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. Ford Connect Van Floor Repair

    Hi, I do believe this is an excellent website. I stumbledupon it 😉 I may return once again since I bookmarked it. Money and freedom is the best way to change, may you be rich and continue to help others.

    http://feed.thepund.it/?url=https://fleetservicesorangecounty.com/sprinter-van-wrap-shop-near-me

    May 14, 2021 at 13:39 | Report abuse | Reply
  2. nearest realtor

    https://www.uonuma-kome.com/link/rank.cgi?mode=link&id=370&url=https://www.meganleary.com

    May 14, 2021 at 16:02 | Report abuse | Reply
  3. LbsoZisse

    cialis lilly australia https://ucialisdas.com/ cialis 20 mg

    May 14, 2021 at 16:18 | Report abuse | Reply
  4. Eye Center Near Me

    https://urm.org/n/november-splash/?redirect_to=http://arizonasvision.com/

    May 14, 2021 at 16:32 | Report abuse | Reply
  5. Maserati Levante Near Me

    Oh my goodness! Awesome article dude! Thank you, However I am encountering problems with your RSS. I don’t know why I cannot subscribe to it. Is there anybody getting the same RSS issues? Anyone who knows the solution will you kindly respond? Thanx!!

    https://lnk.bio/go?d=http://club-maserati.com/

    May 14, 2021 at 17:01 | Report abuse | Reply
  6. toy restoration near me

    https://www.sweetcotton.com/osanpo/search/rank.cgi?mode=link&id=1154&url=https://www.ocrvart.com

    May 14, 2021 at 17:33 | Report abuse | Reply
  7. homes for sale coeur d alene idaho

    https://www.10lowkey.us/UCH/link.php?url=https://meganleary.com

    May 14, 2021 at 18:29 | Report abuse | Reply
  8. platinum refineries

    precious metal refinery

    https://www.northernrefineries.com/

    May 14, 2021 at 18:35 | Report abuse | Reply
  9. motorhome interior renovation

    There's certainly a great deal to know about this subject. I like all of the points you've made.

    http://islulu.com/link.php?url=https://ocrv.fun/

    May 15, 2021 at 00:52 | Report abuse | Reply
  10. Maserati Pricing 2014

    https://www.sports-ranking.com/search/rank.cgi?mode=link&id=7&url=https://club-maserati.com

    May 15, 2021 at 01:28 | Report abuse | Reply
  11. property for sale rathdrum idaho

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

    https://sc.hkexnews.hk/TuniS/www.meganleary.com/

    May 15, 2021 at 01:37 | Report abuse | Reply
  12. homes for sale rathdrum idaho

    Aw, this was a really good post. Taking the time and actual effort to produce a good article… but what can I say… I put things off a lot and don't manage to get nearly anything done.

    https://www.zlatestranky.cz/Cookies/Disagree?returnUrl=https://meganleary.com/

    May 15, 2021 at 01:46 | Report abuse | Reply
  13. house for sale post falls id

    Excellent site you have here.. It’s difficult to find high-quality writing like yours nowadays. I truly appreciate individuals like you! Take care!!

    https://scripts.affiliatefuture.com/AFClick.asp?affiliateID=1567&merchantID=617&programmeID=2028&mediaID=0&tracking=&url=https://meganleary.com

    May 15, 2021 at 01:57 | Report abuse | Reply
  14. Mc12 Maserati

    This site was... how do I say it? Relevant!! Finally I've found something which helped me. Cheers!

    https://app.kartra.com/redirect_to/?asset=url&id=https://club-maserati.com

    May 15, 2021 at 02:16 | Report abuse | Reply
  15. Maserati Pov

    Pretty! This was an extremely wonderful article. Many thanks for providing these details.

    http://fis.com/fis/shared/redirect.asp?banner=6158&url=http://club-maserati.com

    May 15, 2021 at 02:35 | Report abuse | Reply
  16. LebnEncox

    medicine online order https://xlnpharmacy.com/ Atorlip-5

    May 15, 2021 at 02:50 | Report abuse | Reply
  17. Maserati Price 2020

    Nice post. I learn something totally new and challenging on blogs I stumbleupon everyday. It will always be interesting to read through articles from other authors and practice a little something from other websites.

    http://www.meinvz.net/Link/Dereferrer/?https://club-maserati.com/

    May 15, 2021 at 03:36 | Report abuse | Reply
  18. nearest house for sale

    http://closings.cbs6albany.com/scripts/adredir.asp?url=http://meganleary.com/

    May 15, 2021 at 03:56 | Report abuse | Reply
  19. nearest rv repair shop

    There's definately a lot to find out about this topic. I really like all the points you made.

    http://www.xyzprinting.com/prc?e=11p541&redir=https://commercialvanrepairshop.com

    May 15, 2021 at 04:40 | Report abuse | Reply
  20. random fortnite account ps4

    Greetings from Los angeles! I'm bored to tears at work so I decided to browse your site on my iphone during lunch break. I enjoy the information you present here and can't wait to take a look when I get home. I'm surprised at how quick your blog loaded on my cell phone .. I'm not even using WIFI, just 3G .. Anyways, excellent site!|

    https://paste.debian.net/1197667/

    May 15, 2021 at 04:56 | Report abuse | Reply
  21. Maserati Grand Turismo 2014

    https://galter.northwestern.edu/exit?url=https://club-maserati.com/

    May 15, 2021 at 05:28 | Report abuse | Reply
  22. Vision Center Near Me

    Spot on with this write-up, I seriously believe this amazing site needs much more attention. I’ll probably be returning to see more, thanks for the information!

    http://webstolica.ru/go.php?link=http://arizonasvision.com

    May 15, 2021 at 05:57 | Report abuse | Reply
  23. federatedfinancial.com

    carry on, dont stop

    https://www.gatesofantares.com/players/plotangora2/activity/745191/

    May 15, 2021 at 06:09 | Report abuse | Reply
  24. solar orange county

    https://www.girisimhaber.com/redirect.aspx?url=https://theocrv.com

    May 15, 2021 at 06:25 | Report abuse | Reply
  25. dc seo services

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

    https://info-site.siterubix.com/professional-seo-services-can-boost-your-business/

    May 15, 2021 at 06:27 | Report abuse | Reply
  26. Honest Air

    nice information for a new blogger. it is really helpful

    https://www.evernote.com/shard/s550/sh/793daa52-eb44-1be5-899e-6448a28ee0a5/e094914eb9ac3805a841af850e4f618b

    May 15, 2021 at 06:44 | Report abuse | Reply
  27. nearby houses for sale

    https://www.fis.com/fis/shared/redirect.asp?banner=6158&url=https://meganleary.com

    May 15, 2021 at 06:53 | Report abuse | Reply
  28. Taekwondo Crofton MD

    thanks for sharing!

    https://www.gatesofantares.com/players/sloan84morrison/activity/741103/

    May 15, 2021 at 07:00 | Report abuse | Reply
  29. Phoenix Eye Care

    http://gvomail.com/redir.php?k=1560a19819b8f93348a7bc7fc28d0168&url=arizonasvision.com/

    May 15, 2021 at 07:43 | Report abuse | Reply
  30. realtor athol idaho

    Greetings! Very helpful advice within this article! It's the little changes that produce the biggest changes. Thanks for sharing!

    http://preissuchmaschine.de/link.asp?url=https://meganleary.com

    May 15, 2021 at 08:09 | Report abuse | Reply
  31. Pediatric Eye Exam

    You are so awesome! I don't suppose I've truly read a single thing like this before. So nice to find somebody with a few unique thoughts on this topic. Seriously.. thank you for starting this up. This site is one thing that's needed on the web, someone with a bit of originality!

    https://www.ace-ace.co.jp/cgi-bin/ys4/rank.cgi?mode=link&id=26651&url=https://arizonasvision.com

    May 15, 2021 at 08:14 | Report abuse | Reply
  32. Area Rug Cleaning Spokane

    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://carpetspokanecleaning.wordpress.com/2021/05/13/things-that-you-need-to-know-about-carpet-cleaning/

    May 15, 2021 at 08:16 | Report abuse | Reply
  33. movie

    If you wish for too improve your know-how just keep visiting this site and be updated with the most recent news update posted here.

    May 15, 2021 at 08:34 | Report abuse | Reply
  34. gutter replacement and repair Hainesport

    Keep this going please, great job!

    https://roofinghainesport.tumblr.com/post/651047692111364096/roof-repair-contractors

    May 15, 2021 at 08:37 | Report abuse | Reply
  35. rekey Palo Alto

    carry on, dont stop

    https://locksmithpaloaltoca.tumblr.com/post/651060849619959808/locksmith-service-and-its-benefits

    May 15, 2021 at 08:56 | Report abuse | Reply
  36. houses for sale hayden lake idaho

    https://www.eromoe.com/search/rank.cgi?mode=link&id=198&url=https://meganleary.com

    May 15, 2021 at 10:09 | Report abuse | Reply
  37. Glow in the dark stars

    Wonderful blog! I found it while browsing on Yahoo News.

    Do you have any tips on how to get listed in Yahoo News?
    I've been trying for a while but I never seem to get there!

    Thanks

    My web site; Glow in the dark stars

    May 15, 2021 at 10:49 | Report abuse | Reply
  38. Baton Rouge Fence Company LA

    Commenting on a blog is an art. Good comments create relations. You're doing great work. Keep it up.

    https://www.diigo.com/user/hirschkathryn

    May 15, 2021 at 11:12 | Report abuse | Reply
  39. houses for sale twin lakes idaho

    You're so awesome! I don't believe I've truly read through something like this before. So nice to find somebody with a few original thoughts on this subject. Really.. thank you for starting this up. This website is something that is required on the internet, someone with a little originality!

    http://templateshares.net/redirector.php?url=https://meganleary.com/

    May 15, 2021 at 11:13 | Report abuse | Reply
  40. Area Rug Cleaning Spokane

    Commenting on a blog is an art. Good comments create relations. You're doing great work. Keep it up.

    https://www.4shared.com/folder/GyjAzXVL/Carpet_Cleaning_Spokane.html

    May 15, 2021 at 11:28 | Report abuse | Reply
  41. all rv repair

    Everyone loves it when people get together and share views. Great website, stick with it!

    http://www.mortgageboss.ca/link.aspx?cl=960&l=5648&c=13095545&cc=8636&url=http://ocrv.life/

    May 15, 2021 at 11:43 | Report abuse | Reply
  42. gutter replacement and repair Hainesport

    very interesting , good job and thanks for sharing such a good blog.

    https://app.photobucket.com/u/RaneySynthia/a/532f1ff4-a357-4e60-a9a8-194e3499d60e

    May 15, 2021 at 12:09 | Report abuse | Reply
  43. Radon mitigation Lexington KY

    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.

    https://wugold.picturepush.com/

    May 15, 2021 at 12:26 | Report abuse | Reply
  44. Maserati Gran Cabrio Sport

    I have to thank you for the efforts you've put in writing this website. I am hoping to view the same high-grade blog posts by you later on as well. In fact, your creative writing abilities has encouraged me to get my own, personal blog now 😉

    https://www.loma.org/global_loma/handler/TechDirectory.aspx?companyid=10737446431&action=web&dest=https://club-maserati.com/

    May 15, 2021 at 12:29 | Report abuse | Reply
  45. 2015 Maserati Granturismo

    http://gvomail.com/redir.php?k=1560a19819b8f93348a7bc7fc28d0168&url=http://club-maserati.com

    May 15, 2021 at 13:19 | Report abuse | Reply
  46. Eye Appointments Near Me

    Excellent write-up. I definitely love this website. Keep writing!

    https://www.dmca.com/Protection/Status.aspx?ID=edc817fd-d796-4c84-abb8-d1cb5b2e3719&refurl=https://www.arizonasvision.com

    May 15, 2021 at 13:46 | Report abuse | Reply
  47. My Pro Cleaner TX

    I'm not sure where you are getting your information, but great topic.

    https://www.deviantart.com/eastonsavanna/art/Carpet-cleaning-Silver-100-878291852?ga_submit_new=103A1620025467

    May 15, 2021 at 13:54 | Report abuse | Reply
  48. rv supplies near me

    I could not resist commenting. Exceptionally well written!

    https://members.practicegreenhealth.org/eweb/Logout.aspx?RedirectURL=http://ocrv.life

    May 15, 2021 at 14:17 | Report abuse | Reply
  49. property for sale post falls

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

    http://sogo.i2i.jp/link_go.php?url=https://meganleary.com/

    May 15, 2021 at 15:30 | Report abuse | Reply
  50. Eye Care Near Me

    I like looking through an article that will make people think. Also, thank you for permitting me to comment!

    http://www.islulu.com/link.php?url=https://arizonasvision.com

    May 15, 2021 at 16:10 | 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 gutter replacement and repair Hainesport


 

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.