Benzodiazepines are Not Good for Sleep

I’ve frequently prescribed benzodiazepines (benzos) such as Klonopin and Ativan for patients with anxiety. For some patients who are particularly anxious in the evenings, taking the medication can help relax them to the point of falling asleep easier. I usually tell them it’s not a good long term solution for sleep and the most obvious was the habit forming potential and the need to resolve the sleep issue without the long term use of medications. However, another important reason is that benzos decrease slow wave sleep. As mentioned in a previous post, stages 3 and 4 are slow wave, or deep sleep and necessary for us to wake feeling rested. So a benzo can knock you out for several hours which can make you feel better in the short term, but in the long term you need adequate amounts of the deep sleep that you get in stages 3 and 4 to have healthy and restorative sleep.

So how has the pharmaceutical community addressed this? Medications like Ambien, Sonata, and Lunesta have no effect on stage 3 and 4 sleep. In fact, in studies Sonata was shown to increase stages 3 and 4. Do these medications work? Well, for me anecdotally (meaning this is not a scientific study, but based on my practice experience with a limited population), I’ve had the most success with Ambien. I’ve had several patients complain of a bad aftertaste – a kind of metallic taste when taking Lunesta. Brushing their teeth forever didn’t help. BUT, everyone is different and I always tell people, what works for one person may not work for someone else.

Ambien has it’s own quirky side effect that is fairly rare and that is nighttime eating. For those who it affected, I was told they would wake up in the morning and notice plates in the sink or partially eaten food on plates and would not remember leaving their bed.

Despite this issue with Ambien, it’s probably better than taking a benzo for an extended period of time because it doesn’t affect your . But it is important to discuss this with your doctor as all medications have pros and cons and your doctor should prescribe something meets your needs.