Benzodiazepines can effectively induce sleep. Though their sedative properties can make them an applicable sleep aid, they are no longer recommended as a first-line approach to treat insomnia since they can reduce the overall quality of sleep.
Benzodiazepines are sedative drugs that bind to the gamma-aminobutyric acid (GABA) receptors in the brain, making the GABA neurotransmitter more bioavailable to slow down communication between neurons. These drugs became popular alternatives to barbiturate sedatives starting in the 1950s because barbiturates led to higher levels of sedation, daytime fatigue, and dangerous muscle relaxation.
Currently, benzodiazepines are the most widely prescribed medications in the United States. According to IMS Health, in 2011, millions of prescriptions for benzodiazepines were given and filled, including:
- 49 million prescriptions for alprazolam (Xanax)
- 27.6 million for lorazepam (Ativan)
- 26.9 million for clonazepam (Klonopin)
- 15 million for diazepam (Valium)
- 8.5 million for temazepam (Restoril)
Common Benzodiazepines Used in Insomnia Treatment
Insomnia is a condition in which a person has trouble falling asleep or staying asleep through the night. This leads to daytime drowsiness, mood swings, weight gain, difficulty with learning or thinking clearly, and other problems. People who have chronic insomnia may not be able to fall asleep even when they feel tired.
While there are numerous types of benzodiazepine chemicals, about 15 have been approved by the U.S. Food and Drug Administration (FDA) for prescription use in the United States. Of these, only a few are used to treat chronic insomnia, including:
- Flurazepam (Dalmane)
- Temazepam (Restoril)
- Quazepam (Doral)
- Triazolam (Halcion)
Most benzodiazepine drugs are used for the short-term or as-needed treatment of anxiety or panic attacks. Stronger benzodiazepines are used to manage seizure disorders like epilepsy, induce sleep in people who have conditions like narcolepsy, or manage anesthesia during surgery.
Because benzodiazepines are a sedative drug, they can have an impact on fatigue and sleep cycles. Using them as the main approach to insomnia treatment is no longer considered the most medically sound approach.
Problems With Using Benzodiazepines as Sleep Aids
As a treatment for chronic insomnia, benzodiazepines do not force the person to pass out or fall asleep. Instead, they reduce sleep latency, or how long it takes for the person to fall asleep.
One study found that sleep latency was reduced to four minutes, and there was an average of one more hour of sleep gained by taking a benzodiazepine as part of overall insomnia management. They also reduce the number of times a person may wake up during the night. Insomnia and anxiety are linked through GABA neurotransmitter management, so allowing the person to relax helps them fall and stay asleep.
Benzodiazepines change how the brain manages sleep cycles. While the drugs allow the person to fall into non-rapid eye movement (REM) sleep faster, they may change how many sleep cycles the person experiences, how long they stay in NREM sleep, and how often they enter REM sleep.
People who take benzodiazepines to treat insomnia may experience daytime sleepiness as a common side effect. This is because the brain does not move through a regular sleep cycle even though the person may have been asleep for an average timeframe of seven to nine hours.
Benzodiazepines are not recommended for consistent, long-term use anymore. These drugs are addictive, and even when taken as prescribed, they can quickly lead to physical dependence and tolerance.
After a couple of weeks, you will likely start to feel like you need a higher dose to help you fall asleep. This indicates tolerance to the substance.
There are different medications that work better for managing insomnia, but few medical professionals will recommend a drug, including benzodiazepines, as a long-term method of managing sleep problems. Instead, a doctor may prescribe doses of benzodiazepines for a few nights, up to about two weeks at most.
These drugs may be recommended for use as needed, or to help the person get back into the habit of sleep alongside lifestyle changes called sleep hygiene. Making changes with the help of a counselor will help to manage anxiety and sleeplessness better than any medication can.
Your Doctor Can Help You Taper Off Benzodiazepines and Focus On Sleep Hygiene Changes. These May Include:
- Going to bed and getting up at the same time every day
- Turning off all the lights and distractions in your room
- Keeping your bedroom cool
Withdrawal Symptoms Hurt Sleep
Withdrawal from benzodiazepines typically leads to a worsening of symptoms that the drug was initially prescribed to treat. For example, if someone has anxiety and takes benzodiazepines to manage this condition, then suddenly quitting the medication will cause rebound effects, or withdrawal symptoms, that include worse anxiety and panic attacks.
The Following are Other Withdrawal Symptoms:
- Mood swings and irritability
- Apprehension or paranoia
- Tachycardia (rapid heartbeat)
- Muscle tension
- Tremors or shaking
- Hyperreflexia (over-response to stimuli)
- Rebound insomnia
About 50 percent of people who take benzodiazepines develop this withdrawal syndrome, especially if they try to quit by themselves without tapering or medical oversight.
Physiological dependence occurs in about four to six weeks, but psychological dependence may begin immediately. People who take benzodiazepines for chronic anxiety or insomnia may associate the drug with feeling better, and they will have a difficult time quitting it when they no longer need it. They may increase their dose without consulting their doctor.
If they do attempt to quit on their own, the discomfort of withdrawal symptoms makes sleep and daily activity difficult, so they are more likely to quickly relapse.
The Importance of Medical Assistance
Both withdrawal symptoms and ongoing benzodiazepine abuse are dangerous. Medical oversight during detox can prevent severe, life-threatening symptoms like seizures.
The most common method for ending physical dependence on these sedatives is tapering, but an overseeing physician is needed to manage the process. Many rehabilitation programs will help you focus on sleep hygiene and other lifestyle changes to improve anxiety and insomnia symptoms. The goal is to avoid substance abuse and promote good sleep.