Struggling with Insomnia After Stopping Lorazepam: Seeking Expert Advice

I'm not sure what to do~ I hope the doctor can help me?

Your question: Due to autonomic nervous system dysfunction, I was prescribed Lorazepam 0.5 mg by my doctor.
After taking it for over three months, I stopped the medication and developed insomnia, which I never experienced before.
I deeply suspect that this is a result of medication side effects.
After switching doctors, my current physician has tried over a dozen different medications (excluding controlled substances).
I asked if I should go back to taking Lorazepam, but the doctor advised against it, suggesting that we gradually change medications and that there will eventually be a suitable option.
However, after a year and a half, I am still experiencing insomnia.
Falling asleep is somewhat manageable, but I can only sleep for 1-3 hours before waking up, sometimes even within an hour.
After waking, I can fall back asleep, but I often wake up repeatedly, resulting in very poor sleep quality.
I have been suffering from insomnia for a year and a half, which is extremely distressing.
I have also consulted other doctors, some of whom prescribed multiple controlled substances at once, which I am hesitant to take.
After all, stopping one medication led to being prescribed many others, which I cannot accept.
I asked my original doctor about this, and he explained that prescribing many short-acting medications at once only addresses immediate symptoms without treating the underlying issue.
I do not want to take Lorazepam again; when I was on this medication, I felt emotionally numb, even around children, and my stomach pain has not improved.
This is not what I want.
If I take Lorazepam again after a year and a half, will it be effective? If it is effective, will I be able to taper off the medication afterward? Would rTMS be effective? Is there a doctor who can answer my questions? I would be very grateful.

Ning Ning, 40~49 year old female. Ask Date: 2022/12/19

Dr. Li Guanying reply Psychiatry

Dear Sir/Madam,
From your letter, it is evident that you are experiencing discomfort and distress due to autonomic nervous system dysfunction and the pressure of stomach pain.
Whether this is related to the medication Lorazepam requires a professional diagnosis by a physician.
1.
Facing an uncertain future, psychosomatic disorders are common in modern individuals.
This is a chronic condition that requires long-term treatment for recovery.
2.
Psychosomatic disorders are chronic illnesses that have periods of exacerbation, remission, recovery, and relapse.
More than half of patients may experience a recurrence of symptoms even after they have improved.
Due to individual differences in constitution, please discuss this patiently with your physician.
3.
Regarding Lorazepam, every medication may have side effects.
It is advisable to note the duration and frequency of any discomfort you experience and discuss this with your doctor.
4.
In addition to medication and psychotherapy, repetitive transcranial magnetic stimulation (rTMS) is a non-invasive, anesthesia-free, highly safe treatment that does not require hospitalization.
It can improve anxiety and depressive moods.
For patients with treatment-resistant depression or those who cannot tolerate medication side effects, significant improvement in depressive symptoms has been observed following rTMS treatment.
Our clinic is open for consultations from Monday to Friday, both in the morning and afternoon.
We recommend that you consider visiting our clinic for a personal assessment of your symptoms, so we can collaboratively discuss the best decision for you.
Wishing you mental and physical well-being.

Reply Date: 2022/12/19

More Info

It sounds like you are going through a very challenging time with your insomnia and the aftermath of stopping Lorazepam. Your experience is not uncommon, especially for individuals who have been on benzodiazepines for an extended period. Let's break down your concerns and explore some potential paths forward.

Firstly, it's important to understand that insomnia can be a complex issue, especially after discontinuing a medication like Lorazepam. Lorazepam is a benzodiazepine that is often prescribed for anxiety and sleep disorders. While it can be effective in the short term, long-term use can lead to dependence, tolerance, and withdrawal symptoms, including rebound insomnia. This means that when you stop taking the medication, you might experience worse insomnia than before you started the medication.

The duration of insomnia after stopping Lorazepam can vary significantly from person to person. Some individuals may find that their sleep improves within a few weeks, while others may struggle for months or even longer. Given that you've been experiencing insomnia for about a year and a half since stopping the medication, it may be indicative of a more complex underlying issue, possibly related to your autonomic nervous system dysregulation, which you mentioned is causing gastrointestinal symptoms.

Your current situation, where you can fall asleep but wake up frequently and feel exhausted, suggests that your sleep architecture may be disrupted. This could be due to a variety of factors, including anxiety, stress, or even the lingering effects of discontinuing Lorazepam. It's also worth noting that the medications you have tried since stopping Lorazepam may not have been effective for you, which can be frustrating.

Regarding your question about whether returning to Lorazepam would be effective, it's essential to weigh the pros and cons. While Lorazepam may help you sleep better in the short term, it could also lead to a cycle of dependence again. If you do consider going back on Lorazepam, it would be wise to do so under the close supervision of a healthcare provider who understands your history and can help you taper off safely in the future.

As for rTMS (repetitive Transcranial Magnetic Stimulation), it is a non-invasive treatment that has shown promise for various mental health conditions, including depression and anxiety. Some studies suggest that it may also help with sleep disorders, particularly when they are related to mood disorders. If you are open to exploring this option, discussing it with a psychiatrist or neurologist who specializes in rTMS could be beneficial.

In addition to medication and rTMS, consider incorporating non-pharmacological approaches to improve your sleep. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a highly effective treatment that focuses on changing the thoughts and behaviors that contribute to sleep problems. It can help you develop healthier sleep habits and address any underlying anxiety or stress that may be affecting your sleep.

Moreover, practicing good sleep hygiene can make a significant difference. This includes maintaining a consistent sleep schedule, creating a relaxing bedtime routine, limiting caffeine and alcohol intake, and ensuring your sleep environment is conducive to rest (dark, quiet, and comfortable).

Lastly, it may be helpful to consult with a sleep specialist who can conduct a thorough evaluation of your sleep patterns and provide tailored recommendations. They may suggest a sleep study to rule out any underlying sleep disorders, such as sleep apnea, which could be contributing to your insomnia.

In summary, while returning to Lorazepam may provide temporary relief, it's crucial to consider the long-term implications and explore alternative treatments, including rTMS and CBT-I. Working closely with your healthcare providers will be key in finding a solution that addresses both your insomnia and any underlying issues. Remember, recovery from insomnia can take time, but with the right support and strategies, improvement is possible.

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