Struggling with Insomnia After Stopping Lorazepam: Seeking Guidance

I'm not sure how to use the medication?

I have been experiencing insomnia for over a year after discontinuing Lorazepam (Ativan) which I had taken for more than three months.
I stopped the medication a year ago, and I am unsure if stopping too quickly after three weeks contributed to my current condition.
My only symptoms of autonomic nervous system dysregulation are stomach pain and nausea.
Before taking Lorazepam, I never had issues with insomnia, but now while taking Dongjian (Trazodone), I can only sleep for 1-3 hours before waking up.
Although I can lie down and fall back asleep, I feel increasingly fatigued, and my energy levels during the day are very low.

After enduring this for a year, I recently consulted two clinics.
One prescribed Dongjian (Trazodone), half a tablet of Clonazepam (0.5 mg, a long-acting benzodiazepine), and a quarter of 30 mg of Lurasidone (Latuda) (all taken at bedtime).
The other clinic prescribed Lormetazepam (2 mg, half a tablet), Alprazolam (0.25 mg, one tablet), and half a tablet of Doxepin (10 mg) (all taken at bedtime).
Both clinics have provided different approaches for the same symptoms, and I am uncertain which treatment might be more suitable.

I am also concerned about the potential for addiction and the ability to discontinue the medication.
Recently, due to poor sleep, I took a quarter of Clonazepam, but it didn't seem to help much, and my sleep duration remained the same as without medication.
Taking half a tablet allows me to sleep for about 4-5 hours.
Should I continue taking it on the fourth day? I am unsure how long it will take to return to my previous state.
I have read online that discontinuing medication can lead to poor sleep quality in the latter half of the night, and it may persist for months or even years.
This information makes me anxious about how much longer I can endure this situation or if I should return to Lorazepam and taper off more gradually.
I hope the physician can provide me with some answers, and I would be very grateful.

Xiao Xiao, 30~39 year old female. Ask Date: 2022/09/05

Dr. Qiu Junda reply Psychiatry

Hello.
From the perspective of substance addiction issues, the first clinic (Dongjian) that prescribes Quetiapine and similar medications may be more suitable.
Theoretically, Quetiapine has a lower potential for addiction compared to other medications like Lurasidone.
However, managing insomnia and attempting to taper off medications can be challenging.
Generally, it is advisable to consider reducing medication only after achieving treatment stability.
I recommend that you communicate and discuss with your physician during the treatment process to explore feasible approaches for effective outcomes.
Thank you.

Reply Date: 2022/09/05

More Info

Struggling with insomnia after stopping Lorazepam can be a challenging experience, and it's understandable to seek guidance on how to manage your symptoms. Based on your description, it appears that you have been dealing with insomnia for over a year after discontinuing Lorazepam, which you had taken for about three months. This situation can be complex, as it may involve withdrawal symptoms, rebound insomnia, and possibly the underlying issues that led to the initial prescription of Lorazepam.

Firstly, it's important to recognize that Lorazepam is a benzodiazepine, and discontinuing such medications can lead to withdrawal symptoms, including insomnia. The duration and severity of these symptoms can vary significantly from person to person. In many cases, withdrawal symptoms can last for weeks to months, and some individuals may experience prolonged insomnia that can persist for a year or longer. This is sometimes referred to as "post-acute withdrawal syndrome" (PAWS), which can include sleep disturbances, anxiety, and other symptoms.

Your experience of waking up after 1-3 hours of sleep and feeling increasingly fatigued during the day is not uncommon among those who have stopped taking benzodiazepines. The fact that you did not experience insomnia prior to taking Lorazepam suggests that your body may have developed a dependence on the medication, and now that it is no longer present, your sleep architecture has been disrupted.

Regarding the medications you have been prescribed, it seems you are exploring various options, including Quetiapine, Clonazepam, and other sleep aids. Each of these medications has its own profile in terms of efficacy, side effects, and potential for dependence. For instance, Clonazepam is another benzodiazepine and carries a risk of dependence similar to Lorazepam. Quetiapine, while often used off-label for insomnia, can also have side effects and may not be suitable for everyone.

When considering which medication to use, it is crucial to have an open dialogue with your healthcare provider. They can help you weigh the benefits and risks of each option based on your specific symptoms and medical history. Additionally, it may be beneficial to explore non-pharmacological approaches to managing insomnia, such as cognitive-behavioral therapy for insomnia (CBT-I), which has been shown to be effective in treating chronic insomnia without the risks associated with medication dependence.

In terms of your concern about returning to Lorazepam, it's essential to approach this decision carefully. While it may provide temporary relief, the risk of re-establishing dependence is a significant consideration. If you do decide to return to Lorazepam, a gradual tapering schedule under the supervision of a healthcare provider may help mitigate withdrawal symptoms when you choose to stop again.

Lastly, lifestyle modifications can also play a crucial role in improving sleep quality. Establishing a regular sleep schedule, creating a calming bedtime routine, and practicing good sleep hygiene can significantly impact your ability to fall and stay asleep. Avoiding caffeine and electronic devices before bedtime, as well as engaging in relaxation techniques such as mindfulness or gentle yoga, can also be beneficial.

In summary, managing insomnia after stopping Lorazepam can be a complex process that may require a combination of medication, therapy, and lifestyle changes. It's essential to work closely with your healthcare provider to find the most suitable treatment plan for your needs, and to remain patient as you navigate this challenging period. Remember, recovery from insomnia can take time, but with the right support and strategies, improvement is possible.

Similar Q&A

Understanding Insomnia After Stopping Lorazepam: Causes and Solutions

I previously took Lorazepam 0.5 mg for over three months, and after stopping the medication, I have been experiencing insomnia for more than nine months. I can fall asleep quickly, but I wake up after 1 to 3 hours, and when I go back to sleep, it is very light sleep, making me fe...

Dr. Lin Mianzhang reply Psychiatry
Hello, Xiao Cheng: Thank you for your hard work! It seems that your current insomnia may be a symptom of medication withdrawal. I recommend a gradual tapering approach to discontinue the medication, such as first reducing Lorazepam to half a tablet. If you can maintain stable sle...

Understanding Insomnia After Stopping Lorazepam: Causes and Solutions

I previously took Lorazepam 0.5 mg for over three months, and stopping the medication has caused insomnia for more than nine months. I can fall asleep quickly, but I wake up after 2 to 3 hours, and when I go back to sleep, it’s always light sleep, making me feel increasingly fati...

Dr. Yu Quanxun reply Psychiatry
Hello, based on your description in the letter, you are experiencing stomach pain and autonomic nervous system dysfunction. You have previously taken Lexapro but have since discontinued it, and you are currently troubled by sleep issues, worrying that they may be a result of stop...

Understanding Insomnia After Stopping Lorazepam: Causes and Solutions

I previously took Lorazepam 0.5 mg for over three months, and after stopping the medication, I have been experiencing insomnia for over nine months. I can fall asleep quickly, but I wake up after 2 to 3 hours, and when I go back to sleep, it's only light sleep, making me fee...

Dr. Wu Enliang reply Psychiatry
It may be advisable for users to consider using longer-acting benzodiazepines such as Clonazepam or Diazepam instead of Lorazepam, as they may facilitate easier discontinuation (but this should still be discussed with your physician), and to enhance sleep hygiene. Dr. Wu En-Liang...

Understanding Insomnia After Stopping Lorazepam: Causes and Solutions

I previously took Lorazepam 0.5 mg for over three months, and stopping the medication has caused insomnia that has lasted for more than nine months. I can fall asleep quickly, but I wake up after 2 to 3 hours, and when I go back to sleep, it's only light sleep, making me fee...

Dr. Wang Yaoting reply Psychiatry
Hello: The dosage of Lorazepam 0.5 mg that you previously took is considered quite low. This dosage primarily provides anxiolytic effects and should not lead to significant or prolonged withdrawal symptoms. Insomnia may be related to your underlying condition or circadian rhythm ...