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. Conversion Van Repair


    May 29, 2021 at 20:32 | Report abuse | Reply
  2. Semi Truck Collision Repair

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


    May 29, 2021 at 21:11 | Report abuse | Reply
  3. MileSwa

    generic cialis https://ckacialis.com/ – cialis deliver next day mex rx cialis

    May 29, 2021 at 22:59 | Report abuse | Reply
  4. High Top Van Repair Shop

    Pretty! This has been an extremely wonderful post. Thanks for supplying this information.


    May 29, 2021 at 23:38 | Report abuse | Reply
  5. Box Truck Mechanic Shop


    May 30, 2021 at 00:35 | Report abuse | Reply
  6. Box Truck Windshield Replacement Shop Near Me

    Excellent blog post. I absolutely love this website. Thanks!


    May 30, 2021 at 02:26 | Report abuse | Reply
  7. is loose leaf tea better

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


    May 30, 2021 at 02:42 | Report abuse | Reply
  8. Content Marketing Consultants


    May 30, 2021 at 03:28 | Report abuse | Reply
  9. storm repair randolph county

    A great read. I'll definitely be back.


    May 30, 2021 at 03:30 | Report abuse | Reply
  10. Plumber Truck Repair Shop Near Me


    May 30, 2021 at 04:15 | Report abuse | Reply
  11. Tile Cleaning Spokane

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


    May 30, 2021 at 04:39 | Report abuse | Reply
  12. EncoxGtv

    rite aid 24 hour pharmacy store locator viagra online canadian pharmacy paypal online pharmacy discount

    May 30, 2021 at 04:52 | Report abuse | Reply
  13. roofing contractors Hainesport

    Keep this going please, great job!


    May 30, 2021 at 05:04 | Report abuse | Reply
  14. Locksmith Palo Alto

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


    May 30, 2021 at 05:33 | Report abuse | Reply
  15. Emergency Locksmith Las Vegas

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


    May 30, 2021 at 05:54 | Report abuse | Reply
  16. air conditioning repair work

    I am really happy to say it's an interesting post to read . I learn new information from your article , you are doing a great job . Flooring Installers of Pittsburgh, 1933 Crafton Blvd #5, Pittsburgh, PA 15205, (412) 415-7629


    May 30, 2021 at 07:06 | Report abuse | Reply
  17. air conditioner repair

    Interesting stuff to read. Keep it up. Flooring Installers of Pittsburgh, 1933 Crafton Blvd #5, Pittsburgh, PA 15205, (412) 415-7629


    May 30, 2021 at 07:23 | Report abuse | Reply
  18. USA HVAC Services

    Commenting on a blog is an art. Good comments create relations. You’re doing great work. Keep it up. Flooring Installers of Pittsburgh, 1933 Crafton Blvd #5, Pittsburgh, PA 15205, (412) 415-7629


    May 30, 2021 at 08:08 | Report abuse | Reply
  19. Plumber Truck Repair Shop Near Me

    Hi, I do think this is a great website. I stumbledupon it 😉 I may return yet again since i have book marked it. Money and freedom is the best way to change, may you be rich and continue to help others.


    May 30, 2021 at 10:24 | Report abuse | Reply
  20. Content Marketing Consultants

    You ought to be a part of a contest for one of the highest quality blogs on the web. I am going to highly recommend this web site!


    May 30, 2021 at 12:43 | Report abuse | Reply
  21. Rv Windshield Replacement Shop

    I absolutely love your site.. Pleasant colors & theme. Did you create this amazing site yourself? Please reply back as I’m attempting to create my own blog and would love to learn where you got this from or what the theme is named. Thank you!


    May 30, 2021 at 18:21 | Report abuse | Reply
  22. Rv Technician Shop

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


    May 30, 2021 at 23:13 | Report abuse | Reply
  23. Sprinter Van Collision Repair


    May 30, 2021 at 23:29 | Report abuse | Reply
  24. RV Roof Repair Service Near Me

    May I just say what a comfort to discover somebody who truly knows what they're talking about online. You certainly realize how to bring an issue to light and make it important. More people need to read this and understand this side of your story. I was surprised you are not more popular since you most certainly possess the gift.


    May 31, 2021 at 00:52 | Report abuse | Reply
  25. Limo Van Repair Shop Near Me

    This website definitely has all the info I wanted about this subject and didn’t know who to ask.


    May 31, 2021 at 01:20 | Report abuse | Reply
  26. Emergency Vehicle Repair Shop

    An interesting discussion is definitely worth comment. There's no doubt that that you should publish more about this subject, it may not be a taboo matter but usually people do not discuss such issues. To the next! Cheers!!


    May 31, 2021 at 01:20 | Report abuse | Reply
  27. RV Windshield Repair Near Me


    May 31, 2021 at 02:29 | Report abuse | Reply
  28. Sprinter Van Upholstery Shop Near Me


    May 31, 2021 at 02:51 | Report abuse | Reply
  29. Mercedes Sprinter Refrigerater Repair

    Hey there! I simply want to give you a huge thumbs up for the great information you have got right here on this post. I am coming back to your web site for more soon.


    May 31, 2021 at 06:38 | Report abuse | Reply
  30. Mercedes High Top Van Repair

    Wonderful post! We will be linking to this great content on our website. Keep up the great writing.


    May 31, 2021 at 06:50 | Report abuse | Reply
  31. RV Awning Repair Near Me


    May 31, 2021 at 07:20 | Report abuse | Reply
  32. Rv Body Shop Near Me


    May 31, 2021 at 08:31 | Report abuse | Reply
  33. RV Repair Shop Near Me


    May 31, 2021 at 08:40 | Report abuse | Reply
  34. Video Marketing Services

    An impressive share! I have just forwarded this onto a coworker who has been doing a little research on this. And he in fact bought me lunch simply because I found it for him... lol. So allow me to reword this.... Thanks for the meal!! But yeah, thanx for spending time to discuss this issue here on your blog.


    May 31, 2021 at 09:30 | Report abuse | Reply
  35. RV Furnace Repair Near Me


    May 31, 2021 at 09:50 | Report abuse | Reply
  36. Sprinter Van Front Wiper Rust Repair

    This is a topic that's near to my heart... Many thanks! Exactly where are your contact details though?


    May 31, 2021 at 10:15 | Report abuse | Reply
  37. RV Repair Center Near Me


    May 31, 2021 at 10:47 | Report abuse | Reply
  38. CrulkAsd

    cialis sell cialis generic online johannesburg cialis in canada

    May 31, 2021 at 11:13 | Report abuse | Reply
  39. m6rGEpR3Fjltv

    973168 724708I was trying to locate this. Actually refreshing take on the details. Thanks a whole lot. 116382

    May 31, 2021 at 11:15 | Report abuse | Reply
  40. Van Door Repair


    May 31, 2021 at 14:11 | Report abuse | Reply
  41. Luxury Repair Shop Near Me

    Good information. Lucky me I found your blog by chance (stumbleupon). I have book-marked it for later!


    May 31, 2021 at 16:29 | Report abuse | Reply
  42. Rv Frame Repair

    When I originally left a comment I seem to have clicked on the -Notify me when new comments are added- checkbox and from now on whenever a comment is added I get 4 emails with the exact same comment. Is there a way you can remove me from that service? Thank you!


    May 31, 2021 at 16:50 | Report abuse | Reply
  43. Zisseloh

    is there a generic cialis how often to take cialis generic cialis 5mg

    May 31, 2021 at 16:50 | Report abuse | Reply
  44. High Top Van Repair Shop Near Me

    I blog often and I genuinely appreciate your information. Your article has truly peaked my interest. I am going to book mark your site and keep checking for new information about once per week. I opted in for your Feed too.


    May 31, 2021 at 19:14 | Report abuse | Reply
  45. Conversion Shop Near Me

    I couldn’t resist commenting. Exceptionally well written!


    May 31, 2021 at 19:17 | Report abuse | Reply
  46. Ford High Top Van Repair


    May 31, 2021 at 21:17 | Report abuse | Reply
  47. Transport Van Repair Shop


    June 1, 2021 at 01:41 | Report abuse | Reply
  48. Chevrolet High Top Van Repair

    This site truly has all of the information I wanted concerning this subject and didn’t know who to ask.


    June 1, 2021 at 03:20 | Report abuse | Reply
  49. Mercedes Sprinter Body Repair


    June 1, 2021 at 03:26 | Report abuse | Reply
  50. Sprinter Resistor Repair

    This is the perfect blog for everyone who wishes to understand this topic. You know so much its almost hard to argue with you (not that I really will need to…HaHa). You definitely put a brand new spin on a subject which has been discussed for years. Wonderful stuff, just great!


    June 1, 2021 at 04:55 | 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 RV Roof Riverside


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.