- Insomnia is a sleep disorder where people may have trouble in sleeping and medications may help to treat the condition.
- Scientists have studied the surprising effects of the insomnia medication zolpidem.
- Zolpidem was found to wake up some patients from coma and vegetative states.
The surprising effects of Zolpidem drug have been studied by a research team from the University of Michigan.
The research study was published in the journal JAMA Neurology.
Martin "Nick" Bomalaski, M.D., outgoing resident physician in the Department of Physical Medicine & Rehabilation, said, "We saw a dramatic effect in a small number of patients with a variety of conditions."
More than 20 neurological disorders were part of the review.
Zolpidem for Noninsomnia Neurological Disorders
The patients who respond to zolpidem for noninsomnia neurological disorders were found to either have a disorder of consciousness or a movement disorder.
This included people in comas and vegetative states, others with Parkinson's disease and dystonia.
Some patients who had experienced a stroke or traumatic brain injury, or patients with dementia were found to be prescribed for a range of symptoms that include aphasia, apathy and motor coordination.
Significant Effects From Zolpidem
The patients who took zolpidem showed significant improvements and the effects were found to last for one to four hours which were repeatable.
Based on the condition, the progress was reported for coma recovery, dystonia and Parkinson's disease and other scales that could measure motor, auditory and verbal abilities.
Some of them showed a minimally conscious state; however others even tried to speak to their loved ones. And some of the patients' functional neuroimaging results were also improved.
Mark Peterson, Ph.D., M.S., FACSM, assistant professor of physical medicine and rehabilitation and a member of U-M's Institute for Healthcare Policy & Innovation and Neuroscience Graduate Program, said, "This is one of those strange paradoxes where the effects of an insomnia drug seem to have the opposite effect for patients who have paralysis or neurologic conditions."
Some of them also request zolpidem after finding a case study or news article as they feel there are no other real options for their loved ones.
However, zolpidem drug may not work for everyone. And the response rate in the reviewed articles was found to be 5 -7 % for patients with consciousness disorders and up to 24% or even higher for patients who have movement disorders.
The most common adverse effect of zolpidem drug is to sedate the patients as one would see in regular use of the drug. This could happen in 13 of the 551 patients who participated in the systematic review.
The First Review
Most of the patients with consciousness disorders were treated by Bomalaski and also found that the existing case reports could be quite interesting.
Bomalaski said, "I saw how these conditions affected their function and quality of life."
"To see that something as simple as an average dose of a sleeping medicine had, in 15 minutes, woken someone up from a vegetative state seemed extraordinary, and I wanted to pursue it further."
More than 2300 unique articles were researched. The articles were reduced to about 89 after assessing the abstracts.
A screening method also included a full review of the 89 articles which then led to a systematic review of around 67 of them.
Most of them were considered to be low-level evidence that included case reports and small trials.
The 67 articles were reviewed for the type of the disorder, dosage of zolpidem, frequency, effect and other adverse effects. About 11 of these studies had more than 10 participants and all together there were 551 participants.
Guidance for Further Research
Peterson said that the report study could actually bring more questions than answers. However, it would help to guide a larger clinical trial.
The authors also said that the next step is to study the safety and efficacy. And another topic for research may assess whether the zolpidem effects may vary based on the part of the brain that is injured.
The research team also reported that the zolpidem's unique effects might be due to the patients whose basal ganglia are no longer functioning correctly.
Basal ganglia can help to process information to perform an action. Bomalaski said,"The restorative effects on the basal ganglia may surpass the hypnotic effects on the frontal cortex."
"We still need to learn much more in order to answer the question about whether we should be using this in our clinical practice."
- Martin N. Bomalaski,Edward S. Claflin, Whitney Townsend, Mark D. Peterson. Zolpidem for the Treatment of Neurologic Disorders: A Systematic Review. JAMA Neurology Review, June 26, 2017 DOI: 10.1001/jamaneurol.2017.1133
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