Benzodiazepines are the oldest class of sleep medications still commonly in use. Benzodiazepines, as a group, are thought to have a higher risk of dependence than other insomnia sedative hypnotics. All are classified as controlled substances.
Benzodiazepines include diazepam, temazepam, lorazepam, chlordiazepoxide, oxazepam, nitrazepam, loprazolam, lormetazepam, clobazam and clonazepam. They are primarily used to treat anxiety disorders and are only available on prescription.
When benzodiazepines were first used they were thought to be safe. The problems with their long-term use were not known. Benzodiazepines were the most commonly prescribed medicines in western countries in the 1980s. Today we are aware of the negative side effects and there are many support groups that help withdrawal.
It was because benzodiazepines worked so well to ease symptoms of anxiety and poor sleep that many people got hooked. People started to take benzodiazepines regularly – even for many years, some decades. We can become both physically and psychologically dependent on benzodiazepines – fast. When we are on the pills for a period of time, we may believe that we can’t sleep without them, and once we stop taking them, we may actually experience physical withdrawal symptoms like anxiety and rebound insomnia.
Even when benzodiazepine is taken for a short time, we may feel drowsy during the daytime. Older people especially are at a greater risk of having an injury because of the drowsiness. Driving under benzodiazepine should be avoided. Some people have described themselves as being in a zombie state when they were taking a benzodiazepine on a long-term basis.
Benzodiazepines gradually lose their effect. In time, the higher doses don’t work and we need an even higher dose and so on. This effect is called tolerance.
These sleeping pills can, and most probably will, lose their effectiveness if used on a nightly basis, because the brain receptors become less sensitive to their effects. In as little as three to four weeks, benzodiazepines can become no more effective than a sugar pill.
Even if the medication is effective while taking it, insomnia returns once you stop taking them as sleeping pills don’t treat the causes of the problem.
Using benzodiazepines for sleep
MedicinNet advices to take this medication 15 to 30 minutes before bedtime as directed (when taken to improve sleep). Take this with food or milk if stomach upset occurs. Do not suddenly stop taking this medication without first consulting your doctor if you have been taking this for some time. It may be necessary to gradually decrease the dose. Take this exactly as prescribed. Do not increase the dose or take this for longer than prescribed. Tolerance may develop with long-term or excessive use making it less effective.
In case of mental confusion, seizures, rapid heartbeat, yellowing eyes or skin or fever, seek medical attention. Also, in the unlikely event you have an allergic reaction to this drug, seek medical attention immediately. Symptoms of an allergic reaction include: rash, itching, swelling, dizziness, trouble breathing.
To avoid dizziness and light-headedness when rising from a seated or lying position, get up slowly. Also limit your intake of alcoholic beverages which will aggravate these effects. If you notice other effects not listed above, contact your doctor or pharmacist.
The benefits of benzodiazepines are least, and the risks are greatest, in the elderly. The elderly are at an increased risk of dependence and are more sensitive to the adverse effects such as memory problems, daytime sedation, impaired motor coordination, and increased risk of motor vehicle accidents and falls and an increased risk of hip fractures. The long-term effects of benzodiazepines and benzodiazepine dependence in the elderly can resemble dementia, depression, or anxiety syndromes, and progressively worsens over time. Adverse effects on cognition can be mistaken for the effects of old age. As a consequence, extra caution is advised when using this drug in the elderly
This medication must not be used during pregnancy. Consult your doctor before you breast-feed.
Also, do tell your doctor of any over-the-counter, supplement or prescription medication you may take including to avoid any harmful drug interactions.
Side effects of benzodiazepines
In general, benzodiazepines are well-tolerated and are safe and effective drugs in the short term (<4 weeks) for a wide range of conditions. Tolerance can develop to their effects and there is also a risk of dependence and, upon discontinuation, a withdrawal syndrome may occur. These factors, combined with other possible secondary effects after prolonged use such as psychomotor, cognitive, or memory impairments, limit their long-term applicability.
Likely side-effects include stomach upset, blurred vision, headache, dizziness, depression, impaired coordination, trembling, nightmares, weakness, memory loss, hangover effect (grogginess) or clouded thinking may occur. If any of these effects persist or worsen, inform your doctor promptly. Report promptly: mental confusion, seizures.
Benzodiazepines can be useful for short-term treatment of insomnia. It is preferable to take benzodiazepines intermittently and at the lowest effective dose. They improve sleep-related problems by shortening the time spent in bed before falling asleep, prolonging the sleep time, and, in general, reducing wakefulness. However, they worsen sleep quality by increasing light sleep and decreasing deep sleep. Other drawbacks of hypnotics, including benzodiazepines, are possible tolerance to their effects, rebound insomnia, and reduced slow-wave sleep and a withdrawal period typified by rebound insomnia and a prolonged period of anxiety and agitation.
There is a good chance that we will become dependent on a benzodiazepine if it’s taken for more than four weeks. This means that withdrawal symptoms occur if the tablets are stopped suddenly. In effect, you will need the medicine just to feel normal. Possible withdrawal symptoms include psychological symptoms (such as anxiety, panic attacks, odd sensations, feeling as if you are outside your body, feelings of unreality, or just feeling awful) and physical symptoms such as sweating, severe headache, restless feelings, being unable to sleep, tremor, feeling sick, palpitations, muscle spasms and being oversensitive to light, sound and touch.
The duration of withdrawal symptoms varies but often lasts up to six weeks and sometimes longer (even months). Withdrawal symptoms may not start for two days after stopping the tablet and tend to be worst in the first week or so.