When people stop taking certain medications that usually help them sleep, they may experience a relapse of insomnia, which involves difficulty falling or staying asleep. Recurrent insomnia is sometimes worse than the insomnia experienced before treatment.
What is rebound insomnia?
Recurrent insomnia is a sleep disorder that occurs when you stop taking a medication that usually helps you fall asleep. It is a common side effect of some sleeping pills.
Sometimes, recurrent insomnia is worse than before treatment. Doctors often prescribe medications that can cause recurrent insomnia only for the shortest possible time.
Which medications can cause insomnia relapses?
Benzodiazepines and “Z” drugs, known as Z drugs, can cause insomnia relapses after discontinuation. Both benzodiazepines and Z drugs act on gamma-aminobutyric acid (GABA), which decreases stimulation of the nervous system. This growths feelings of relaxation and drowsiness, but also carries the risk of addiction and side effects.
Some examples of these medications are:
- zolpidem (Ambien)
- zopiclone (Imovana)
- zaleplon (Sonata)
- eszopiclone (Lunesta)
- alprazolam (Xanax)
- chlordiazepoxide (Librium)
- lorazepam (Ativan)
- oxazepam
- clonazepam (Klonopin)
- diazepam (Valium)
- clorazepate (Tranxen)
- estazolam
- flurazepam
- temazepam (Restoril)
- triazolam (Halcion)
- midazolam (Nayzilam)
Because of the risk of insomnia recurrence and other side effects of these medications, many doctors prefer other types of sleep aids. Doctors may prescribe them off-label, that is, for resolves other than those approved by the Food and Drug Administration (FDA).
Doctors may prescribe:
- antihistamines, such as diphenhydramine (Benadryl) and hydroxyzine; antidepressants, such as mirtazapine (Remeron);
- antipsychotics, such as quetiapine (Seroquel) and olanzapine (Zyprexa);
- some other medications, such as melatonin, are available over the counter.
How long does an insomnia relapse last?
The duration of an insomnia relapse is not defined. It likely varies from person to person. However, doctors generally expect benzodiazepine withdrawal symptoms to last no more than 4 weeks.
The duration of withdrawal symptoms can depend on the drug, the dose change, and its half-life. This is the time it takes for the amount of the drug in the body to be reduced by half.
Short-acting benzodiazepines are less likely to cause insomnia relapses than long-acting drugs. More potent benzodiazepines whitethorn also be more likely to cause insomnia relapses.
Can insomnia relapses be prevented?
It may not be possible to prevent insomnia relapses in everyone, but you can try the following measures to reduce the risk:
- Take medications with a short half-life;
- Take them for the shortest possible time;
- Reduce the dose gradually. However, gradually reducing the dose does not always prevent insomnia relapses. Some people may experience insomnia relapses until the drug is completely eliminated from the body.
- However, it is essential to gradually reduce the dose of benzodiazepines, especially if the person has been taking them for more than a month. Abruptly stopping these medications can cause severe symptoms, even death.
How to deal with insomnia relapses?
- Insomnia relapses occur due to changes in brain chemistry, and some people find them difficult to cope with. The person may need to wait for the drug to wear off before being able to go back to sleep. Here are some things that may help:
- psychoeducation, which involves learning about insomnia, its causes, and how to cope;
- relaxation training, which involves learning techniques to calm the nervous system;
- cognitive behavioral therapy (CBT), which can help a person cope emotionally with withdrawal symptoms.
Improve Sleep Naturally
According to a 2018 Trusted Source review, long-term benzodiazepine use is often due to addiction or a lack of knowledge about how to manage insomnia in other ways.
Non-drug or natural treatments may be less risky and still effective.
After stopping sleeping pills, a person may find relief by:
- Treating mental health conditions: Stress and anxiety are common causes of insomnia. Reducing stress and seeking therapy or other anxiety treatments can help improve sleep.
- Treating physical conditions: Chronic pain, shortness of breath, and other bodily conditions can also contribute to insomnia. Getting help to address these can be helpful.
- Sleep hygiene: This includes developing sleep-promoting habits and maintaining a regular sleep-wake schedule. Exposure to natural light in the morning, limiting light exposure at night, maintaining a regular routine, and using the room only for sleep or sex are all part of sleep hygiene. Relaxation: Having a relaxing bedtime routine or regular relaxation practices can help you fall asleep. This could include taking a deep bath, doing yoga, or meditating.
- Avoid caffeine and alcohol: People with insomnia may be tempted to consume caffeine to cope with insomnia. However, this can make it worse. Alcohol can also disrupt sleep.
- Natural sleep aids are also available. However, scientists have not proven their safety and effectiveness for all of them. Furthermore, there is little research on whether they cause insomnia relapses.
Examples of over-the-counter sleep aids:
- valerian
- passionflower
- lemon balm
- lavender
- California poppy
- These sleep aids may act similarly to benzodiazepines.
- Always consult a doctor before trying natural sleep aids. This is especially important if the person is taking other medications or has other medical conditions.
When to Seek Help
People who have difficulty stopping any medication due to recurrent insomnia should seek medical help. Doctors can help people gradually withdraw from benzodiazepines and other medications by developing an individualized strategy.
Do not change the dosage of sleep aids without first consulting your doctor.
Conclusion
Insomnia after medication withdrawal is a common and often temporary problem, especially when discontinuing medications that affect the chief nervous system, such as antidepressants, anti-anxiety medications, or sleeping pills. Recurrence of insomnia may be due to physiological changes or the return of underlying sleep problems treated with the medication. Understanding potential sleep disturbances after withdrawal allows patients to plan treatment in advance and work closely with healthcare professionals to manage symptoms. Gradual dose reduction, lifestyle changes, and non-pharmacological interventions, such as cognitive behavior healing for insomnia (CBT-I), can significantly ease the transition and encourage long-term sleep health. If insomnia persists or worsens, professional advice should be sought to ensure a safe recovery and maintain overall mental and physical well-being.
Frequently Asked Questions
1. Why does insomnia occur after stopping medications?
Insomnia after stopping medications (often called rebound insomnia) can occur as the body adjusts to life without the effects of the medication. Some medications, especially sleeping pills, antidepressants, and anti-anxiety medications, alter brain chemistry and sleep regulation. When the medication is stopped, the brain may have temporary difficulty restoring its natural sleep patterns.
2. Which medications most commonly cause insomnia after discontinuation? Common medications that can cause sleep problems upon discontinuation include:
- Benzodiazepines (e.g., lorazepam, diazepam)
- Sortarizines (e.g., zolpidem, eszopiclone)
- Antidepressants (e.g., SSRIs, e.g., fluoxetine, or SNRIs, e.g., venlafaxine)
- Stimulants (e.g., to treat ADHD)
- Corticosteroids and some pain relievers
3. How long does insomnia last after discontinuing medications?
The duration of insomnia varies by patient and specific medication. In most cases, symptoms improve within a few days or weeks. However, in some cases, especially after prolonged use, insomnia may persist longer and require additional treatment.
4. Is rebound insomnia dangerous?
Rebound insomnia is not usually dangerous, but it can be frustrating and disruptive. If this causes severe sleep deprivation, mood swings, or affects with your daily life, consult your doctor.
5. What can I do to improve my sleep after stopping medication?
To maintain healthy sleep during withdrawal:
- Maintain a consistent sleep routine.
- Practice good sleep hygiene (limit screen time, caffeine, and large meals before bedtime).
- Consider cognitive behavioral therapy for insomnia (CBT-I).
- Use relaxation techniques such as deep breathing or meditation.
- Avoid alcohol and over-the-counter sleep aids without consulting your doctor.
6. Should I restart my medication if I can’t sleep?
Do not restart any medication without consulting your doctor. In some cases, temporary support may be necessary, but alternatives such as behavioral therapy or lifestyle changes may be safer and more effective in the long term.
7. When should I see a doctor for insomnia after stopping medication? You should contact your doctor if:
- Insomnia persists for more than 2 to 3 weeks.
- Your daytime activities are affected.
- You experience symptoms of anxiety, depression, or withdrawal.
- You are considering restarting medication on your own.
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