Stopping Sleeping Pills and Rebound Insomnia

Rebound insomnia happens when you have been taking sleeping pills and suddenly stop. Whether or not you get rebound insomnia when you stop taking sleeping medications depends on personal factors and the sleep aid you were taking.

This article will go over why rebound insomnia occurs with medications like Ambien, Lunesta, Benadryl, Klonopin, Ativan, and trazodone and what you can do if it happens to you.

What Is Rebound Insomnia?

Rebound insomnia is difficulty initiating or maintaining sleep that gets worse when you stop taking sleep pills all of a sudden. After stopping sleeping pills, you may experience a complete loss of sleep that lasts for hours or sleep that gets worse over days.

Causes

Sleeping pills act on chemicals that are naturally present in the brain and nervous system, such as neurotransmitters like GABA, serotonin, and tryptophan, and the hormone melatonin.

If you take sleeping pills regularly, your body adapts to the drug’s effects. Your body may even down-regulate to manage the increased chemicals. If you suddenly stop taking a sleep aid, the lack of those chemicals is not immediately compensated for, leaving your brain in a lurch.

If you develop a tolerance to sleeping pills, you may need to take more and more of the medication to get the same effect. It works less and less well and may stop working completely. Depending on the medication you take, you may develop a physical dependence on it over time.

Some prescription medications for sleep, including the benzodiazepines like Klonopin and Ativan, can cause withdrawal symptoms if they are taken at high doses and then suddenly stopped.

The symptoms of withdrawal can be serious and include blood pressure and heart rate changes, and in some cases, seizures.

How Long Does Rebound Insomnia Last?

Rebound insomnia is more likely to occur when you suddenly stop taking a medication you have been taking daily—especially at higher doses. It can happen with any over-the-counter (OTC) or prescription sleep aids.

The intensity of the rebound insomnia depends on your sensitivity to withdrawal. It can be made worse by other factors that contribute to insomnia and is felt more strongly if the drug you were taking has a shorter half-life.

The Half-Lives of Sleeping Pills

Knowing a drug’s half-life can help determine how long you might have rebound insomnia. A drug’s half-life is the amount of time it takes for half of the drug to be metabolized by your body, which means the level that is in your body drops.

For example, if a drug has a 4-hour half-life, its levels will fall to 12.5% of the starting levels within 12 hours (50% in 4 hours, 25% in 8 hours, and 12.5% in 12 hours).

Some of the most common sleep aids and their half-lives include:

• Benadryl or diphenhydramine (2.4–9.3 hours)
• Unisom or doxylamine (10 hours)
• Ambien, Ambien CR, or zolpidem (2.5 hours)
• Lunesta or eszopiclone (6 hours)
• Sonata or zaleplon (1 hour)
• Silenor or doxepin (15)
• Belsomra or suvorexant (12 hours)
• Trazodone (3–6 hours in first phase, 5–9 hours in second phase)
• Rozerem or ramelteon (1–2.6 hours for parent drug)
• Xanax or alprazolam (11.2 hours)
• Ativan or lorazepam (14 hours)
• Klonopin or clonazepam (30–40 hours)
• Valium or diazepam (24–48 hours for parent drug, 48–120 hours for metabolites)

A drug with a short half-life will be out of your system quickly and the rebound insomnia may be more intense and start sooner. Fortunately, it will also resolve more quickly, often fading within a few days up to a week after stopping the medication.

Longer-acting medications may not have as noticeable rebound insomnia. However, it may take longer for the drug to fully leave your system. These drugs are also more likely to cause “morning hangover” effects.

Treatment

You have a few options for managing rebound insomnia—and not all of them involve taking more medication or using a different sleep aid.

Know that the effects of rebound insomnia will not last forever. It can be helpful to reduce your dose gradually under your healthcare provider’s supervision. This is especially important if you are taking higher doses or using benzodiazepine medications.

Prevention

You may want to start a new medication to replace the one you’re stopping, but this is not always a helpful way to deal with or prevent rebound insomnia. There are often other elements of your sleep hygiene (or routine) and lifestyle that could be changed to help you deal with your insomnia.

For example:

• Setting a wake-up time and sticking to it
• Getting 15-30 minutes of sunlight when you first wake up
• Going to bed when you feel sleepy
• Delaying your bedtime with sleep restriction (e.g., only spending 6 to 7 hours of time in bed) when you are experiencing rebound insomnia
  

In general, it is best to avoid the daily use of sleeping pills. Don’t allow yourself to escalate the doses, especially beyond what your healthcare provider has recommended for you.

Summary

Rebound insomnia can happen if you stop taking sleeping pills suddenly after taking them daily for a long time or at a high dose. Rebound insomnia can be worse than the sleeping trouble you had to start with that prompted you to start using a sleep aid.

Some medications are more likely to cause rebound insomnia than others. How long you’ll have rebound insomnia also depends on how long it takes your body to clear the medication.

If you’re taking sleeping pills and want to stop, talk to your provider. Reducing your dose gradually may help you avoid rebound insomnia.

A Word From Verywell

If you find that you need sleeping pills beyond 2 weeks, speak with your healthcare provider about other options, including the use of cognitive behavioral therapy for insomnia (CBTI). This therapy can be very effective to help you to taper the medications while putting some other skills in place to prevent the insomnia rebound. You can use our Healthcare Provider Discussion Guide below to start that conversation with your healthcare provider.

Insomnia Healthcare Provider Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

Download PDF

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