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 (870 Responses)
  1. rv body work near me


    May 12, 2021 at 20:56 | Report abuse | Reply
  2. motorhome body shop

    I like it when individuals come together and share opinions. Great site, stick with it!


    May 12, 2021 at 21:10 | Report abuse | Reply
  3. windshield repair orange county ca


    May 12, 2021 at 21:28 | Report abuse | Reply
  4. Mercedes-Benz Sprinter Repair Shop Near Me

    Oh my goodness! Impressive article dude! Thanks, However I am going through difficulties with your RSS. I don’t understand why I can't subscribe to it. Is there anybody having the same RSS issues? Anyone who knows the answer will you kindly respond? Thanks!!


    May 12, 2021 at 21:49 | Report abuse | Reply
  5. Sprinter Auto Repair


    May 12, 2021 at 22:14 | Report abuse | Reply
  6. esurance rv


    May 12, 2021 at 22:30 | Report abuse | Reply
  7. Sprinter Van Repair Abs

    Hi, I do think this is a great site. I stumbledupon it 😉 I am going to return yet again since I book-marked it. Money and freedom is the greatest way to change, may you be rich and continue to guide other people.


    May 12, 2021 at 23:52 | Report abuse | Reply
  8. rv window repair near me


    May 13, 2021 at 00:08 | Report abuse | Reply
  9. FmrfEncox

    canada cialis with dapoxetine https://cialisee.com/ price comparison cialis

    May 13, 2021 at 01:25 | Report abuse | Reply
  10. Mercedes Benz Sprinter Authorized Repair Shop


    May 13, 2021 at 02:46 | Report abuse | Reply
  11. rv repair materials

    Spot on with this write-up, I absolutely feel this website needs far more attention. I’ll probably be back again to see more, thanks for the advice!


    May 13, 2021 at 03:33 | Report abuse | Reply
  12. Sprinter Van Brake Repair Near Me


    May 13, 2021 at 03:41 | Report abuse | Reply
  13. RV Batteries Near Me

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

    https://pickyourown.org/PYOredirectpause.php?PAGGE=/PAnefarmmarkets.php&NAME=Gulicks Fruit Farm&URL=https://yelp.com/biz/ocrv-center-yorba-linda-2

    May 13, 2021 at 04:54 | Report abuse | Reply
  14. repair blinds near me

    After 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 receive four emails with the same comment. Perhaps there is an easy method you can remove me from that service? Many thanks!


    May 13, 2021 at 04:55 | Report abuse | Reply
  15. Handicapped Van Repair

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


    May 13, 2021 at 05:20 | Report abuse | Reply
  16. RV Paint Shop Los Angeles


    May 13, 2021 at 07:47 | Report abuse | Reply
  17. qq101

    I have read so many articles concerning the blogger
    lovers except this piece of writing is really a nice
    post, keep it up.

    May 13, 2021 at 08:19 | Report abuse | Reply
  18. camper repairs near me


    May 13, 2021 at 08:40 | Report abuse | Reply
  19. truck collision repair near me


    May 13, 2021 at 09:16 | Report abuse | Reply
  20. RV Renovation Orange County

    I’m impressed, I must say. Seldom do I come across a blog that’s both equally educative and amusing, and let me tell you, you have hit the nail on the head. The problem is something too few people are speaking intelligently about. I'm very happy that I stumbled across this in my search for something relating to this.


    May 13, 2021 at 09:22 | Report abuse | Reply
  21. Sprinter Broken Flex Pipe Repair

    When I initially commented I seem to have clicked on the -Notify me when new comments are added- checkbox and now whenever a comment is added I recieve 4 emails with the same comment. Is there a means you can remove me from that service? Cheers!


    May 13, 2021 at 14:58 | Report abuse | Reply
  22. paint job shops near me

    That is a really good tip particularly to those new to the blogosphere. Brief but very precise info… Thanks for sharing this one. A must read article!


    May 13, 2021 at 14:59 | Report abuse | Reply
  23. blue sky rv insurance reviews

    The next time I read a blog, I hope that it won't disappoint me as much as this particular one. After all, Yes, it was my choice to read through, however I truly believed you would have something helpful to talk about. All I hear is a bunch of crying about something you can fix if you weren't too busy searching for attention.


    May 13, 2021 at 15:07 | Report abuse | Reply
  24. JebgEncox

    Tegretol Viagra with Duloxetine Viagra with Duloxetine

    May 13, 2021 at 16:54 | Report abuse | Reply
  25. news

    certainly like your web-site but youu have to take a look at the spellling on several
    of your posts. Several of them are rife withh spellingg problems and I to find it very botyhersome to
    tell the reality nevertheless I'll surely come back

    May 13, 2021 at 17:24 | Report abuse | Reply
  26. body repair near me


    May 13, 2021 at 18:04 | Report abuse | Reply
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Leave a Reply to Savanna Ruszala


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.