Insomnia can be a common and challenging symptom during benzodiazepine withdrawal. Understanding why insomnia occurs during this process and how to cope with it effectively is crucial for a safe and sustainable recovery journey.

Understanding Insomnia in Benzodiazepine Withdrawal

Benzodiazepines are a class of medications primarily used to treat conditions such as anxiety and insomnia. They work by enhancing the effect of the neurotransmitter gamma-aminobutyric acid (GABA), which induces sedation and relaxation. The drug’s effect on GABA can cause some GABA receptors to downregulate (no longer function). The body may then experience a significant disruption in its ability to regulate sleep, rendering it difficult to fall or remain asleep.

Benzodiazepine-induced insomnia can occur while on the medication, tapering, or after cessation of the drug. Sidebar: All benzos can cause insomnia; however, Ativan is known for being the benzo that seems to cause the most insomnia, which is interesting, as it is the benzo often prescribed for treating insomnia.

The Risk of Treating Insomnia with GABAergic Medications or Supplements

During benzodiazepine withdrawal, it’s vital to avoid treating insomnia with GABAergic medications or supplements. These substances work on the same receptors as benzodiazepines, which can potentially lead to cross-dependence or worsening of withdrawal symptoms. Introducing new GABAergic substances can impede the brain’s effort to regain balance (upregulate the GABA receptors), prolonging the withdrawal process and making the eventual cessation of all GABA-affecting substances more difficult. You can see a list of GABAergic medications to avoid here. You can see a list of GABAergic supplements to avoid here.

Commonly Used Medications and Supplements and Their Risks

Some suffering from benzo withdrawal-induced insomnia turn to medications or supplements to help them sleep. Only you can decide if you can wait out your sleeplessness or if you want to treat it. Two common non-psych med approaches to treating insomnia in the benzo community are antihistamines and melatonin.

Antihistamines

The risk: While over-the-counter antihistamines (like Benadryl) are often used for sleep, they come with risks such as daytime drowsiness and cognitive decline. (Long-term use of antihistamines can cause dementia.) In some cases, they may paradoxically cause agitation or restlessness. Prescribed antihistamines like Hydroxyzine are used in the benzo community. Antihistamines are usually well-tolerated, but some may feel revved up or overly sedated. It is best not to take an antihistamine longer than you need to, as long-term use can downregulate GABA receptors. Do not drive if you are taking an antihistamine and you are drowsy.

Melatonin

The risk: Research has shown that over-the-counter melatonin supplements may be many times more potent than what the label indicates, and they can contain serotonin, which is not advisable for someone going through benzodiazepine withdrawal due to the sensitivity of the nervous system during this time. It is best to take the smallest dose that makes you sleepy. Not everyone likes how melatonin makes them feel, so it is not for everyone. Melatonin is listed as a possible GABAergic supplement on the Benzodiazepine Information Coalition website, as it has been shown to increase GABA in animal studies; however, many people in the benzo community use it.

Pysch-Med Approaches to Treating Benzo Withdrawal Insomnia

These medications, while sometimes prescribed off-label for sleep issues, come with risks. Please educate yourself about these drugs before you decide to take one. Many in the benzo community have struggled with healing while on some psych meds and have had to manage a second withdrawal syndrome.

  • Seroquel is an antipsychotic with potential side effects like metabolic syndrome and tardive dyskinesia. When you want to stop taking it, the withdrawal syndrome can be challenging.
  • Trazodone is a tricyclic antidepressant that can lead to orthostatic hypotension and priapism. Withdrawal symptoms can occur in some people.
  • Remeron is an antidepressant that may result in weight gain and metabolic changes. Many have struggled with withdrawal symptoms when they tried to stop taking it.
Anticonvulsant-Med Approaches to Treating Benzo Withdrawal Insomnia
  • Gabapentin is an anticonvulsant that can cause dizziness, fatigue, and dependency. The withdrawal syndrome mimics benzo withdrawal and can be quite intense.

Coping with Insomnia Without Medications or Supplements

Many choose not to treat their insomnia with medications or supplements. It can be challenging to face the long hours of the night staring at the ceiling or pacing the floor. Negative thoughts may fill our heads, telling us that we will feel terrible come the light of day. It is easy to develop fears about not sleeping and dread bedtime. But it is essential to work with our negative thoughts and feelings so that we are less stressed out by sleepless nights and more able to understand that insomnia is a prevalent withdrawal symptom that will eventually go away as our GABA receptors upregulate and our hyperexcited nervous system calms down. Here are some coping techniques to use when dealing with insomnia.

Establish a Sleep-Conducive Environment

Creating a restful environment is key to promoting sleep. This includes maintaining a cool, dark, quiet room and using your bed only for sleep and intimacy. If you are ‘bedbound,’ try using the couch during the day.

Regular Sleep Schedule

Stick to a consistent sleep schedule, even on weekends. This helps regulate your body’s internal clock.

Mindfulness and Relaxation Techniques

Mindfulness meditation, progressive muscle relaxation, or deep breathing exercises can reduce stress and prepare your body for sleep.

Limit Screen Time

The blue light emitted by screens can interfere with your circadian rhythm. Limiting screen time at least an hour before bed can help.

Diet and Exercise

Consuming a well-balanced, plant-based diet and regular gentle exercise can improve sleep quality. However, avoid heavy meals and workouts close to bedtime.

Gentle Body Movement

Practices like yoga or tai chi can help calm the mind and prepare the body for rest.

Managing Stress

Techniques such as journaling, listening to calming music, or reading can help manage stress before bed.

Support Groups and Coaching

Joining support groups or seeking the help of a health and wellness coach who understands the complexities of benzodiazepine withdrawal can provide personalized strategies and encouragement.

Practicing Acceptance

Practicing acceptance for benzodiazepine withdrawal-induced insomnia can be a powerful step in healing. Acknowledging that sleep disturbances are a temporary part of the withdrawal process without judgment can lessen the anxiety surrounding sleep, paving the way for a more restful state of mind and being.

Distraction

Engaging in gentle distraction, like immersing yourself in a good book, coloring, knitting, etc., can provide a valuable reprieve from the worry about a sleepless night, creating mental breathing space and aiding overall coping. Learn something new! It gives you a boost of feel-good dopamine.

Positive Self-Talk

Remind yourself that insomnia is a common benzo withdrawal symptom. Observe any negative thoughts or feelings associated with insomnia instead of believing them. Tell yourself that you are healing and will get through this, because you will!

Conclusion

Coping with insomnia during benzodiazepine withdrawal requires patience and a holistic approach. Avoiding GABAergic medications and supplements is essential for your nervous system to recalibrate naturally. By adopting a lifestyle incorporating the four cornerstones of well-being—eating right, moving enough, stressing less, and loving well- you can better navigate withdrawal and support your overall health and wellness.

Add Your Voice

How do you cope with insomnia? Leave a comment and share your thoughts.