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. w88

    Thông Tin, Sự Kiện Liên Quan Lại Đến Thẳng Bóng Đá Nữ cờ tướng zingplayĐội tuyển chọn futsal nước Việt Nam đã có được một trận đấu đồng ý được trước đối thủ đầy mức độ mạnh Lebanon. Kết quả Bà Rịa-Vũng Tàu vs Bình Phước ngày hôm nay 18h00 ngày 5/5, Hạng nhất Việt Nam.

    https://naija5.com/

    June 29, 2021 at 06:26 | Report abuse | Reply
  2. Sprinter Calliper Repair

    https://www.okmedicalboard.org/external-link?url=https://www.ocrvandtrucks.com

    June 29, 2021 at 06:30 | Report abuse | Reply
  3. Nearby RV Repairs

    https://www.immobilien-magazin.at/redirect.php?url=http://www.rvcollisionrepairpaintshop.com

    June 29, 2021 at 06:32 | Report abuse | Reply
  4. burnley đấu với man utd

    Thẳng đá Bóng Ngày Hôm NayxoactvXem 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 cập nhật chính xác nhất.

    https://murraystivoli.com/detail/tennis-truc-tiep-43735.html

    June 29, 2021 at 06:53 | Report abuse | Reply
  5. truc tiep htv 7

    Thẳng Soccer Hôm Nay, Links Coi Soccer Trực Tuyến 24h cờ tướng zingplayĐội tuyển chọn nước ta chỉ muốn một kết trái hòa có bàn thắng để lần thứ hai góp mặt trên World Cup futsal. Nhưng, nhằm làm được điều đó

    https://naija5.com/

    June 29, 2021 at 07:24 | Report abuse | Reply
  6. casino trực tuyến

    Tin Tức, Sự Khiếu Nại Liên Quan Tiền Đến Thẳng đá Bóng Nữ w88 casinoĐội tuyển nước ta chỉ cần thiết một kết trái hòa có bàn thắng để lần thứ hai góp mặt tại World Cup futsal. Nhưng, để làm được điều đó

    https://naija5.com/

    June 29, 2021 at 08:05 | Report abuse | Reply
  7. Mercedes Sprinter Van Abs Repair

    Right here is the right web site for anybody who hopes to find out about this topic. You understand so much its almost tough to argue with you (not that I actually will need toÖHaHa). You certainly put a new spin on a topic that has been written about for ages. Great stuff, just excellent!

    http://link.harikonotora.net/?https://ocrvmotorsports.org

    June 29, 2021 at 08:42 | Report abuse | Reply
  8. RV Repair Shop Near My Location

    https://100kursov.com/away/?url=https://www.www.ocrvcenter.biz

    June 29, 2021 at 09:11 | Report abuse | Reply
  9. RV Repair California

    Very good post! We are linking to this great content on our website. Keep up the good writing.

    http://biblioteca.infotec.com.mx/cgi-bin/koha/tracklinks.pl?uri=https://www.ocrv.vip/

    June 29, 2021 at 11:05 | Report abuse | Reply
  10. Sprinter Repair Orange County

    bookmarked!!, I like your website!

    http://aboutlincolncenter.org/component/dmms/handoff?back_url=https://www.carsonrvexperience.com/

    June 29, 2021 at 11:14 | Report abuse | Reply
  11. link vao m88

    Trực Tiếp Soccer Thời Điểm Hôm Nay, Liên Kết Xem Soccer Trực Tuyến 24h truc tiep kenoĐội tuyển chọn nước ta chỉ cần một kết quả hòa có bàn thắng để lần thứ hai góp mặt tại World Cup futsal. Nhưng, nhằm thực hiện được điều đó

    https://thisisthegreenroom.com/

    June 29, 2021 at 11:33 | Report abuse | Reply
  12. Passenger Van Repair

    There's certainly a lot to know about this topic. I really like all the points you've made.

    https://www.motobuy.com.tw/banner_direct.php?b_id=5&url=https://ocrvmotorsports.co

    June 29, 2021 at 11:58 | Report abuse | Reply
  13. RV Repair Shops Nearby

    http://gizoogle.net/tranzizzle.php?search=https://www.orangecountyrvrepair.com

    June 29, 2021 at 12:25 | Report abuse | Reply
  14. Sprinter Van Alignment Shop

    https://khazin.ru/redirect?url=https://www.ocrvshop.com

    June 29, 2021 at 12:27 | Report abuse | Reply
  15. RV Repair Shop

    Next time I read a blog, I hope that it won't fail me as much as this one. After all, I know it was my choice to read through, however I really thought you would have something useful to say. All I hear is a bunch of complaining about something that you can fix if you were not too busy seeking attention.

    http://www.activecabarete.com/links/index.php?https://ocrv.club/

    June 29, 2021 at 13:13 | Report abuse | Reply
  16. Conversion Shop

    http://openforbusinessmagazine01.businesscatalyst.com/Redirect.aspx?destination=https://oc-rv.com/

    June 29, 2021 at 13:23 | Report abuse | Reply
  17. Authorized Mercedes Sprinter Service Centers Near Me

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

    https://www.yamanashi-kosodate.net/blog/count?id=34&url=http://ocrvshop.com/

    June 29, 2021 at 13:29 | Report abuse | Reply
  18. Nearby RV Repairs

    Saved as a favorite, I really like your website!

    https://www.sunzu.com/link/?url=ocrvcenter.biz

    June 29, 2021 at 14:00 | Report abuse | Reply
  19. Mercedes Benz Sprinter Repair Shops Near Me

    http://www.artshub.com.au/job-apply-external/?ListingId=227894&ApplyUrl=https://www.www.ocrv.mobi

    June 29, 2021 at 14:09 | Report abuse | Reply
  20. Mechanic Shop Near Me

    This website was... how do I say it? Relevant!! Finally I have found something which helped me. Thanks!

    http://www.gzisp.net/?action=url&goto=ocrvcenter.com/

    June 29, 2021 at 14:55 | Report abuse | Reply
  21. Nearby RV Repair

    You have made some good points there. I checked on the internet for more info about the issue and found most individuals will go along with your views on this website.

    http://list-unsubscribe.com/__media__/js/netsoltrademark.php?d=ocrvcenter.com

    June 29, 2021 at 15:11 | Report abuse | Reply
  22. RV Repair Mission Viejo

    https://www.chiefarchitect.com/go?resource=redirect&url=https://ocrvcenter.com

    June 29, 2021 at 15:17 | Report abuse | Reply
  23. Sprinter Repair Costa Mesa

    http://web.trailerpark.com/__media__/js/netsoltrademark.php?d=ocrvcenter.com

    June 29, 2021 at 15:54 | Report abuse | Reply
  24. users.atw.hu

    Hello everyone, it's my first go to see at this website,
    and paragraph is genuinely fruitful in support of me, keep up posting these
    posts.

    My site ... NZT-48 Pills – users.atw.hu,

    June 29, 2021 at 15:57 | Report abuse | Reply
  25. RV Repair Near Me Now

    This is a good tip especially to those new to the blogosphere. Simple but very precise informationÖ Thank you for sharing this one. A must read article!

    http://www.inetbet.com/affiliates/aiddownload.asp?affid=1579&redirect=http://ocrvcenter.com/

    June 29, 2021 at 15:58 | Report abuse | Reply
  26. game đánh bài

    Coi Thẳng Viettel Vs Tỉnh Bình Dương Tại V League 2021 Ở Kênh Nào? truc tiep kenoĐội tuyển chọn nước ta chỉ cần thiết một kết quả hòa có bàn thắng để lần loại hai góp mặt tại World Cup futsal. Nhưng, để thực hiện được điều này

    https://naija5.com/

    June 29, 2021 at 16:00 | Report abuse | Reply
  27. trực tiếp bóng đá việt nam hôm nay

    Trực Tiếp Bóng Đá Việt Nam Vs Lebanon. Coi Truc Tiep Bong Da. Futsal Việt Namlịch phát sóng bóng đáXem 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 ngày hôm nay được Webthethao cập nhật chính xác nhất.

    https://virandoamor.com/detail/101tv-bong-da-99433.html

    June 29, 2021 at 16:31 | Report abuse | Reply
  28. hồng nhung

    Thông Tin, Sự Khiếu Nại Liên Quan Lại Đến Thẳng đá Bóng Nữ Giới truc tiep bong da keo nha caiĐội tuyển chọn futsal nước Việt Nam đã được một trận đấu đồng ý được trước đối thủ đầy sức mạnh Lebanon. Kết trái Bà Rịa-Vũng Tàu vs Bình Phước thời điểm hôm nay 18h00 ngày 5/5, Hạng nhất Việt Nam.

    https://novelinkblog.com/

    June 29, 2021 at 16:46 | Report abuse | Reply
  29. Ram Cargo Van Repair Shop

    https://lnfcu.com/helpers/choice.asp?h=https://sprintervanrepair.com

    June 29, 2021 at 16:51 | Report abuse | Reply
  30. RV Repairs Near My Location

    https://www.wblib.org/includes/statistics.php?StatType=Link&StatID=Instagram&weblink=https://ocrvcenter.org/

    June 29, 2021 at 17:09 | Report abuse | Reply
  31. Sprinter Repair Shop Near Me

    http://www.dauntless-soft.com/products/android/beforeyougo.asp?U=http://www.ocrvandtrucks.com/

    June 29, 2021 at 17:15 | Report abuse | Reply
  32. Camper Repairs Near Me

    You need to be a part of a contest for one of the greatest sites on the net. I am going to highly recommend this website!

    http://redir.tripple.at/countredir.asp?lnk=https://www.rvcollisionrepairpaintshop.com

    June 29, 2021 at 17:51 | Report abuse | Reply
  33. RV Repair Shops Near Me Now

    Greetings! Very helpful advice in this particular post! It's the little changes that produce the biggest changes. Thanks for sharing!

    http://cine.astalaweb.net/_inicio/Marco.asp?dir=https://ocrv.org/

    June 29, 2021 at 17:55 | Report abuse | Reply
  34. RV Repair Santa Ana

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

    http://webmasters.astalaweb.com/_inicio/Visitas.asp?dir=http://theocrv.com

    June 29, 2021 at 18:32 | Report abuse | Reply
  35. RV Repair Shops Near Me Now

    https://intranet.canadabusiness.ca/?URL=http://ocrvmotorsports.net

    June 29, 2021 at 18:34 | Report abuse | Reply
  36. kèo nhà cái

    Xoilac Tv Thẳng Bóng Đá đánh bài onlineĐội tuyển chọn Việt Nam chỉ cần một kết trái hòa có bàn thắng để lần loại hai góp mặt tại World Cup futsal. Nhưng, để làm được điều đó

    https://sshuebner.org/

    June 29, 2021 at 19:05 | Report abuse | Reply
  37. Marijuana Gummies

    Thanks for the blog post.Much thanks again.

    https://www.kitsapdailynews.com/marketplace/best-thc-gummies-top-3-marijuana-edibles-on-the-rise-in-2021/

    June 29, 2021 at 19:39 | Report abuse | Reply
  38. Sprinter Van Service Near Me

    http://d-click.eou.com.br/u/210/88/16386/291/af9db/?url=https://customcampervans.com/

    June 29, 2021 at 22:03 | Report abuse | Reply
  39. live 90p

    Thẳng Bóng Đá Việt Nam Vs Lebanon. Xem Truc Tiep Bong Da. Futsal Việt Namket qua tennis truc tuyenXem đá bóng trực tuyến Trực tiếp Odd BK vs Sarpsborg, 20h ngày 24/5, giải VĐQG Na Uy. Xem lịch phạt sóng thẳng bóng đá EURO thời điểm hôm nay được Webthethao cập nhật chính xác nhất.

    https://virandoamor.com/detail/bxh-phap-3-4501.html

    June 30, 2021 at 00:41 | Report abuse | Reply
  40. http://corona.scaling-experience.de/index.php/nachricht

    Excellent items from you, man. I've be aware your stuff prior
    to and you are just extremely fantastic. I actually like what you've bought here, certainly like what you're saying
    and the way in which in which you say it. You are making it
    entertaining and you continue to take care of to stay it sensible.
    I can't wait to read much more from you. This
    is actually a wonderful site.

    Here is my site NZT-48 Pills Reviews (http://corona.scaling-experience.de/index.php/nachricht)

    June 30, 2021 at 01:09 | Report abuse | Reply
  41. Rv Mercedes Sprinter Service Center Near Me

    http://dawnofwar.org.ru/go?http://fleetvehiclerepairshop.com

    June 30, 2021 at 01:34 | Report abuse | Reply
  42. dudoanbongda

    Link Coi Thẳng đá Bóng Futsal Việt Nam Vs Lebanon Vòng Loại World Cupsổ tay fo4Xem soccer trực tuyến Trực tiếp Odd BK vs Sarpsborg, 20h ngày 24/5, giải VĐQG Na Uy. Xem lịch vạc sóng trực tiếp bóng đá EURO ngày hôm nay được Webthethao cập nhật chính xác nhất.

    https://murraystivoli.com/detail/truc-tiep-bong-da-vtv3-94977.html

    June 30, 2021 at 02:45 | Report abuse | Reply
  43. RV Repair Santa Ana

    https://www.fisherly.com/redirect?type=website&ref=listing_detail&url=https://oc-rv.com/

    June 30, 2021 at 03:17 | Report abuse | Reply
  44. dangky.tlu

    Xoilac Tv Thẳng Bóng Đá 1gom.ỏgĐội tuyển nước Việt Nam chỉ cần thiết một kết quả hòa có bàn thắng để lần thứ hai góp mặt trên World Cup futsal. Nhưng, nhằm thực hiện được như vậy

    https://frontsportsbox.com/

    June 30, 2021 at 03:29 | Report abuse | Reply
  45. RV Repair

    Good post. I will be dealing with a few of these issues as well..

    http://www.predatormastersforums.com/adbanner/adclick.php?bannerid=92&zoneid=0&source=&dest=https://ocrvshop.com

    June 30, 2021 at 04:16 | Report abuse | Reply
  46. RV Repair Near Me Now

    https://www.leroymerlin.com.br/logout?redirect=https://ocrv.rocks/

    June 30, 2021 at 04:41 | Report abuse | Reply
  47. keo nhà cái

    Xoilac Tv Thẳng Soccer vwinĐội tuyển chọn futsal nước Việt Nam đã được một trận đấu đồng ý được trước đối thủ đầy sức mạnh Lebanon. Kết quả Bà Rịa-Vũng Tàu vs Bình Phước thời điểm hôm nay 18h00 ngày 5/5, Hạng nhất Việt Nam.

    https://novelinkblog.com/

    June 30, 2021 at 04:50 | Report abuse | Reply
  48. Nearest RV Repair

    Very good info. Lucky me I found your website by accident (stumbleupon). I have bookmarked it for later!

    https://www.scga.org/Account/AccessDenied.aspx?URL=http://ocrvcenter.biz

    June 30, 2021 at 05:02 | Report abuse | Reply
  49. Credit Counseling orlando

    such a great information for blogger i am a professional blogger thanks

    https://goo.gl/maps/WTPBHu1Md2N2

    June 30, 2021 at 05:36 | Report abuse | Reply
  50. www.pharmaceptica.com

    sildenafil citrate 100mg tab https://pharmaceptica.com/

    June 30, 2021 at 06:01 | 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 Seo Marketing Job


 

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.