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 (1,966 Responses)
  1. trực tiếp bóng đá nhà cái

    Xem Trực Tiếp Viettel Vs Tỉnh Bình Dương Trên V League 2021 Ở Kênh Nào? cờ tướng zingplayĐội tuyển chọn futsal nước ta đã có được một trận đấu đồng ý được trước phe đối lập đầy mức độ mạnh Lebanon. Kết trái Bà Rịa-Vũng Tàu vs Bình Phước ngày hôm nay 18h00 ngày 5/5, Hạng nhất Việt Nam.

    https://novelinkblog.com/

    June 20, 2021 at 21:36 | Report abuse | Reply
  2. Felisa Aldred

    Oh my goodness! Incredible article dude! Thanks, However I am going through difficulties with your RSS. I donít know the reason why I am unable to subscribe to it. Is there anybody else getting identical RSS problems? Anyone who knows the solution will you kindly respond? Thanks!!

    https://www.pichak.net/verification/index.php?n=39&url=http://www.maseratis.net

    June 20, 2021 at 21:37 | Report abuse | Reply
  3. medical supply store near me

    http://lolayoung.com/out.php?https://reviewnearme.com

    June 20, 2021 at 22:27 | Report abuse | Reply
  4. pharmaceptica

    tadalafil citrate powder https://pharmaceptica.com/

    June 21, 2021 at 00:14 | Report abuse | Reply
  5. rv rentals near me

    Way cool! Some extremely valid points! I appreciate you penning this post plus the rest of the site is also very good.

    http://www.shoppasmaterialhandling.net/__media__/js/netsoltrademark.php?d=bestservicenearme.com

    June 21, 2021 at 00:47 | Report abuse | Reply
  6. RV Repair Near My Location

    Iím amazed, I have to admit. Seldom do I encounter a blog thatís both educative and interesting, and let me tell you, you've hit the nail on the head. The problem is an issue that not enough people are speaking intelligently about. Now i'm very happy that I found this in my search for something regarding this.

    http://www.geezergizmos.com/__media__/js/netsoltrademark.php?d=ocrvcenter.com

    June 21, 2021 at 01:07 | Report abuse | Reply
  7. xem vtv6 hd truc tuyen

    Tỷ Số Soccer Trực Tuyến Thời Điểm Hôm Naybangthang.tvTheo 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 ko 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, quý khách rất có thể chuẩn bị xếp công việc

    https://virandoamor.com/detail/truc-tiep-vietnam-vs-curacao-27228.html

    June 21, 2021 at 01:53 | Report abuse | Reply
  8. petco near me

    http://www.dekirunavi.net/rd.asp?url=http://www.bulknearme.com

    June 21, 2021 at 03:17 | Report abuse | Reply
  9. camping near me

    Very good post. I am dealing with a few of these issues as well..

    http://www.bollywoodgupshup.com/__media__/js/netsoltrademark.php?d=reviewnearme.com

    June 21, 2021 at 03:31 | Report abuse | Reply
  10. bài

    Xoilac Tv Thẳng đá Bóng ca cuoc 365Đội tuyển chọn Việt Nam chỉ cần một kết trái hòa có bàn thắng nhằm lần loại hai góp mặt trên World Cup futsal. Nhưng, để thực hiện được như vậy

    https://thisisthegreenroom.com/

    June 21, 2021 at 03:39 | Report abuse | Reply
  11. RV Repair Huntington Beach

    Good information. Lucky me I ran across your blog by chance (stumbleupon). I have saved it for later!

    http://www.deanspotter.com/__media__/js/netsoltrademark.php?d=ocrvcenter.com

    June 21, 2021 at 03:42 | Report abuse | Reply
  12. in n out near me

    http://toughmudder.ch/__media__/js/netsoltrademark.php?d=nearmyspot.com

    June 21, 2021 at 05:07 | Report abuse | Reply
  13. chiropractic near me

    Aw, this was an extremely good post. Finding the time and actual effort to produce a very good articleÖ but what can I sayÖ I put things off a lot and never seem to get nearly anything done.

    http://xiuang.tw/debug/frm-s/bestservicenearme.com/cotyledon/cotyledon-p.php

    June 21, 2021 at 05:49 | Report abuse | Reply
  14. RV Repair

    Pretty! This was a really wonderful post. Thanks for providing this info.

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

    June 21, 2021 at 06:31 | Report abuse | Reply
  15. Isidra Slice

    How can I copyright the material on my website, content, images and all?

    https://www.linkedin.com/in/kmkowalsky/

    June 21, 2021 at 07:14 | Report abuse | Reply
  16. culver's near me

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

    June 21, 2021 at 08:15 | Report abuse | Reply
  17. gyms near me

    http://www.elysee.com/__media__/js/netsoltrademark.php?d=bestshopnearme.com

    June 21, 2021 at 08:27 | Report abuse | Reply
  18. RV Repair Shops Nearby

    http://www.australia8.com/__media__/js/netsoltrademark.php?d=ocrvcenter.com

    June 21, 2021 at 08:34 | Report abuse | Reply
  19. Nearby RV Repair

    Good article. I definitely love this website. Stick with it!

    http://4ts.a2zhousing.com/__media__/js/netsoltrademark.php?d=ocrvcenter.com

    June 21, 2021 at 08:43 | Report abuse | Reply
  20. RV Repair Near Me Now

    That is a very good tip especially to those fresh to the blogosphere. Short but very precise informationÖ Many thanks for sharing this one. A must read post!

    http://cloudtip.com/__media__/js/netsoltrademark.php?d=www.ocrvcenter.com/

    June 21, 2021 at 09:55 | Report abuse | Reply
  21. drive in theater near me

    http://distancerunningnews.com/__media__/js/netsoltrademark.php?d=www.reviewnearme.com/

    June 21, 2021 at 11:22 | Report abuse | Reply
  22. verizon stores near me

    http://www.musicpool.com/__media__/js/netsoltrademark.php?d=reviewnearme.com

    June 21, 2021 at 12:26 | 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

Leave a Reply to free diet pill


 

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.