Anyone who has had trouble sleeping understands the value of a good night’s rest.
Although getting high-quality sleep may be easy for some, the reality is very different for others. The problem can be compounded when the same medication that is supposed to help you sleep causes many sleepless nights instead.
If you are having trouble sleeping after discontinuing your sleep medications, you may be suffering from rebound insomnia.
Several different sleep aids can make it harder to rest in the long term. Even natural substances like melatonin may lead to rebound insomnia. This condition can also be caused by sleeping medications such as:1
- Ambien (zolpidem)
- Klonopin (clonazepam)
- Lunesta (eszopiclone)
- Restoril (temazepam)
- Sonata (zaleplon)
- Halcion (triazolam)
- Benadryl (diphenhydramine)
Read on to learn more about this side effect of sleeping pills. Discover the definition of rebound insomnia, why this condition happens, and steps you can take to help prevent or treat it.
What is Rebound Insomnia?
Rebound insomnia is difficulty sleeping that occurs once you abruptly stop taking commonly prescribed sleep medications like benzodiazepine hypnotic drugs.1
If you have rebound insomnia, you may have trouble falling asleep or staying asleep. This phenomenon can be difficult to deal with on a psychological level — if you have rebound insomnia, you may start to lose confidence in your body’s ability to get to sleep on its own.
What Causes Rebound Insomnia?
The ease with which you fall asleep depends upon an intricate balance between different neurotransmitters (chemicals in the brain). Sleeping pills also influence these neurotransmitters.
For example, benzodiazepine drugs induce sleep through a neurotransmitter known as gamma-aminobutyric acid (GABA). GABA calms nerve cells and slows down different processes in the body and brain, helping improve sleep. Benzodiazepines help enhance GABA’s relaxing effects.2
As you continue to use sleeping medications, your brain gets used to having altered levels of different neurotransmitters, and you may eventually need to increase your medication dose to fall asleep. This process is known as tolerance.3
When you stop taking sleep aids, the levels of sleep-supporting neurotransmitters drop sharply. Your brain, which is used to higher-than-normal levels of these substances, can no longer relax as easily as it once did. Sudden changes in brain chemistry can lead to symptoms of withdrawal, including rebound insomnia.4
How Long Does Rebound Insomnia Last?
Rebound insomnia is temporary. Symptoms may last anywhere from a few days to a few weeks after you stop taking a sleeping pill.5
The exact duration of rebound insomnia depends upon a couple of factors. Some studies have found that higher doses of sleeping pills may be more likely to lead to rebound insomnia.1 If you’re using sleeping medication, make sure to follow your doctor’s instructions. Don’t take a higher dose than recommended, or you may be putting yourself at risk for rebound insomnia and other withdrawal symptoms.
Rebound insomnia may also last for varying amounts of time based on your own biological factors and the sleeping medication’s half-life.
Why Is the Half-Life of a Drug Important?
The half-life of a drug describes how long it is active within your body. Sleeping medications with shorter half-lives tend to cause harsher rebound insomnia, but fortunately, the effect is shorter-lived. Medications with a longer half-life may lead to longer-lasting rebound insomnia.
By definition, a drug’s half-life is the amount of time it takes for your body to clear away half of the drug.6 For example, if a drug has a half-life of two hours, then two hours after taking it, you will have 50% of the original dose remaining in your body. After another two hours, or four hours total, the concentration will drop in half again, leaving you with 25% of your starting dose.
Benzodiazepine drugs prescribed for sleeping problems are grouped into three categories based on their half-life:1
- Short-acting drugs have a half-life of less than six hours
- Intermediate-acting drugs have a half-life between six and 24 hours
- Long-acting drugs have a half-life of more than 24 hours
Rebound insomnia may be more likely to occur after you use short- or intermediate-acting benzodiazepines.1 Short-acting drugs include Sonata (average half-life of 1 hour),7 Halcion (1.5-5.5 hours),8 and Ambien (2.8 hours).9 Intermediate-acting drugs include Lunesta (6 hours)10 and Silenor (15.3 hours).11 Klonopin is a long-acting benzodiazepine with a half life of 30-40 hours.12
Is Rebound Insomnia Treatable?
‘Prevention is better than cure’ is a phrase health professionals swear by, and with good reason. Thus, the best way to avoid rebound insomnia is by avoiding sleeping medications altogether.
If you are already taking sleeping meds, it's vital that you do not discontinue their use abruptly. Gradually tapering the dose under professional supervision can help you prevent rebound insomnia. Try reducing your dose a little more each week.
Alternatively, if you already take a low dose and are using the medication every night, start taking your medication every other day. Eventually switch to using it once every three days, and then every four, slowly taking it less often.13 Give it time and let your body adjust to not having to rely on medications to sleep.
If you’re experiencing rebound insomnia, try to have a consistent wake-up time to aid your natural sleep drive in getting you back on track. Cognitive Behavioral Therapy can also help.
Cognitive Behavioral Therapy for Insomnia (CBT-I)
CBT-I is a proven and completely natural technique that can help you overcome insomnia and stay on track as you stop relying on sleeping medications. It may also help you avoid taking sleeping pills to begin with. CBT-I is the better alternative to sleeping medications as it is equally effective in the short term and more effective in the long term.14
CBT-I is a form of talking therapy that focuses on the idea that our thoughts, habits, and emotions are connected and influence one another and our sleep. Challenging your thoughts, changing habits, and being more accepting of feelings can help you through any difficult phases while discontinuing your sleeping medication.
Ready To Overcome Rebound Insomnia?
- Roehrs, T., Vogel, G., & Roth, T. (1990). Rebound insomnia: its determinants and significance. The American journal of medicine, 88(3A), 39S–42S. https://doi.org/10.1016/s0002-9343(13)80001-0
- Griffin, C. E., 3rd, Kaye, A. M., Bueno, F. R., & Kaye, A. D. (2013). Benzodiazepine pharmacology and central nervous system-mediated effects. The Ochsner journal, 13(2), 214–223.
- Miller, N. S., Dackis, C. A., & Gold, M. S. (1987). The relationship of addiction, tolerance, and dependence to alcohol and drugs: a neurochemical approach. Journal of substance abuse treatment, 4(3-4), 197–207. https://doi.org/10.1016/s0740-5472(87)80014-4
- Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline. Journal of clinical sleep medicine, 13(2), 307–349. https://doi.org/10.5664/jcsm.6470
- Merlotti, L., Roehrs, T., Zorick, F., & Roth, T. (1991). Rebound insomnia: duration of use and individual differences. Journal of clinical psychopharmacology, 11(6), 368–373.
- Hallare, J., & Gerriets, V. (2021, August 23). Half Life. https://www.ncbi.nlm.nih.gov/books/NBK554498/
- Terzano, M. G., Rossi, M., Palomba, V., Smerieri, A., & Parrino, L. (2003). New drugs for insomnia: comparative tolerability of zopiclone, zolpidem and zaleplon. Drug safety, 26(4), 261–282. https://doi.org/10.2165/00002018-200326040-00004
- U.S. Food and Drug Administration. (2014, September). Halcion triazolam tablets, USP CIV. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/017892s047lbl.pdf
- U.S. Food and Drug Administration. (2005, August 29). Ambien CR (zolpidem tartrate extended-release tablets). https://www.accessdata.fda.gov/drugsatfda_docs/label/2005/021774lbl.pdf
- U.S. Food and Drug Administration. (2008, January 24). Lunesta (eszopiclone) tablets. https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/021476s005s008lbl.pdf
- U.S. Food and Drug Administration. (2010, March 17). Silenor (doxepin) tablets for oral administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022036lbl.pdf
- U.S. Food and Drug Administration. (2013, October). Klonopin tablets (clonazepam). https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/017533s053,020813s009lbl.pdf
- Cleveland Clinic. (2020, May 4). Here’s how you can overcome insomnia. https://health.clevelandclinic.org/heres-how-you-can-overcome-insomnia/
- Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M., & Cunnington, D. (2015). Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Annals of internal medicine, 163(3), 191–204. https://doi.org/10.7326/M14-2841
Dr. Colleen Ehrnstrom is a licensed clinical psychologist with a specialty practice in Acceptance and Commitment Therapy (ACT). Areas of expertise include insomnia and other sleep disorders, anxiety, and depression.