 |
|
|
|
June 7th, 2011
04:28 PM ET
Get Some Sleep: Beware the sleeping pill hangoverLisa 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.
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. soundoff (2,309 Responses)« Previous 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 Next »Leave a Reply to rv repair shop
Next entry »Scientists warn of chemical-autism link
« Previous entryCDC: Non-straight youth more at risk
|
  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.
 |
|
|
|
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.
Xem Trực Tiếp Viettel Vs Bình Dương Tại V League 2021 Ở Kênh Nào? keo bong daĐội tuyển Việt Nam chỉ cần một kết quả hòa có bàn thắng để lần loại hai góp mặt trên World Cup futsal. Nhưng, để thực hiện được như vậy
https://arubaeducation.info/detail/tylecacuoc-33038.html
difference between chloroquine phosphate and hydroxychloroquine https://pharmaceptica.com/
Trực Tiếp đá Bóng Thời Điểm Hôm Nayhtv2 liveXem đá bóng trực tuyến Trực tiếp Odd BK vs Sarpsborg, 20h ngày 24/5, giải VĐQG Na Uy. Xem lịch vạc sóng thẳng bóng đá EURO ngày hôm nay được Webthethao cập nhật chính xác nhất.
https://virandoamor.com/detail/vtc9-truc-tiep-bong-da-hom-nay-vtv6-62226.html
https://www.portalfarma.com/paginas/redirigir.aspx?redirect=https://ocrvart.com
http://fishbiz.seagrant.uaf.edu/click-thru.html?url=http://globaldir.org/
Coi Trực Tiếp Viettel Vs Bình Dương Tại V League 2021 Ở Kênh Nào? fun 88Đội tuyển chọn Việt Nam chỉ muốn một kết trái hòa có bàn thắng để lần thứ hai góp mặt trên World Cup futsal. Nhưng, để thực hiện được điều đó
https://frontsportsbox.com/detail/m-w88wvn-138848.html
/
https://bbs.pku.edu.cn/v2/jump-to.php?url=https://katsfineartstudio.com
Top 5 Trang Net Tỷ Lệ Kèo Bóng Đá Tốt Nhất 2021Tỷ Lệ Kèo Bóng Đá, Tỷ Lệ Cá Cược, Tỷ Lệ Kèo Nhà Cái casino việt namHai trận đấu của lượt cuối mỗi bảng bắt buộc phải thi đấu cùng giờ. Kết thúc vòng bảng, đội nhất, nhì các bảng và 4 đội xếp thứ ba có thành tích tốt nhất sẽ giành quyền vào vòng sixteen đội.
https://www.vnd188.bet/
High 5 Trang Internet Tỷ Lệ Kèo Bóng Đá Tốt Nhất 2021Biến Động Tỷ Lệ Kèo Nhà Cái Thụy Điển Vs Ba Lan Hôm Nay 23 dafabet casinoHai trận đấu của lượt cuối mỗi bảng bắt buộc phải thi đấu cùng giờ. Kết thúc vòng bảng, đội nhất, nhì các bảng và four đội xếp thứ ba có thành tích tốt nhất sẽ giành quyền vào vòng sixteen đội.
https://www.vnd188.bet/
https://www.rya.org.uk/coursestraining/professional/pages/redir.axd?ciid=671&cachename=advertising&pagegroupid=212&url=https://www.www.personaltrainerhub.com
tadalafil peptides https://www.pharmaceptica.com/
https://www.igive.com/isearch/NonStoreExit.cfm?type=1&isid=0df7d37f-4feb-4f0f-b472-1df60f43914d&rurl=https://vacationspot.in
You need to take part in a contest for one of the finest websites online. I'm going to highly recommend this site!
https://accounts.cast.org/register.php?home=http://backbonehunters.com
Custom Dab Mathttps://itsmyurls.com/r0zggoz994All products intended for use with legal smoking/vaping mixtures only .
https://torgi.gov.ru/forum/user/edit/1382757.page
Intrinsic Muscles Of The Handhttps://www.posts123.com/user/823477/eelcomb09All products intended for use with legal smoking/vaping mixtures only .
https://www.posts123.com/user/837513/designbeef2
Coi Thẳng Viettel Vs Bình Dương Trên V League 2021 Ở Kênh Nào? ty le nha caiĐội tuyển chọn nước Việt Nam chỉ cần thiết một kết trái hòa có bàn thắng nhằm lần thứ hai góp mặt trên World Cup futsal. Nhưng, để làm được điều này
https://novelinkblog.com/
Hello, i read your blog from time to time and i own a similar one and i was just
curious if you get a lot of spam remarks? If so how do you prevent it,
any plugin or anything you can recommend? I get so
much lately it's driving me insane so any help is very much appreciated.
I really love your site.. Great colors & theme. Did you build this amazing site yourself? Please reply back as Iím looking to create my own personal site and would like to know where you got this from or what the theme is called. Cheers!
https://www.suzuki.saikyou.biz/rank.cgi?mode=link&id=5&url=https://backboneleaders.com/
Good information. Lucky me I discovered your website by chance (stumbleupon). I have saved it for later!
https://www.scratchapixel.com/code.php?id=8&origin=https://backboneleaders.com/
https://content.sixflags.com/news/director.aspx?gid=0&iid=72&cid=3714&link=https://www.backbonehunters.com
https://sso.aoa.org/Authenticate.aspx?Return=http://backboneleaders.com/
Trực Tiếp đá Bóng Hôm Nay, Link Coi Soccer Trực Tuyến 24h kèo nhà cáiĐội tuyển chọn futsal nước ta đã có được một trận đấu đồng ý được trước phe đối lập đầy sức mạnh Lebanon. Kết quả Bà Rịa-Vũng Tàu vs Bình Phước hôm nay 18h00 ngày 5/5, Hạng nhất nước Việt Nam.
https://naija5.com/
You made some good points there. I looked on the internet to learn more about the issue and found most people will go along with your views on this website.
http://www.chiswickw4.com/default.asp?section=info&link=https://backboneleaders.com
http://clevacances032.clevacances.com/stat.php?langue=fr&id_location=HLOMIP032MS00786&agrement=32MS00786&type_location=meuble&id_departement=032&acces_site=1&url=https://www.backbonehunters.com
Thông Tin, Sự Khiếu Nại Liên Quan Lại Đến Trực Tiếp đá Bóng Nữ live casinoĐội tuyển chọn nước ta chỉ muốn một kết trái hòa có bàn thắng nhằm lần thứ hai góp mặt trên World Cup futsal. Nhưng, để làm được điều đó
https://sshuebner.org/
http://truehits.net/webout.php?url=https://www.backbonehunters.com
Very good blog post. I definitely appreciate this website. Continue the good work!
https://pages.audioteka.com/app/rdir.php?rdir=https://www.backbonehunters.com
Thẳng đá Bóng Việt Nam Vs Lebanon. Xem Truc Tiep Bong Da. Futsal Việt NamxoivoXem bóng đá trực tuyến Trực tiếp Odd BK vs Sarpsborg, 20h ngày 24/5, giải VĐQG Na Uy. Xem lịch phát sóng thẳng soccer EURO ngày hôm nay được Webthethao update chính xác nhất.
https://murraystivoli.com/detail/11met-tv-94102.html
Everything is very open with a really clear clarification of the issues. It was definitely informative. Your website is very useful. Thank you for sharing!
http://aquarist-classifieds.co.uk/BANNER-MANAGEMENT/click.php?id=44&url=https://backboneleaders.com
http://x.webdo.cc/global_outurl.php?now_url=http://backboneleaders.com
Thông Tin, Sự Khiếu Nại Liên Quan Lại Đến Thẳng Bóng Đá Phái Nữ 12betĐội tuyển chọn Việt Nam chỉ cần một kết trái hòa có bàn thắng nhằm lần loại hai góp mặt tại World Cup futsal. Nhưng, để thực hiện được điều đó
https://thisisthegreenroom.com/detail/game-do-vui-kinh-thanh-98742.html
Hello there! I simply would like to give you a big thumbs up for your excellent info you have here on this post. I will be coming back to your website for more soon.
http://rapetaboo.com/out.php?https://backboneleaders.com
Links Xem Trực Tiếp Bóng Đá Futsal Việt Nam Vs Lebanon Vòng Chủng Loại World Cupmu vs psg lượt vềNếu cứ chơi như cách vừa đè bẹp Everton tới 3-1 bên trên sảnh khách
https://chiefscreolecafe.com/detail/truc-tiep-vtv3-huong-duong-nguoc-nang-tap-19-121805.html
http://blog.pianetadonna.it/fiylm/?wptouch_switch=desktop&redirect=https://backboneleaders.com
Xoilac Tv Trực Tiếp đá Bóng 188betĐội tuyển chọn futsal nước ta đã có một trận đấu chấp nhận được trước đối thủ đầy mức độ mạnh Lebanon. Kết quả Bà Rịa-Vũng Tàu vs Bình Phước thời điểm hôm nay 18h00 ngày 5/5, Hạng nhất nước ta.
https://frontsportsbox.com/detail/88net-131097.html
Very good blog post. I absolutely love this site. Thanks!
https://www.hypercomments.com/api/go?url=http://backbonehunters.com/
https://priyo.com/feed/redirection?url=https://backbonehunters.com
This website was... how do you say it? Relevant!! Finally I have found something which helped me. Cheers!
http://etracker.cefic.org/click.aspx?uid=7aad121c-9f74-447a-8222-9ba69cb40182&fw=https://www.backboneleaders.com
https://scripts.affiliatefuture.com/AFClick.asp?affiliateID=1567&merchantID=617&programmeID=2028&mediaID=0&tracking=&url=https://www.backbonehunters.com
https://www.cropscience.bayer.ca/?setlanguage=en&returnUrl=http://backbonehunters.com/
Xem Thẳng Viettel Vs Tỉnh Bình Dương Trên V League 2021 Ở Kênh Nào? ku777Đội tuyển chọn futsal Việt Nam đã có được một trận đấu chấp nhận được trước phe đối lập đầy mức độ mạnh Lebanon. Kết quả Bà Rịa-Vũng Tàu vs Bình Phước hôm nay 18h00 ngày 5/5, Hạng nhất nước Việt Nam.
https://frontsportsbox.com/
Xoilac Tv Trực Tiếp Soccer lich phat song vtc11Đội tuyển futsal nước ta đã có được một trận đấu chấp nhận được trước đối thủ đầy sức mạnh Lebanon. Kết trái Bà Rịa-Vũng Tàu vs Bình Phước ngày hôm nay 18h00 ngày 5/5, Hạng nhất Việt Nam.
https://thisisthegreenroom.com/detail/tvhd-101750.html
Trực Tiếp Bóng Đá Việt Nam Vs Lebanon. Xem Truc Tiep Bong Da. Futsal Việt Namhtv2 trực tiếpXem bóng đá trực tuyến Trực tiếp Odd BK vs Sarpsborg, 20h ngày 24/5, giải VĐQG Na Uy. Xem lịch vạc sóng thẳng bóng đá EURO hôm nay được Webthethao cập nhật chủ yếu xác nhất.
https://murraystivoli.com/detail/truc-tiep-nong-dai-thvl1-75619.html
https://www.mauihealthguide.com/ads/adclick.php?bannerid=25&zoneid=16&source=&dest=https://backboneleaders.com
http://www.deltacore.us/__media__/js/netsoltrademark.php?d=boxtruckrepairshop.com
http://www.putneysw15.com/default.asp?section=info&link=https://ocrv.store/
Right here is the right site for anyone who would like to find out about this topic. You understand so much its almost tough to argue with you (not that I actually would want toÖHaHa). You certainly put a fresh spin on a topic which has been written about for decades. Great stuff, just great!
http://wiaj.org/__media__/js/netsoltrademark.php?d=ocrvcenter.co
Aw, this was an exceptionally good post. Taking the time and actual effort to make a very good articleÖ but what can I sayÖ I put things off a whole lot and never seem to get anything done.
http://www.readoc.com/__media__/js/netsoltrademark.php?d=www.ocrv.club
Tin Tức, Sự Kiện Liên Quan Lại Đến Thẳng Bóng Đá Phái Nữ soi keo nha caiĐội tuyển futsal nước ta đã có một trận đấu chấp nhận được trước đối thủ đầy sức mạnh Lebanon. Kết quả Bà Rịa-Vũng Tàu vs Bình Phước hôm nay 18h00 ngày 5/5, Hạng nhất Việt Nam.
https://naija5.com/