Two unrelated women (“Mrs. A,” age 21, and “Mrs. B,” age 28) had self-referred to a psychiatrist because of zolpidem misuse (10 mg–15 mg per dose, 1–2 times per week) associated with pleasant visual hallucinations. Both Mrs. A and Mrs. B had no personal or family history of psychiatric disorders and did not take any other medications. The subjects were nonsmokers, and occasionally used alcohol and cannabis, but not other drugs of abuse. Neither Mrs. A nor Mrs. B reported any visual abnormalities requiring ophthalmological treatment.
Both women started zolpidem use for sleep-onset insomnia after receiving the drug from a family member. Approximately 30 minutes after the first and successive zolpidem administrations, the subjects experienced florid visual hallucinations lasting 20–30 minutes, and associated with relaxation but not drowsiness. They saw, for example, dwarfs sitting by a fireplace, dancing mascots, a tongue-shaped robot, and ghosts flying around a TV set. Mrs. B often potentiated her sensations by playing video games. Diplopia was experienced by both subjects, and mild agitation with logorrhea was occasionally experienced by the older woman. The subjects were aware that the things they saw were unreal. Neither Mrs. A nor Mrs. B developed zolpidem dependence.