home
RSS
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 (2,091 Responses)
  1. RV Awning Repair Near Me

    bookmarked!!, I love your blog!

    http://www.theringdigital.com/__media__/js/netsoltrademark.php?d=ocrvparts.com

    June 23, 2021 at 11:56 | Report abuse | Reply
  2. tractor supply near me

    Can I simply say what a comfort to discover somebody that truly understands what they're discussing on the net. You definitely realize how to bring an issue to light and make it important. More people need to check this out and understand this side of your story. I can't believe you are not more popular since you most certainly possess the gift.

    http://bestdressed4less.com/__media__/js/netsoltrademark.php?d=masternearme.com/

    June 23, 2021 at 12:40 | Report abuse | Reply
  3. Best RV Repair Shop Near Me

    You have made some decent points there. I checked on the web to find out more about the issue and found most people will go along with your views on this web site.

    https://www.commentdressersondragon.be/notice.php?url=https://ocrvparts.com

    June 23, 2021 at 13:41 | Report abuse | Reply
  4. play zing

    Xem Trực Tiếp Viettel Vs Tỉnh Bình Dương Trên V League 2021 Ở Kênh Nào? gacha life vietnamĐội tuyển chọn nước Việt Nam chỉ cần một kết trái hòa có bàn thắng nhằm lần thứ hai góp mặt trên World Cup futsal. Nhưng, nhằm làm được điều đó

    https://thisisthegreenroom.com/

    June 23, 2021 at 14:23 | Report abuse | Reply
  5. Video Marketing Agency

    http://digitalprintingbeaverton.com/__media__/js/netsoltrademark.php?d=makemoneymommas.com/

    June 23, 2021 at 15:41 | Report abuse | Reply
  6. thethao90

    Thẳng đá Bóng Hôm Nay, Links Xem Soccer Trực Tuyến 24h90 phút.tvTheo thể thức thi đấu, đội thắng ở cặp đấu này sẽ giành tấm vé đến Lithuania vào ngày hội bóng đá lớn nhất thế giới mang đến futsal. Tuyển futsal Việt Nam bước vào trận play-off lượt đi tranh vé dự play-off World Cup 2021 với sự tự tin. Tuy vậy, HLV Phạm Minh Giang bày tỏ, toàn đội không ngán Lebanon tuy nhiên sẽ tìm cách để khắc chế sức mạnh của đối thủ bởi bên trên băng ghế huấn luyện là nhà cầm quân Ramiro Lopez, người từng dẫn dắt futsal Tây Ban Nha.|Dựa vào lịch thi đấu, quý khách có thể sắp xếp việc làm

    https://virandoamor.com/detail/truc-tiep-vtv3hd-44503.html

    June 23, 2021 at 15:55 | Report abuse | Reply
  7. https://topphimhot.net

    Best view i have ever seen !

    http://www.astro.wisc.edu/?URL=https://topphimhot.net

    June 23, 2021 at 15:57 | Report abuse | Reply
  8. RV Glass Repair Near Me

    http://processplus.biz/__media__/js/netsoltrademark.php?d=ocrv.today

    June 23, 2021 at 16:07 | Report abuse | Reply
  9. 24 Hour RV Repair Near Me

    http://www.youneed.com/__media__/js/netsoltrademark.php?d=www.rvmarketingexperts.com

    June 23, 2021 at 17:08 | Report abuse | Reply
  10. Content Marketing Boutique

    This blog was... how do you say it? Relevant!! Finally I've found something which helped me. Appreciate it!

    http://kyonan.net/navi/rank.cgi?mode=link&id=29449&url=https://cdaseo.com

    June 23, 2021 at 17:14 | Report abuse | Reply
  11. RV Generator Repair Near Me

    Your style is really unique in comparison to other folks I have read stuff from. Thank you for posting when you've got the opportunity, Guess I will just book mark this site.

    http://www.edina.com.ec/guia-telefonica/setUrl.ashx?u=https://www.rvmarketingexperts.com

    June 23, 2021 at 17:28 | Report abuse | Reply
  12. trực tiếp k cộng

    Thẳng Bóng Đá Thời Điểm Hôm Nay, Links Coi Soccer Trực Tuyến 24htruyền hình trực tuyến vtv3Theo thể thức thi đấu, đội thắng ở cặp đấu này sẽ giành tấm vé đến Lithuania trong ngày hội bóng đá lớn nhất thế giới đến futsal. Tuyển futsal Việt Nam bước vào trận play-off lượt đi tranh vé dự play-off World Cup 2021 với sự tự tin. Tuy vậy, HLV Phạm Minh Giang bày tỏ, toàn đội không ngán Lebanon song sẽ tìm cách để khắc chế sức mạnh của đối thủ bởi bên trên băng ghế huấn luyện là nhà cầm quân Ramiro Lopez, người từng dẫn dắt futsal Tây Ban Nha.|Dựa vào lịch tranh tài, quý khách hoàn toàn có thể chuẩn bị xếp công việc

    https://rucyprus.net/detail/90-phut-tv-101473.html

    June 23, 2021 at 18:41 | Report abuse | Reply
  13. Content Marketing Agency Near Me

    Everything is very open with a clear clarification of the challenges. It was truly informative. Your website is very helpful. Many thanks for sharing!

    http://nephromine.com/__media__/js/netsoltrademark.php?d=consciousgrowthmarketing.com

    June 23, 2021 at 18:53 | Report abuse | Reply
  14. RV Satellite Repair Near Me

    http://www.minuscript.com/Redirect.aspx?destination=https://www.ocrvmotorsports.biz

    June 23, 2021 at 19:01 | Report abuse | Reply
  15. pharmaceptica

    what is hydroxychloroquine used for arthritis https://pharmaceptica.com/

    June 23, 2021 at 20:30 | Report abuse | Reply
  16. RV Collision Repair Near Me

    http://filmcrewpro.com/__media__/js/netsoltrademark.php?d=ocrv.me

    June 23, 2021 at 20:59 | Report abuse | Reply
  17. vietnamnetdantri

    Coi Thẳng Bóng Đáthvl truc tiepTheo thể thức thi đấu, đội thắng ở cặp đấu này sẽ giành tấm vé đến Lithuania vào ngày hội bóng đá lớn nhất thế giới đến futsal. Tuyển futsal Việt Nam bước vào trận play-off lượt đi tranh vé dự play-off World Cup 2021 với sự tự tin. Tuy vậy, HLV Phạm Minh Giang bày tỏ, toàn đội không ngán Lebanon tuy vậy sẽ tìm cách để khắc chế sức mạnh của đối thủ bởi bên trên băng ghế huấn luyện là nhà cầm quân Ramiro Lopez, người từng dẫn dắt futsal Tây Ban Nha.|Dựa vào lịch tranh tài, bạn có thể sắp xếp làm việc

    https://equinome.com/detail/bet888-truc-tiep-96666.html

    June 23, 2021 at 21:31 | Report abuse | Reply
  18. online casino

    Coi Thẳng Viettel Vs Tỉnh Bình Dương Trên V League 2021 Ở Kênh Nào? galaxy cinema hải phòngĐội tuyển chọn futsal nước Việt Nam đã có một trận đấu chấp nhận được trước đối thủ cạnh tranh đầy sức mạnh Lebanon. Kết trái Bà Rịa-Vũng Tàu vs Bình Phước ngày hôm nay 18h00 ngày 5/5, Hạng nhất nước ta.

    https://thisisthegreenroom.com/

    June 23, 2021 at 21:59 | Report abuse | Reply
  19. kèo nhà cái chấm net

    Thẳng Soccer Ngày Hôm Nay, Link Coi Soccer Trực Tuyến 24h keo nha cai hom nayĐội tuyển chọn futsal Việt Nam đã có một trận đấu chấp nhận được trước đối thủ cạnh tranh đầy sức mạnh Lebanon. Kết quả Bà Rịa-Vũng Tàu vs Bình Phước thời điểm hôm nay 18h00 ngày 5/5, Hạng nhất Việt Nam.

    https://naija5.com/

    June 23, 2021 at 22:01 | Report abuse | Reply
  20. Google Marketing Agencies

    An outstanding share! I have just forwarded this onto a colleague who had been conducting a little homework on this. And he in fact ordered me breakfast because I found it for him... lol. So let me reword this.... Thank YOU for the meal!! But yeah, thanks for spending time to discuss this topic here on your blog.

    http://www.levring.biz/__media__/js/netsoltrademark.php?d=www.internetmarketingwashington.com

    June 23, 2021 at 23:05 | Report abuse | Reply
  21. sherwin williams near me

    http://www.chinashoes.com/Trade_News/SendThisPageToFrind.aspx?TLE=u62DB:u6837u7248u5E08&URL=http://www.bestshopnearme.com

    June 23, 2021 at 23:15 | Report abuse | Reply
  22. Digital Marketing Consultants

    I absolutely love your website.. Excellent colors & theme. Did you build this website yourself? Please reply back as Iím planning to create my very own site and would love to find out where you got this from or what the theme is named. Kudos!

    https://italfarmaco.ru/bitrix/rk.php?goto=http://lifeboosterpack.com/

    June 23, 2021 at 23:23 | Report abuse | Reply
  23. RV Camper Repair Near Me

    When I initially left a comment I seem to have clicked the -Notify me when new comments are added- checkbox and now whenever a comment is added I recieve four emails with the exact same comment. There has to be a means you can remove me from that service? Thanks a lot!

    http://bar-b-cueparts.com/__media__/js/netsoltrademark.php?d=ocrvart.com

    June 23, 2021 at 23:49 | Report abuse | Reply
  24. Digital Marketing Agency Near Me

    Can I simply say what a relief to discover somebody that genuinely knows what they are discussing on the net. You certainly understand how to bring a problem to light and make it important. A lot more people must read this and understand this side of your story. I was surprised you aren't more popular given that you definitely have the gift.

    http://www.rivieratoscana.com/gen/inc/redir.asp?url=https://postfallsbootcamp.com/

    June 23, 2021 at 23:54 | Report abuse | Reply
  25. Google Marketing Services

    http://tcbox.com/__media__/js/netsoltrademark.php?d=internetmarketingwashington.com

    June 24, 2021 at 00:23 | Report abuse | Reply
  26. lich phat song vtc4

    Trực Tiếp Soccer Việt Nam Vs Lebanon. Coi Truc Tiep Bong Da. Futsal Việt Namvao roi tvĐây có lẽ là ngôi trường hợp “của đi thay cho người" khá như ý đối cùng với Ben McLemore. Thiếu chút nữa tay ném của Los Angeles Lakers đã có được thể bắt gặp tai nạn nguy hiểm. Cập nhật kết quả trận nước ta vs Lebanon nằm trong play-off vòng loại Futsal World Cup 2021.

    https://murraystivoli.com/detail/the-vang-tv-21311.html

    June 24, 2021 at 01:01 | Report abuse | Reply
  27. RV Collision Repair Near Me

    https://www.triathlon.org/?URL=http://ocrv.biz/

    June 24, 2021 at 01:58 | Report abuse | Reply
  28. ถ่ายทอด สด หวย ลาว วัน นี้

    Paragraph writing is also a excitement, if you be acquainted with then you can write otherwise it is complex to write.

    June 24, 2021 at 02:04 | Report abuse | Reply
  29. Content Marketing Boutique

    May I simply say what a relief to uncover somebody who truly knows what they are discussing on the internet. You definitely understand how to bring a problem to light and make it important. A lot more people should read this and understand this side of your story. I was surprised you aren't more popular because you most certainly possess the gift.

    http://www.orphus.ru/redir.php?https://postfallslocal.com/

    June 24, 2021 at 02:36 | Report abuse | Reply
  30. RV Repair Centers Near Me

    http://www.riversideca.org/__media__/js/netsoltrademark.php?d=ocrv.today

    June 24, 2021 at 02:39 | Report abuse | Reply
  31. RV Awning Repair Near Me

    Oh my goodness! Amazing article dude! Thank you so much, However I am experiencing difficulties with your RSS. I donít understand the reason why I am unable to join it. Is there anybody else getting similar RSS issues? Anyone that knows the answer will you kindly respond? Thanx!!

    http://suzuki.saikyou.biz/rank.cgi?mode=link&id=5&url=https://ocrvshop.com/

    June 24, 2021 at 02:59 | Report abuse | Reply
  32. RV Repair Near Me

    Very good write-up. I absolutely appreciate this website. Continue the good work!

    http://tinyrul.com/__media__/js/netsoltrademark.php?d=ocrvcenter.biz

    June 24, 2021 at 03:08 | Report abuse | Reply
  33. vape shops near me

    Wonderful article! We are linking to this particularly great article on our site. Keep up the good writing.

    http://kacsantim.com/__media__/js/netsoltrademark.php?d=quotenearme.com

    June 24, 2021 at 03:35 | Report abuse | Reply
  34. full time jobs near me

    http://job-application-online.com/__media__/js/netsoltrademark.php?d=quotenearme.com

    June 24, 2021 at 04:24 | Report abuse | Reply
  35. RV Roof Repair Service Near Me

    http://www.sunselectcompany.com/__media__/js/netsoltrademark.php?d=ocrvmotorsports.us

    June 24, 2021 at 07:03 | Report abuse | Reply
  36. Internet Marketing Service

    http://elsadat.com/__media__/js/netsoltrademark.php?d=boosterpackforlife.com

    June 24, 2021 at 07:31 | Report abuse | Reply
  37. truyen hinh truc tuyen thvl1

    Kết Quả Futsal Việt Nam Vs LebanonxoitvTheo thể thức thi đấu, đội thắng ở cặp đấu này sẽ giành tấm vé đến Lithuania vào ngày hội bóng đá lớn nhất thế giới đến futsal. Tuyển futsal Việt Nam bước vào trận play-off lượt đi tranh vé dự play-off World Cup 2021 với sự tự tin. Tuy vậy, HLV Phạm Minh Giang bày tỏ, toàn đội ko ngán Lebanon tuy nhiên sẽ tìm cách để khắc chế sức mạnh của đối thủ bởi bên trên băng ghế huấn luyện là nhà cầm quân Ramiro Lopez, người từng dẫn dắt futsal Tây Ban Nha.|Dựa vào lịch thi đấu, bạn rất có thể chuẩn bị xếp làm việc

    https://virandoamor.com/detail/xem-bongda-liverpool-vs-everton-118314.html

    June 24, 2021 at 08:53 | Report abuse | Reply
  38. RV Repair Service Near Me

    http://mypracticepartner.com/__media__/js/netsoltrademark.php?d=ocrvshop.com

    June 24, 2021 at 09:20 | Report abuse | Reply
  39. RV Water Repair Man Near Me

    You need to be a part of a contest for one of the finest sites on the net. I will highly recommend this website!

    https://www.anonymz.com/?https://www.ocrvmotorcoaches.com

    June 24, 2021 at 09:37 | Report abuse | Reply
  40. RV Brake Repair Near Me

    http://dopravci.eu/bannerclick.asp?menu=136&record=3639&lang=1&url=https://ocrv.us

    June 24, 2021 at 13:03 | Report abuse | Reply
  41. RV Electrical Repair Near Me

    https://www.wwx.tw/debug/frm-s/ocrvcenter.com

    June 24, 2021 at 13:19 | Report abuse | Reply
  42. RV Repair Shops Near My Location

    https://soom.cz/projects/get2mail/redir.php?id=c2e52da9ad&url=http://www.ocrvcenter.com

    June 24, 2021 at 13:43 | Report abuse | Reply
  43. RV Repair Garden Grove

    https://www.putclub.com/link.php?url=ocrvcenter.com

    June 24, 2021 at 13:50 | Report abuse | Reply
  44. RV Repair And Service Near Me

    Itís nearly impossible to find experienced people in this particular topic, however, you sound like you know what youíre talking about! Thanks

    https://workcircle.com/adclick.php?bannerid=135&zoneid=48&source=&dest=ocrvcenter.com/

    June 24, 2021 at 14:17 | Report abuse | Reply
  45. RV Repair Near Me

    Having read this I thought it was rather enlightening. I appreciate you taking the time and energy to put this content together. I once again find myself personally spending way too much time both reading and posting comments. But so what, it was still worth it!

    https://www.wikimapia.org/external_link?url=http://ocrvcenter.com

    June 24, 2021 at 14:49 | Report abuse | Reply
  46. bong da gh

    Tỷ Số Bóng Đá Trực Tuyến Thời Điểm Hôm Naytivi101Theo thể thức thi đấu, đội thắng ở cặp đấu này sẽ giành tấm vé đến Lithuania trong ngày hội bóng đá lớn nhất thế giới đến futsal. Tuyển futsal Việt Nam bước vào trận play-off lượt đi tranh vé dự play-off World Cup 2021 với sự tự tin. Tuy vậy, HLV Phạm Minh Giang bày tỏ, toàn đội không ngán Lebanon tuy nhiên sẽ tìm cách để khắc chế sức mạnh của đối thủ bởi bên trên băng ghế huấn luyện là nhà cầm quân Ramiro Lopez, người từng dẫn dắt futsal Tây Ban Nha.|Dựa vào lịch thi đấu, bạn hoàn toàn có thể chuẩn bị xếp công việc

    https://arubaeducation.info/detail/fpt-play-vtv6-topsoikeo-129541.html

    June 24, 2021 at 15:17 | Report abuse | Reply
  47. RV Fridge Repair Near Me

    http://www.sunlife.jp/cgi-bin/click3.cgi?cnt=shukatsutext&url=https://www.ocrvcenter.com/

    June 24, 2021 at 15:22 | Report abuse | Reply
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41

Leave a Reply to SocialMedia Services2021


 

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.

Advertisement
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.