Rebound Insomnia after titrating off of Ativan/Lorezepan

I have had insomnia in recent years and avoided sleeping tablets because they are so addictive. I find that antihistamines are great....the original ones like benadryl or nytol (in Ireland). I also find melatonin good. I take melatonin to get to sleep 3mg and then the antihistamines during the night when I wake up.

I tapered off of .5 mg Ativan over about 6 months after several quicker tapers that didn’t work. Began taking it for anxiety over a cancer diagnosis, then began relying on it for sleep. I saw a sleep med dr who referred me to a sleep therapist who was big on CBTi. It did not work for me and I went back to Ativan but my pcp was against my staying on it. While tapering, I switched therapists and she recommended a low dose of mirtazapine. It’s not a benzo like Ativan and I’m finally sleeping through the night. Although I’d prefer not to stay on drugs, the ability to sleep again is life changing.

It is said that complete healing of gaba receptors happens after the drug is completely out of the system, and likely once you finished your taper it took the drug a couple weeks to get out of your system: it is stored in fat tissue so the process takes awhile. Thus the sudden onset of symptoms, What you are experiencing is pretty normal, I'm told, I haven't got that far yet. Complete healing can take weeks to months. Here's the thing about taking more "rescue doses" once you've finished your taper: it stalls the healing of the receptors because you are once again supplying them with the gaba that has damaged them. Don't take any more benzo; I understand the distress caused by untenable insomnia, it drove me to reinstate the drug, which I regret deeply. If I had stuck to my guns, even at that level of distress, I would be healed by now.
Yes, do the CBT-I. ACT is another one. Even though your insomnia has a component that is drug induced, you are also having a lot of distress, and maybe some patterns of thinking and behaving that aren't helpful. It's almost inevitable that this level of insomnia goes hand in hand with anxiety about not sleeping, your nervous system is very ramped up and the anxiety further ramps it up, making sleep nearly impossible. Learn to address the anxiety, learn coping mechanisms for turning down your stress response. Very hard to do but worth the effort. Do things that calm you, that keep your thoughts in the RIGHT NOW, not on yesterday's difficulty or fear of what tonight or tomorrow will bring. Learn about mindfulness, deep abdominal breathing. meditation. Write about the good and the bad, remember to express gratitude, in writing, for the good things you have, like your husband sticking by your side through this (many of us are going through this process alone); spend time outside, move your body in whatever way you can; mindful walks are great as you take note of what you hear, see, smell, feel. Lean into your creativity, yes you do have creativity: draw, paint, sew, cook, build... I know it's hard to do this stuff when you are exhausted, do what you can. Some days I can't get off the couch, but I can write and sketch and practice deep breating and meditate. The idea is to get your mind off your trouble, because ruminating about this all day is ramping up your already fragile nervous system, that needs to heal. DO NOT take more lorazepam, it may give you relief in the very short term, but every time you take one of those it delays your healing and prolongs your suffering. Your idea about pursuing NON DRUG ways of calming your system is the correct direction. You've done an amazing thing, you have got off benzos. Hooray!! Celebrate that, your battle is moving toward its end. Hang on. Best ~

Careful about relying on benadryl (1st generation antihistamines) nightly long term. They will lead to dependence, and tolerance as they eventually stop helping because your histamine receptors adjust to their presence. Also, these drugs are on the BBERS list of drugs that negatively affect cognition. Long term, they mess up your ability to think and remember. They are very bad for brain health. Yes, I know insomnia is bad for bran health too, it's hard to know what to do. But you can learn to address insomnia without drugs. Best to learn about some NON DRUG approaches to your insomnia. Best ~

Thank you so much for all the great information. I will try my best. You were so kind to take the time to offer so much reassurance and advice. I will try to be strong but this is truly so very difficult. All the best and I appreciate you.

I am wondering what the side effects of mirtazapine could be. I am afraid to start any new meds. I hope that you are well now. I know things work differently for different people. I really can't deal with only sleeping two hours a night and feel I might need to stay with the drug for now. All the best and thank you so much for responding to me. Your help is appreciated.

Thank you so much for responding to me. Appreciate the helpful advice.

Wanted to let you know that I looked up the information on mirtazapine and it has a very good track history with rare side effects and is not a controlled substance. I am going to look into it. I am thinking my primary care doctor would not know anything about these types of drugs so I am thinking I would need a psychologist/psychiatrist type of physician to help me with this. I read that a 15 mg is a good start dose. Have you had any side effects and what dose are you taking if I may ask. I also have IBS and this med is helpful for this condition as well. I am older and this would be safer then some of the other meds out there. Thanks again

I too am tapering off lorazepam.
I have been on .5 mg for almost 6 years for PTSD after open heart surgery.
Working with my pcp I have reduced dose by 25% every 2 weeks. I am now down to .125 mg. I now have horrible insomnia. Maybe 2 hours of sleep a night. And that is not continuous. 30 minutes …15 minutes.
I too wondered which was worse …no sleep or lorazepam??
Let my pcp know what was going on and he prescribed hydroxyzine. It is a prescription antihistamine. I have taken it the last 2 nights and have slept 8 hours. Only drawback is that I am sleepy all day. Guess that is better than the anxiety.
I have an appointment with pcp this week. Thinking I can take the hydroxyzine until my body heals from lorazepam. We will see.
Also I am seeing a therapist. I am to journal while listening to bilateral stimulation.
Prayers for all of us.

7.5 mg is recommended for sleep issues. The only side effect I’ve noticed is feeling groggy in the morning, but it’s worth it since I can now sleep. Good luck and let me know if you have any more questions!