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 couldn’t refrain from commenting. Very well written!
Excellent write-up. I absolutely love this site. Keep writing!
This blog was... how do you say it? Relevant!! Finally I have found something that helped me. Kudos!
An intriguing discussion is definitely worth comment. There's no doubt that that you need to write more about this topic, it might not be a taboo subject but typically people don't discuss such topics. To the next! Kind regards!!
There is certainly a great deal to know about this subject. I love all the points you made.
This is a topic that is close to my heart... Best wishes! Where are your contact details though?
vidalista 60 side effects https://tadalisxs.com/ tadlafil
Excellent web site you have here.. It’s hard to find excellent writing like yours nowadays. I honestly appreciate people like you! Take care!!
You're so interesting! I don't think I have read a single thing like this before. So wonderful to discover another person with some genuine thoughts on this subject. Really.. thanks for starting this up. This web site is something that is required on the internet, someone with some originality!
You should take part in a contest for one of the best sites online. I will recommend this blog!
Good information. Lucky me I found your blog by accident (stumbleupon). I have saved it for later!
An outstanding share! I have just forwarded this onto a colleague who was doing a little homework on this. And he in fact ordered me lunch because I stumbled upon it for him... lol. So allow me to reword this.... Thank YOU for the meal!! But yeah, thanks for spending some time to talk about this matter here on your site.
After I originally commented I seem to have clicked the -Notify me when new comments are added- checkbox and from now on whenever a comment is added I receive four emails with the exact same comment. There has to be a means you are able to remove me from that service? Many thanks!
Spot on with this write-up, I truly believe that this amazing site needs much more attention. I’ll probably be returning to see more, thanks for the info!
Oh my goodness! Amazing article dude! Thank you, However I am going through troubles with your RSS. I don’t understand the reason why I cannot subscribe to it. Is there anyone else having identical RSS issues? Anybody who knows the answer can you kindly respond? Thanx!!
accurate rx pharmacy columbia mo 24 hour pharmacy canadian pharmacy no rx needed
I’m amazed, I must say. Seldom do I come across a blog that’s equally educative and entertaining, and let me tell you, you have hit the nail on the head. The issue is an issue that not enough men and women are speaking intelligently about. I am very happy that I came across this during my search for something regarding this.
Everything is very open with a really clear description of the issues. It was really informative. Your site is useful. Thank you for sharing!
walgreens cialis price https://krocialis.com/ – how much does cialis cost at walgreens what does generic cialis look like
Having read this I thought it was extremely enlightening. I appreciate you spending some time and effort to put this information together. I once again find myself spending a significant amount of time both reading and posting comments. But so what, it was still worthwhile!
There's certainly a lot to find out about this issue. I love all the points you made.
Good article. I will be dealing with a few of these issues as well..
I’m impressed, I have to admit. Seldom do I encounter a blog that’s both equally educative and entertaining, and let me tell you, you have hit the nail on the head. The problem is something not enough men and women are speaking intelligently about. I'm very happy that I stumbled across this in my search for something regarding this.
does cialis make you last longer in bed https://krocialis.com/ – compra cialis online cialis super active plus reviews
viagra cialis canadian pharmacy canadian pharmacies list rite aid pharmacy online
online pharmacy forums https://pharmacyken.com/ – online pharmacies canada albuterol canadian pharmacy
comprar cialis online https://rcialisgl.com/ – what is the difference between viagra and cialis why is cialis so expensive
cialis blurred vision temporary https://cialishav.com/ – buying cialis from canada buy cialis no prescription