleep behaviors (parasomnias) documented in adults taking this medication:

  • making and eating food
  • sleep driving
  • sleepwalking
  • having sex

In order for you to get a better idea of how rare sleepwalking and parasomnias are secondary to zolpidem (and by extension other sedative-hypnotics), makers of the drug conducted two post-marketing studies examining the prevalence of sleepwalking among participants taking the drug. In one study, researchers found that 7 of 1972 (0.3 percent) participants experienced sleepwalking. In another study, they found 1 of 96 participants (1 percent) experienced sleepwalking.

On a final note, it's hypothesized that zolpidem's sleepwalking effects have something to do with lengthening of the third and fourth stages of sleep. Usually, sleepwalking is more common in children and rare in adults who aren't taking psychoactive medications.

Selected Sources

Article titled “Zolpidem-Induced Sleepwalking, Sleep Related Eating Disorder, and Sleep-Driving: Fluorine-18-Flourodeoxyglucose Positron Emission Tomography Analysis, and a Literature Review of Other Unexpected Clinical Effects of Zolpidem” by R Hoque and AL Chesson, Jr., published in the Journal of Clinical Sleep Medicine in 2009.  Accessed on 6/1/2015.

Mihic S, Harris R. Chapter 17. Hypnotics and Sedatives. In: Brunton LL, Chabner BA, Knollmann BC. eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. New York, NY: McGraw-Hill; 2011. Accessed April 29, 2015.

Article titled "One Rare Side Effect of Zolpidem: Sleepwalking: A Case Report" by W Yang and co-authors published in Archives of Physical Medicine and Rehabilitation in 2005.