Driving while sleeping

Via the Fort Worth Star Telegram:

FDA says pills can cause ‘sleep-driving’

by LAURAN NEERGAARD

AP Medical Writer

All prescription sleeping pills may sometimes cause sleep-driving, federal health officials warned Wednesday, almost a year after the bizarre side effect first made headlines when Rep. Patrick Kennedy crashed his car after taking Ambien.

It’s a more complicated version of sleepwalking, but behind the wheel: getting up in the middle of the night and going for a drive – with no memory of doing so.

The Food and Drug Administration wouldn’t say exactly how many cases of sleep-driving it had linked to insomnia drugs, but neurology chief Dr. Russell Katz said the agency uncovered more than a dozen reports – and is worried that more are going uncounted.

Given the millions of prescriptions for insomnia drugs, Katz called the problem rare, and said he was unaware of any deaths…

I had a sleep-driving case, within the last six months or so (some details are changed).  The actual patient care was ho-hum, but the story is interesting.

An adult male patient came to the attention of firemen when he fell asleep on the horn in front of their fire station.  At about 3AM.  The firefighters found a patient who would arouse but then go directly back to sleep.  He’d answer his name, but that was about it.  No smell of alcohol, no drug paraphernalia present.

Notable was his car: the left front wheel had no tire, but no other major or even minor damage to the car.  There was a groove in the pavement made by the wheel and the PD, thinking maybe they could find his origin, followed the groove.  They returned after a bit stating it went for miles, and had no idea how long he’d been driving on the one rim.  They surmised he’d hit something while driving, blew out the left front, then drove on the shredded tire until it fell off, then a while longer, fortuitously stopping at a fire station.

EMS reported normal vitals on arrival to the hospital and we had to go through the story several times, as usually an altered patient from a vehicle with virtually any damage gets a big trauma workup, but there was no evidence of damage (except the missing tire).

The physical exam clinched the ‘tox’ thing for me, though at the time we had no idea what.  Normal vitals, pulse-ox, blood sugar.  Normal exam except when asked questions you’d get the right answer, then a volunteered answer you didn’t expect: “I’m Jim Jones,…my service number is xxxxxx…..and my Sergeant is…” followed by sleep.  As he was well beyond military service age, this kind of answer seemed odd.  As time progressed, the arousable periods got slowly longer, and we got a phone number.

A number which clinched the diagnosis, as it produced a spouse with a new pill bottle for the patient.  She hadn’t been aware he was missing, and was more than a little startled at the events.  Yes, the (sleeping pill*) was fairly new, no he’d never had a sleepwalking history she knew of, etc.  Several hours he awakened with no ill effects and went home.  Not an exciting case, but after a few years in EM you enjoy the cases where patients don’t die and it’s a little interesting.

 

So, my recommendation is to have somebody hide your keys when you take the sleeping pills, but that’s just me*.

 

*Not actual medical or legal advice, no actual product is mentioned or implied.  Your mileage may vary, void where prohibited, and thank a lawyer if you read crap like little tiny asterisked text.


Comments

  1. I was a recent recipient of an Ambien CR induced phone call. It was my aunt. Phone calls at 2am get my and when I answered, she mumbled something about “the roses” to me. I got my uncle on his cell phone via my cell phone while talking to her fearing an significant health problem.
    He said she was on new sleeping meds. It shook the hell out of me!

  2. NoAcuteDistress says:

    A surgical tech of ours described how she’d taken an Ambien the night before, and how her hsuband was impressed by her “amorous ways” that night. She couldn’t remember a thing about the evening, but did note that it was a bit uncomfortable to sit the following day.

  3. Type-B Premed says:

    The above grammar mistakes can not be blamed on medication. Grrr.

  4. Goatwhacker says:

    I’ve had 3 patients so far who have experienced eating while asleep on Ambien, plus a few others with strange behaviors. This is some funky stuff and I’ve been shying away from prescribing it.

  5. That’s scary, and I had no idea that this kind of stuff could happen as a med side effect. I thought that such things might only happen if the person drank ETOH or used other pills on top of the Ambien. Well, that takes care of that idea, then—because I’ve been having worsening bouts of insomnia lately and I was tempted to ask the doc for something to help me with it. I’ve used Ambien in the past before without problems…but then again…maybe I just don’t remember what happened, yikes!

  6. Our neighbor didn’t do any sleep driving, but he did get up at 11:30 PM and tried to mow his lawn. Thankfully he ran out of gas in the mower and his wife was able to get him back in the house. Did I forget to mention he was out there in his underwear and barefoot.

    He no longer takes Ambien CR, and his wife hides the car keys and locks the garage door so it doesn’t hapen again.

    With so many prescriptions out there and obesity on the rise, There is proably more sleep eating going on than reported.

  7. Now do benzos cause this too? In the past, I have taken klonopin, ativan, and serax for sleep – now I just use serax prn on the really bad nights when the clusters don’t stop – but I never did anything in my sleep that I know of! I have plms in my sleep though, and I have had comments from an exboyfriend about how I have accidentally punched him in the face during my sleep on more than a few occasions – which startled the hell out of him! I always feel bad when I hear that, but I never remember it. Maybe it’s some serious subconscious anger issues against my exboyfriend. lol I do tend to be a very restless sleeper.

    My brother is a sleep-talker. He has entire conversations in his sleep and doesn’t remember them the next day. It’s pretty hilarious.

    Ambien and the like never touched my insomnia problems when I tried them…granted, this was during my first few hospital stays and never at more than the lowest doses.

    I will say something about melatonin and sleep. I know a LOT of people who take melatonin at night because it’s considered a cluster preventative – not sure if it actually prevents the cluster attacks or if you just sleep through them…which would seem unlikely, given the nature of cluster headaches, but if you’re knocked out well enough, then I suppose it’s possible! At any rate – I know people who had to come off of melatonin because of how awful their dreams became. They started having night terrors – one friend dreamed of nothing but spiders. Hearing the accounts of the dreams that people were having on that stuff really was somewhat interesting! Very vivid dreams… Must be a known thing about melatonin – and hence the remelteon (rozerem) comercials for “You’re dreams miss you.”

    This past week I have had extremely vivid dreams – and on and off, I do have very strong dreams, but this is pretty consistently every night. Not taking any sleep aids, but I did just re-start domperidone. Wouldn’t think that would cause any dream side-effects, but now I’m kind of curious!

    I love stuff like this….

    And your patient story is interesting. It’s kinda like getting the opportunity to be a Sherlock Holmes from time to time, isn’t it? Glad he wasn’t hurt!! I’ve heard similar stories, and it’s amazing how far people can drive while sleeping and not be injured…!

    Take care,
    Carrie :)

  8. My ex was pulling night callout at the clinical lab at the little local hospital years ago. She had been taking Halcyon for sleep problems and had absent-mindedly taken her dose (maybe even two) before turning in. Of course, she was paged out by phone a couple of hours later. About a half hour later the phone rang- police had found her car at the end of the road adjacent to the hospital and it was atop the bent remains of a basketball goal just short of the front of a house. She’d failed to stop at the T-intersection with a stop sign, continued across the opposite curb and over the 3 foot high landscape crossties, became airborn and hit the bb goal at about 5 feet above ground. Bent it over and fouled the underside of the car on the backboard. The car was suspended at about 4 feet off the ground, still running. She’d gotten out and walked the 2 blocks to the hospital and was sitting in the lab when the police tracked her down.

    And to this day she doens’t remember a thing.

  9. The tiny asterisked text at the bottom should be the healthcare bloggers’ creed. May I please have your permission to add it to my blog posts? The cynicism is pitch perfect, and I may add just a wee bit about JCAHO, too. ;^)

  10. But of course, though I’d like credit.

  11. Hey N=1, did you know that JCAHO no longer wants to be referred to as “JayCo” – they now want to be referred to as the “Joint Commission”? Our manager told us this in a staff meeting not all that long ago. What will they think up next? ;)

  12. ian henry says:

    i bet this was zopiclone. have seen this before in a lady who drove from london to nottingham (2+hrs, motorways) before remming oun in a crossroad.

  13. Ian,

    You just made me smile with that comment. I’ve only been to England once – this past September – to stay with a friend of mine. She lived in Nottingham (Bingham), and we traveled over 2000 miles together in 8 days, including 2 trips to London and back. :) So now after reading what you wrote, I can picture the drive. I miss it!

    Take care,
    Carrie :)

  14. A couple of years ago I was hospitalized for a week after passing out in my car while driving. I was taking Ambien at the time. After two more incidences where I was having problems that left me in the hospital, I fired the doctor who prescribed it and quit taking the drug. I haven’t had any problems since.

  15. Erica Austria says:

    What a great blog, made me laugh out loud several times. And having just been prescribed Halcyon by my Persian Professor for menopausally induced insomnia, maybe I should not laugh. But after a week of being spiked, poked, prodded and pricked, believe me, I need a laugh.

    I have Melatonin too. Bought at a health food shop but so far, untried.

    The sleep med which caused the amorous wife with sitting difficulties may be the answer, as I am finding it hard to keep up with my much younger husband in that department. Worth a try I guess.

    Fortunately I don’t drive.

  16. @medskep my ambien patient. http://t.co/Cer4Dy0Bxi