Benzos And Sleep: Withdrawal Insomnia's Dark Days

Benzodiazepines, or benzos, are a group of drugs called nervous system depressants. They are not intended to be taken long-term, as prolonged use can cause the brain to become both physically and psychologically dependent on them. Withdrawal symptoms, ranging from a return of uncomfortable psychological symptoms to physical manifestations such as nausea and diarrhea, may occur when the drugs are removed from the bloodstream.

Withdrawal side effects are not generally lethal, although they are best managed with professional medical attention and supervision. Symptoms can include anxiety, panic, insomnia, muscle spasms or tension, nausea and/or vomiting, diarrhea, blurred vision, seizures, hallucinations, short-term memory impairment, trouble concentrating, clouded thinking, mood swings, agitation, drug cravings, twitching, weight loss, and more.

Withdrawal symptoms can begin several hours after you stop taking a short-acting benzodiazepine or up to three weeks after you stop taking a long-acting benzodiazepine. The longer you take benzodiazepines, the more likely it is that you will find it difficult to stop and the greater your risk of withdrawal symptoms.

Insomnia, anxiety, panic attacks, and other sleep disturbances

Insomnia is a common symptom of benzodiazepine withdrawal. During withdrawal, individuals may experience difficulty falling asleep, frequent awakenings during the night, and a return of pre-existing sleep disorders such as insomnia or nightmares. This is due to the rebound effect, where the symptoms that were being suppressed by the drug come back. The sleep disturbances may be more intense and occur sooner if withdrawing from short-acting benzodiazepines compared to long-acting ones.

Anxiety is another common symptom of benzodiazepine withdrawal. It can manifest as muscle tension, a tight chest, a fast heartbeat, sweating, trembling, or shaking. During withdrawal, the anxiety may be more intense and occur sooner with short-acting benzodiazepines compared to long-acting ones. Panic attacks may also occur during withdrawal, which can be frightening and distressing but are not fatal and typically last less than 30 minutes.

Other sleep disturbances that may occur during benzodiazepine withdrawal include vivid dreams, nightmares, restless legs syndrome, and hypnagogic hallucinations (hallucinations that occur while falling asleep). These symptoms are typically temporary and can be minimised by slow tapering of the drug dosage.

It is important to note that benzodiazepine withdrawal should be done gradually and under the guidance of a healthcare professional to minimise the risk of severe withdrawal symptoms.

Physical withdrawal symptoms: nausea, vomiting, diarrhoea, muscle spasms, and weight loss

Benzodiazepines (benzos) are not intended to be taken long-term, as prolonged use can cause the brain to become both physically and psychologically dependent on them. Withdrawal symptoms can range from uncomfortable psychological symptoms to physical symptoms such as nausea, vomiting, diarrhoea, muscle spasms, and weight loss.

Nausea is a common symptom of benzo withdrawal, and it can be accompanied by other gastrointestinal issues such as vomiting and diarrhoea. These symptoms may be due to overactivity in the autonomic nervous system, which controls the motility and secretions of the gut and is very reactive to stress, including the stress of benzo withdrawal. Additionally, there are benzo receptors in the gut, and alterations in these receptors during withdrawal may also contribute to gastrointestinal issues.

Muscle spasms are another possible physical symptom of benzo withdrawal. This is likely due to a rebound increase in muscle tension after stopping the medication, as benzos are efficient muscle relaxants. The discontinuation of benzos can lead to a rebound increase in muscle tension, resulting in various symptoms such as stiffness, pain, tremors, and twitching.

Weight loss is also a possible physical symptom of benzo withdrawal. This may be due to a decrease in appetite and changes in metabolism. Additionally, some people may experience an increase in appetite during withdrawal, leading to weight gain. However, these changes in weight are typically not severe and usually return to normal after withdrawal.

It is important to note that benzo withdrawal symptoms can vary from person to person and can range from mild to severe. Most benzo withdrawal symptoms start within 24 hours of stopping the medication and can last from a few days to several months or even years, depending on the length of use and the strength of the benzo. It is recommended to gradually taper off benzos under the supervision of a medical professional to minimise the risk of severe withdrawal symptoms.

Mental health concerns: depression, paranoia, and suicidal ideation

Benzodiazepine withdrawal can have a significant impact on mental health, and the resulting mental health concerns can vary widely in severity. Some people may experience mild to moderate depression, while others may suffer from more severe symptoms such as paranoia and suicidal ideation.

Depression

Withdrawal from benzodiazepines can lead to feelings of depression, which can range from mild to moderate in severity. This is a common symptom of benzodiazepine withdrawal, and it can be difficult to manage. It is important to seek professional help if you are experiencing depression during withdrawal, as it can be a complex and challenging emotion to navigate. Antidepressants may be offered by a doctor to help manage the symptoms of depression during this time. However, it is worth noting that some research suggests that selective serotonin reuptake inhibitor (SSRI) antidepressants may not be effective for treating depression that arises specifically from benzodiazepine withdrawal.

Paranoia

In more severe cases of benzodiazepine withdrawal, individuals may experience paranoia, or strongly held beliefs that are not shared by others. This can be a frightening and distressing experience for the person going through it, and it is crucial to have a strong support system in place to help manage these feelings. Professional medical attention and supervision are recommended to ensure the safest and most effective withdrawal process.

Suicidal Ideation

Suicidal thoughts and actions are possible during acute benzodiazepine withdrawal, which typically occurs a few days after stopping the medication. It is a critical time that requires close monitoring and support from mental health professionals and loved ones. Therapy and support groups can be incredibly beneficial during this phase, providing individuals with a safe space to express their emotions and work through their complicated feelings. It is important to prioritize seeking help and not hesitate to reach out for support during this challenging time.

Long-term effects: protracted withdrawal syndrome, post-acute-withdrawal syndrome, and post-traumatic stress disorder

Benzodiazepine withdrawal syndrome (BZD withdrawal) is a cluster of signs and symptoms that emerge when a person who has been taking benzodiazepines as prescribed develops a physical dependence and then reduces the dose or stops taking them without a safe taper schedule.

Protracted withdrawal syndrome (PWS) or post-acute withdrawal syndrome (PAWS) occurs in patients who have withdrawn from benzodiazepines and remain with long-term withdrawal effects. The term "protracted" refers to the time duration, describing withdrawal symptoms that persist for months and even years after benzodiazepine cessation. These protracted symptoms are due to a major functional change within the neuroreceptors and areas of the central nervous system that benzodiazepines affect.

Disturbances in mental function can persist for several months or years after withdrawal from benzodiazepines, and this is referred to as post-acute-withdrawal syndrome. Psychotic depression persisting for more than a year following benzodiazepine withdrawal has been documented in medical literature. Symptoms can include major depressive disorder with psychotic features, persistent depressed mood, poor concentration, decreased appetite, insomnia, anhedonia, anergia, and psychomotor retardation.

Post-traumatic stress disorder (PTSD) can also develop as a result of over-rapid withdrawal, lack of explanation, and failure to reassure individuals that they are experiencing temporary withdrawal symptoms. A slow withdrawal regimen, coupled with reassurance from family, friends, and peers, improves the outcome and can prevent the development of PTSD.

The severity and length of the withdrawal syndrome are likely determined by various factors, including the rate of tapering, length of use, dosage size, and possible genetic factors. A slow withdrawal rate significantly reduces the risk of a protracted or severe withdrawal state.

Treatment options: medical detox, tapering, and alternative therapies

Treatment options

Medical detox

Medical detox is the process of tapering off benzos under the supervision of a doctor. This can be done through inpatient rehab or outpatient care. Inpatient rehab provides a distraction- and temptation-free environment, while outpatient care allows people to receive treatment without disrupting their daily schedule. Medical detox can last several months, depending on the drug taken and the duration of use.

Tapering

Tapering involves reducing the dose of benzos or prescribing a less potent alternative. This can be done using long-acting and less potent benzos such as Diazepam (Valium) or Clonazepam (Klonopin). These drugs keep withdrawal symptoms at bay while the user reduces their dose. The tapering process can be slow, typically taking several weeks, or rapid, lasting between eight to 12 weeks. A slow taper is generally preferred as it reduces the risk of severe withdrawal symptoms and gives the brain time to adapt to the benzodiazepine-free environment.

Alternative therapies

Alternative therapies can be used alongside medical detox and tapering to help manage withdrawal symptoms. These include:

• Supportive counselling and targeted therapies or medications to address specific symptoms and improve quality of life.
• Referral to benzodiazepine withdrawal support groups for peer support and reassurance.
• Psychological interventions such as relaxation training, cognitive-behavioural treatment of insomnia, and self-monitoring of consumption and symptoms.
• Alternative medications such as buspirone, flumazenil, or pregabalin. Buspirone is often prescribed to people with generalized anxiety disorder and a history of substance abuse as it does not cause physical dependence. Flumazenil has been found to be effective in treating protracted benzodiazepine withdrawal symptoms. Pregabalin may help reduce the severity of withdrawal symptoms and the risk of relapse.

Frequently asked questions