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.
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.
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.
I used to be able to find good information from your blog articles.
Pretty! This was an incredibly wonderful article. Many thanks for providing these details.
cialis generic http://rcialisgl.com/ – cialis from bc, no prescription cialis super active
Hello! I could have sworn I’ve been to your blog before but after browsing through a few of the articles I realized it’s new to me. Anyways, I’m definitely delighted I discovered it and I’ll be bookmarking it and checking back frequently!
This is a really good tip particularly to those new to the blogosphere. Brief but very accurate information… Thank you for sharing this one. A must read post!
online pharmacy for cialis http://cialisee.com/ cialis free sample
cyclosporine eye drops cyclomune 0.1% eye drops cost
https://cttadalafil.com/ cialis at canadian pharmacy https://tadacipetadalafil.com/ – cheap generic cialis for sale cialis tadalafil
Cyclomune eye drops 0.05% cyclomune eye drops 1%
https://tadacipetadalafil.com/ tadalafil drug https://tadalafilww.com/ – tadalafil price walmart where to buy generic cialis online safely
buy generic combigan combigan side effects
is there a generic viagra https://loxviagra.com/ viagra foods
Having read this I believed it was rather informative. I appreciate you taking the time and energy to put this informative article together. I once again find myself personally spending a lot of time both reading and leaving comments. But so what, it was still worth it!
Hello, I do believe your site could be having internet browser compatibility problems. When I take a look at your website in Safari, it looks fine but when opening in I.E., it's got some overlapping issues. I just wanted to give you a quick heads up! Besides that, fantastic blog!
cyclosporine for humans cyclosporine lab tube
Great article. Couldn't be write much better! Keep it up!
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.
this is very informative and intersting for those who are interested in blogging field.
http://radio.cancaonova.com/iframe-loader/?t=Dating Single: No Longer a Mystery â€“ RÃ¡dio&ra=&url=https://ocrvcenter.com/rv-furniture-repair-near-me
Trecator SC https://pharmacylo.com/ canadian pharmacy ltd
brimonidine brimonidine generic
Hi! I could have sworn I’ve been to your blog before but after going through a few of the posts I realized it’s new to me. Nonetheless, I’m certainly pleased I came across it and I’ll be bookmarking it and checking back frequently!
Iím impressed, I must say. Rarely do I come across a blog thatís both equally educative and entertaining, and without a doubt, you have hit the nail on the head. The problem is something too few men and women are speaking intelligently about. Now i'm very happy that I came across this in my search for something concerning this.
prescription tadalafil online https://tadagatadalafil.com/ – side effects for tadalafil best price usa tadalafil cialis cost https://apcalisetadalafil.com/
Oh my goodness! Awesome article dude! Thanks, However I am having troubles with your RSS. I don’t understand why I can't subscribe to it. Is there anybody else getting identical RSS issues? Anyone who knows the answer will you kindly respond? Thanks!!
After checking out a few of the blog articles on your web page, I seriously like your technique of blogging. I added it to my bookmark site list and will be checking back soon. Please visit my web site as well and let me know your opinion.
Way cool! Some very valid points! I appreciate you penning this post and the rest of the site is extremely good.
https://tadagatadalafil.com/ buy cialis generic cialis tadalafil tadalafil generic tadalafil price walmart
cialis cost https://tadalafilol.com/ – buy cialis pills tadalafil side effects tadalafil cialis https://cttadalafil.com/
I love it when people come together and share ideas. Great website, keep it up!
brimonidine eye drops brimonidine generic
cheap generic cialis for sale buy tadalis buy tadalis cost of cialis https://tadacipetadalafil.com/ – prescription tadalafil online
cialis 20mg overnight https://cialisjla.com/ – cialis southafrica generic cialisis
This is a really good tip particularly to those new to the blogosphere. Brief but very precise info… Thank you for sharing this one. A must read post!
I used to be able to find good advice from your content.