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 (2,310 Responses)
  1. Arie Pyron

    Hmm is anyone else experiencing problems with the images on this blog loading? I'm trying to figure out if its a problem on my end or if it's the blog. Any feedback would be greatly appreciated.

    http://www.froleprotrem.com/

    March 24, 2021 at 11:51 | Report abuse | Reply
  2. Charlette Ogley

    Aw, this was a very nice post. In idea I want to put in writing like this moreover – taking time and precise effort to make a very good article… but what can I say… I procrastinate alot and certainly not seem to get one thing done.

    http://www.froleprotrem.com/

    March 24, 2021 at 13:12 | Report abuse | Reply
  3. Norris Gangler

    certainly like your web-site but you have to check the spelling on quite a few of your posts. Many of them are rife with spelling issues and I to find it very troublesome to inform the truth nevertheless I?¦ll definitely come back again.

    http://www.froleprotrem.com/

    March 24, 2021 at 14:20 | Report abuse | Reply
  4. FbshEncox

    https://thesisacloud.com/ – thesis chapters how do i write a thesis writing the thesis help in thesis writing

    March 24, 2021 at 17:13 | Report abuse | Reply
  5. GrvCrulk

    https://kloviagrli.com/ – buying viagra in mexico https://vigedon.com/ – free samples of viagra https://llecialisjaw.com/ – goodrx cialis https://jwcialislrt.com/ – 20 mg cialis https://jecialisbn.com/ – is cialis safe

    March 24, 2021 at 17:54 | Report abuse | Reply
  6. Burton Groombridge

    Heya i’m for the first time here. I found this board and I find It truly useful & it helped me out a lot. I hope to give something back and aid others like you aided me.

    http://www.froleprotrem.com/

    March 24, 2021 at 18:13 | Report abuse | Reply
  7. FStagemeada

    therapies cognitivo-comportementales psychologues, pharmacie bailly mozart therapies douces provillus.gen.in , https://maps.google.fr/url?q=http://owl.li/DzAf30rBUAO# pharmacie amiens saint roch. pharmacie de garde avignon intra muros viagra bestellen ohne rezept , pharmacie lafayette vichy pharmacie en ligne inde , therapies de conversion arte. pharmacie boulogne billancourt rue michelet pharmacie hubert beaulieu sur loire , pharmacie bordeaux ouverte dimanche pharmacie auchan eaubonne community college near zeeland mi BE 43830a2 , pharmacie de garde aujourd'hui gueret. pharmacie angers 24h/24 pharmacie grace de dieu , medicaments wellbutrin therapie cognitivo comportementale nevers pharmacie carrefour nice lingostiere. pharmacie angers rue beaurepaire therapie cognitivo comportementale alger pharmacie ouverte sarcelles.

    March 24, 2021 at 18:34 | Report abuse | Reply
  8. FStagemeada

    therapie comportementale et cognitive c'est quoi, pharmacie rue des jacobins amiens pharmacie discount amiens Viagra gГјnstig Viagra kaufen , https://maps.google.fr/url?q=http://owl.li/MV1J30rBUwU# pharmacie lille. therapie gestalt provillus for men provillus.gen.in , formation therapies alternatives traitement herpes genital , therapie de couple mulhouse. pharmacie romains annecy wellington zhaotai therapies , pharmacie test covid autour de moi pharmacie leclerc libourne environments of the world belgique a23d2_0 , therapies breves pau. pharmacie eisenbeth boulogne billancourt pharmacie a proximite nantes , pharmacie de garde aujourd'hui noumea pharmacie en ligne julie ricci pharmacie de garde aujourd'hui en sarthe. pharmacie lafayette toulouse l'union pharmacie ouverte wattrelos therapies autisme.

    March 24, 2021 at 18:51 | Report abuse | Reply
  9. Calvin Kjellsen

    I've been absent for some time, but now I remember why I used to love this blog. Thank you, I¦ll try and check back more often. How frequently you update your website?

    http://www.froleprotrem.com/

    March 24, 2021 at 21:39 | Report abuse | Reply
  10. Best Window Washing Service Near Me University Hills, Denver, CO

    A great read. I'll definitely be back.

    https://lifestyle.xtra1063.com/story/43461794/signature-window-washing-company-celebrates-6-years-in-business

    March 25, 2021 at 00:16 | Report abuse | Reply
  11. Window Washing Service Belcaro, Denver, CO

    Fairly high-quality explanation. continue the good work

    https://lifestyle.rewind1019.com/story/43461794/signature-window-washing-company-celebrates-6-years-in-business

    March 25, 2021 at 01:08 | Report abuse | Reply
  12. Kayla Capes

    Hi, Neat post. There is a problem with your website in web explorer, could check thisK IE nonetheless is the market chief and a large part of other people will pass over your fantastic writing because of this problem.

    http://www.froleprotrem.com/

    March 25, 2021 at 01:25 | Report abuse | Reply
  13. Wallace Urness

    Good day very cool site!! Man .. Beautiful .. Wonderful .. I'll bookmark your website and take the feeds additionally…I am satisfied to search out a lot of useful information right here within the post, we'd like develop extra strategies in this regard, thank you for sharing. . . . . .

    http://www.froleprotrem.com/

    March 25, 2021 at 02:06 | Report abuse | Reply
  14. Martha Arnsberger

    I liked as much as you will receive carried out proper here. The sketch is tasteful, your authored material stylish. nevertheless, you command get got an nervousness over that you wish be turning in the following. unwell indisputably come more before again as exactly the similar nearly very incessantly within case you defend this increase.

    http://www.froleprotrem.com/

    March 25, 2021 at 09:14 | Report abuse | Reply
  15. Kathaleen Byers

    Some really superb info , Sword lily I detected this. "The only truly affluent are those who do not want more than they have." by Erich Fromm.

    http://www.froleprotrem.com/

    March 25, 2021 at 10:32 | Report abuse | Reply
  16. Henarexcem

    pharmacie thiers avignon, pharmacie fouassier bourges horaires pharmacie centrale annecy viagra kaufen ohne rezept , http://channel.pixnet.net/newdirect.php?blog=cr19h3id&serial=0&url=http://owl.li/DzAf30rBUAO# pharmacie angers maison bleue. pharmacie auron bourges Viagra gГјnstig kaufen , act therapy for trauma therapies breves formation , pharmacie en ligne illicopharma. pharmacie brunet Г  proximite traitement osteoporose , pharmacie auchan st quentin pharmacie en ligne portugal positive feedback definition anatomy yyagh b2b0b98 , pharmacie eglise argenteuil. therapie comportementale et cognitive vaucluse pharmacie lafayette jean jaures toulouse horaires , pharmacie rue des jacobins beauvais Ivermectine Achat En Ligne France therapies esseniennes et egyptiennes. pharmacie de garde quimper act therapy criticism pharmacie brest garde.

    March 25, 2021 at 12:40 | Report abuse | Reply
  17. Henarexcem

    pharmacie de garde juan les pins, pharmacie rue president favre annecy pharmacie de garde beauvais aujourd'hui acheterlasix.loan lasilix sans ordonnance , https://maps.google.fr/url?q=http://owl.li/7INa30rBUAy# pharmacie de garde xertigny. produits non medicamenteux achatacheterprix.com , pharmacie lafayette europe pharmacie lafayette zenith , pharmacie xertigny. pharmacie du bailly salouel pharmacie de garde aujourd'hui reunion , pharmacie de garde porto vecchio therapies work for pharmacie de garde ouverte aujourd'hui fontainebleau to eeb3b2b , pharmacie leclerc le relecq kerhuon. pharmacie amiens azzedine pharmacie en ligne leclerc , pharmacie bordeaux test covid 19 Ivermectine Achat medicaments omeprazole. pharmacie cora pharmacie fontainebleau pharmacie lafayette ile de france.

    March 25, 2021 at 14:32 | Report abuse | Reply
  18. Henarexcem

    traitement lupus, pharmacie de garde quimperle act therapy willingness viagrabasprix.com , https://www.bing.com/news/apiclick.aspx?ref=FexRss&aid=&url=http://owl.li/DzAf30rBUAO# therapie de couple casablanca. pharmacie jeu de paume beauvais Viagra en pharmacie , pharmacie ouverte annecy pharmacie leclerc bressuire , therapies for anxiety. pharmacie lafayette facebook traitement hypothyroГЇdie , pharmacie nouvian beauvais pharmacie homeopathique annecy community college florida CH e25e92e , pharmacie la bailly amiens. act therapy google scholar pharmacie herblay , therapies used to treat cystic fibrosis Ivermectine Achat En Ligne France pharmacie escudier boulogne billancourt. pharmacie ligne xade therapies comportementales et cognitives pleine conscience medicaments oxyures.

    March 25, 2021 at 15:10 | Report abuse | Reply
  19. Laojjz

    R Baker pro copy writer profile content

    not too long authored content made by R Baker

    hard anodized cookware teens to get counselling west Men cherish usI made ourselves most guys why many overseas men seek for the not to mention lifestyle appearing in ethnics lands are and different from so their own? alongside this asked with regards to was that most european men first matured personal attractive force to hard anodized cookware brides within the Philippines.

    filipino wives what they aspire to in overeignerAs extra fat plus years, they are both pluses inside Philippines. We have the top esteem on behalf of maturation, and moreover an age category effect is no problem because filipino young women.

    wrote in free dating online chnlove review tease found on June 16, 2012

    how to find a Perfect philippine mail order BrideIf you will determined require a sophisticated, warm in addition,yet sensitive philippine teleshopping bridal is what you want, the simplest way to look through genuine and reliable candidates can be to consult an individual use products and services.

    issued in matchmaking flirting up can 23, 2012

    things philippine mail order wedding brides Want MostThe normal sweetheart would really like a very very long basically and keeping going relationship back with her wife flame and. they generate the best spouses from the ethnic appreciates drilled into them made by her family because psychic teachings they are raised which has.

    in print in internet dating tease during may perhaps perhaps 09, 2012

    what makes european adult males how to choose philippine teleordering birdes-to-beMost usa men in need of have to have a tender, ancestry primarily based life. your point is unique will probably be decoration of everyone solution, looking after and as well as nurturing everyone includes occur to be numerous disappearing provided by america community.

    submitted while married life to do with quite possibly 07, 2012

    making genuine philippine young ladies to receive weddings for the Philippines a relationship SiteA personal evolution products and services is an established, reliable and harmless way to and get to know a wide selection of remarkable, amazing and high single filipino female on behalf of relationship.

    in print in online dating teasing during might just 01, 2012

    oriental teleordering brides-to-be picking the proper Better LifeThe developed man regularly includes your spouse equipped with significant comfort and ease, help and support and a lifestyle purchase that your girlfriend might relish a lot more health and availability. associated with girls thus organize the man and simply hold good care of a must.

    launched found in marital life with regards to April 29, 2012

    cookware and even traditional western man or woman A reduing grass of personal ValuesIn the increase within the east and West, It has been seen as if ever the west man is giving ability and relief girl and snacks your darling with additional pride and appreciation.

    March 25, 2021 at 17:38 | Report abuse | Reply
  20. Bkargoabock

    medicaments urgence reanimation pdf pharmacie lafayette perpignan Viagra Generico en linea Viagra Generico , pharmacie argenteuil cote seine. pharmacie pomies aix en provence therapie cognitivo comportementale trois rivieres pharmacie beauvais en ligne , ouverture pharmacie angers. pharmacie grand annecy pharmacie auchan pharmacie yerres therapies systemiques europe b984383 , therapies katy pharmacie lafayette gambetta .

    March 25, 2021 at 20:33 | Report abuse | Reply
  21. best restaurant Orlando

    This blog is great check it out

    https://italianrestaurantinorlando.wordpress.com/2021/03/18/what-makes-good-italian-food-and-a-great-italian-restaurant/

    March 26, 2021 at 01:56 | Report abuse | Reply
  22. italian restaurants downtown orlando

    This blog is great check it out

    https://italianrestaurantorlando.blogspot.com/2021/03/why-are-italian-restaurants-so-popular.html

    March 26, 2021 at 02:25 | Report abuse | Reply
  23. best independent Italian spot

    Thanks for wonderful information I used to be in search of this info for my mission.

    https://italianrestaurantorlando.tumblr.com/post/646006119207239680/what-should-you-consider-when-choosing-an-italian

    March 26, 2021 at 02:43 | Report abuse | Reply
  24. Italian Orlando

    this is very informative and intersting for those who are interested in blogging field.

    https://diigo.com/0k0eg0

    March 26, 2021 at 06:53 | Report abuse | Reply
  25. best italian restaurants in orlando

    I really like this post

    https://www.behance.net/gallery/116109573/Italian-Restaurant-Gateway-to-the-Culture-of-Italy

    March 26, 2021 at 08:44 | Report abuse | Reply
  26. italian restaurants orlando

    very nice! Ireally like your blog

    https://diigo.com/0k2bv6

    March 26, 2021 at 09:14 | Report abuse | Reply
  27. emergency tree removal near South Park Phoenix, AZ

    This is a very interesting article. Please, share more like this!

    https://beavertreeservices.tumblr.com/post/645924617753673728/tree-trimming-is-not-for-everyone

    March 26, 2021 at 10:41 | Report abuse | Reply
  28. fallen tree removal cost Southern Gardens Phoenix, AZ

    nice information for a new blogger. it is really helpful

    https://www.behance.net/gallery/115640721/Hiring-Tree-Trimming-Services-For-Your-Lawn

    March 26, 2021 at 11:03 | Report abuse | Reply
  29. tree removal companies near Garfield Phoenix, AZ

    Keep this going please, great job!

    https://www.scoop.it/topic/why-would-you-need-tree-removal-services

    March 26, 2021 at 11:23 | Report abuse | Reply
  30. BrfgMile

    https://ljcialishe.com/ – does cialis expire https://cialisvja.com/ – how long does cialis stay in your system https://viagraonlinejc.com/ – what is viagra made of https://viagratx.com/ – is viagra government funded https://buycialisxz.com/ – cialis alternative

    March 26, 2021 at 17:02 | Report abuse | Reply
  31. cost to remove tree Phoenix

    such a great information for blogger i am a professional blogger thanks

    https://www.behance.net/gallery/116097987/Top-Tree-Trimming-Services-For-Your-Home

    March 27, 2021 at 01:40 | Report abuse | Reply
  32. fallen tree removal cost South Park Phoenix, AZ

    Great article. Couldn't be write much better! Keep it up!

    https://www.scoop.it/topic/tree-trimming-costs-what-factors-in

    March 27, 2021 at 02:00 | Report abuse | Reply
  33. cheap auto body repair Raleigh

    thanks for sharing!

    https://autobodyrepairraleigh.wordpress.com/2021/03/23/do-you-need-auto-body-repair-services/

    March 27, 2021 at 06:02 | Report abuse | Reply
  34. ac hose repair Mission, TX

    A great read. I'll definitely be back.

    https://www.behance.net/gallery/115716135/Finding-The-Best-Heating-Repair-Services

    March 27, 2021 at 06:53 | Report abuse | Reply
  35. DSomotimi

    community action agency poughkeepsie ny followers plus , Ivermectin medication for sale ivermectinsale.me positive correlation relationship.
    positive u words positive correlation psychology example . community health center greenville ky, community uplift synonym community college week planning process in a sentence positive reinforcement training for dogs US ee25e92 , followers skyrim list, community first credit union yncu .

    March 27, 2021 at 07:16 | Report abuse | Reply
  36. DSomotimi

    community ecology biology example community health , ivermectin for sale Sale Ivermectin 3 mg positive punishment.
    environmental quality improvement act changing environments year 4 . community impact, community first credit union tacoma community america independence positive and negative numbers in the real world brookdale community college xray tech usa 43830a2 , community bank of santa maria, community action georgetown ky .

    March 27, 2021 at 08:15 | Report abuse | Reply
  37. DSomotimi

    positive feedback loop breastfeeding community bank washington pa , ivermectin pills Ivermectin medication community first credit union zip code.
    community definition tax positive pregnancy test yesterday and not today . environments youtube, community mental health community action council harrison county community blood center ballantyne community organizer usa b984383 , individual-level heterogeneity, followers spy .

    March 27, 2021 at 08:36 | Report abuse | Reply
  38. Francie Stjulian

    Having read this I believed it was very informative. I appreciate you spending some time and energy to put this article together. I once again find myself personally spending a significant amount of time both reading and posting comments. But so what, it was still worth it!

    https://extraproxies.com

    March 27, 2021 at 21:48 | Report abuse | Reply
  39. Window Cleaning Service South Park Hill, Denver, CO

    Thank you, I've just been looking for information approximately this topic for a long time and yours is the greatest I have discovered so far. But, what in regards to the conclusion? Are you certain concerning the supply?

    http://finance.burlingame.com/camedia.burlingame/news/read/41077120

    March 28, 2021 at 01:44 | Report abuse | Reply
  40. Window Cleaning Service Globeville

    Thank You for your information

    http://google.dk/url?q=https://goo.gl/maps/bDKYVuKajtBKA72h9

    March 28, 2021 at 07:00 | Report abuse | Reply
  41. Window Washing Service East Colfax, Denver, CO

    Impressive! Thanks for the post

    http://google.com.et/url?q=https://posts.gle/FaTsydGwPrG8sewb9

    March 28, 2021 at 08:04 | Report abuse | Reply
  42. Window Cleaning Service Auraria, Denver, CO

    Impressive! Thanks for the post

    http://google.li/url?q=https://posts.gle/FaTsydGwPrG8sewb9

    March 28, 2021 at 08:26 | Report abuse | Reply
  43. Joanie Bakemeier

    The Best Health Plans and Nutritional Products Online

    http://plans7.com

    March 28, 2021 at 13:02 | Report abuse | Reply
  44. https://j-website.net

    Best view i have ever seen !

    http://cse.google.com/url?q=https://j-website.net

    March 29, 2021 at 20:38 | Report abuse | Reply
  45. Peffofopate

    community in biology positive urine culture , pills ivermectin ivermectinsale.me friends forever. community health center fort scott ks community first credit union bartram park . positive words starting with a, positive pregnancy test quiz planning process construction followers bfa followers goodreads ohio 23d3_31 , community minded synonym, community acquired pneumonia x ray .

    March 31, 2021 at 05:15 | Report abuse | Reply
  46. Peffofopate

    community first credit union jobs jacksonville fl community action agency allegan , ivermectin pills Ivermectin 3 mg sale positive pregnancy test then period. xbox followers bot community bridges employee benefits . followers guardian tales, community advocates housing community college transfer friends emoji community population biology usa ee25e92 , community health center kissimmee, social justice warrior .

    March 31, 2021 at 06:31 | Report abuse | Reply
  47. Chet Mancillas

    I blog quite often and I genuinely appreciate your content. This article has truly peaked my interest. I am going to bookmark your site and keep checking for new information about once a week. I subscribed to your RSS feed as well.

    https://extraproxies.com/how-to-guide-simplify-for-generalized-mean/

    April 1, 2021 at 04:06 | Report abuse | Reply
  48. Tiffanie Sandstrom

    After looking into a number of the blog posts on your web page, I really appreciate your way of writing a blog. I book-marked it to my bookmark webpage list and will be checking back in the near future. Please check out my website as well and tell me what you think.

    https://extraproxies.com/nao-consigo-importar-um-projeto-no-netbeans/

    April 1, 2021 at 07:53 | Report abuse | Reply
  49. Sydney Furnia

    Hello there! This article could not be written any better! Reading through this article reminds me of my previous roommate! He constantly kept preaching about this. I'll send this information to him. Pretty sure he's going to have a good read. Thanks for sharing!

    https://extraproxies.com/100-cpu-with-bad-execution-plan/

    April 1, 2021 at 21:55 | Report abuse | Reply
  50. AbgcEncox

    https://thesiswritingtob.com/ – thesis writing uk thesis express phd thesis defense how do i write a thesis

    April 2, 2021 at 21:55 | 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 42 43 44 45 46

Leave a Reply to cost to remove tree Phoenix


 

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.