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Millions of people suffer chronic insomnia. They toss and turn and worry about the consequences of inadequate sleep. The trouble is that almost all the drugs that are prescribed come with side effects. This reader has a bad sleeping problem but is a benzodiazepine like lorazepam the best solution?
Q. I’ve always had problems with insomnia. A few times every week I would get only two or three hours of sleep a night. Four months ago, I was lucky if I slept six hours even one night a week.
My doctor prescribed lorazepam. I take it nightly and it seems to work most of the time. Nothing else worked: chamomile tea, warm milk or reading to relax.
I told him about my fear of addiction, and he said I should not worry unless I felt the need to take more than one tablet a night. He added that I might need to take these the rest of my life if I want to sleep at night. That worries me. What do you think about taking this medication for a long period of time?
A. Lorazepam (Ativan) is a benzodiazepine, meaning it belongs to a class of anti-anxiety agents like alprazolam (Xanax) and diazepam (Valium). The official prescribing information states that lorazepam is for “the short-term relief of the symptoms of anxiety” and doesn’t mention insomnia.
The Official Stance on Benzos for Insomnia:
The FDA warns about adverse reactions such as depression, dizziness, unsteadiness, confusion and memory problems. Nine out of ten studies in one review found an increased risk of dementia among long-term benzodiazepine users (Expert Opinion on Drug Safety, May, 2015). Not all scientists are convinced that this is a problem, but your concern may have merit.
We are sending you our Guide to Getting a Good Night’s Sleep for information about sleeping pills and many other approaches to overcoming insomnia. This recently revised 16-page downloadable guide is available at PeoplesPharmacy.com.
NEVER Stop a Benzo Suddenly!
Your physician said that you had no worries with lorazepam as long as you do not increase the dose. Should you ever need to stop, though, please consult your doctor and do not stop suddenly on your own. The withdrawal symptoms can be serious and unpleasant.
Symptoms of Benzodiazepine Withdrawal:
- Anxiety, agitation, restlessness
- Irritability, sensitivity to light, touch and sound
- Difficulty concentrating
- Insomnia that may be worse than before
- Panic attacks
- Memory problems
- Depression
- Headache
- Fatigue
- Muscle cramps, muscle twitching
- Seizures
- Sweating
- Digestive problems including diarrhea
Gradual tapering of the dose over several weeks or months may be necessary if you have to stop lorazepam. Your doctor may need to switch you to a different benzo with a longer half life to make this process easier. Our Guide to Getting a Good Night’s Sleep will provide some other options.
Pema
Which is worse for developing dementia – taking lorazepam for sleep, or no sleep at all?
Joe
FL
Ativan is the the worst to get off of. I only took it “as needed” for relatively mild anxiety (mild compared to the rebound anxiety). I’ve never felt anything like it in my 55 years. I slowly got off it over a few weeks but then for a month after stopping I thought of nothing but suicide going as far as researching and planning. Never before in my life have I been suicidal. It’s been 8 months off now, and I’m still alive so that’s good, I guess. I truly think I’ll never be myself again, tho. I wish I’d never taken it.
M
Boston
Ativan is the Devil. Stay away from it, and do not be deceived. It will ruin you in the long run, and I tell you this from experience.
Waldowski
Orange County, California
I am 79 years old and have been taking Lorazepam 0.5 mg for sleeping for the last 20 years! I call it the miracle drug! I also have GAD but it has always been under control thanks to the medication. I have a Ph.D. and do a lot of writing. I just finished a book. I also travel with my wife twice a year, usually to Europe, and never have relied on tours. Kaiser doctors want to take the Lorazepam away from me. I have no sign of dementia and am relatively healthy (except for HB pressure). I have tried to reason with the doctors, explaining that in my case the benefit of taking such a small dose far outweigh the cost.
Now they have asked me to see a psychiatrist, who is trying to wean me off the medication. I feel really frustrated. Any suggestions? If I refuse to accept an alternative treatment, can they take the medication away from me? I am in the process of consulting a lawyer as well, and I may have to be ready for some legal battles. Thanks.
Kim
MT
Like everyone else in this forum, I have chronic, severe insomnia. Been taking lorazapam and ambient (I switch between these periodically) for over 20 years, but now I’m scared as hell from all the talk about increased dementia risks with these drugs.
I don’t know what to do. I have been trying to work my way off these meds but don’t sleep hardly at all now….resulting in very poor quality of life. Tonight I finally took a lorazapam because I cant stand another night of no sleep. No other type of meds or natural approaches do anything to improve my sleep. Feel like I’m in a no-win situation.
Robert
Calgary, Canada
Taking Ativan for 33 years. Works well for me. Happy “Sailing”
Ani
NC
I started taking Xanax in 2008 and was advised to switch to Lorazapam (Ativan) in 2013. For a while I was taking 2 or more mg. a night to get to sleep because i was under a lot of emotional stress. However, I have suffered from insomnia most of my life, with periods of wonderful good sleep for no reason I can find that then disappear and I am back to my bleary-eyed self. Have tried Ambien, Halcyon (a real disaster) and many natural sleep aids.
As my life has become more settled, I have found .5 to 1 mg. of lorazapam works well most nights. I try to stay with .5 unless I’m feeling especially anxious or restless. I am a Zen meditator, have been for 20 years, meditate every night before bed for 20minutes with incense, candles, peaceful surroundings. Don’t watch tv, listen to calming music, eat healthily and get exercise. I have no conscious anxiety now, but even so, will not be able to sleep without a small amount of Ativan. My brain just does not want to shut off even though I know mediation techniques and can be totally relaxed and in samadhi when meditating! Have realized that when I am in sleep mode, I start seeing images float up, but usually there is a black void, like a hard surface not allowing me to sink into that world of images and sleep. I am rather intellectual so perhaps that is a problem. I am a 73 yr old active happy woman, but am afraid of the talk of long-term problems from this drug. As one person said, insomnia can cause dementia and other mental problems, too, so which way to go?
Vivien
new zealand
Hi, ive been on Lorazepam 1mg for a year for terrible anxiety and all of a sudden they stopped working so i increased to two per day after a month i started reducing really slowly and got down to 1.5mg then the anxiety came back full on ,i’ve increased by another quarter of a pill so am now on one and three quarters but the anxiety is still there should i just keep it at that and suffer or increase back up to two i am so scared that i’ll have to increase to more as time goes on as they may stop working again Help ps i am waiting for an appointment to see a phsyc but they don’t usually understand
MAGGIE
Philly
Please let me know what you decide
I’m 56 .. On atavan for nearly 20 yrs steady 2mg at 4x
I got myself to 3x’s
I’m at 4mg bed
Trying to get off completely
And for the last two nights in a row I took one and right now my heart is beating out of my chest…
I feel like you said no sleep is deadly and on the atavan I have no deep meditation ability…etc
Dori
Canada
If it works for you, and the doctor feel like you are in control and taking a safe dose, and it’s helping, then sleep tight. Don’t worry about what others think.
jan
california
I was always a good sleeper until I had back surgery years ago with complications and I couldn’t sleep for days because of the anxiety connected with this. Ever since, I have had trouble sleeping because I can’t forget those days of not sleeping. It is like I revisit this fear every night and I can’t get to sleep even though my back is fine now.
I take 1 mg of Ativan at bedtime. It doesn’t always help much. I am afraid to increase because I am afraid I will have to increase and increase. Any suggestions to get rid of this recurring fear? It keeps me awake. Or, any suggestion on how to accept that I just can’t sleep anymore.
Lucie
Ottawa, Ontario
Hi Jan in California,
I am a mental health professional in Ottawa, Canada. You expressed the presenting problem perfectly: you body is remembering an experience connected to the surgery. Perhaps by the time you ready my reply, a year after your surgery, your difficulties with sleep may have resolved. If not, find a therapist training in somatic experiencing (an approach created by Peter A Levine). Those therapists are trained to help the body to let go of memories that no longer serve us. I hope this helps.
Elizabeth
Boston
My anxiety and insomnia came on with menopause. I do yoga, I meditate, I drink sleep-type tea in the evening. I can fall asleep, but I cannot stay asleep past 3-4 hours. I would then take half my .5 lorazapam, and usually I can sleep for another 3 hours. The other night, I tried taking the pill at bedtime, which felt wrong because that is when I am OK falling asleep (reading usually does it for me) and miraculously I slept through the night. I guess it lasts long enough to get me through the point where I was waking up in the past, and miraculously I have been able to sleep 7 hours straight the night I take it at bedtime. I am worried about becoming hooked, but hope that once menopause subsides (another year or two? ugh) then I will sleep on my own again. I have no side effects from the lorazapam, luckily, but hate to have to take anything at all. I do believe INTENSE sweat-inducing exercise is the key. Not just walks or yoga, but running or an aerobic type class. Don’t be one of those people who thinks a pill can fix your problem, please find exercise that is FUN and makes you sweat A LOT — it will really help (I hope)
James Buchanan
Hamilton Ont. Canada.
Well,I am 85yrs.old and are in anxiety some time .Dr. put me on 0.5mg. Lorazapam but a little afraid of drugs like that ,so I’m not sure what to do. My wife passed away and am alone now. Live by myself is not what I’m used to. Not knowing how safe the drug is. I take one the odd time fearfully. My health is good otherwise.
Melissa
US
I am so sorry your wife passed and to hear of your loneliness without her. I can’t imagine how difficult this must be for you. I believe the lorazepam will definitely help with any anxiety you are feeling and also help with your sleep. I have been taking a very low dose for a few years now so I am able to get a full nights sleep. I started taking it when I became severely depressed over several losses I had suffered in a very short time. My insomnia was so bad I would stay awake entire nights, often multiple nights in a row where I might get a couple hours of sleep here and there. Also, I already have an anxiety disorder, which just became more magnified with everything I was dealing with at the time. I can tell you that being prescribed a benzo saved me from a life of misery, possible hospitalization and losing my job because I absolutely was no longer able to function on my own and needed help. Good luck to you and I hope you find some relief in your suffering
Annie
Lancaster, Ca
I have taken Lorazepam 1mg. at night to sleep for ten yrs. now. It doesn’t always work if I am worried or if I have a set time I have to get up next day ( I’m retired and 69 yr.) But I sure don’t sleep well AT ALL and have nightmares if I don’t take it, I really feel like I have no side effects at all, and my DR. says I can safely take it for the rest of my life.
Ken
San Francisco
The nightmares are from withdrawal. I have been taking it for periods of time for years, mainly when I travel for getting to sleep. When I stop taking it I get vivid dreams, usually enjoyable. It is great for jet lag.
Mark
Murphys, CA
I’ve gotten rid of alprazolam but didn’t know it’d cause so much problem sleeping after. Don’t want to stop this stuff suddenly and on your own.
I’m thinking of taking this new one on my conditions as in only when I’m heading for bed.
Dan
Well, I don’t sleep well without some help. I have tried most every drug type. Ativan works but the MD does not use it for long term. Zolpidem I used for years but leaves me dull the next day. I have been using CPAP for years.
What works for me is Indica Cannabis, but it is expensive and the spouse is not happy with this choice.
It needs to be legalized. Ridiculous history of lies about Marijuana.
Cheers
Sandra
MI
I have POTS dysautonomia, and have been experiencing either adrenergic storms, sympathetic storms, and Paroxysmal sympathetic hyperactivity. I diagnose myself most of the time because doctors don’t.
I began taking .5 lorazapam, on days my sympathetic system is hyper. I have bad cases where I will have an episode out of the blue and I take 2 mgs of it so I don’t get a stroke or heart attack from it. Since I am not being treated, I take it only when I need it. Sometimes 4 days in a row, but then stop, cause even tho i probably need it daily, I am afraid to get on the regular. Plus my blood pressure is usually between 40/30-88/40 and it dont want it to drop it more.
howard
Delmont Pa.
Everey night i stay awake until 4:am in the morning. I go to bed around 11;30 pm.My brain is going hundreds of miles a minute. I get afraid at nite thinking i might not get to sleep. what should i do.Every day i think about weather i am going to sleep at nite or the next nite. My wife say i dwelt on it to much. Will ativan and is it safe help me.Thanks Howard
Tracy
California
Yes. Ativan is the best for sleep. I struggled within insomnia for years. I also have a small dvd player with ear buds by my bed and listen to old Columbos which helps put me to sleep faster.
Bob
NC
Sounds like you may have delayed sleep onset insomnia. You may want to talk to a doctor about behavorial therapy to reset your sleep clock. I don’t have this problem but I know of a friend that does and this was his course of action. Good luck.
TERRY
Smith County, KS
Don’t worry about it. The doctor prescribed it for you and the drug is effective. Many worry about the side effects or withdrawal, but a .5mg
dose may work for you from now on and I doubt you will be interested in abusing the drug for recreational purposes. I am 78 years
old and had my first heart attack a couple of weeks ago and lost my
best friend a few months back. I have taken .5mg a night for years
and my doctor prescribed another .5mg for the anxiety and depression I have been having. Nothing is as effective at relieving the anxiety you must be having at the moment
Carly
Ann Arbor, MI
Well said. I appreciate your wisdom and honestly. When I don’t sleep I feel physically ill, my anxiety is through the roof and I struggle at work. .5mg. works and is worth it. All these healthy remedies DO NO WORK. Obviously if they did we would not have any further discussions on the issue of insomnia or anxiety. I am sure most people would like to sip a cup of warm milk following a 3 mile walk and an hour of yoga to sleep but this does not work for everyone. I decided NOT to take Ativan because I got paranoid and felt horrible. I took .5mg last night and feel 100% today.
Dan
Well, I don’t sleep well without some help. I have tried most every drug type. Ativan works but the MD does not use it for long term. Zolpidem I used for years but leaves me dull the next day. I have been using CPAP for years.
What works for me is Indica Cannabis, but it is expensive and the spouse is not happy with this choice.
It needs to be legalized. Ridiculous history of lies about Marijuana.
Cheers
Laura
I took 1 mg Ativan for 15 years because without it I would not have been able to work, plain and simple. I had no side effects, I never needed to increase my dose in all those years, and I felt mentally and physically great. My doctor wanted me off them so I complied, and guess what? Five years later I STILL don’t sleep. And now doctors won’t prescribe these, even though it would mean I could have a life. I sleep no more than 3 hours nightly. The thought of living this way for another 30 years is too hard to contemplate. My cognitive abilities are now in the toilet and getting worse all the time. Horrible.
Robert
So sorry to hear you’re having a lot of trouble. Have you tried another non addictive medication to help like trazodone or remeron? I’ve been taking this medication for quite some time as well and want to cut back slowly. Those 2 meds as well as paxil have been recommended to me to help with the insomnia as well as the slow taper.
Alana
Melbourne
Go see a psychiatrist! I went to over 5 different GP’s and none of them would prescribe me Ativan for my insomnia even though 1mg works great for me. Then I went to a psychiatrist and I told him I get suicidal if I only sleep 1-2 hours a night so I must have Ativan and I do not abuse it! Ive been taking it for 3 months now and Zoloft in the morning for my anxiety. My natural sleep has had no improvement which is disappointing but I am hoping the Zoloft will help with that.
Lily R.
WA
Switch Drs. if the one you have won’t prescribe it.
Brandy
When I started having symptoms that were diagnosed as a result of Lupus, I also stopped sleeping (100%). I’d always been a heavy sleeper. It wasn’t computer lights or bad habits that suddenly kept me from sleeping. My doctor put me on Xanax. I took half a pill every night. I started having panic attacks out of the blue. I tried melatonin, and various other sleep aids with no success. I’ve weaned myself off the Xanax and now take 5-HTP and California Poppy seed extract (no opioids) and get decent sleep.
Linda
Hooksett nh
I have been on Ativan for 20 yrs. no side effects six mths.ago I only sleep 3 or 4 hrs. Why all of a sudden
LF
Linda, sometimes sleep aids just stop working. Either you need a dose increase (which is never desirable with benzos), or you need to switch.
My GP put me on low-dose antidepressants six months ago and I now sleep well. It isn’t ideal, but at least I have a life again. Perhaps your doctor might consider this switch. Beware of benzo withdrawal, though. It can take three to four months, in spite of what many health professionals believe.
George
Blowing Rock, NC
I’ve been taking 1 mg of lorazepam every night for over 6 years with little to no side effects.
Jackie
North Carolina
I’ve been on 0.5 mg. of Lorazepam for quite a few years for insomnia. Sometimes you need to weigh the benefits vs. the risks. Maybe there’s an increased risk of dementia from chronic insomnia. Any studies on that?
A good night’s sleep is worth it’s weight in gold. Chronic insomnia is a long lonely road at night.
Heather
Australia
On bad nights now I take under the tongue 2 x Melatonin no side effects as yet.
Allison
Boston
This is very worrisome for those of us who have severe anxiety that interferes with sleep as well as with functioning during waking hours. Suggestions for better getting-to-sleep practices have been widely publicized. But what about crippling anxiety while awake? I hope no one responds that “exercise” and “meditation” are effective alternatives; they may work for some but are either not viable for others or make only a modest dent.
PP
Florida
Instead of treating the symptom of insomnia, look for the cause: too much screen time before bed, sugar in the evening, etc. etc. Try keeping a log of your activities , diet, and meds, and so on. Then figure out when it’s the worst, and what might be making the problem. I have a theory that all this use of computer, smartphone and tablet blue light screens might be the reason for the national epidemic of insomnia. The simple fix of a blue light filter on your screen could make all the difference.
Then try some lavender essential oil: a drop or 2 on the pillow, under your nose and on your wrists can really help people get to sleep.
LF
Sorry to be so blunt, and I know you mean well, but you clearly have never experienced severe, life-destroying long term chronic insomnia. Lavender oil? Might as well try to harpoon a whale with a darning needle. Nothing works. Not exercise, not “clean living,” not CBT, not any of the suggestions for non-intervention sleep remedies. Over a 20 year period I tried them all. Nothing helps. Not one thing. My body just does not sleep. Many post-menopausal women are in this category, and we get judged; we’re told it’s something we’re doing wrong. But it isn’t that. It’s that our bodies just don’t work properly any more.
Teresa
Mass
What have you been doing , the quality of life is awful. Have you found your answer? Thank you
Sandy
Minnesota
I’ve been taking 3.0 mg of lorazepam for the last 20 years. For horrific anxiety and insomnia caused by so many traumatic events in my life. However, I’m starting to have memory problems that are worrying. I’m also frequently dizzz. I’ve tried tapering and I can’t do it. I get horribly depressed and so anxious that I feel like I’m having a heart attack. I try adding melitonin or valerian and neither do much. I have high blood pressure, osteo arthritis, dry sinusitis, fatty liver and cataracts from having to take drug to cure kidney tb. Last year I almost died from a virus. I’m worried about taking these drugs. I’ve tried every natural remedy under the sun and nothing works like this drug. I also haven’t dreamt in years. Any thoughts? Help.
Lisa
Wyoming
Yes, please – those of you who are trying to recommend exercise, yoga, lavender oil, no screen viewing – just stop it. You think we haven’t tried all of that before? I’ve had insomnia for most of my life and it’s much worse now that I’m going through menopause. I’ve tried all the natural sleep-aides, the prescription sleep-aides – nothing worked for me…nothing.. until I tried Xanax. I don’t have anxiety attacks during the day, but the Xanax does shut my thinking down at night and I’m finally able to sleep. Working full time on 2 hours of sleep each night for months at a time makes you feel like you’re going to die. Xanax is a life-saver.
mil
south africa
I have had insomnia since I was a child. More recently the cycles have gotten longer and Im now in the longest Ive ever had. Lavender Oil most certainly is not for chronic insomnia sufferers. As far as medical science has come, why is this condition so poorly understood and treated? I would love to connect with any other chronic insomnia sufferers to get some advice and support on those long lonely nights.
Jean
FL
I have been taking 1mg of Ativan every night for 20 years without any side effects. It allows me to sleep for eight hours, waking up feeling refreshed and without the “hangover” of other OTC or Rx medications. And I’ve never had to increase the dosage strength. Before Ativan I fell asleep easily, but awoke after 3 or 4 hours unable to get back to sleep.
Heidi
Ca
I completely understand, I have dealt with insomnia since I was 16, I’m 31 now. I tried 8 months free of meds and I got pretty close to a psychotic break. Your body needs to sleep and mine just refuses! My drs look at me like, why don’t you just meditate more, tea, oils… don’t you think I would be doing that if it had helped!!
Ken
Sleep is very allusive for me. I’ve always had a hard time shutting the mental machinery down. I envy those who can nap or sleep at any given time. When I lay down my brain goes into high gear. I lay awake till 2-3am thinking about everything. Melatonin helps a little to reset my sleep clock. I’ve taken most every Benzo known without much success. I have yet to find the answer but it’s harder if you fight it. My artistic side is most likely the cause of an overactive brain. The blessing & the curse. Tried alcohol, sleeping pills, anti-histamines, natural remedies and herbs to no avail. I hardly function every day. I hope and pray for a solution but fear it’s just part of who I am.
Elizabeth
Ken, Have you tried the free app Insight Timer? You can do sleep meditations that will take your mind off of your thoughts and help you focus on breathing that will help you sleep. It works for me.
sheri
surfside beach sc
Um, geewhiz, isn’t anxiety one of those things that can keep you up all night?? I take 1/2 a Xanax (.25) once or twice a week when my insomnia gets really out of hand. Makes me a little stupid the next morning but that wears off and a good night’s sleep is worth almost anything.
Adrian
Los Angeles
Same here. I have suffered from insomnia most of my life. Recently, I have been placed on Atenolol, a heart beta blocker and that makes me a little sleepy. Still, every now and then, I break a Xanax in half and take that just to get me to sleep.
Carla
Here is some excellent information about tapering off benzos:
http://www.benzo.org.uk/manual/bzcha02.htm