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. truc tiep thvl1

    Xoilac Tv Trực Tiếp Bóng Đávtv1 fptNếu cứ đùa như cách vừa tiêu diệt Everton tới 3-1 trên Sảnh quý khách hàng

    https://chiefscreolecafe.com/detail/xem-the-thao-truc-tuyen-thvl1-91745.html

    June 13, 2021 at 22:46 | Report abuse | Reply
  2. dennys near me

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

    http://cross-a.net/go_out.php?url=https://www.duiattorneyphoenixaz.com/

    June 14, 2021 at 00:36 | Report abuse | Reply
  3. boba near me

    https://www.triathlon.org/?URL=http://www.socalforklifttraining.com/

    June 14, 2021 at 01:10 | Report abuse | Reply
  4. dogs for sale near me

    This is a topic that is near to my heart... Best wishes! Where are your contact details though?

    http://www.theamericanmuslim.org/tam.php?URL=https://www.fleettruckrepairshop.com

    June 14, 2021 at 01:16 | Report abuse | Reply
  5. movers near me

    https://www.azlawhelp.org/externalsite.cfm?url=//local-business-video-marketing.com

    June 14, 2021 at 03:03 | Report abuse | Reply
  6. strip club near me

    http://www.lifestream.tv/players/mocd.php?c=secebenezer&access=1&url=fleettruckrepairshop.com

    June 14, 2021 at 04:41 | Report abuse | Reply
  7. rv dealers near me

    This is the perfect webpage for anybody who would like to understand this topic. You realize a whole lot its almost hard to argue with you (not that I actually would want toÖHaHa). You certainly put a fresh spin on a subject that has been discussed for a long time. Great stuff, just great!

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

    June 14, 2021 at 06:03 | Report abuse | Reply
  8. seafood near me

    Iím impressed, I must say. Rarely do I encounter a blog thatís both equally educative and entertaining, and without a doubt, you've hit the nail on the head. The issue is something which too few people are speaking intelligently about. I am very happy that I found this during my hunt for something concerning this.

    https://anonym.to/?https://marketingpostfalls.com/

    June 14, 2021 at 06:26 | Report abuse | Reply
  9. printing near me

    https://sc.devb.gov.hk/TuniS/www.getmoneysocial.com

    June 14, 2021 at 08:14 | Report abuse | Reply
  10. viet nam thai lan seagame

    Link Xem Thẳng Soccer Futsal Việt Nam Vs Lebanon Vòng Loại World Cupviet nam thai lan seagameNếu cứ nghịch như cách vừa tiêu diệt Everton cho tới 3-1 trên sảnh khách

    https://virandoamor.com/detail/lich-phat-song-champions-league-2021-76216.html

    June 14, 2021 at 08:18 | Report abuse | Reply
  11. mexican food near me

    https://telemail.jp/_pcsite/?des=015660&gsn=0156603&url=http://newrvowners.com/

    June 14, 2021 at 08:36 | Report abuse | Reply
  12. carl's jr near me

    http://www.infotiger.com/addurl.html?url=www.fleetservicesorangecounty.com&

    June 14, 2021 at 09:15 | Report abuse | Reply
  13. wing stop near me

    https://yellowpages.oakridger.com/__media__/js/netsoltrademark.php?d=www.heatingairconditioningcontractorsmissionviejo.com

    June 14, 2021 at 09:32 | Report abuse | Reply
  14. catholic church near me

    This is the right blog for anyone who would like to understand this topic. You know so much its almost tough to argue with you (not that I really will need toÖHaHa). You definitely put a new spin on a subject which has been written about for years. Excellent stuff, just excellent!

    https://ea.delawarecpf.com/__media__/js/netsoltrademark.php?d=http://www.ocrvmotorcoachsales.com

    June 14, 2021 at 09:51 | Report abuse | Reply
  15. lumber yard near me

    http://slides.virtualpathology.leeds.ac.uk/research_4/slide_library/r_bishop_collection/card_index_set/soft_tissue/33959.svs/view.apml?returnurl=spokanevalleymarketing.com/

    June 14, 2021 at 11:04 | Report abuse | Reply
  16. micro center near me

    https://www.mundijuegos.com/messages/redirect.php?url=http://newwavevisual.com

    June 14, 2021 at 11:39 | Report abuse | Reply
  17. places that deliver near me

    https://www.mhc.ie/?URL=ocrv.tv

    June 14, 2021 at 11:45 | Report abuse | Reply
  18. wells fargo bank near me

    Greetings! Very helpful advice in this particular article! It is the little changes that produce the most significant changes. Many thanks for sharing!

    http://atari.org/links/frameit.cgi?footer=YES&back=http://www.cleanuponlinereputation.com

    June 14, 2021 at 12:18 | Report abuse | Reply
  19. malls near me

    Greetings! Very helpful advice within this article! It's the little changes that will make the most important changes. Many thanks for sharing!

    https://oliverhume.com.au/enquiry/thank-you/?redirectTo=www.bettersightovernight.com

    June 14, 2021 at 13:23 | Report abuse | Reply
  20. five guys near me

    https://ww17.acconsthost.com/__media__/js/netsoltrademark.php?d=https://bulknearme.com/

    June 14, 2021 at 13:59 | Report abuse | Reply
  21. pawn shops near me

    Oh my goodness! Awesome article dude! Thank you, However I am having issues with your RSS. I donít know why I cannot subscribe to it. Is there anyone else having the same RSS issues? Anybody who knows the answer will you kindly respond? Thanks!!

    https://de.paltalk.com/client/webapp/client/External.wmt?url=http://www.ocrv.online/

    June 14, 2021 at 14:03 | Report abuse | Reply
  22. for additional information

    This is a really good tip especially to those new to the blogosphere.
    Simple but very accurate information… Appreciate your
    sharing this one. A must read post!

    June 14, 2021 at 14:34 | Report abuse | Reply
  23. trực tuyến vtv1

    Thẳng Soccer Hôm Nay, Links Coi Trực Tuyến đoạn Phim Trường Hợp90.tvTrên băng ghế đào tạo, Lebanon đã bổ nhiệm Ramiro Lopez cơ hội đây 3 tuần. Nhà cầm cố quân người Tây Ban Nha công ty yếu thực hiện việc tại Ý và từng có thời hạn thực hiện việc trên Kuwait.|Và NHM bóng đá Việt Nam đang chờ Minh Trí cùng đồng đội hóa giải đối thủ để tạo lợi thế đến trận lượt về tại đây hai ngày. Chelsea đã cần trải qua 8 phút bù giờ không thở được bảo vệ chiến thắng.

    https://sepiswestwood.com/detail/psg-vs-mu-93933.html

    June 14, 2021 at 15:04 | Report abuse | Reply
  24. chicken wings near me

    Everything is very open with a clear explanation of the challenges. It was definitely informative. Your site is useful. Many thanks for sharing!

    http://infotiger.com/addurl.html?url=www.postfallswebsites.com&

    June 14, 2021 at 15:31 | Report abuse | Reply
  25. mailbox near me

    There is definately a lot to learn about this topic. I love all of the points you have made.

    https://cssdrive.com/?URL=promotionalproductsforless.com

    June 14, 2021 at 15:54 | Report abuse | Reply
  26. vao roi

    Xoilac Tv Trực Tiếp đá Bónghtv2 trực tiếpXem đá bóng trực tuyến Trực tiếp Odd BK vs Sarpsborg, 20h ngày 24/5, giải VĐQG Na Uy. Xem lịch phát sóng thẳng bóng đá EURO hôm nay được Webthethao cập nhật chủ yếu xác nhất.

    https://murraystivoli.com/detail/kqbd-12994.html

    June 14, 2021 at 16:22 | Report abuse | Reply
  27. truck stop near me

    Right here is the perfect webpage for anyone who wishes to understand this topic. You realize so much its almost hard to argue with you (not that I personally would want toÖHaHa). You definitely put a new spin on a subject that has been written about for a long time. Wonderful stuff, just wonderful!

    https://blog.tieonline.com/feedtie/feed2js.php?src=thehighriseco.com/&num=3&au=y&date=y&utf=y&html=y

    June 14, 2021 at 16:46 | Report abuse | Reply
  28. lịch thi đấu tennis hôm nay

    Tỷ Số đá Bóng Trực Tuyến Hôm NayvaoroiTheo thể thức thi đấu, đội thắng ở cặp đấu này sẽ giành tấm vé đến Lithuania vào ngày hội bóng đá lớn nhất thế giới mang đến futsal. Tuyển futsal Việt Nam bước vào trận play-off lượt đi tranh vé dự play-off World Cup 2021 với sự tự tin. Tuy vậy, HLV Phạm Minh Giang bày tỏ, toàn đội không ngán Lebanon song sẽ tìm cách để khắc chế sức mạnh của đối thủ bởi bên trên băng ghế huấn luyện là nhà cầm quân Ramiro Lopez, người từng dẫn dắt futsal Tây Ban Nha.|Dựa vào lịch tranh tài, bạn rất có thể chuẩn bị xếp làm việc

    https://equinome.com/detail/liverpool-dau-voi-west-ham-101970.html

    June 14, 2021 at 17:45 | Report abuse | Reply
  29. apple store near me

    https://raincoast.com/?URL=https://ocrvfleetservices.com

    June 14, 2021 at 17:48 | Report abuse | Reply
  30. electrical supply near me

    http://yp.ocregister.com/__media__/js/netsoltrademark.php?d=http://customcampervans.com/

    June 14, 2021 at 18:17 | Report abuse | Reply
  31. harbor freight near me

    Your style is very unique in comparison to other people I have read stuff from. Thanks for posting when you have the opportunity, Guess I will just book mark this site.

    https://www.cassinausa.com/__media__/js/netsoltrademark.php?d=https://forkliftserviceshop.com

    June 14, 2021 at 19:08 | Report abuse | Reply
  32. tivi101

    Kết Quả Futsal Việt Nam Vs Lebanonxem vtv3 trực tuyến nhanh nhấtTheo thể thức thi đấu, đội thắng ở cặp đấu này sẽ giành tấm vé đến Lithuania vào ngày hội bóng đá lớn nhất thế giới mang đến futsal. Tuyển futsal Việt Nam bước vào trận play-off lượt đi tranh vé dự play-off World Cup 2021 với sự tự tin. Tuy vậy, HLV Phạm Minh Giang bày tỏ, toàn đội ko ngán Lebanon tuy vậy sẽ tìm cách để khắc chế sức mạnh của đối thủ bởi trên băng ghế huấn luyện là nhà cầm quân Ramiro Lopez, người từng dẫn dắt futsal Tây Ban Nha.|Dựa vào lịch thi đấu, bạn rất có thể sắp xếp làm việc

    https://virandoamor.com/detail/tt-vtv3-95668.html

    June 14, 2021 at 19:21 | Report abuse | Reply
  33. xoilac

    Thẳng Bóng Đá Việt Nam Vs Lebanon. Coi Truc Tiep Bong Da. Futsal Việt Namxem kenh k+Nếu cứ nghịch như cơ hội vừa tiêu diệt Everton cho tới 3-1 trên sảnh khách hàng

    https://virandoamor.com/detail/viet-nam-vs-malaysia-truc-tiep-fpt-52267.html

    June 14, 2021 at 20:06 | Report abuse | Reply
  34. ibongda

    Thẳng Soccer Việt Nam Vs Lebanon. Xem Truc Tiep Bong Da. Futsal Việt Nammu vs psg lượt vềĐây có lẽ là trường hợp “của đi thay cho nhân viên" khá may mắn đối với Ben McLemore. Thiếu chút nữa tay ném của Los Angeles Lakers đã có thể gặp hiểm họa nguy hiểm. Cập nhật kết quả trận Việt Nam vs Lebanon thuộc play-off vòng chủng loại Futsal World Cup 2021.

    https://virandoamor.com/detail/ma-soi-online-free-website-103290.html

    June 14, 2021 at 21:19 | Report abuse | Reply
  35. Sprinter Repair Shop Near Me

    http://www2.golflink.com.au/out.aspx?frm=gglcmicrosite&target=ocrvcenter.com/rv-repair-shop-coachella-california

    June 14, 2021 at 22:39 | Report abuse | Reply
  36. RV Repair Shop Near My Location

    http://yumi.rgr.jp/puku-board/kboard.cgi?mode=res_html&owner=proscar&url=ocrvcenter.com/rv-repair-shop-moreno-valley-california/&count=1&ie=1

    June 14, 2021 at 23:20 | Report abuse | Reply
  37. thethaotv

    Trực Tiếp Soccer Hôm Nay, Link Xem đá Bóng Trực Tuyến 24hthedo.tvTheo thể thức thi đấu, đội thắng ở cặp đấu này sẽ giành tấm vé đến Lithuania trong ngày hội bóng đá lớn nhất thế giới mang đến futsal. Tuyển futsal Việt Nam bước vào trận play-off lượt đi tranh vé dự play-off World Cup 2021 với sự tự tin. Tuy vậy, HLV Phạm Minh Giang bày tỏ, toàn đội không ngán Lebanon tuy vậy sẽ tìm cách để khắc chế sức mạnh của đối thủ bởi trên băng ghế huấn luyện là nhà cầm quân Ramiro Lopez, người từng dẫn dắt futsal Tây Ban Nha.|Dựa vào lịch thi đấu, bạn có thể sắp xếp công việc

    https://equinome.com/detail/xem-vtv3-93984.html

    June 14, 2021 at 23:42 | Report abuse | Reply
  38. Camper Repair Near Me

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

    https://www.bitly.com/a/warning?hash=3nUs1YL&url=www.ocrvcenter.com/motorhome-blinds-repair-near-me/

    June 14, 2021 at 23:48 | Report abuse | Reply
  39. RV Repair Near My Location

    This excellent website truly has all of the info I needed concerning this subject and didnít know who to ask.

    https://bizfinder.registerguard.com/__media__/js/netsoltrademark.php?d=www.ocrvcenter.com/rv-repair-shop-lemon-grove-california

    June 15, 2021 at 00:47 | Report abuse | Reply
  40. k+pm hd

    Thẳng đá Bóng Việt Nam Vs Lebanon. Coi Truc Tiep Bong Da. Futsal Việt Namhd javXem soccer trực tuyến Trực tiếp Odd BK vs Sarpsborg, 20h ngày 24/5, giải VĐQG Na Uy. Xem lịch vạc sóng trực tiếp đá bóng EURO hôm nay được Webthethao cập nhật chính xác nhất.

    https://murraystivoli.com/detail/fifa-club-2020-crack-google-driver-119413.html

    June 15, 2021 at 01:53 | Report abuse | Reply
  41. mc vs liverpool

    Xem Trực Tiếp Soccertcvn 104-07Theo thể thức thi đấu, đội thắng ở cặp đấu này sẽ giành tấm vé đến Lithuania trong ngày hội bóng đá lớn nhất thế giới mang đến futsal. Tuyển futsal Việt Nam bước vào trận play-off lượt đi tranh vé dự play-off World Cup 2021 với sự tự tin. Tuy vậy, HLV Phạm Minh Giang bày tỏ, toàn đội ko ngán Lebanon song sẽ tìm cách để khắc chế sức mạnh của đối thủ bởi trên băng ghế huấn luyện là nhà cầm quân Ramiro Lopez, người từng dẫn dắt futsal Tây Ban Nha.|Dựa vào lịch thi đấu, quý khách rất có thể sắp xếp làm việc

    https://arubaeducation.info/detail/nha-lich-thi-dau-fa-cup-120551.html

    June 15, 2021 at 03:56 | Report abuse | Reply
  42. RV Repair Santa Ana

    Itís nearly impossible to find experienced people in this particular topic, but you seem like you know what youíre talking about! Thanks

    https://www.radar.techcabal.com/clicks/track?url=www.ocrvcenter.com/class-7-truck-collision-repair-shop-near-me/

    June 15, 2021 at 04:01 | Report abuse | Reply
  43. bdtv

    Links Coi Thẳng Soccer Futsal Việt Nam Vs Lebanon Vòng Loại World Cupcopa america 2019 truc tiepĐây có lẽ rằng là ngôi trường hợp “của đi thay cho người" khá như mong muốn đối cùng với Ben McLemore. Thiếu chút nữa tay ném của Los Angeles Lakers đã có thể gặp gỡ tai nạn nguy hiểm. Cập nhật kết quả trận nước Việt Nam vs Lebanon thuộc play-off vòng loại Futsal World Cup 2021.

    https://chiefscreolecafe.com/detail/everton-vs-west-ham-sofascore-103218.html

    June 15, 2021 at 05:18 | Report abuse | Reply
  44. lich thi dau asiad 2019

    Trực Tiếp Bóng Đá Việt Nam Vs Lebanon. Xem Truc Tiep Bong Da. Futsal Việt Namhtv9 hdXem bóng đá trực tuyến Trực tiếp Odd BK vs Sarpsborg, 20h ngày 24/5, giải VĐQG Na Uy. Xem lịch phát sóng thẳng đá bóng EURO ngày hôm nay được Webthethao cập nhật chính xác nhất.

    https://murraystivoli.com/detail/bxh-anh-b-4440.html

    June 15, 2021 at 05:28 | Report abuse | Reply
  45. RV Repair Shops Near My Location

    http://www.bytecheck.com/results?resource=http://ocrvcenter.com/rv-repair-shop-arcadia-california

    June 15, 2021 at 05:45 | Report abuse | Reply
  46. RV Repair Seal Beach

    This is a good tip particularly to those new to the blogosphere. Brief but very precise informationÖ Appreciate your sharing this one. A must read article!

    http://community.nxp.com/t5/custom/page/page-id/ExternalRedirect?url=ocrvcenter.com/rv-remodeling-near-me/

    June 15, 2021 at 05:56 | Report abuse | Reply
  47. live90

    Links Coi Trực Tiếp đá Bóng Futsal Việt Nam Vs Lebanon Vòng Chủng Loại World Cuphtv7 hdNếu cứ đùa như cơ hội vừa tiêu diệt Everton tới 3-1 trên Sảnh khách hàng

    https://chiefscreolecafe.com/detail/fifa-2021-56003.html

    June 15, 2021 at 05:57 | Report abuse | Reply
  48. Nearest RV Repair

    Howdy! This post couldnít be written much better! Looking through this post reminds me of my previous roommate! He continually kept preaching about this. I will send this article to him. Pretty sure he will have a very good read. Thank you for sharing!

    http://yellowpages.oakridger.com/__media__/js/netsoltrademark.php?d=https://ocrvcenter.com/5th-wheel-trailer-collision-repair-shop-near-me

    June 15, 2021 at 06:04 | Report abuse | Reply
  49. RV Repair Places Near Me

    http://img.2chan.net/bin/jump.php?www.ocrvcenter.com/tour-bus-collision-repair-shop-near-me

    June 15, 2021 at 06:26 | Report abuse | Reply
  50. link nha cai

    Xem Thẳng Viettel Vs Bình Dương Tại V League 2021 Ở Kênh Nào? ag332bet comĐội tuyển nước Việt Nam chỉ muốn một kết trái hòa có bàn thắng nhằm lần loại hai góp mặt trên World Cup futsal. Nhưng, để thực hiện được điều đó

    https://arubaeducation.info/

    June 15, 2021 at 06:48 | 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 Windshield California


 

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.