Struggling with Insomnia After Stopping Lorazepam: Seeking Guidance

Q: Struggling with Insomnia After Stopping Lorazepam: Seeking Guidance

A： It is possible that the different medications prescribed by doctors are due to variations in how you describe your symptoms. <br>It is advisable not to frequently switch doctors; instead, find a physician you trust and follow their treatment recommendations. <br>Regarding whic

I'm not sure how to use the medication?

I previously took Lorazepam for over three months, and stopping the medication has led to insomnia that has lasted for over a year (I stopped after three weeks, and I wonder if that was too quick).
My symptoms of autonomic nervous system dysfunction are limited to stomach pain, nausea, and a feeling of wanting to vomit.
Before taking Lorazepam, I never experienced insomnia; now, even with Dongjian (likely referring to a sleep aid), 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 I have been struggling with low energy during the day for a year.
Recently, I consulted two clinics.
One prescribed Dongjian Quetiapine, half a tablet of Clonazepam 0.5 mg (a long-acting benzodiazepine), and a quarter of Loxapine 30 mg (all taken before bed).
The other clinic prescribed Lorazepam 2 mg, half a tablet of Alprazolam 0.25 mg, and half a tablet of Trazodone 10 mg (all taken before bed).
Both clinics provided different approaches for the same symptoms, and I am unsure which one is more suitable.
I also wonder which option is less likely to lead to dependence and can be discontinued more easily.
Currently, due to poor sleep, I have taken a quarter of Clonazepam for the past few days, but it seems ineffective, providing the same amount of sleep as without medication.
A half tablet allows me to sleep for 4-5 hours.
Should I continue taking it on the fourth day? I am uncertain 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, and it may persist for months or even years.
Seeing this makes me question how much longer I can endure this or if I should return to Lorazepam and taper off more slowly.
I hope the physician can provide me with answers, and I would be very grateful.

Xiao Xiao, 30~39 year old female. Ask Date: 2022/09/08

Dr. Wu Enliang reply Psychiatry

A: It is possible that the different medications prescribed by doctors are due to variations in how you describe your symptoms.
It is advisable not to frequently switch doctors; instead, find a physician you trust and follow their treatment recommendations.
Regarding which medication is less likely to cause dependence and can be discontinued more easily, it is generally observed that shorter-acting sedative-hypnotics tend to develop dependence more readily.
It is recommended to focus on improving sleep hygiene and increasing physical activity, as these are often more important than taking sedative-hypnotics.
Only use medication occasionally when absolutely necessary.

As for your question about how long it will take to return to your previous sleep patterns, it varies for each individual.
I have seen information online suggesting that discontinuing medication can lead to poor sleep in the latter half of the night, which may persist for months or even years.
This can be concerning, and you may wonder how much longer you can endure this or if you should resume taking medications like Lamotrigine and then taper off slowly.

A: There are many causes of insomnia, so I recommend discussing this further with your physician.
Dr.
Wu Enliang

Reply Date: 2022/09/08

More Info

Struggling with insomnia after discontinuing Lorazepam can be a challenging experience, especially when the symptoms persist for an extended period, as you have described. It’s important to understand that the withdrawal from benzodiazepines like Lorazepam can lead to a range of symptoms, including insomnia, anxiety, and other physical symptoms. The duration and severity of these withdrawal symptoms can vary significantly from person to person.

In your case, having stopped Lorazepam for over a year and still experiencing insomnia suggests that you may be dealing with a combination of withdrawal effects and possibly the re-emergence of the underlying issues that led to the prescription of Lorazepam in the first place. It is not uncommon for individuals to experience rebound insomnia after stopping benzodiazepines, where the original sleep issues return, sometimes even more intensely.

The fact that you have been prescribed various medications, including Quetiapine, Clonazepam, and others, indicates that your healthcare providers are trying to find a suitable treatment plan for your insomnia. Each of these medications has different properties and potential side effects. For instance, Clonazepam is a long-acting benzodiazepine that can help with sleep but carries a risk of dependence, especially with long-term use. Quetiapine, while sometimes used off-label for insomnia, is primarily an antipsychotic and can have significant side effects, including sedation and metabolic changes.

When considering which medication might be best for you, it’s crucial to weigh the benefits against the risks of dependence and side effects. Short-acting benzodiazepines like Lorazepam may provide quicker relief but can lead to rebound insomnia if used long-term. On the other hand, long-acting benzodiazepines like Clonazepam may help maintain sleep but can also lead to tolerance and dependence over time.

In addition to pharmacological treatments, non-pharmacological approaches should also be considered. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a highly effective treatment that focuses on changing sleep habits and misconceptions about sleep. It can help you develop better sleep hygiene practices, manage anxiety related to sleep, and ultimately improve your sleep quality without the need for long-term medication.

Moreover, lifestyle changes can significantly impact your sleep. Regular physical activity, maintaining a consistent sleep schedule, and creating a restful sleep environment can all contribute to better sleep quality. Avoiding caffeine and heavy meals close to bedtime, as well as limiting screen time before sleep, can also be beneficial.

If you are feeling overwhelmed by your current situation, it may be helpful to seek a second opinion or consult with a sleep specialist who can provide a comprehensive evaluation of your sleep patterns and overall health. They can help tailor a treatment plan that addresses both your insomnia and any underlying issues, such as anxiety or gastrointestinal symptoms related to autonomic nervous system dysregulation.

In summary, while it can be tempting to return to Lorazepam for immediate relief, it’s essential to consider the long-term implications of such a decision. A combination of medication management, therapy, and lifestyle changes may provide a more sustainable solution to your insomnia. Remember, recovery from insomnia can take time, and it’s important to be patient with yourself as you navigate this process.

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