An Ambien amnesia presidency

So what exactly is going on with John McCain’s health? John posted yesterday about McCain’s “energy” drink and mentioned that McCain was taking Ambien. McCain’s Ambien drug use isn’t new, it’s been covered by ABC News here, but in the flurry of the Democratic primary, I missed it. Reading it yesterday for the first time, my jaw dropped.

While Ambien is a heavily advertised drug here in the US – $200 million annually in ad spending – it’s extremely potent and has the potential to be addictive. That’s why it’s a D.E.A. Schedule IV controlled substance.

In addition to the addictive qualities, Ambien has a rather bizarre and frightening potential side effect if you take the drug and don’t quickly fall asleep for eight hours – you’re physically awake up but your conscious mind doesn’t know it (and everyone around you will think you’re actually awake when you really aren’t). It’s somewhat akin to sleepwalking. The effects are so striking that in 2007 the FDA required a relabeling (Official Sanofi-Aventis PDF):

A variety of abnormal thinking and behavior changes have been reported to occur in association with the use of sedative-hypnotics. Some of these changes may be characterized by decreased inhibition (e.g., aggressiveness and extroversion that seemed out of character), similar to effects produced by alcohol and other CNS depressants. Visual and auditory hallucinations have been reported as well as behavioral changes such as bizarre behavior, agitation, and depersonalization. Complex behaviors such as “sleep-driving”(i.e., driving while not fully awake after ingestion of a sedative-hypnotic, with amnesia for the event) have been reported. These events can occur in sedative- hypnotic- naive as well as in sedative-hypnotic-experienced persons. Although behaviors such as” sleep-driving” may occur with Ambien alone at therapeutic doses, the use of alcohol and other CNS depressants with Ambien appears to increase the risk of such behaviors, as does the use of Ambien at doses exceeding the maximum recommended dose. Due to the risk to the patient and the community, discontinuation of Ambien should be strongly considered for patients who report a “sleep-driving” episode. Other complex behaviors (e.g., preparing and eating food, making phone calls, or having sex) have been reported in patients who are not fully awake after taking a sedative-hypnotic. As with “sleep-driving”, patients usually do not remember these events. (italics and bold my highlights)

And that’s how they explained it to doctors – amnesia and “complex behaviors.” Here’s how they explain it to patients, in English. Again, from Sanofi-Aventis:

Changes in Behavior and Thinking

Some people using sleep medicines have experienced unusual changes in their thinking and/or behavior. These side effects are not common. However, they have included:

  • more outgoing or aggressive behavior than normal
  • confusion
  • strange behavior
  • agitation
  • hallucinations
  • worsening of depression
  • suicidal thoughts

How often these side effects occur depends on several factors, such as a person’s general health, the use of other medicines, and which sleep medicine is being used.

Any of that sound familiar? Erratic? Angry? Confusion? These aren’t just sleepwalking behaviors, these are behaviors that Ambien reportedly might imbue on someone while awake.

In looking back into this story, I found a great compilation of McCain’s “Dazed and Confused” moments via TPM:

[youtube=http://www.youtube.com/watch?v=iWX5u69hmzY]

This isn’t happening once and while, it just goes on, and on, and on. And this video is two months old. There have been more slip-ups since that time. Now, I’m not suggesting that John McCain is sleepwalking through the debates. I am concerned, however, that he is exhibiting many of the symptoms of someone suffering from Ambien’s worst possible side effects. Side effects that are very dangerous for a president.

So why does McCain taking Ambien matter? Lots of people take sleeping medication. It’s prescribed by a doctor, so it must be okay.

Sure, but lots of people don’t have to worry about being drugged up on Ambien and getting a call at 3AM that affects the lives of 300+ million people. Perhaps McCain’s erratic behavior of late is simply because it’s hard to get a good eight hours of sleep when you’re running for President. Just like it’s going to be hard for him to not always be worn out were he to become President. But that’s why 72 year olds don’t usually run for the presidency. It’s an impossibly difficult, strenuous, energy-sapping job. The capacity to do the job and not be drugged up is a legitimate factor in determining whether someone is qualified to be President.

The impact on McCain’s less-than-stellar personal constitution is substantial. From the earlier ABC News story:

“Ambien should only be taken when you have a window of seven to eight hours for sleep,” Greenblatt said. “Your staff should know that you’ve taken the medication, and that you should not be involved in any decision-making during that time.”

Fotinakes added that sleeping pills and other sedatives have been proven to be more potent in the elderly. In light of this, he said, “It may not be the best idea for the commander-in-chief to be under the influence when he or she may have to make a snap decision regarding national security in the middle of the night; Hillary’s so-called telephone call at 3:00 a.m.”

“The key is to use Ambien-like sleeping medications in moderation and don’t mix them with other sedative drugs or alcohol,” Fotinakes said. “Most importantly, avoid use in the event you have to consider escalation from Defcon 4 to Defcon 3.”

Does that mean, if elected President, McCain is truly checked out and inaccessible eight hours a day – even if an emergency hits after his 10pm bedtime? What happens if that phone rings at 3AM? Is McCain going to pick it up in a Ambien haze and bomb bomb bomb Iran, not even remembering what he did in the morning?

Again, this isn’t a joke. This is what Ambien does to some people. It makes them do things, while having no idea they’re doing them. They tell you not to drive a car after having taken this drug. How is John McCain going to drive a country? To accept the former as fact, yet not worry about the latter, is illogical and dangerous.

And if John McCain won’t be answering the phone from dusk until dawn, who will? Cindy (a-la Edith and Woodrow Wilson)? Sarah Palin? Who will really be in charge for the 1/3 of the Presidency McCain would sleep away?

More disturbingly, in a crisis, how is the White House staff supposed to know if the President is truly aware of what’s going on or not? Whether he’s under an
Ambien haze or truly himself? I’ve had a couple of experiences with people in exactly this situation, under the influence of sleeping pills, and the reality is you can’t tell that they’re under the influence. I’ve had a face-to-face conversation with someone who had taken Ambien and not fallen asleep – the next day they didn’t remember any of the hour long discussion. The scary part? I had no idea that I was speaking to someone who wasn’t fully conscious. To me, it was like having a regular conversation and I had no idea the person across from me was completely out of it. The prospect of a President “sleep-driving” the country on Ambien is terrifying.

That this hasn’t been an enormous issue since the Palin appointment is shocking. It’s why Presidential candidates let reporters see their medical records – so the country knows what to expect if the candidate becomes President. If all of this hasn’t yet scared you into thinking that McCain’s medical records need a REAL exploration, ponder this – do you think that terrorists or other national enemies might want to strike us while the President is incapacitated by his sleeping pills?

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