When people stop taking certain medications that usually help them sleep, they may experience rebound insomnia and have difficulty falling or staying asleep. Rebound insomnia is sometimes worse than the insomnia a person had before treatment.
Medications that can cause rebound insomnia include benzodiazepines and Z-drugs, such as zopiclone, zolpidem, and zaleplon. However, other drugs that people use for sleep may also cause it.
Keep reading to learn more about the drugs that cause rebound insomnia. This article also offers strategies to cope with rebound insomnia.
Rebound insomnia is difficulty sleeping that occurs when a person stops taking a medication that usually helps them sleep. It is a common side effect of some sleeping pills.
Sometimes, rebound insomnia is worse than the insomnia a person experienced before treatment. Typically, doctors only prescribe drugs likely to cause rebound insomnia for the shortest time possible.
Benzodiazepines and drugs from the “Z” group, known as Z-drugs, can cause rebound insomnia when a person stops taking them.
Both benzodiazepines and Z-drugs affect gamma-aminobutyric acid (GABA), which reduces stimulation of the nervous system. This increases feelings of relaxation and drowsiness but also comes with a risk of dependence and side effects.
Examples of these medications include:
- zolpidem (Ambien)
- zopiclone (Imovane)
- zaleplon (Sonata)
- eszopiclone (Lunesta)
- alprazolam (Xanax)
- chlordiazepoxide (Librium)
- lorazepam (Ativan)
- clonazepam (Klonopin)
- diazepam (Valium)
- clorazepate (Tranxene)
- temazepam (Restoril)
- triazolam (Halcion)
- midazolam (Nayzilam)
Because of the risk of rebound insomnia and other side effects from these drugs, many doctors favor other types of sleep-promoting medications. Doctors can prescribe these off-label, which means they prescribe them for a different purpose than the Food and Drug Administration (FDA) has approved them for.
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 drugs, such as melatonin, are available over the counter (OTC) without a prescription.
There is no set amount of time that rebound insomnia will last. Each person will likely have a different experience. Generally, though, doctors expect withdrawal symptoms for benzodiazepines to last no more than 4 weeks.
The duration of withdrawal effects can depend on the drug, the change in dose, and the drug’s half-life. This is the time it takes for the amount of drug in the body to halve.
Shorter-acting benzodiazepines cause less rebound insomnia than longer-acting drugs. More potent benzodiazepines may also be more likely to cause rebound insomnia.
It might not be possible to prevent rebound insomnia in all people, but people can try the following to reduce the risk:
- taking drugs with a shorter half-life
- taking them for as short a time as possible
- reducing intake slowly
However, lowering the dose slowly does not always prevent rebound insomnia. Some people may experience rebound insomnia until the drug has entirely left their bodies.
Nevertheless, it is crucial to reduce the intake of benzodiazepines gradually, especially if a person has been taking them for more than 1 month. Stopping this drug abruptly can cause severe symptoms, and it can be fatal.
Rebound insomnia occurs because of changes in brain chemistry, and some people can find it difficult to cope with. A person may need to wait until the drug’s effects wear off before they can sleep again.
Some things that
- psychoeducation, which involves learning about insomnia, what contributes to it, and how to manage it
- relaxation training, which involves learning techniques that calm the nervous system
- cognitive behavioral therapy (CBT), which may help a person cope emotionally with withdrawal symptoms
According to a
Non-pharmacological or natural treatments can have fewer risks and yet still be effective.
After stopping taking the sleep drug, a person may find relief by:
- Treating mental conditions: Stress and anxiety are common causes of insomnia. Reducing stress and seeking therapy or other treatments for anxiety may make sleeping easier.
- Treating physical conditions: Chronic pain, breathing difficulties, and other physical conditions can also contribute to insomnia. Getting support for these may help.
- Sleep hygiene: This involves adopting habits that promote sleep and a regular sleep-wake schedule. Getting daylight exposure in the morning, limiting light exposure in the evening, having a regular daily routine, and using the bedroom only for sleep or sex are
part ofsleep hygiene.
- Relaxation: A relaxing bedtime routine, or regular relaxation practice, may help with sleep. This could include taking a warm bath, practicing yoga, or meditation.
- Avoiding caffeine and alcohol: People with insomnia may feel tempted to use caffeine to cope with sleep deprivation. However, this may exacerbate insomnia. Similarly, alcohol can disrupt sleep.
There are also natural sleep aids. However, scientists have not tested all these to ensure they are safe and effective. There is also little research on whether they cause rebound insomnia.
Examples of nonprescription sleep aids
- lemon balm
- Californian poppy
These sleep remedies may work in a similar way to benzodiazepines.
Always speak with a doctor before trying a natural product for sleep. This is especially important if a person takes other drugs or has other health conditions.
People having trouble stopping any drug because of rebound insomnia should seek medical advice. Doctors can help people wean themselves off benzodiazepine and other drugs by creating a personalized strategy.
Do not alter the dose of sleep medications without discussing it with a doctor first.
Rebound insomnia is common after stopping taking certain sleeping pills, such as benzodiazepines and Z-drugs. Off-label sleep aids may also cause rebound insomnia.
To prevent rebound insomnia, doctors suggest slowly lowering the dose of some sleep medications. This is especially important for benzodiazepines. If rebound insomnia does occur, relaxation training and other natural strategies may help a person cope.