Managing Anxiety-Related Insomnia: Medication Concerns and Alternatives

Insomnia, anxiety, and medication issues?

Hello, I have been taking Xanax for nearly six months due to insomnia caused by anxiety.
However, I only take it the night before I have to go to school; if I don’t take it, I can’t sleep all night and my heart races.
In short, when it’s time to sleep, I feel very anxious and scared.
However, if I don’t take it during breaks, I can sleep normally because when I’m relaxed, I can fall asleep anytime.
But when it’s actually time to sleep, I become very fearful and worry about not being able to sleep before school, and I can’t help but feel afraid.
I initially tried various methods, but nothing worked.
Although I understand that it’s a mental issue, I still tried many things.
When I go to bed, I can’t stop my mind from racing.
I have been experiencing insomnia for four months, which has caused me to develop gray hair, and that’s when I decided to see a psychiatrist.
The doctor prescribed Xanax, but it has affected my memory and my ability to concentrate during exams at school.
However, the doctor didn’t inform me about the side effects.
Recently, I went to see a counselor, and the doctor advised against taking Xanax at such a young age.
I’m wondering if the memory loss and forgetfulness caused by Xanax are permanent.
If they are permanent, how can I prepare for exams and restore my memory? Will it recover if I stop taking it? I really want to quit Xanax.
Recently, I learned about Promethazine; is it safe to take long-term? Its side effects may help with sleep, but they are not as severe as Xanax.
However, Promethazine can cause drowsiness, which might affect my learning.
How long does the drowsiness side effect last? Since my insomnia is quite severe, is Promethazine really that effective? I know psychological treatment takes longer, and I hope the medication doesn’t have a permanent impact on my body.
But I can’t avoid sleep altogether; my insomnia makes it hard for me to concentrate and feel comfortable, leading to a fear and dislike of sleeping.
What should I do?

zero, 10~19 year old female. Ask Date: 2023/07/28

Dr. Wu Enliang reply Psychiatry

Hello, I have been experiencing insomnia due to anxiety, so I have been taking Zolpidem for almost half a year.
However, I only take it on the nights before school; if I don’t take it, I can’t sleep all night and my heart races.
In short, I feel very anxious and scared when it’s time to sleep.
However, if I don’t take it during breaks, I can sleep normally because I can relax and sleep anytime.
But when it’s time to sleep, I become very fearful and worry about not being able to sleep before school.
I have tried various methods at the beginning, but nothing worked.
Although I understand that it’s a mental issue, I still tried many things.
I can’t stop my mind from racing when I’m trying to sleep.
I have been suffering from insomnia for four months, which has caused me to develop gray hair, so I went to see a psychiatrist.
The doctor prescribed Zolpidem, but it has affected my memory and my ability to concentrate during exams at school.
However, the doctor did not inform me about the side effects.
Recently, I went to see a counselor, and the doctor advised against taking Zolpidem at such a young age.
I am wondering if the side effects of memory loss and forgetfulness from Zolpidem are permanent.

A: No, they are not permanent; your memory will improve once you stop taking the medication.
Didn’t you feel better during summer break when you didn’t have school? If it were permanent, how would I prepare for exams and recover my memory? Will it return to normal if I stop taking it?
A: Yes, it will return to normal if you stop taking it because you really want to stop Zolpidem.
Recently, I learned about a medication called Promethazine.
Is it safe to take it long-term?
A: It’s better to take it for a short term.
If stopping the medication leads to insomnia, you should discuss with your child and adolescent psychiatrist whether there is an anxiety disorder issue.
The side effects can help with sleep because they are not as strong as Zolpidem, but Promethazine can cause drowsiness.
Will that affect my learning?
A: There is a possibility that the drowsiness side effect may last for several hours.
But since my insomnia is quite severe, is Promethazine really that effective?
A: It’s not very strong because psychological treatment takes longer.
I hope the medication doesn’t have a permanent effect on my body, but I can’t avoid sleeping.
Insomnia makes it hard for me to concentrate and feel uncomfortable, leading to fear and dislike of sleep.
What should I do?
A: I recommend consulting a child and adolescent psychiatrist.
Dr.
Wu En-Liang.

Reply Date: 2023/07/28

More Info

Managing anxiety-related insomnia can be a complex issue, especially when it involves medication like Zolpidem (commonly known as Ambien). It’s understandable that you are concerned about the side effects of the medication, particularly regarding memory and concentration, especially as you prepare for exams.
Firstly, it’s important to acknowledge that anxiety can significantly impact sleep quality. The fear and anxiety associated with upcoming responsibilities, such as school, can create a cycle of insomnia that can be difficult to break. This is often compounded by the physiological responses to anxiety, such as increased heart rate and racing thoughts, which can make it even harder to fall asleep.

Regarding Zolpidem, while it is effective for short-term management of insomnia, it can have side effects, including memory impairment and difficulties with concentration. These side effects are generally more pronounced with long-term use. However, the extent to which these effects are permanent can vary from person to person. In many cases, cognitive functions return to baseline levels after discontinuation of the medication, but this is not guaranteed for everyone. It’s crucial to discuss these concerns with your prescribing physician, who can provide guidance tailored to your specific situation.

If you are considering tapering off Zolpidem, it’s advisable to do so under medical supervision. Abruptly stopping medication can lead to withdrawal symptoms, including rebound insomnia, which could exacerbate your anxiety. Your doctor may suggest a gradual reduction in dosage or switching to a different medication that has a lower risk of cognitive side effects.

As for the alternative medication you mentioned, Promethazine, it is primarily an antihistamine that can help with sleep due to its sedative properties. While it may have fewer cognitive side effects compared to Zolpidem, it can still cause drowsiness, which might affect your ability to concentrate during the day. The duration of drowsiness can vary, but it typically lasts a few hours after taking the medication. Again, this is something you should discuss with your healthcare provider to weigh the benefits against potential impacts on your studies.

In addition to medication, there are several non-pharmacological strategies that can help manage anxiety and improve sleep quality. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a highly effective treatment that focuses on changing thoughts and behaviors that contribute to sleep problems. Mindfulness and relaxation techniques, such as deep breathing exercises, progressive muscle relaxation, or guided imagery, can also be beneficial in reducing anxiety and promoting better sleep.

Establishing a consistent sleep routine can also help. This includes going to bed and waking up at the same time every day, creating a calming bedtime environment, and limiting exposure to screens before bed. Engaging in regular physical activity during the day can also promote better sleep, but try to avoid vigorous exercise close to bedtime.

Lastly, it’s essential to maintain open communication with your healthcare providers. They can help you navigate your treatment options, monitor your progress, and make necessary adjustments to your medication or therapy plan. Remember, you are not alone in this journey, and there are effective strategies and treatments available to help you manage your anxiety and improve your sleep.

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