 |
|
|
|
June 7th, 2011
04:28 PM ET
Get Some Sleep: Beware the sleeping pill hangoverLisa 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.
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. 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. soundoff (2,309 Responses)« Previous 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 Next »Leave a Reply to Soosteemocush
Next entry »Scientists warn of chemical-autism link
« Previous entryCDC: Non-straight youth more at risk
|
  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.
 |
|
|
|
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.
A formidable share, I just given this onto a colleague who was doing a bit analysis on this. And he actually purchased me breakfast because I discovered it for him.. smile. So let me reword that: Thnx for the deal with! But yeah Thnkx for spending the time to discuss this, I feel strongly about it and love studying extra on this topic. If attainable, as you change into expertise, would you mind updating your weblog with more details? It's extremely helpful for me. Large thumb up for this blog post!
https://dreamproxies.com/tag/buy-private-proxy-anonymity/
buy avanafil canada avanafil
Elavil http://onlinecanda21.com/ Super Avana
do you need a prescription for viagra in canada https://canadaviagrastore.com/ generic viagra shipping from canada
best i have ever seen!Hello, always i used to check webpage posts here early in the daylight, for the reason that i love to gain knowledge of more and more.
https://www.google.com/maps?cid=14663314353945436015
such a great information for blogger i am a professional blogger thanks
https://maps.google.com/maps?ll=39.72703132688135,-104.92552727651984&z=6&t=m&hl=en&gl=US&mapclient=embed&cid=8694579260586646626&q=painal+brother
Usually I never comment on blogs but your article is so convincing that I never stop myself to say something about it. You're doing a great job Man,Keep it up.
http://businessezz.com/directory/listingdisplay.aspx?lid=5738
drugstore online shopping https://canadianeve21.com/ – pharmacie canadienne approved canadian online pharmacies
Oh my goodness! Incredible article dude! Thank you so much, However I am encountering problems with your RSS. I don’t know why I cannot join it. Is there anyone else getting the same RSS issues? Anybody who knows the answer will you kindly respond? Thanx!!
http://www.sandiegofamilylaw.com/__media__/js/netsoltrademark.php?d=www.meganleary.com
http://huranahory.cz/sleva/pobyt-pec-pod-snezko-v-penzionu-modranka-krkonose/343?show-url=https://meganleary.com
canadian pills online https://canadapillstorex.com/ canadian generic pills
order medicine online https://uspharmus.com/ – canada pharma limited llc Atarax
sildenafil purchase canada https://eunicesildenafilcitrate.com/ 20 mg sildenafil cheap
avana india avana 50 mg
is viagra safe http://gensitecil.com/ – cialis viagra online average age of man taking viagra
canadianmed cialis https://cileve.com/ – best price for cialis 20 mg cialis in malaysia
pfizer viagra canada pharmistry https://canadaviagrastore.com/ how to buy teva sub for viagra in canada
thanks for sharing!
https://soundbrandingcom.23video.com/vandkunsten-architects-torpedohallen-1
Interesting stuff to read. Keep it up.
http://www.memursenakademi.com/some-guidelines-on-quick-plans-of-window-cleaning-service/
carry on, dont stop
http://www.spdownloads.com/no-nonsense-tips-for-window-cleaning-service-new-ideas/
This is a very interesting article. Please, share more like this!
http://www.ibericusgourmet.com/an-in-depth-analysis-of-convenient-strategies-in-window-cleaning-service/
dapoxetine for sale priligy tablets for sale
Good day! I could have sworn I've visited this site before but after looking
at some of the posts I realized it's new to me.
Nonetheless, I'm definitely pleased I found it and I'll be bookmarking it and checking back regularly!
I am гeally happy to glance at this blog posts which contains lots of useful
data, thanks for providing these kinds of data.
Other ingredients commonly found in high quality probiotic supplements are Lactobacillus acidophilus, Bifidobacterium crickets, and other naturally occurring organisms. All of these can help restore the normal functions of the gastrointestinal tract, including proper digestion and absorption of nutrients.
https://bestproducts-4u.com/tag/best-probiotics-for-weight-loss/
To get the maximum benefit from probiotics, you need to take them over an extended period of time. Talk to your doctor about what type of supplementation might be right for you. In some cases, your health care professional may even recommend probiotics for you to try.
https://bestproducts-4u.com/tag/best-probiotic-drink/
Diamox http://canadianeve21.com/ Fincar
erectile machines https://canadaerectiledysfunctionpills.com/ erectile on demand pdf
como funciona el viagra http://gensitecil.com/ viagra for men for sale
With all of the different options for a shower these days, narrowing it down to the best shower radio speaker is often tough. Not only do you have to consider the look and style, but also the compatibility and durability.
https://bestproducts-4u.com/tag/best-shower-radio-wirecutter/
health canada drug database https://onlinecanda21.com/ best 10 online canadian pharmacies
generic viagra cost walmart canada https://canadaviagrastore.com/ canada pharmacy viagra
I like reading a post that will make people think. Also, thank you for allowing for me to comment!
https://extraproxies.com/buy-proxies/2000-proxy-pack/
canadian generic pills https://canadapillstorex.com/ canadian pills pharmacy
tadalafil e20 http://boxtadafil.com/ tadalafil otc
counterfeit canadian drugs cialis https://canadacialisstore.com/ how can i order cialis from a canadian pharmacy
erectile over the counter products https://canadaerectiledysfunctionpills.com/ erectile clinic
cialis supplier uk https://cileve.com/ grapefruit cialis
buying canadian cialis https://canadacialisstore.com/ canadian meds cialis
Valtrex http://uspharmus.com/ – canadian pharmacies top best canada pharma limited
buy cialis on line overnight http://asciled.com/ buy generic cialis australia
how do you spell viagra https://jokviagra.com/ generic viagra release date
cialis samples canada http://rcialisgl.com/ where to buy cialis online for cheap
buy avana canada avanafil stendra dosage
I could not resist commenting. Very well written!
http://www.hitsongs.net/__media__/js/netsoltrademark.php?d=www.aikareborn.com
http://images.google.tk/url?rct=j&sa=t&url=https://bettersightovernight.com
100mg viagra instructions http://llviagra.com/ – domande sul viagra viagra movie jake
http://local.google.co.ug/url?sa=t&source=web&rct=j&url=https://aikareborn.com
http://abort.ee/banner?banner_id=25&redirect=https://fleetvehiclerepairshop.com
Oh my goodness! Incredible article dude! Thanks, However I am experiencing problems with your RSS. I don’t know the reason why I can't join it. Is there anybody else having similar RSS problems? Anyone that knows the answer can you kindly respond? Thanks!!
https://clients1.google.si/url?rct=j&sa=t&url=https3A2F2Foptometristphoenixaz.com&sa=D&sntz=1&usg=AFQjCNGaY_nlK9ozc51fqwjiVdMaYZL7rg