Benzodiazepines are common remedies for an all too common problem in the United States: sleeplessness. Sleep disorders like insomnia can have a significant effect on your overall health and well-being, affecting both your physical and mental health.
According to the U.S. Centers for Disease Control and Prevention (CDC), as much of a third of adults don’t get the recommended amount of sleep each night. With so many people struggling with sleeplessness, the remedy for doctors and researchers have worked to develop pharmaceutical remedies since the 1800s. Benzodiazepines were first introduced in the mid-20th century, and they quickly grew in popularity.
By the 1970s, they were the No. 1 most commonly prescribed class of drugs in the world. They took over as the main sleep aid, supplanting barbiturates, a medication that has similar effects but can more easily lead to overdose. However, the more popular benzodiazepines became, the more people began to realize that they came with some of the same risks that were present in barbiturates. Though they are less likely to lead to an overdose through regular use, they can lead to chemical dependence and addiction.
Using a benzodiazepine for more than your doctor recommends (typically less than four weeks) you may start to develop a tolerance to the drug, and then dependence. If you miss a dose or stop using, you may start to feel uncomfortable withdrawal symptoms, which include anxiety, insomnia, discomfort, shaking hands, and tremors. If you stop using abruptly, after developing a serious dependence on the drug, you can experience potentially life-threatening symptoms. Benzos are a depressant, which means they work by suppressing excitability in the central nervous system.
They achieve this by interacting with a naturally occurring brain neurochemical called GABA (gamma-Aminobutyric acid), which is responsible for regulating excitability. Benzos bind to GABA receptors and increase the chemical’s effectiveness, leaving you to feel relaxed, sedated, sleepy, and without any anxieties. Unfortunately, when the drug is abused, these effects are also similar to another depressant: alcohol. People who use benzos recreationally often achieve an alcohol-like euphoric high that includes slurred speech, loss of motor skills, and a release of inhibition. If you use benzos like that for long enough, your brain will start to adapt to the drug and integrate it into normal brain functions. Before long, the benzo will be playing a key role in balancing your excitability levels.
Your brain may even work to counteract the drug, increasing its levels of excitatory neurotransmitters. But the drug keeps them at bay, especially when you increase your dosage as your tolerance grows. When you stop using abruptly, it’s like a levee breaking in your brain. The excitatory affects the brain had increased to balance your neurochemistry, is no longer held back by the depressant. It floods your nervous system, causing it to become overexcited. You can’t sleep, you feel anxious, and your body will begin to shake.
In some cases, you can experience debilitating seizures and a disturbing medical phenomenon called delirium tremens (DTs). Delirium tremens is characterized by sudden episodes of extreme confusion, panic, terror, seizures, and catatonia. You may become unresponsive, though still awake. Without medical treatment, delirium tremens can lead to coma or even death around 25 percent of the time. Withdrawal symptoms can last for about 10 days before your brain chemistry balances out and returns to normal function.
But can you manage benzodiazepine detox at home?
It isn’t recommended. Central nervous system depressants are unique in that they are among the few drug classes that are dangerous during withdrawal, while others are uncomfortable but not life-threatening. The shock that comes with nervous system overexcitement is generally not safe to overcome without help.
Learn more about benzodiazepine detox and your safest possible options.
Benzodiazepines are potentially deadly during withdrawal, especially when you stop using them abruptly. And if you become addicted to benzos and start doctor shopping to get more after your prescription runs out, there may come a day where you can’t get another dose, leading to withdrawal. You may be able to withstand anxiety, insomnia, and other uncomfortable symptoms, but seizures and delirium can be dangerous, especially if you’re by yourself. Seizures aren’t usually deadly on their own, but they can come on suddenly and with very little warning.
Seizures are characterized by two phases: the tonic phase and the clonic phase. In the tonic phase, you may lose consciousness, and your muscles will tense up violently. Your limbs may suddenly shoot out or be pulled in beyond your control. This is the shortest phase of the seizure, lasting about 10 to 20 seconds. But the sudden loss of consciousness and motor control can lead to a fall or other kind of accident. The clonic phase is marked by convulsions where the muscles contract and relax rapidly. This phase can last for up to a minute, and your thrashing body can lead to further injuries. When the seizure subsides, you may be in a sleep-like state, you’ll be confused, and you may have a temporary loss of memory.
Delirium tremens can come on just as quickly. But unlike seizures, delirium can be deadly in and of itself. It can come in the form of nightmares, agitation, confusion, disorientation, and even hallucinations. In fact, people who go through it often report common visions that cause physical or emotional discomfort like insects, snakes, or rats.
But it can also cause potentially serious medical complications like tremors, seizures, fever, hypertension, extreme sweating, and rapid heart rates. Without treatment, delirium tremens can lead to respiratory depression, heart arrhythmias, and pneumonia, which can be fatal. Before the area of intensive medical care and modern pharmacological approaches, delirium ended in death as much as 35 percent of the time. With treatment, delirium tremens is fatal as little as 5 percent of the time.
If you start to feel benzodiazepine withdrawal symptoms, it’s important to speak to a doctor as soon as possible. If symptoms are severe, it may be necessary to check into a hospital. However, if you are addicted to benzos and you’d like to stop using, you can seek help from a medical detox center. Medical detox is the highest level of care in addiction treatment and involves 24-hour medical services daily for between five to 10 days.
You will be treated by medical professionals that are specialized in drug and alcohol detox. Treatment will be tailored to your individual needs. If necessary, you may be treated with medications to ease uncomfortable symptoms or to wean you off of the benzodiazepine slowly.
You may also be treated with thiamine, also known as vitamin B1 to treat or prevent delirium. After you make it through the withdrawal stages, clinicians will help you find the next stage of treatment. If you developed a moderate to severe substance use disorder, you might need longer-term addiction treatment, including clinical therapies.
Burns, M. J., M.D. (2018, May 16). Delirium Tremens (DTs). from https://emedicine.medscape.com/article/166032-overview
CDC. (2018, February 22). Sleep and Sleep Disorders. from https://www.cdc.gov/sleep/index.html
WebMD. (n.d.). Thiamine (Vitamin B1): Uses, Side Effects, Interactions, Dosage, and Warning. from https://www.webmd.com/vitamins/ai/ingredientmono-965/thiamine-vitamin-b1