Managing Insomnia After Discontinuing Lorazepam: Seeking Solutions

I have been prescribed Lexotan for gastrointestinal pain caused by autonomic nervous system dysfunction. However, after stopping the medication, I still have insomnia and haven't improved. What should I do?

I previously took Lorazepam for over three months, and stopping the medication has resulted in insomnia.
It has now been three months since I stopped, and I have been experiencing insomnia for three months.
This insomnia is not caused by autonomic nervous system dysfunction; my symptoms of autonomic dysregulation are limited to stomach pain, nausea, and vomiting.
However, since stopping Lorazepam, the stomach pain symptoms have significantly decreased.
Before taking Lorazepam, I did not experience insomnia at all.
The doctor who initially prescribed Lorazepam told me that taking it for life would not cause any issues.
When I asked my current doctor, he said he does not understand why my previous doctor recommended long-term use of Lorazepam.
He mentioned that there are many alternative medications available.
I am concerned about how long the insomnia after stopping the medication will last.
(I tapered off the medication over three weeks before stopping completely; I wonder if that was too fast.) Currently, I am taking Dong Quai, but I can only sleep for 1-2 hours before waking up.
Although I can lie down and fall back asleep, I feel increasingly fatigued, and I have very low energy during the day.
The doctor I am seeing now says that things will gradually improve, so he prescribed a lighter medication, but I am unsure how long it will take to return to my previous state.
I have read some information online stating that stopping medication can lead to poor sleep in the latter half of the night, and it may potentially last for months or even years.
Seeing this makes me wonder how much longer I can endure this or if I really need to go back to taking Lorazepam.
I hope the doctor can provide me with some answers, and I would be very grateful.

Xiao Hao, 30~39 year old female. Ask Date: 2021/12/17

Dr. Jiang Junyi reply Neurology

Dear Mr.
Hao,
You mentioned the issue of dependence after taking "Lorazepam." Generally, Lorazepam is easily absorbed when taken orally, reaching peak plasma concentration approximately 2 hours after administration.
The half-life in human plasma is about 12 to 18 hours.
For treating insomnia, a total daily dose of 2 mg can be administered before bedtime.
Some individuals may find that 0.5 mg is sufficient to induce sleep.
Compared to Z-drugs (including Zolpidem, Zopiclone, and Zaleplon), Lorazepam has a relatively lower potential for addiction.
For sleep disorders, it is recommended to practice good sleep hygiene and maintain a sleep diary.
In terms of sleep hygiene, try to avoid napping during the day.
Avoid consuming coffee outside of morning hours.
Refrain from smoking and drinking alcohol, as both can lead to fragmented sleep.
Avoid placing distracting items in the bedroom, such as televisions.
Keep the bedroom dark and quiet.
It is advisable to maintain a regular sleep schedule, going to bed and waking up at the same time every day, including weekends and holidays.
Avoid exercising or eating large meals 2 to 3 hours before bedtime to improve sleep quality.
Sleep studies and monitoring can be arranged at a sleep center, and you may also consider using a smartwatch with blood oxygen monitoring, such as the Apple S6, for sleep and oxygen level tracking.
If you have related concerns, I recommend discussing evaluation and treatment options with a sleep medicine specialist.
Wishing you good health and peace.
Dr.
Jiang Junyi
Department of Internal Medicine, Taoyuan Hospital

Reply Date: 2021/12/17

More Info

Managing insomnia after discontinuing Lorazepam can be a challenging and frustrating experience, especially when the insomnia seems to have developed after stopping the medication. It’s important to understand that Lorazepam, a benzodiazepine, can lead to dependence, and discontinuing it can result in withdrawal symptoms, including sleep disturbances. Here’s a comprehensive overview of your situation and some potential strategies for managing your insomnia.

Understanding Your Symptoms
1. Withdrawal Effects: After discontinuing Lorazepam, it’s common for individuals to experience rebound insomnia, which is a temporary worsening of sleep problems. This can occur because the body has become accustomed to the sedative effects of the medication. The duration and severity of withdrawal symptoms can vary significantly among individuals, and while some may recover quickly, others may experience prolonged difficulties.

2. Sleep Architecture Changes: Benzodiazepines can alter sleep architecture, affecting the balance between different sleep stages. After stopping the medication, your body may take time to readjust, leading to fragmented sleep and difficulty maintaining sleep throughout the night.

3. Psychological Factors: Anxiety about sleep can exacerbate insomnia. If you are worried about not sleeping well, this anxiety can create a cycle that makes it even harder to fall and stay asleep.

Potential Solutions
1. Gradual Tapering: If you stopped Lorazepam too quickly, it might have contributed to your current insomnia. In some cases, a gradual tapering of the medication under medical supervision can help minimize withdrawal symptoms. If you haven't already, discussing this with your healthcare provider may be beneficial.

2. Alternative Medications: Your current physician has mentioned alternative medications. It’s essential to find a medication that works for you without the side effects associated with benzodiazepines. Options may include non-benzodiazepine sleep aids (like Zolpidem or Eszopiclone), certain antidepressants (like Trazodone or Mirtazapine), or even melatonin supplements. Each of these has different mechanisms and side effect profiles, so it’s crucial to work closely with your doctor to find the right fit.

3. Cognitive Behavioral Therapy for Insomnia (CBT-I): This is a highly effective treatment for chronic insomnia. CBT-I focuses on changing sleep habits and misconceptions about sleep. It can help address the anxiety surrounding sleep and teach you techniques to improve sleep quality without relying on medication.

4. Sleep Hygiene Practices: Implementing good sleep hygiene can significantly improve your sleep quality. This includes maintaining a consistent sleep schedule, creating a comfortable sleep environment, avoiding caffeine and heavy meals before bedtime, and limiting screen time in the evening.

5. Mindfulness and Relaxation Techniques: Practices such as meditation, deep breathing exercises, or progressive muscle relaxation can help reduce anxiety and promote better sleep. These techniques can be particularly beneficial if anxiety is contributing to your insomnia.

6. Regular Physical Activity: Engaging in regular exercise can help improve sleep quality. However, try to avoid vigorous workouts close to bedtime, as they may have the opposite effect.

Monitoring Progress
It’s essential to keep track of your sleep patterns and any changes in your symptoms. This information can be valuable for your healthcare provider in adjusting your treatment plan. If you find that your insomnia persists or worsens, don’t hesitate to reach out to your doctor for further evaluation and support.

Conclusion
In summary, while it can be daunting to manage insomnia after discontinuing Lorazepam, there are various strategies and treatments available. It’s crucial to work closely with your healthcare provider to explore these options and find a solution that works for you. Remember, recovery from insomnia can take time, and it’s essential to be patient with yourself during this process.

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