01/17/2012 06:42 pm ET Updated Mar 18, 2012

Don't Sleep and Drive: How to Avoid Complex Sleep Behaviors

Sleeping pills, like any other medication, can have unpleasant side effects. One dangerous side effect is complex sleep behaviors. These behaviors include sleep eating, sleep driving, sexomnia and sleep violence.

Ambien (zolpidem) has gotten a bad reputation for being associated with these problems, even though the risk of complex sleep behaviors is present with all sleeping medication. There are two reasons that explain why this problem seems to be associated more with Ambien.

The first is that Ambien is a popular sleeping pill with widespread distribution, more so than some of the older sleep medications that don't work as well. So, in part, Ambien's reputation of being associated with complex sleep behaviors can be explained simply because it's prescribed more than some of the other sleep medications and, statistically, impacts many patients.

The second reason is that Ambien is a medication that's easy to abuse. Some people will take 15 mg or 20 mg when the maximum recommended dose is 10 mg. Why do some disregard this warning?

Although Ambien is generally effective, for many it can stop working quickly. So, for example, where one person may take one pill with a good effect, once the effect wears off, it is very tempting to take just another half or whole pill to kickstart the effect again. While it may seem as though this should not be problematic if the lower dose stopped working, taking more than the recommended maximum of a sleeping medication increases the risk of complex sleep behaviors.

Another contributing factor to complex sleep behaviors is consuming alcohol close to the time when the medication is taken. Sleeping pills and alcohol are a dangerous combination because the two agents act similarly in the brain and have an additive effect.

The effects of alcohol on your sleep are often not immediately noticeable, leading some to falsely conclude that combining alcohol and sleeping pills is safe. The effects of alcohol are unpredictable and can vary depending on how your body metabolized the alcohol. Therefore, it's prudent to abstain from alcohol consumption in the evening if sleep medications are being taken.

A third factor that leads to complex sleep behaviors is taking the sleeping medication too late and waking while you have too much of it in your system. This problem was one of the reasons why Intermezzo, the new middle-of-the-night sleeping pill, was rejected twice by the FDA before being accepted.

Intermezzo is a sublingual, smaller-dose formulation of zolpidem. The regular formulation of Zolpidem is designed to last seven to eight hours, so you should only take it if you plan to sleep that long.

But what if you wake up in the middle of the night and still have four hours of sleep ahead of you? It's tempting to break the Zolpidem in half and take it, but this could lead to problems. If you take a sleeping pill too late, awake from a deep sleep and then take more medication to fall back to sleep, you're more susceptible to performing your routine activities, including driving, while you're partly asleep.

Intermezzo requires that you still have four hours left to sleep and five hours before you need to drive. Therefore, this drug can present problems for people who easily fall asleep but wake a few hours before the alarms sounds and look for something to help them get those few more hours of sleep.

The fourth factor that can lead to complex sleep behaviors is combining sedating medications.
This is similar to the problem associated with mixing alcohol and sleeping medication, but this problem is easier to overlook because of the assumption that anything prescribed by a medical doctor is safe to take at anytime.

Some people have multiple medical conditions and, therefore, take several medications prescribed by different doctors. Sometimes these medications can overlap each other or, when combined, lead to dangerous side effects that wouldn't be present where they're not taken together.

For example, anxiety medications like Klonopin, Ativan and Xanax, when taken in the evening, can have an additive effect when combined with a sleeping pill. While some can tolerate taking both, this combination increases the risk of experiencing complex sleep behaviors.

This risk is heightened when combining a sleep drug like Intermezzo, which is designed to be taken in the middle of the night, with another sleeping medication like Ambien, which is intended to be taken in order to fall asleep. So if you wake up a few hours after taking Ambien, it's not advisable to take Intermezzo in order to try to fall asleep again.

Sleeping pills are generally safe, especially when used short-term. Complex sleep behaviors such as sleep eating, sleep driving and sleep violence are uncommon side effects. But there are known factors that increase the risk of this happening to you.

Take precautions when taking these medications and consult your doctor if you have unusual sleep experiences. Don't fret if you have a negative experience with one drug, since adjusting your medication can often reduce or eliminate its side effects.

For more by Tracey Marks, M.D., click here.

For more on sleep, click here.