RE: Zolpidem use?
We tend to not recommend any sleeping medications if we can in my country, but Swiss medicine is a bit different, in that we do recognise and recommend "natural" medicines when we find them to be effective, so Baldrian (Valerian) is the go-to choice for getting people to sleep, but I often think it is the brandy that it is suspended in that actually does the job - 40 drops in a little water and off you go, no side effects, unless you are intolerant to the ingredients. I would suggest you try it instead of any sleep meds.
We prescribe Zolpidem sparingly. But then, we prescribe most things sparingly. For a country that is partly based on the pharma industry, we tend to keep the use of them relatively low ( heck, cardio aspirin is restricted and only available under prescription here). Our training is to exhaust all natural methods before resorting to "school" medicine if we can.
Tyrone's point about the rarity of the extreme side effects with most drugs is true - what is included in the actual drug's literature is a pretty good break down of the frequency and severity of the side effects for most, but not all people. Sure there are some horror stories, but it comes down to a lot of different things, from varying body chemistries to problems of non-compliance (our biggest problem in medicine, to be honest) to interactions with other medications, often without the prescribing doctor's knowledge, to unforeseen effects of diet (we only learned about grapefruit's dangers to some medications relatively recently, for instance, and that was after a certain class of drugs were, for years, showing inconsistent results in certain populations, until some doctor in Florida twigged) and so on and so on. Sometimes effects were confused with possible causes, as in some suicides thought to relate to using Prozac - they now have a warning on them that it may increase suicidal feelings, but there is no solid proof of it, rather a suspected causal relationship (which may be muddied by other factors) so as to make the prescribing doctor AND the patient not take the use of Prozac so lightly. Ambien has clear warnings of what to mix it with or not, and if you ignore it, you are your own fool. I have suspected for a very long time that Americans are rather blithe when it comes to taking medicines and it certainly explains many of the horror stories that one hears. But then again, I have never encountered prescription medicines being openly and attractively advertised on television except in the US. I thought it utterly mad.
As for Zolpidem's effects on SA, there is no solid evidence one way or the other - the nature of the drug would suggest that it could increase CA events in some cases, and may create false positives in OA events by depressing the respiration rate, thus making the CPAP machine assume a borderline event via flow limitation, even when there is no actual event. the best way to be sure is to test it for yourself, as it may have an entirely different effect on you than on the next person. The literature holds no clear answers in this regard. My trusty desktop CPA is silent on this, as is Journals In Respiratory Medicine. This does not mean the phenomenon does not exist, only that it has not been documented to the point that it is published. On the whole, though, sleep medicines are a risk of depressing the respiratory process, just as alcohol is, so if you suffer from SA, even when using a CPAP, best to avoid it. And to put it in perspective, since I suffer from hexenschuss often ( a sort of muscle spasm in the back for which i have long since forgotten the English term or the medical term since we use hexenschuss here as a medical term - aren't we Swiss cute?), I regularly must take a muscle relaxant, Sirdalud in combination with Olfen Retard before going to bed, which has a strong combination that in me knocks me out - if I do take it, I always hook up my pulseox with an alarm for desats below 80% for more than 3 seconds, just in case, and because my CPAP will not be able to do enough were that to happen. Luckily, it has happened only once that the alarm was triggered, and it woke me quickly. But even on nights where the alarm was not triggered, the read-out the next day showed a clear increase of desat events and increase in severity, in comparison to normal nights when I have not used the combination of the two drugs.
That is a long winded way of pointing out that you need to be aware of what you are taking, test the dangers reasonably, assemble data from your own use and always use any drugs advisedly and with caution. And of course, don't mix with alcohol or other drugs.