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Rebound insomnia (1/13/12)

January 13, 2012

When You Can’t Stop Using Sleeping Pills

You can’t sleep and you must.  You start to take sleeping pills.

They work – for a while.  Then you find you need more.

You try some nights without those pills.

You can’t sleep at all – until you take the pills again.

You’ve got rebound insomnia.  Join a very large group.

When Work and Family Stress Become Too Much

Let me introduce a client of mine.  She enjoyed her job but was induced to do the same work for another company.

Her new co-worker did not play by the rules.

She missed her old job but could not go back.  To keep up with the new one she worked 8 AM to 7 PM six days a week.

Her mother came in to help raise her daughter.

For the first time in her life she could not sleep.  She tried different sleeping pills.

They were great – until they didn’t work.  She took more.

Soon she was on more than one benzodiazepine – drugs like valium originally devised for anxiety and sleep.  She added zolpidem (ambien) to the mix – not knowing that zolpidem hits one of the same brain receptors as the benzodiazepines.

Now she can’t sleep without multiple pills.

According to a friend of mine who has longed worked at health insurance companies, the use of anxiety and sleeping pills in 25-40 year old female workers is skyrocketing. People are scared of losing their jobs. To many companies competing in this economy, if  work is making people anxious, sleepless, and crazy, that’s their problem.

Now it’s our problem.

Can You Get Rebound Insomnia with Over the Counter Sleeping Pills?

Definitely.  A recent study at Henry Ford Hospital claimed that 30-40% of people  taking sleeping pills – for short periods or a year – had rebound insomnia.  The rates were the same whether they took zolpidem or placebo.

Yes, you can get habituated to non-prescription sleeping pills – easily.

I like this research group very much, but my clinical experience is that it’s still often much harder for people to get off prescription benzodiazepines and others, like zopiclone and zolpidem, than it is Benadryl or “relaxation” drinks.  Often you need to a physician’s help to stop using the pills.

Some things you can do on your own.

Getting Off Sleeping Pills I:

If even placebo can cause rebound insomnia, it’s clear behavioral cues are pretty important in keeping people on sleeping pills drugs.

For many pill=sleep.  No pill means no sleep.

First order of business – do natural things that help you sleep:

1. Create a sleep ritual – floss your teeth, brush teeth, put out your clothes for the next day. Condition your brain that a set hour is sleep time – and a set wake time, too.

2. Rest before sleep.  Take at least an hour before bed time to turn down the lights, turn off all those electronic devices, and do something that helps relax and regenerate the mind – using active rest techniques like listening to music, yoga, paradoxical relaxation, meditation, and reading.

3. Get fitter.  Walking in the morning – especially in sunlight – helps people sleep.

Getting Off Pills II:

Determine if your lack of sleep is due in part to  overarousal – too much work stress, family stress, impossible  scheduling and personal demands.

If so, use cognitive behavioral homework to calm things down.  You’ll probably also need to make your schedule accommodate enough time for rest – without it your body won’t properly regenerate.

However, if you suffer from pain, depression, anxiety disorders, or have multiple medical disorders, you may need to treat them effectively to help you get off sleeping pills.

Off Pills III:

If things are medically uncomplicated – you’re pretty healthy except for inability to sleep – most people try slow tapers.

I emphasize the word slow.

Cutting your dose of pills with a knife, paring down the amounts, often helps – especially if you have a new, decent sleep ritual going.

It once took me three years to get a patient off sleeping pills.  True, she had been on multiple pills for 60 years, and was 95 when I first met her.  Her rebound insomnia was intense, but gentle changes worked.

Most people get off pills more easily when they don’t have a deadline measured in days or a few weeks.

Off Pills IV:

Sometimes you simply can’t get off what you’re taking.  Your doctor may help you by shifting you to another agent that can be more easily tapered.

Some people get off benzodiazepines by going on trazodone, a sedating antidepressant which can also treat anxiety.  Many physicians use a variety of approaches – as every individual requires different techniques.

Bottom Line:

Rebound insomnia is common.  It afflicts many – whether they’re on prescription or non-prescription sleeping pills.

There are many ways to get off pills. Getting normal sleep – as described in my book “The Power of Rest” – is a worthy first step.

Most people sleep more naturally and fully without pills.  Sleep is too much fun to require “mommy’s little helper” each night.
Rest, sleep, Sarasota Sleep Doctor, well-being, regeneration, longevity, body clocks, insomnia, sleep disorders, the rest doctor, matthew edlund, the power of rest, the body clock, psychology today, huffington post, redbook, longboat key news

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