Struggling with Insomnia After Stopping Lorazepam: Seeking Guidance

I don't know how to use the medication?

I previously took Lorazepam for over three months, and stopping the medication has caused me to experience insomnia for over a year now (I stopped after three weeks, and I'm not sure if that was too fast).
My symptoms of autonomic nervous system dysregulation are limited to stomach pain, nausea, and a feeling of wanting to vomit.
Before taking Lorazepam, I never had insomnia; now, even with Dongjian, I can only sleep for 1-3 hours before waking up.
Although I can lie down and fall back asleep for a bit, I feel increasingly fatigued.
I've been struggling for a year, and 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 30 mg of Loxapine (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).
One doctor prescribed long-acting medications while the other prescribed short-acting ones, but I have the same symptoms.
I'm unsure which approach is more suitable or which medications are less likely to cause dependence and easier to discontinue.
Currently, due to poor sleep, I've taken a quarter of Clonazepam for the past few days, but it hasn't been effective, and my sleep duration is the same as without medication.
A half tablet allows me to sleep for 4-5 hours.
Should I continue taking it on the fourth day? I also wonder how long it will take to return to my previous state.
I've 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 uncertain about how much longer I can endure this or if I should return to Lorazepam and taper off slowly.
I hope the doctor can provide me with answers, and I would be very grateful.

Xiao Xiao, 30~39 year old female. Ask Date: 2022/09/12

Dr. Cai Yunlin reply Psychiatry

Hello, if sleep aids are suddenly discontinued after being taken for a period of time, it may lead to a worsening of insomnia symptoms, a phenomenon known as rebound insomnia.
Therefore, tapering off sleep medications is usually done gradually.
It is advisable for you to return to the outpatient clinic and discuss your current symptoms and individual medication considerations with your physician, as this would be more beneficial for you.
Wishing you all the best.

Reply Date: 2022/09/12

More Info

Struggling with insomnia after stopping Lorazepam can be a challenging experience, especially when the symptoms persist for an extended period. Your situation is not uncommon, as many individuals who discontinue benzodiazepines like Lorazepam may experience withdrawal symptoms, including insomnia. The duration and severity of these symptoms can vary significantly from person to person.

When you stopped taking Lorazepam after three months of use, it is possible that the abrupt cessation contributed to your ongoing insomnia. Generally, tapering off benzodiazepines gradually is recommended to minimize withdrawal symptoms. A rapid discontinuation can lead to rebound insomnia, where the original sleep issues return, sometimes even more intensely than before. This rebound effect can last for weeks or even months, depending on various factors, including the duration of use and individual physiology.

Your current symptoms of waking up after 1-3 hours of sleep and feeling increasingly fatigued during the day are indicative of disrupted sleep architecture, which can be a result of both the withdrawal from Lorazepam and the potential underlying anxiety or stress that may have prompted its initial use. It’s worth noting that while Lorazepam can be effective for short-term management of anxiety and insomnia, long-term use can lead to dependence and tolerance, making it challenging to discontinue.

Regarding the medications prescribed by different doctors, it’s essential to understand that each medication has its profile in terms of efficacy, side effects, and potential for dependence. Clonazepam and Alprazolam are both benzodiazepines, similar to Lorazepam, and can carry a risk of dependence, especially with long-term use. Quetiapine, while primarily an antipsychotic, is sometimes used off-label for insomnia, but it can also have side effects and may not be suitable for everyone.
The choice between long-acting and short-acting benzodiazepines often depends on your specific sleep pattern. Long-acting medications may help maintain sleep throughout the night, while short-acting options can be beneficial for those who have difficulty falling asleep. However, both types can lead to dependence if used for extended periods.

In terms of non-pharmacological approaches, cognitive-behavioral therapy for insomnia (CBT-I) is highly effective and recommended as a first-line treatment for chronic insomnia. This therapy focuses on changing sleep habits and misconceptions about sleep, which can help improve sleep quality without the need for medication. Additionally, practicing good sleep hygiene—such as maintaining a consistent sleep schedule, creating a comfortable sleep environment, and avoiding stimulants like caffeine—can also be beneficial.

If you are considering returning to Lorazepam, it is crucial to discuss this with your healthcare provider. They can help you weigh the benefits and risks, considering your history and current symptoms. A gradual reintroduction followed by a slow taper might be a strategy to consider if deemed appropriate by your doctor.

Ultimately, the path to recovery from insomnia after stopping Lorazepam may take time, and it is essential to be patient with yourself. Regular follow-ups with your healthcare provider can help monitor your progress and adjust your treatment plan as needed. Remember, you are not alone in this struggle, and seeking support from healthcare professionals can make a significant difference in your journey toward better sleep.

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