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. 2006 Mercades Sprinter 2500 Turbo Actuator Repair

    That is a very good tip particularly to those fresh to the blogosphere. Brief but very precise info… Thanks for sharing this one. A must read post!

    http://www.lawgistics.biz/__media__/js/netsoltrademark.php?d=sprintervanrepairnearme.com/

    June 3, 2021 at 04:43 | Report abuse | Reply
  2. Authorized Mercedes Sprinter Service Centers Near Me

    https://www.procolleges.com/college_search/go.php?url=https://fleetservicesocrv.com

    June 3, 2021 at 04:45 | Report abuse | Reply
  3. https://shiatsu-web.com

    Best view i have ever seen !

    https://images.google.cg/url?q=https://shiatsu-web.com

    June 3, 2021 at 05:22 | Report abuse | Reply
  4. Internet Marketing Businesses

    I quite like reading through a post that will make people think. Also, thanks for allowing me to comment!

    http://www.london.umb.edu/?URL=http://www.rankemailads.com

    June 3, 2021 at 05:58 | Report abuse | Reply
  5. Sprinter Van Repair

    I enjoy reading an article that can make people think. Also, many thanks for allowing for me to comment!

    http://carmax-blows.net/__media__/js/netsoltrademark.php?d=www.sprintervanrepair.com/

    June 3, 2021 at 06:04 | Report abuse | Reply
  6. 2010 Mercedes Sprinter Repair Panels

    http://iacconline.org/Redirect.aspx?destination=fleetservicerepairshop.com/

    June 3, 2021 at 09:06 | Report abuse | Reply
  7. solar freakin roadways busted

    https://www.google.bs/url?q=https://ocrvmotorsports.org

    June 3, 2021 at 09:07 | Report abuse | Reply
  8. RV Shower Orange County

    Everyone loves it when folks get together and share views. Great website, continue the good work!

    http://www.sagehotel.com/__media__/js/netsoltrademark.php?d=www.ocrvcenter.net/

    June 3, 2021 at 09:57 | Report abuse | Reply
  9. Conversion Van Repair

    http://mariela.com/__media__/js/netsoltrademark.php?d=fleetservicerepairshop.com/

    June 3, 2021 at 10:16 | Report abuse | Reply
  10. buy cialis pills

    tadalafil research powder cialis tadalafil cost walmart

    June 3, 2021 at 10:30 | Report abuse | Reply
  11. RV Bedroom Los Angeles

    http://checkstarfirst.com/__media__/js/netsoltrademark.php?d=www.ocrvandtrucks.com/

    June 3, 2021 at 10:55 | Report abuse | Reply
  12. horse trailer paint

    http://neo-cam.net/mt/mt4i/mt4i.cgi?id=4&mode=redirect&no=8&ref_eid=370&url=https://www.ocrvmotorsports.biz

    June 3, 2021 at 11:39 | Report abuse | Reply
  13. Google Marketing Agency

    http://owlsource.com/__media__/js/netsoltrademark.php?d=www.local-business-video-marketing.com/

    June 3, 2021 at 12:27 | Report abuse | Reply
  14. Social Media Marketing Consultants Near Me

    https://www.fens.org/EPiServerMail/Public/CheckLink.aspx?url=https://searchinteraction.com/

    June 3, 2021 at 13:16 | Report abuse | Reply
  15. trailer repair places near me

    http://disastertemporaryhousing.com/__media__/js/netsoltrademark.php?d=www.ocrv.info/

    June 3, 2021 at 13:46 | Report abuse | Reply
  16. Social Media Marketing Agencies Near Me

    Everything is very open with a really clear description of the issues. It was definitely informative. Your site is very helpful. Thank you for sharing!

    https://domaindirectory.com/servicepage/?domain=spokanevalleymarketing.com/

    June 3, 2021 at 14:09 | Report abuse | Reply
  17. truck repair service near me

    I really love your site.. Pleasant colors & theme. Did you make this amazing site yourself? Please reply back as Iím attempting to create my very own blog and would like to know where you got this from or exactly what the theme is named. Cheers!

    https://baoviet.com.vn/Redirect.aspx?url=http://youtube.com/watch?v=6wjZagtl0GE/

    June 3, 2021 at 16:17 | Report abuse | Reply
  18. Sprinter Van Repair Los Angeles

    Aw, this was an exceptionally nice post. Finding the time and actual effort to make a good articleÖ but what can I sayÖ I procrastinate a whole lot and never manage to get anything done.

    https://www.recklinghausen.de/inhalte/startseite/ruhrfestspiele_kultur/musik_und_theater/musik__choere_und_vereine/index.asp?db=17&form=RedirectAction&redirecturl=https://youtube.com/watch?v=jAS0oIH5Ong

    June 3, 2021 at 16:20 | Report abuse | Reply
  19. Sprinter Van Service

    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 personally spending a significant amount of time both reading and posting comments. But so what, it was still worthwhile!

    https://tvtropes.org/pmwiki/no_outbounds.php?o=https://youtube.com/watch?v=k4-6fPlUQCw

    June 3, 2021 at 16:23 | Report abuse | Reply
  20. truck shop oc

    I love it when individuals come together and share views. Great site, stick with it!

    https://hudsonltd.com/?URL=youtube.com/watch?v=aMf59t3yH14

    June 3, 2021 at 16:24 | Report abuse | Reply
  21. ZisseVed

    do you need to take cialis everyday why does cialis cost so much cialis prices walmart

    June 3, 2021 at 18:21 | Report abuse | Reply
  22. Zisseloh

    discount super active cialis is super active cialis a scam cialis stopped working

    June 3, 2021 at 19:07 | Report abuse | Reply
  23. oc rv storage

    http://www.jimwrightonline.com/php/tcpdf_php4/serverData.php?a%5B%5D=<a+href=http://youtube.com/watch?v=H2tQf8SMQUY/

    June 3, 2021 at 20:23 | Report abuse | Reply
  24. Mb Sprinter Repair Shop

    http://pichak.net/verification/index.php?n=39&url=youtube.com/watch?v=KUwXWCtXXpI

    June 3, 2021 at 21:26 | Report abuse | Reply
  25. orange county ca rv parks

    You ought to be a part of a contest for one of the most useful sites on the internet. I am going to highly recommend this website!

    https://secure.duoservers.com/?lang=en&s_id=123179&rdomain=youtube.com/watch?v=ZHUFNkLBHms/&action=order

    June 3, 2021 at 21:47 | Report abuse | Reply
  26. EncoxDev

    types of prescription drugs my canadian pharmacy com online pharmacies of canada

    June 3, 2021 at 22:09 | Report abuse | Reply
  27. Release Clip Repair On Mercedes Sprinter Seat

    Having read this I believed it was rather informative. I appreciate you spending some time and effort to put this article together. I once again find myself personally spending way too much time both reading and leaving comments. But so what, it was still worth it!

    http://atari.org/links/frameit.cgi?ID=238&url=https://www.youtube.com/watch?v=eM-QoxMsFXI

    June 3, 2021 at 22:21 | Report abuse | Reply
  28. Sprinter Van Repair Laguna Niguel

    You made some really good points there. I checked on the internet for more information about the issue and found most people will go along with your views on this site.

    https://emex.ru/error?url=https://youtube.com/watch?v=swnJdHAlat8/

    June 3, 2021 at 22:33 | Report abuse | Reply
  29. Kum Perera

    Good information. Lucky me I discovered your website by accident (stumbleupon). I've bookmarked it for later!

    https://extraproxies.com/buy-proxies/500-proxy-pack

    June 3, 2021 at 23:11 | Report abuse | Reply
  30. paint shops around me

    https://www.google.com.ag/url?q=http://youtube.com/watch?v=o6Uo8ZWSewA/

    June 4, 2021 at 00:01 | Report abuse | Reply
  31. ZisseVed

    cialis with effexor which is safer viagra or cialis cialis typical dosage

    June 4, 2021 at 00:18 | Report abuse | Reply
  32. Repair Shop For Mercedes Sprinter Vans

    http://www.certifiedgrillparts.com/__media__/js/netsoltrademark.php?d=ocrvparts.com

    June 4, 2021 at 01:38 | Report abuse | Reply
  33. Google Marketing Services

    http://talk4freeplug.com/__media__/js/netsoltrademark.php?d=internetmarketingnevada.com/

    June 4, 2021 at 01:41 | Report abuse | Reply
  34. horse trailer roof repair

    Iím amazed, I must say. Rarely do I encounter a blog thatís both equally educative and amusing, and let me tell you, you have hit the nail on the head. The problem is something that not enough people are speaking intelligently about. I am very happy I came across this during my hunt for something concerning this.

    http://sc.hkexnews.hk/TuniS/www.ocrv.xyz/rv-repair-shop-santa-clarita-california

    June 4, 2021 at 01:44 | Report abuse | Reply
  35. fireworks near me

    After I originally left a comment I seem to have clicked the -Notify me when new comments are added- checkbox and from now on each time a comment is added I get 4 emails with the same comment. There has to be a way you can remove me from that service? Cheers!

    http://www.joomla-code.ru/go.php?gogo=https://quotenearme.com

    June 4, 2021 at 01:45 | Report abuse | Reply
  36. Sprinter Van Body Repair

    Way cool! Some very valid points! I appreciate you penning this write-up and the rest of the site is very good.

    https://letronc-m.com/redirector?url=http://sprintervanrepair.com

    June 4, 2021 at 01:45 | Report abuse | Reply
  37. Sprinter Repair Los Angeles

    http://bloodblackandblue.com/__media__/js/netsoltrademark.php?d=www.sprintervanrepair.com

    June 4, 2021 at 04:00 | Report abuse | Reply
  38. roof repairs orange county ca

    http://www.canvasdemos.com/__media__/js/netsoltrademark.php?d=rvmarketingexperts.com

    June 4, 2021 at 05:45 | Report abuse | Reply
  39. Ivelisse Vanderhurst

    What i don't realize is actually how you are not really much more well-liked than you might be right now. You are so intelligent. You realize therefore significantly relating to this subject, produced me personally consider it from a lot of varied angles. Its like men and women aren't fascinated unless it’s one thing to accomplish with Lady gaga! Your own stuffs great. Always maintain it up!

    http://www.e-tsuyama.com/cgi-bin/jump.cgi?jumpto=https://cli.re/wrYZz2

    June 4, 2021 at 06:04 | Report abuse | Reply
  40. Mercedes Sprinter Diesel Service Near Me

    Good day! I just would like to offer you a big thumbs up for your excellent information you have right here on this post. I will be returning to your web site for more soon.

    http://kurose96.or.tv/ys4/rank.cgi?mode=link&id=217&url=http://ocrv.rocks/rv-repair-shop-cahuenga-pass-california

    June 4, 2021 at 07:28 | Report abuse | Reply
  41. plumbing supply near me

    http://www.universaldisplaycorp.com/__media__/js/netsoltrademark.php?d=bestservicenearme.com/

    June 4, 2021 at 07:28 | Report abuse | Reply
  42. Repair 2006 Dodge Sprinter

    I was very happy to uncover this web site. I need to to thank you for ones time due to this wonderful read!! I definitely enjoyed every bit of it and i also have you book marked to look at new stuff in your site.

    http://setprojects.com/__media__/js/netsoltrademark.php?d=sprinterrepairnearme.com

    June 4, 2021 at 07:38 | Report abuse | Reply
  43. rv entertainment system upgrade

    http://www.independenttravel.com/__media__/js/netsoltrademark.php?d=ocrvexperts.com

    June 4, 2021 at 09:26 | Report abuse | Reply
  44. Auto Sprinter Repair

    I want to to thank you for this great read!! I absolutely loved every bit of it. I have you book marked to look at new stuff you postÖ

    http://asia.google.com/url?q=https://sprintervanrepairnearme.com/

    June 4, 2021 at 09:27 | Report abuse | Reply
  45. travel trailer slide out repair

    http://e.nm.com/nw40/c2.php?NWPR/25216049/72909/H/N/V/http://ocrvmotorcoaches.com/rv-repair-shop-panorama-city-california

    June 4, 2021 at 12:52 | Report abuse | Reply
  46. indeed jobs near me

    Great info. Lucky me I came across your website by accident (stumbleupon). I have bookmarked it for later!

    http://5-0mustang.net/__media__/js/netsoltrademark.php?d=www.wholesalenearme.com/

    June 4, 2021 at 12:55 | Report abuse | Reply
  47. frame repair shop near me

    https://www.bing.com/news/apiclick.aspx?ref=FexRss&aid=&url=https://www.ocrvexperts.com/&cc=ru

    June 4, 2021 at 13:37 | Report abuse | Reply
  48. EncoxGtv

    sildenafil citrate canada pharmacy online.com cialis 5mg canadian pharmacy

    June 4, 2021 at 14:20 | Report abuse | Reply
  49. Ecu Repair Shop For Sprinter Van

    You are so awesome! I don't suppose I have read through a single thing like this before. So nice to find someone with genuine thoughts on this issue. Really.. many thanks for starting this up. This web site is one thing that is needed on the web, someone with a bit of originality!

    https://www.4geo.me/redirect/?service=catalog&url=sprintervanrepairnearme.com/

    June 4, 2021 at 14:21 | Report abuse | Reply
  50. EncoxAni

    pharmacy technician training programs online buy pain pills online pharmacy Zebeta

    June 4, 2021 at 16:29 | 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 plumbing supply near me


 

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.