Excessive zolpidem and the risks of medicalizing sleep | Special Reports

To overcome the problem of insomnia, the use of drugs that induce this sleep process has become common among populations. However, the Ministry of Health already considers the use of sleeping pills a public health problem. Medicalizing this physiological activity generates severe health problems, ranging from hallucinations, dependence and, above all, insomnia itself.

Laura (fictitious name) started using zolpidem under psychiatric supervision. In the package insert, zolpidem is classified as a hypnotic that induces sleep. “I needed to be in college beyond any reason. The evening made me desperate and made me anxious. I couldn’t sleep, I felt anguish and I started taking it,” she explains.

She remembers that her doctor advised her not to use her cell phone after taking the drug. “I really slept soundly, woke up and went to do things”, she says. Laura comments that as she took it, the medicine gradually lost its effectiveness. “According to my psychiatrist, the function of zolpidem is to be short-term, but I continued using it,” she recalls.

Laura’s psychiatrist, who treats depression, continued to prescribe zolpidem. At a certain point during the treatment, the young woman says that she started taking two doses of the drug and still did not feel the benefits in her body.

At these moments, the student chose to go a week without using it, in order to bring the benefits of the drug when it started to be used again, but all the symptoms of insomnia returned to the body when the medicine was not taken.

“There was an episode of great anguish, when I was taking zolpidem without having the effect it should have, but I continued taking it… So, I decided to go out to buy cigarettes and went to drive my car. It’s risky, you become very disconnected”, he asks.

Finally, the student comments that she bought a meditation app for sleeping worth 300 reais on a colleague’s card, without remembering what had happened. In addition to the messages, videos and audios sent to colleagues and sexual partners, which she does not remember sending.

Sleep is a surrender to the unknown

“The issue of sleep is very complex. Often the difficulty in sleeping is that when we sleep we lose control of everything”, says Psychology professor at the Federal University of Ceará, Alesandra Xavier. She comments that you need to be relaxed, safe, confident, in a peaceful environment, “because sleep is a surrender, a surrender to the unknown”.

Alesandra says that when you are awake, you are minimally aware of your cognitive abilities. “When we sleep, we practically surrender to our unconscious”, she says. Anxiety, depression, situations of threat of violence are some of the thoughts mentioned by the teacher that make people feel threatened about their physical integrity.

“So, the subject is unable to slow down his thoughts, he is unable to relax, trust the environment, or himself”, comments the psychoanalyst. Furthermore, the teacher comments on the hyperstimuli that increase anxiety about the day that is about to begin, and the activities that must be done.

Being in a society that demands that we have control, planning and alertness about everything, resting, relaxing and being able to surrender to this dream world is beyond our control. “This space that often brings unconscious desires and questions what we do when we are conscious”, explains the teacher. Sleeping is giving yourself over to yourself, without knowing what tomorrow will bring.

Understanding the Medicine

According to the United States regulatory agency, Food and Drug Administration (FDA), zolpidem has been available on the market for more than 30 years. In the country, the drug was approved in 1992. However, in Brazil, the drug had already arrived in the mid-1990s. In addition to being expensive, its properties were unknown to the public. In 2007, when the drug’s patent expired, several laboratories began to manufacture it as a generic.

The professor explains that when a medicine starts to be produced by other industries, competition is stimulated and the price drops due to market laws. “And then you will have an increase in sales and what the industries expect is an increase in consumption”, she narrates.

The UFC professor explains that zolpiden is a non-benzodiazepine from the imidazopyridine group, a hypnotic that has a high affinity for receptors for certain neurotransmitters. Drugs that act in this way are classified as Z Drugs, which include zolpidem, zaleplone, and zopiclone. These medications act on the Central Nervous System and have sedative, relaxing and anxiolytic properties.

“They bind to so-called receptors, which are structures found in our neural cells. And they bind to a specific site called the benzodiazepine receptor. And, when they bind, they will promote sedation, they will be able to induce sleep… We have a brain structure called the hippocampus, and it is known that drugs that bind in the hippocampus in some way and compromise memory.” explains Miriam.

Regarding the hallucinations, the teacher comments that “there is no plausible explanation, because these reactions happen, we know that they happen, but we don’t know exactly”.

Mirian Monteiro remembers that a medicine, first of all, “is a commodity, we cannot close our eyes to this reality. The industry is really not very reliable with information.”

Medicalizing sleep

According to WHO estimates, after the pandemic caused by COVID-19, there was a 25% global increase in psychiatric disorders such as depression, anxiety and post-traumatic stress disorder. Furthermore, data from Anvisa states that zolpidem, one of the most commonly prescribed benzodiazepine hypnotic drugs for insomnia and depression, saw its consumption increase at the same time.

“Sleeping is a physiological act”, says professor of Medicine at the State University of Ceará (Uece) and doctor in pharmacology, Gislei Frota Aragão. The scholar says that we cannot hypermedicalize this activity as it is of great importance for the development of human cognition.

However, “the so-called drug Z (zolpidem), in 2018 alone, was sold in Brazil, more than 13 billion boxes. In 2023, five years later, this number jumped to 22 billion”, he narrates. He reports that all of this was due to insomnia problems.

The professor explains that insomnia exists with and without a cause. “I have insomnia, because in a week I’m going to have a job interview, which is very important for me or I just can’t sleep a wink”, he explains. Zolpidem appears as a novelty because it is a medication made only to induce sleep.

Hallucination or dream?

“The principle is not to recommend that you use any type of medicine. What you need to do is sleep hygiene”, explains professor Gislei Frota. Sleeping later, using electronic equipment and eating heavy foods at night only make it difficult to sleep and prevent it from being well cleaned.

He explains that with the use of zolpidem there is a kind of deactivation and the use of “many elements that activate our nervous system comes into conflict with what was supposed to be deactivating. It causes hallucinations. The person becomes more talkative, becomes uninhibited. Many people are using it for recreational purposes.”

However, the drug has a series of side effects such as headache, nausea, bitter taste in the mouth, dizziness and irritability. “You have to take the medicine and go straight to bed, because it causes amnesia”, says the scholar. The professor adds, “you will be as if you were asleep awake, you will do things that you will not remember”, he warns.

On the internet, many internet users share their experiences when using zolpidem.

The doctor in pharmacology warns that the drug presents the ‘Phenomenon of Tolerance’. The leaflet recommends that insomnia treatment can only be done for a maximum of four weeks, but people go beyond this time, says the professor. “I need to be increasing the dose to have the same effect. There are people who take it for six months, there are people who take it for two years and increase the dose. There are cases of people taking 30 compliments a day”, explains the professor.

The ease with which this medicine is obtained is due to the prescriptions. “It’s just a carbonated prescription, the control is much less, that’s why it’s much easier for you to acquire this medicine”.