The One-Two Punch
"Beer and valium, that's how I sleep. Works every time -- the perfect night's sleep." So said an actor friend of mine, who often had trouble "coming down" after a play and used this cocktail three or four times a week.
Yet often alcohol plus sleeping pills do not "work." Thirty percent of American women use some kind of sleeping pill each week, but combinations are rarely remarked upon -- though clinically common. Studies of them are relatively sparse, as researchers tend to look at one drug at a time.
Alcohol plus sleeping pills can kill you; it was the inadvertent cause of death of Brian Epstein, the Beatles' manager in 1967, and many famous and not-so-famous media folks since. The combination can produce horrific accidents and falls, increase the incidence of anxiety and depression and dramatically decrease the ability to function the next day.
And then there's ambien (generic name zolpidem).
The Strange Saga of the Sleepless Paramedic
Thomas Gatz is a Chicago-area paramedic who woke up in the hospital. He had arrived via the police. They found him driving eastbound in his underwear on westbound lanes in the famed penitentiary town of Joliet in July 2010. His Honda had smashed into the cars of two women, multiply fracturing the arm of one. His blood alcohol level was well above legal limits.
His defense -- ambien made me do it.
Gatz kept a bottle of vodka in a fridge close to his car keys. He remembered taking two ambien. That's all he recalled until waking up in the hospital.
His legal defense team explained ambien was famous for causing sleepwalking. Their claim -- Gatz took the ambien, under its influence drank the vodka, then continued to sleepwalk into the driver's seat of his car.
But Gatz already knew ambien could cause him trouble. In April he had taken the drug and this time fully dressed driven into two light poles.
A judge will rule on Gatz's underwear ride perhaps this week.
Ambien is an exceedingly popular drug. It works by hitting one of the three benzodiazepine receptors in the brain. This does not produce sleep itself. Rather, it provokes an in-between wake and sleep state that allows sleep to come thereafter.
And that's the trouble. Sleeping pills, of which the most common are the older benzodiazepines like valium (diazepam), clonazepam (klonopin), ativan (lorazepam), restoril (temazepam), and the like, hit all three of benzodiazepine receptors and still do not produce fully natural sleep. All of them can provoke sleepwalking behaviors in people so prone, but ambien, at least by clinical report, seems to produce more sleepwalking than many other pills.
Sleep and Consciousness
Many folks think of sleep as a light switch. That's why many did not understand that Michael Jackson's use of the anesthetic propofol did not produce sleep, but something very like a coma.
And you need sleep to live. Lots of the body's rebuilding occurs during sleep, particularly for memory and learning. Use an anesthetic to "sleep" and your brain doesn't get the chance it needs to rewire itself.
You won't make good decisions that way.
You don't get sleep when you first take ambien. You go to someplace in between awake and sleep. And lots of strange things can happen when you do.
Now add alcohol. The chance for strange doings goes up manifold.
Rules of the Game
Sleeping pills have many distinct uses. I personally use sleeping pills, like ambien, to overcome jet lag. Sleeping pills are highly useful in stressful times, and can be used by shift workers to overcome the perpetual jet lag of their work cycle.
Yet combining depressants like booze and sleeping pills is a kind of personal roulette. You don't know what you'll get at the end of the day.
Sometimes you don't get another day. I was pilloried by a blogger furious for suggesting Heath Ledger's death had something to do with sleeping pills. He had accepted at face value that Ledger's "anti-anxiety agents" were somehow not sleeping pills, which is one of their major uses.
1. Alcohol plus sleeping pills does not create normal sleep.
2. Alcohol with sleeping pills' additive effects may set you up for sleepwalking, accidents, falls or worse.
3. If you do take a sleeping pill, get right into bed. Don't write end-of-the-day emails; plenty of people are now texting in the middle of the night unaware that they're "awake."
4. Recognize that consciousness is complicated, shifting up and down throughout the 24-hour day. Focus well, and you get a lot done -- and for that you need a real night's sleep.
Follow Matthew Edlund, M.D. on Twitter: www.twitter.com/therestdoctor