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 (2,309 Responses)
  1. CGotstwill

    an individual's level of job satisfaction is determined by quizlet community dental , ivermectin medication for sale ivermectin for covid positive correlation definition. social quotes positive feedback loop melting ice . positive affirmations encouragement, omadacycline for community-acquired bacterial pneumonia journal club positive pregnancy test morning negative evening positive quotes jesus environments crossword clue Canada b2b0b98 , cultural geography, positive affirmations meditation .

    April 16, 2021 at 02:47 | Report abuse | Reply
  2. acheter modafinil

    Hello there! This post couldn't be written any better!
    Reading through this post reminds me of my previous room mate!

    He always kept talking about this. I will forward this post to
    him. Pretty sure he will have a good read. Thank you for sharing!

    April 16, 2021 at 13:08 | Report abuse | Reply
  3. buy viagra from canada

    new viagra in canada https://canadaviagrastore.com/ do you need a prescription for viagra in canada

    April 16, 2021 at 15:11 | Report abuse | Reply
  4. fathor shirt australia

    Thanks , I've recently been searching for info about this
    topic for a while and yours is the best I have discovered till now.
    However, what concerning the bottom line? Are you sure
    concerning the source?

    April 16, 2021 at 23:22 | Report abuse | Reply
  5. buy topical alprostadil gel

    buy online alprostadil vials https://alprostadildrugs.com/ how much alprostadil vials cost

    April 17, 2021 at 18:47 | Report abuse | Reply
  6. tadalafil online

    tadalafil gel https://elitadalafill.com/ tadalafil online

    April 17, 2021 at 22:25 | Report abuse | Reply
  7. https://mbee.com.vn/dia-chi-ban-vach-ngan-ve-sinh-compact-tai-ho-chi-minh-hcm/

    What's up, for all time i used to check weblog posts here early in the morning, for the
    reason that i like to learn more and more.

    April 18, 2021 at 00:15 | Report abuse | Reply
  8. Savanna Ruszala

    Hello! Do you know if they make any plugins to protect against hackers? I'm kinda paranoid about losing everything I've worked hard on. Any recommendations?


    April 18, 2021 at 12:28 | Report abuse | Reply
  9. injectable erectile dysfunction medicine

    how to administer transurethral alprostadil https://alprostadildrugs.com/ aprostadil

    April 19, 2021 at 13:37 | Report abuse | Reply
  10. Hubert Tuzzolo

    Hello, thanks for your blog, the tips you shared for natural hair is amazing. I also prefer natural hair and take care of them naturally. Thanks and keep sharing.


    April 19, 2021 at 15:34 | Report abuse | Reply
  11. https://thuocladientu123.com

    Best view i have ever seen !


    April 21, 2021 at 08:17 | Report abuse | Reply
  12. TAttangeGats

    pharmacie obernai, therapies comportementales et cognitives lyon pharmacie auchan longuenesse paroxetine livraison , https://www.etracker.com/lnkcnt.php?et=qPKGYV&url=https://bitly.com/3arqBkG+# therapies of counselling. therapies cognitivo-comportementales depression Ivermectine prix en ligne , therapies breves formation pharmacie de garde levallois , pharmacie livraison boulogne billancourt. pharmacie de garde aujourd'hui gard therapie cognitivo comportementale phobie , pharmacie boulogne billancourt jean baptiste clement therapie comportementale et cognitive clermont-ferrand community bank zama suisse 2eeb3b2 , pharmacie ouverte jusqu'Г  20h. guide clinique de therapie comportementale et cognitive fontaine therapie comportementale et cognitive casablanca , therapie de couple tours pharmacie de garde aujourd'hui pas de calais pharmacie ouverte maintenant autour de moi. centre de therapies alternatives les sables d'olonne therapie de couple orange pharmacie palix annecy.

    April 21, 2021 at 08:38 | Report abuse | Reply
  13. TAttangeGats

    therapie comportementale et cognitive niort, pharmacie beaulieu sur mer pharmacie avignon horaire generique Stromectol , https://www.bing.com/news/apiclick.aspx?ref=FexRss&aid=&url=https://bitly.com/3v88f06+# pharmacie precheur aix en provence. pharmacie annecy le vieux pommaries acheter champix en ligne pas cher , pharmacie de garde oued zem aujourd'hui pharmacie ouverte ivry sur seine , pharmacie auchan villebon. pharmacie en ligne suisse sans ordonnance pharmacie thoraval brest fax , act therapy values exercises xena therapies red wing mn positive reinforcement can only be given to friends stable 3830a23 , therapie genique cancer. pharmacie argenteuil rue d'epinay pharmacie auchan st loup , traitement de texte pharmacie lafayette villeneuve sur lot pharmacie en ligne belge. pharmacie de garde aujourd'hui limoges pharmacie prado bourges horaires pharmacie auchan fleury sur orne.

    April 21, 2021 at 09:29 | Report abuse | Reply
  14. TAttangeGats

    act therapy goals, therapie cognitivo comportementale orleans pharmacie marivaux amiens ivermectine pas cher , https://maps.google.fr/url?q=https://bitly.com/3szexE4+# therapies mental health. pharmacie brest test covid Achat Ivermectine pas cher , pharmacie auchan perpignan pharmacie ouverte issy les moulineaux , zylkene pharmacie lafayette. therapies geniques pharmacie bourges hopital , therapies breves orientees solutions parapharmacie leclerc hyeres community acquired pneumonia microbiology yahoo 16ee25e , pharmacie brest jaures. traitement ulcere pharmacie bailly , therapie cognitivo comportementale formation pharmacie beaulieu laplante pharmacie beauvais route de calais. pharmacie tronche beaulieu sur dordogne therapies quantiques aix en provence therapie cognitivo comportementale liege.

    April 21, 2021 at 09:45 | Report abuse | Reply
  15. signature window washing denver

    Thank You for your information


    April 21, 2021 at 15:04 | Report abuse | Reply
  16. Bfloactcof

    pharmacie wilson, pharmacie nansouty bordeaux horaires therapie de couple waremme pregabaline vente libre , https://www.bing.com/news/apiclick.aspx?ref=FexRss&aid=&url=https://u.to/YllDGw# therapie de couple granby. pharmacie touati argenteuil Colchicine sans Ordonnance Belgique , therapies breves lille pharmacie en ligne lille , pharmacie bailly rue de rome. pharmacie en ligne brest traitement mycose pied , pharmacie leclerc colmar pharmacie de garde aujourd'hui compiegne positive affirmations synonyms yahoo 843830a , therapie de couple paris. pharmacie montesquieu angers pharmacie en ligne livraison internationale , therapie de couple a quoi ca sert pharmacie aix en provence club hippique therapies analytiques. pharmacie auchan trignac therapies used in psychiatry pharmacie en ligne xenical.

    April 21, 2021 at 19:05 | Report abuse | Reply
  17. sildenafil canada cost

    sildenafil best price https://eunicesildenafilcitrate.com/ sildenafil price canada

    April 22, 2021 at 00:43 | Report abuse | Reply
  18. how to get alprostadil injection

    erection injection medication https://alprostadildrugs.com/ alprostadil cream on ebay

    April 22, 2021 at 11:59 | Report abuse | Reply
  19. 카지노사이트



    April 22, 2021 at 16:29 | Report abuse | Reply
  20. GvdbCrulk

    buy tadalafil 5mg http://boxtadafil.com/ 100 mg cialis tadalafil

    April 22, 2021 at 20:07 | Report abuse | Reply
  21. RfvbZisse

    brand cialis on line http://cileve.com/ – what\'s better viagra cialis levitra cialis generic date

    April 23, 2021 at 03:58 | Report abuse | Reply
  22. home for sale hauser idaho

    You made some decent points there. I looked on the internet to find out more about the issue and found most people will go along with your views on this website.


    April 23, 2021 at 16:07 | Report abuse | Reply
  23. New Forklift For Sale California


    April 23, 2021 at 16:07 | Report abuse | Reply
  24. RV Bathroom Los Angeles

    A motivating discussion is definitely worth comment. I think that you should write more about this issue, it may not be a taboo matter but typically people don't talk about such topics. To the next! Cheers!!


    April 23, 2021 at 16:07 | Report abuse | Reply
  25. RV TV California


    April 23, 2021 at 19:04 | Report abuse | Reply
  26. Forklift Parts California


    April 23, 2021 at 19:04 | Report abuse | Reply
  27. 3 bedroom homes for sale near me


    April 23, 2021 at 19:04 | Report abuse | Reply
  28. AbdgEncox

    Zebeta https://canadianeve21.com/ canadian family pharmacy

    April 23, 2021 at 19:11 | Report abuse | Reply
  29. teva pharms vardenafil

    vardenafil cheap https://vegavardenafil.com/ staxyn (vardenafil)

    April 23, 2021 at 20:37 | Report abuse | Reply
  30. Proxies Buy

    hey there and thank you in your info – I have definitely picked up anything new from proper here. I did however expertise several technical points using this web site, since I experienced to reload the site lots of instances previous to I could get it to load correctly. I were considering in case your web host is OK? Now not that I am complaining, but sluggish loading instances times will sometimes impact your placement in google and could injury your high-quality rating if advertising and ***********|advertising|advertising|advertising and *********** with Adwords. Well I’m including this RSS to my email and could glance out for much extra of your respective exciting content. Make sure you replace this once more very soon..


    April 23, 2021 at 21:53 | Report abuse | Reply
  31. rv repair parts near me


    April 24, 2021 at 06:56 | Report abuse | Reply
  32. RV Dent Repair Orange County


    April 24, 2021 at 07:05 | Report abuse | Reply
  33. rv repair service near me


    April 24, 2021 at 16:06 | Report abuse | Reply
  34. RV Restoration Los Angeles


    April 24, 2021 at 16:23 | Report abuse | Reply
  35. JbsdEncox

    Dipyridamole Vastarel prescription price comparison

    April 24, 2021 at 16:34 | Report abuse | Reply
  36. FbsfEncox

    Indocin http://uspharmus.com/ canada pharmacies online

    April 24, 2021 at 17:10 | Report abuse | Reply
  37. ed pills vardenafil

    why vardenafil dosage over 65 https://vegavardenafil.com/ vardenafil- vardenafil tablet, film coated

    April 24, 2021 at 20:57 | Report abuse | Reply
  38. RV Technician Near Me

    Greetings! Very useful advice within this article! It's the little changes that make the greatest changes. Thanks for sharing!


    April 24, 2021 at 22:11 | Report abuse | Reply
  39. buy zithromax online uk

    citromax https://zithromaxes.com/ zithromax 500 mg

    April 25, 2021 at 00:09 | Report abuse | Reply
  40. Forklift For Sale California

    I truly love your website.. Excellent colors & theme. Did you develop this web site yourself? Please reply back as I’m looking to create my own personal website and would love to learn where you got this from or exactly what the theme is named. Thanks!


    April 25, 2021 at 02:42 | Report abuse | Reply
  41. Cory Knotowicz

    Watch. Join. Earn.


    April 25, 2021 at 08:43 | Report abuse | Reply
  42. sildenafil drug

    sildenafil tablets 100mg india https://eunicesildenafilcitrate.com/ sildenafil 10 mg

    April 25, 2021 at 10:40 | Report abuse | Reply
  43. RfvbZisse

    generic cialis online overnight http://cileve.com/ – can ubuy cialis on streets cialis ontario no prescription

    April 25, 2021 at 17:21 | Report abuse | Reply
  44. LrbsEncox

    levitra free samples http://uslevitraanna.com/ levitra where to buy

    April 25, 2021 at 22:58 | Report abuse | Reply
  45. tv repair in temecula


    April 26, 2021 at 00:14 | Report abuse | Reply
  46. RV Repair Los Angeles


    April 26, 2021 at 00:32 | Report abuse | Reply
  47. LhdvZisse

    cialis shop usa https://asciled.com/ discount cialis

    April 26, 2021 at 00:57 | Report abuse | Reply
  48. signature window washing denver

    A great read. I'll definitely be back.


    April 26, 2021 at 07:28 | Report abuse | Reply
  49. LhdvZisse

    cheap t jet 60 cialis online http://asciled.com/ cialis for sale brand

    April 26, 2021 at 09:21 | Report abuse | Reply
  50. LrbsEncox

    levitra how long http://uslevitraanna.com/ what are the side effects of levitra

    April 26, 2021 at 14:12 | 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 tausAffessy


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.