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No Rest for the Weary

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The crumbs in her bed were a mystery, and so was the food that regularly disappeared from the fridge. Brenda Pobre, a teaching assistant from Salinas, Calif., blamed her husband or their two sons—until the night in 2003 when the boys came home late and found their mom sleepwalking. “I walked into the kitchen, grabbed a knife, swung it around and started chopping three pomelos,” she says. “I ate all three of them.” It wasn’t the last time the boys caught her eating while apparently asleep, but Pobre, who gained more than 100 lbs. in four years, refused to believe them until, while sleepwalking again, she smashed a cherished Nativity scene to pieces. Turning to doctors for help, Pobre was shocked to learn what caused her nighttime roaming: the sleep drug Ambien.

More than 26 million prescriptions were written for Ambien last year, and legions of the drug’s faithful users report results no more serious than a restful night of sleep (see box). But a couple of small-scale studies have lately brought to light extreme—and extremely rare—side effects suffered by an unlucky few. There are reports of people driving in their sleep, painting in their sleep, even having sex in their sleep. Last July 11, British painter Sean Joyce, then 38, boarded a US Airways flight in Charlotte, N.C., with a tablet of Ambien his mother had slipped him for the long trip back to London. After taking the pill and drinking some wine, Joyce, normally mild-mannered, ripped off his shirt, threatened to kill other passengers and head-butted a flight attendant. The flight had to be diverted to Boston, where Joyce was led off by police. “The last thing I remember was sitting on the aircraft,” he says. “The next thing was waking up in jail.” (Charged with interfering with the flight crew, Joyce pleaded guilty, but spent only five days in prison.)

Introduced in 1993, Ambien has enjoyed a reputation as a reliable sleep aid with few unpleasant side effects. “If it is used as directed, it’s a very safe and effective drug,” says Dr. Frank Steinberg, a medical consultant for French manufacturer Sanofi-aventis. While the company does acknowledge rare instances of sleepwalking, that translated into “less than one in a thousand cases” in clinical trials, adds Steinberg. So why the bizarre nighttime behavior currently making headlines? Dr. Carlos Schenck, a psychiatrist at the Minnesota Regional Sleep Disorders Center who studied 32 Ambien users suffering from sleep-related eating disorder, says that adverse reactions with other drugs, including antidepressants, antianxiety medications and painkillers, may cause patients to become active in the night without having any recollection of it in the morning. “[These complications] affect a very small percentage of users,” says Schenck, “but if it’s you, it’s 100 percent.”

Still, even insomniacs who had complications from Ambien have a difficult time giving it up. In October 1999, Judie Evans was thrown from a show horse, breaking her spine. She had several surgeries, and following one in August 2003, Evans, 59, a retired nurse, was in a full body cast and a leg brace. She needed a nursing aide to help her get out of bed, and took OxyContin for her pain. Schenck prescribed 5 mg of Ambien to help Evans sleep, later increasing it to 10 mg. Soon, she noticed “things would be missing from the cupboard. I would go to make a salad, and there wouldn’t be any dressing. Or I’d think I’m gonna have a glass of milk but there wouldn’t be any.” Finally, her son caught her sleep-cooking—without her walker. “It was just unreal.” Schenck took her off Ambien and the sleep-gorging stopped. Now Evans takes two other drugs to help her sleep, but they don’t work as well. “I go to sleep at 10:30, and I’ll be awake at 1:30. I’m lucky to sleep four hours a night,” she says. “I miss my Ambien.”