How Long Will It Take to Recover from Medication-Induced Insomnia?

Q: How Long Will It Take to Recover from Medication-Induced Insomnia?

Hello： "Rebound insomnia" caused by sedative medications occurs because our brain produces certain inhibitory neurotransmitters under the influence of these drugs, leading to changes in nerve cells. <br>As a result, the sleep center becomes lethargic, and it may take several days

How much longer will it take to return to normal?

Your question: Hello doctor, I would like to inquire about medication issues.
I have been experiencing stomach pain due to autonomic nervous system dysfunction, and I never had insomnia before taking the medication.
After being prescribed Lorazepam for over three months, a pharmacist friend mentioned that this medication could be addictive and suggested I taper off.
I reduced the dosage and stopped taking it three weeks later.
Now, it has been almost three months, and I still cannot sleep well.
I fall asleep quickly but wake up after 2-3 hours.
I am unsure how much longer this will last.
Will I be like this for the rest of my life? Has my brain been damaged and will it not recover? Currently, I am seeing another doctor who prescribed half a dose of Mirtazapine and one dose of Trazodone, but I still wake up after 2-3 hours.
I hope a kind doctor can see my issue and help me.

Response from Dr.
Wang Yaoting, Psychiatrist: Hello, I apologize for the delay in responding as the system did not notify me.
Lorazepam is considered a relatively mild sedative, so there is no need to worry too much about addiction.
However, stopping it too quickly may lead to rebound insomnia.
I believe your current sleep issues are less likely to be caused by brain damage from the medication and more likely due to unresolved autonomic nervous system dysfunction or sleep disorders.
There are many factors contributing to sleep disturbances, including emotions, stress, sleep environment, and physical factors, which can ultimately affect the hypothalamic sleep center.
I recommend reflecting on the possible causes of your insomnia and working to improve them, as well as correcting some poor sleep habits (such as drinking tea or coffee in the afternoon, engaging in vigorous exercise before bed, or using your phone in bed).
Establishing a regular sleep schedule and incorporating aerobic exercise weekly can be beneficial.
If you prefer not to use medication, consider seeking cognitive behavioral therapy for insomnia.
Hello Dr.
Wang, I previously experienced insomnia after stopping Lorazepam, and it has now been three months since I stopped.
You mentioned rebound insomnia; how long does it typically last? I have been struggling for over three months without recovery.
My previous symptoms of autonomic nervous system dysfunction were just stomach pain and nausea, but since stopping Lorazepam, the stomach pain has significantly decreased.
Before taking Lorazepam, I never had insomnia and slept well, so I don't believe my insomnia is due to autonomic nervous system issues.
The doctor who originally prescribed Lorazepam only told me that taking it for life would not cause any problems.
When I asked my current doctor, he said he did not understand why my previous doctor recommended long-term use of Lorazepam.
He mentioned that there are many alternative medications available.
I am unsure how long the insomnia from stopping the medication will last (I tapered off in three weeks; was that too fast?).
Now, with Trazodone and Mirtazapine, I can only sleep for 2-3 hours before waking up.
Although I can lie down and fall back asleep, I feel increasingly tired and lack energy during the day.
The doctor I am currently seeing said it will gradually improve, so he prescribed lighter medications, but I am unsure how long it will take to return to my previous state.
I have read online that stopping medication can lead to poor sleep in the latter half of the night, possibly lasting for months or even years.
Seeing this makes me wonder how much longer I can endure this or if I should return to taking Lorazepam.
I hope the doctor can provide me with answers.
Thank you very much.

Xiao Hao, 30~39 year old female. Ask Date: 2021/11/17

Dr. Wang Yaoting reply Psychiatry

Hello: "Rebound insomnia" caused by sedative medications occurs because our brain produces certain inhibitory neurotransmitters under the influence of these drugs, leading to changes in nerve cells.
As a result, the sleep center becomes lethargic, and it may take several days or even weeks to recover after discontinuing the medication, with the duration varying from person to person.
The most important aspect of addressing insomnia is to identify and treat the underlying causes, maintain good sleep hygiene (as noted), adjust to a regular daily routine, and learn appropriate relaxation techniques.
If the situation does not show significant improvement, it is advisable to visit a sleep center at a major hospital for further evaluation and treatment.
Adjustments to medication should be discussed with your current physician.

(Note) Sleep hygiene tips:
1.
Regardless of how well you sleep at night, keep a consistent wake-up time.
Waking up at the same time each day makes it easier to fall asleep at a regular time.

2.
Stop using substances that can affect sleep, such as coffee, tea, alcohol, and cigarettes.

3.
Avoid lying in bed during non-sleeping hours, unless past experiences have shown it helps with nighttime sleep.

4.
Increase daytime physical activity (exercise that makes you sweat and raises your heart rate), especially in the afternoon and evening, but avoid vigorous exercise close to bedtime.

5.
In the evening, avoid stimulating and overly busy activities; instead, engage in gentle, relaxing activities.

6.
Increase exposure to outdoor light during the day to promote better sleep quality at night.

7.
Take a warm bath for 20 to 30 minutes 1 to 2 hours before bedtime.

8.
Avoid eating too much at night (especially hard-to-digest foods); a small amount of warm milk and a light snack before bed is fine, but avoid drinking too much water.

9.
Maintain a comfortable sleep environment and minimize disturbances.

10.
Do not force yourself to sleep; if you cannot fall asleep within 20 to 30 minutes in bed, get up and do some gentle activities, returning to bed only when you feel sleepy, and repeat this principle as needed.

11.
Aside from regular activities that promote sleep, avoid using the bed for other non-sleep activities, except for sleeping and sexual activity.

12.
Sleep is sufficient as long as you feel refreshed the next day; excessively long sleep can actually lead to poor sleep quality.

I hope this answers your question :)

Reply Date: 2021/11/17

More Info

Recovering from medication-induced insomnia, particularly after discontinuing benzodiazepines like Lorazepam, can be a challenging and complex process. The timeline for recovery varies significantly from person to person, influenced by several factors including the duration of medication use, the dosage, individual physiology, and underlying mental health conditions.

When you stop taking a medication like Lorazepam, which is often prescribed for anxiety and sleep disturbances, your body may experience withdrawal symptoms, including rebound insomnia. This rebound effect can occur because the body has become accustomed to the sedative effects of the medication. For some individuals, rebound insomnia can last anywhere from a few days to several weeks. However, in your case, you mentioned that you have been experiencing insomnia for three months after discontinuation, which suggests that your body is still adjusting.

The concept of "rebound insomnia" refers to the worsening of sleep disturbances after stopping a medication that was previously used to manage those symptoms. This phenomenon can be particularly pronounced if the medication was stopped abruptly rather than tapered off gradually. In your situation, you reduced your dosage over three weeks before stopping completely, which may have been too rapid for your body to adjust. It is generally recommended to taper off benzodiazepines slowly to minimize withdrawal symptoms and rebound effects.

In addition to rebound insomnia, other factors may be contributing to your sleep difficulties. Stress, anxiety, and changes in your daily routine can all impact sleep quality. Since you mentioned that your initial insomnia was not present before taking Lorazepam, it is possible that the underlying anxiety or stressors that led to the prescription of the medication have resurfaced. Addressing these factors through cognitive-behavioral therapy (CBT) or other therapeutic approaches can be beneficial.

Regarding your concerns about potential long-term effects on your brain or whether you will experience insomnia indefinitely, it is important to note that while benzodiazepines can lead to dependence and tolerance, they do not typically cause permanent brain damage. Most individuals do recover their sleep patterns over time, although the duration of recovery can vary widely. Some may find improvement within a few weeks, while others may take several months to return to their baseline sleep quality.

To facilitate recovery, consider implementing good sleep hygiene practices. This includes maintaining a consistent sleep schedule, creating a relaxing bedtime routine, and avoiding stimulants like caffeine in the afternoon and evening. Engaging in regular physical activity and managing stress through mindfulness or relaxation techniques can also support better sleep.

If your insomnia persists or worsens, it may be beneficial to consult with a sleep specialist or a psychiatrist who can provide tailored recommendations and possibly explore alternative treatments that do not carry the same risk of dependence as benzodiazepines. Medications like Trazodone or Quetiapine, which you mentioned, can be effective for some individuals without the same level of risk associated with benzodiazepines.

In conclusion, while the timeline for recovery from medication-induced insomnia can be uncertain, many individuals do experience improvement over time. It is crucial to remain patient and proactive in addressing both the psychological and behavioral aspects of sleep disturbances. Regular follow-ups with your healthcare provider can help ensure that you are on the right path to recovery and can provide support as you navigate this challenging period.

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