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.

Post by:
Filed under: Sleep

soundoff (468 Responses)
  1. notebook and pen

    It's a shame you don't have a donate button! I'd certainly donate
    to this brilliant blog! I suppose for now i'll settle for bookmarking and adding
    your Feed to my Google account. I enjoy new updates and will discuss this site with my Facebook group.
    Chat soon!

    my site: notebook and pen

    February 24, 2021 at 10:50 | Report abuse | Reply
  2. calendar stickers

    My family all the time claim that I am just killing my time here at web, but
    I know I am getting familiarity everyday by reading such pleasant articles.

    Look into my site: calendar stickers

    February 25, 2021 at 07:44 | Report abuse | Reply
  3. BonusLikes Social Likes

    With the whole thing which seems to be building inside this particular subject matter, all your viewpoints happen to be very refreshing. Even so, I am sorry, but I do not subscribe to your whole suggestion, all be it refreshing none the less. It looks to me that your remarks are not entirely justified and in simple fact you are yourself not wholly confident of the argument. In any event I did take pleasure in examining it.


    February 26, 2021 at 04:14 | Report abuse | Reply
  4. Cheap Twitter Likes

    At this time it sounds like Drupal is the top blogging platform available right now. (from what I've read) Is that what you're using on your blog?


    February 26, 2021 at 11:38 | Report abuse | Reply
  5. FjjuZisse

    buy generic 100mg viagra online http://viagraonlinejc.com/ viagra for sale ebay

    February 26, 2021 at 19:27 | Report abuse | Reply
  6. NbmoZisse

    how does cialis work cialis windsor canada cialis price at walmart

    February 27, 2021 at 08:24 | Report abuse | Reply
  7. Cukrzyca

    Fantastyczny tekst Brawo! szczegolnie spodobala mi sie szata graficzna twojego bloga 🙂 zapraszam do siebie...


    February 28, 2021 at 01:27 | Report abuse | Reply
  8. KndnMile

    viagra or cialis get viagra online viagra usage

    February 28, 2021 at 11:18 | Report abuse | Reply
  9. ClarkTauts

    dy6mn p8k8w at2o

    February 28, 2021 at 18:12 | Report abuse | Reply
  10. ClarkTauts

    x40pv 5x9mm kkpm

    February 28, 2021 at 19:41 | Report abuse | Reply
  11. ClarkTauts

    9bmx9 nt3iv f9xa

    February 28, 2021 at 23:18 | Report abuse | Reply
  12. Hipoglikemia Znaczenie

    Hello, could I reference some of the content from this post if I provide a link back to your site? Cu


    February 28, 2021 at 23:49 | Report abuse | Reply
  13. Cukrzyca News

    Thats a very good feedback. Wondering what you think of its implication on society as a whole though? There are times when things like this begin to have global expansion and frustration. Ill be around soon to check out your response.


    March 1, 2021 at 00:28 | Report abuse | Reply
  14. ClarkTauts

    3yf29 z1lkm ibns

    March 2, 2021 at 01:35 | Report abuse | Reply
  15. Rodolfo Payano

    Hey, I think your blog might be having browser compatibility issues. When I look at your website in Safari, it looks fine but when opening in Internet Explorer, it has some overlapping. I just wanted to give you a quick heads up! Other then that, awesome blog!


    March 2, 2021 at 07:03 | Report abuse | Reply
  16. chic sparrow sidekick

    Very shortly this web site will be famous among all blogging and
    site-building viewers, due to it's nice articles or reviews

    My site chic sparrow sidekick

    March 2, 2021 at 08:29 | Report abuse | Reply
  17. wallet with notebook

    We are a gaggle of volunteers and starting a
    completely new scheme in your community. Your site offered us with helpful info
    to function on. You've performed an impressive activity and our entire
    group shall be thankful to you personally.

    My homepage wallet with notebook

    March 3, 2021 at 03:39 | Report abuse | Reply
  18. Pablo Brodnex


    March 4, 2021 at 09:42 | Report abuse | Reply
  19. Marlin Darvin


    March 4, 2021 at 10:16 | Report abuse | Reply
  20. Jeanne Nieves

    You are my inhalation, I have few web logs and rarely run out from post :). "No opera plot can be sensible, for people do not sing when they are feeling sensible." by W. H. Auden.


    March 4, 2021 at 10:22 | Report abuse | Reply
  21. anxiety pill

    This piece of writing is actually a pleasant one it assists new web viewers, who are wishing in favor of blogging.

    My web page ... anxiety pill

    March 5, 2021 at 13:40 | Report abuse | Reply
  22. Nardil Champion

    Nardil is way more effective than SSRI anti-depressants in treating social anxiety and depression.


    March 6, 2021 at 11:33 | Report abuse | Reply
  23. Jillian Threets

    whoah this blog is excellent i love studying your posts. Stay up the great work! You already know, a lot of people are hunting around for this information, you could help them greatly.


    March 6, 2021 at 14:13 | Report abuse | Reply
  24. weight loss supplements

    Good post and right to the point. I am not sure if this is
    really the best place to ask but do you people have any ideea where to employ some professional writers?

    Thanks in advance 🙂

    my site ... weight loss supplements

    March 6, 2021 at 20:44 | Report abuse | Reply
1 2 3 4 5 6 7 8 9

Leave a Reply to Hairstyles


CNN welcomes a lively and courteous discussion as long as you follow the Rules of Conduct set forth in our Terms of Service. Comments are not pre-screened before they post. You agree that anything you post may be used, along with your name and profile picture, in accordance with our Privacy Policy and the license you have granted pursuant to our Terms of Service.

About this blog

Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.