Get Some Sleep: Beware the sleeping pill hangover
June 7th, 2011
04:28 PM ET

Get Some Sleep: Beware the sleeping pill hangover

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She blogs on Tuesdays on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog.

Henry was 80 years old and “tired all the time.” His primary care doc had done a thorough work up. I tested for every sleep disorder known to man and god and found no underlying problem with his sleep quality.

At our initial visit, I had expressed my concern that his hypnotic medication, Clonazepam, could be part of the problem, especially because his dose of 2 mg was rather high for a man his age. He had been reluctant to make any changes to a medication that, from his point of view, had worked so well for him over the years. Now, with all other explanations ruled out, he was ready to try to get off it in order to feel less groggy in the morning.

I tapered him slowly and he had no withdrawal symptoms nor any rebound insomnia. He feels more energetic and less sleepy in the daytime and he only occasionally uses a sleeping aid when he has trouble falling asleep.

This is a scenario that is played out every day in my sleep clinic: the medications that we doctors give to help patients sleep end up making them feel tired and groggy the next day.

Clonazepam (Klonopin) is a common culprit. It belongs to a class of drugs called benzodiazepines. They have been used as sleeping agents for decades. They have many other uses including the treatment of anxiety, seizure and muscle spasm.

In general, these drugs can be very useful sleep aids, but must be used cautiously because they will often cause dependence, tolerance, withdrawal and rebound insomnia if used long enough on a nightly basis. Dependence is fairly self-explanatory and means that a person cannot sleep without the drug. Tolerance means that that the dosage has to be repeatedly increased to achieve the same affect. It is not the same as addiction but is often confused with it.

They can also cause withdrawal which means the emergence of a new set of symptoms that were not present before using the medication. Common withdrawal symptoms include agitation, nausea, sweating and palpitations.

The benzodiazepines can cause rebound insomnia. Rebound insomnia means insomnia that is worse than it was before a patient started the drug. Typically, it lasts only one or two nights.

The problem with Clonazepam in particular is that it has a very long half life. Therefore, it takes a long time to clear the system and its hypnotic and sedating effects can last well into the next day. There can be withdrawal if stopped abruptly, but it is less likely to cause rebound insomnia when compared to shorter-acting benzos.

Besides daytime sedation, any of the benzodiazepines can cause amnesia, sleepwalking and sleep eating. There are studies showing increased fall risk in the elderly, but there is also research showing that untreated insomnia increases falls. There is definite concern that these medications can have multiple deleterious effects in the elderly including memory and cognition problems. As with most medications, the doses should be lower when patients are elderly or have liver or kidney impairment.

For insomnia treatment, it is better to use benzodiazepines that have a medium half life such as lorazepam or temazepam. They will usually help someone get to sleep and stay asleep most of the night without too much hangover effect the next morning.

As with most prescription sleep aids, I recommend intermittent use so that tolerance and withdrawal might be avoided.

Medications such as zolpidem (Ambien) are called non-benzodiazepines but that is misleading because they act on the same GABA benzodiazepine receptors in the brain. They just don’t bind to as many subunits as the traditional benzos which has good and bad effects. One bad effect is that drugs like Ambien have no anti-anxiety properties and most people with insomnia have anxiety either that is fueling the insomnia or as a consequence of the insomnia.

Therefore, if someone has chronic, nightly difficulty falling asleep or staying asleep, I recommend CBT-I (cognitive behavioral therapy for insomnia). As I have discussed in previous posts, it is the safest treatment and actually the most effective one in the long term.

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Filed under: Sleep

soundoff (107 Responses)
  1. Graham Cyster

    Would natural sleep medication clash with Klonopin

    December 12, 2016 at 19:15 | Report abuse | Reply
  2. Nombre

    For anyone still wondering, please stay away from benzodiazepines. The stories are real, the danger is real, the benefits are few and far between. For those suffering and considering benzo treatment, please consider medical marijuana if it is available, or look into a combination of tea and herbs, light excersise in the early daytime and deep breathing. If anxiety comes, remember that even laying there without sleep still helps the body relax and counts for rest. That fact usually helps my brain relax if I can't sleep, and i try to meditate as i lay there to ease into sleep. As many already know, those truly suffering will try anything for relief. Just don't try benzos. They will ruin you.

    January 7, 2017 at 03:24 | Report abuse | Reply
    • cyberclark

      I am 78 years and recently became inflicted with "night terrors" which take the shape of larger purple wheels chasing me or aggressive response to something that turns out to be my headboard when I wake up. Clonazepam is the only thing prescribed by Drs. in Alberta. Apart from my own private circus about 6 hours into my sleep; it spills over to involve me attacking my wife and screaming at her in my sleep which is grossly unfair. I will check my physician on the alternatives mentioned. I think a shorter half-life will improve things.

      April 5, 2018 at 16:44 | Report abuse |
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  11. Kyle H.

    Can't sleep and feel depressed without the meds. I feel addicted. PLEASE RECOMMEND SOMETHING TO ME, WHAT SHOULD I DO.

    February 1, 2018 at 20:04 | Report abuse | Reply
    • C. Compton

      Hello Kyle. I don't know if you have found a resolution to your sleep & depression issues, but I have to take Melatonin for my insomnia, & occasionally I will take an O.T.C. sleep aid of some type. I have now been off all psyche' meds., including Klonopin/Clonazepam, for several months and it wasn't easy, particularly the Klonopin. I have become a bit disillusioned with pharmaceuticals, the synthetic medications because of the adverse reactions & now try to ingest "natural supplements" for my insomnia, but have yet found anything "natural" for any depression or anxiety. Also, please keep in mind, diet plays a huge part, in many disorders, so there is the "gut-mind" related issues to be aware of & beware of. The question I have and will pose to my primary physician is, CAN or DO "natural supplements" become habit-forming, AND can they rob our brain & body of it's own melatonin, other natural chemicals? I hope you have found positive, constructive resolve! Be well & safe & take good care!

      March 22, 2018 at 17:48 | Report abuse |
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    I'm buying cionazepam as it's cheaper
    To buy from the streets . How much is not save to take as I do 5 mil twice a week to sleep .

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  13. Mario

    Eehhh, the pill is good and does not cause insomnia or withdrawal if you do not cover your ass and continue to prescribe.
    What a bunch of hooey you wrote in the article. Booo hooo, it is a benzodiazepine. So what? Yet another brainwashed “doctor” who wants an 80 year old man to go through withdrawal. Get a grip woman.

    March 22, 2018 at 16:19 | Report abuse | Reply
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  15. Barbara

    Taking 0.5 mg. a day nighttime actually. I sleep for 12 hours. Someone could break in and I wouldn’t know it. I was prescribed it for anxiety and seizures. It works well, but so tired in the morning to get up. perscription is 3 clonapam a day, but I only take one a night. I was told if you want to get off clonazapam go slowly...one every other day and work it down until none. Especially for my seizures

    October 3, 2018 at 23:32 | Report abuse | Reply
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