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Rebound Insomnia: What Causes It? How Long Does it Last?

by Dale Cudmore | Updated: Mar 08, 2022

Many people who take some form of medication for insomnia eventually reduce their dosage or stop taking it altogether.

In some cases, they develop insomnia even worse than it originally was.

This is due to rebound insomnia.

We’re going to take a look at how common rebound insomnia is when you stop taking a variety of common sleep medications, and what to expect.

What is Rebound Insomnia?

Rebound insomnia, also called the rebound effect, is a brief period of insomnia that can occur once someone stops taking sleep medication (or reduces dosage significantly).

It is often more severe than the original insomnia, and typically lasts 1-3 days.

Rebound insomnia is most common with long-term usage of a drug, but can occur after short term usage.

How is Rebound Insomnia Treated?

Because of the potential severity of rebound insomnia, there’s a common urge to either go back to the medication that was being used, or try a different one. But this makes someone dependent on the drug for an indefinite period of time.

Instead, rebound insomnia typically isn’t treated at all.

In most cases, it only lasts a night or two and the patient must bear with it. For example, a study of rebound insomnia after zolpidem treatment observed (1):

The positive triazolam control group had rebound insomnia only on the first discontinuation night

If insomnia persists past the first few nights, that’s likely not due to the medication, but the underlying original issue of sleep problems that hasn’t been addressed.

That’s the point where a patient needs to see their doctor again, and potentially follow a new treatment plan consisting of alternative therapies like: Cognitive behavioral therapy for insomnia (CBTi), sleep hygiene education, relaxation therapy.

Does Melatonin Cause Rebound Insomnia?

Melatonin is a common supplement used for insomnia that’s available over the counter.

Since melatonin is a natural hormone that your body produces, melatonin supplements are generally safe with minimal side effects.

Studies have shown that melatonin is not likely to cause rebound insomnia once you stop using it (2):

Short- or longer-term treatment with melatonin was not associated with dependence, tolerance, rebound insomnia or withdrawal symptoms.

What if insomnia is still bad after you stop taking melatonin?

That indicates someone hasn’t resolved their underlying problems.

If melatonin helps in the first place, it indicates that the source of sleep issues is mainly not producing enough melatonin before going to sleep. In other words, the cause of insomnia is likely blue light exposure at night.

If someone is still exposed to too much blue light that suppresses melatonin production, of course the sleep issues will not go away.

What Sleep Medication Causes Insomnia?

There are different types of sleep medication that can be prescribed.

The degree and risk of rebound insomnia varies between drugs.

The most commonly prescribed type of hypnotic drugs are benzodiazepines, which enhance the effects of GABA, an important neurotransmitter for sleep.

However, benzodiazepines have serious potential side effects that have been known for decades.

Research shows that even short term benzodiazepine use can lead to rebound insomnia (3):

Even though the periods of drug administration were quite brief (12 nights), withdrawal of triazolam consistently produced rebound insomnia, with increases in total wake time above baseline of 61% and 51%, respectively, for the first night of each withdrawal period

While it varies based on the specific benzodiazepine used, current research suggests that all drugs of this class produce some level of rebound effect during withdrawal (4).

Another class of hypnotic drugs are nonbenzodiazepines, which function similarly by enhancing GABA’s effects.

One study of 12 months of usage of zolpidem, a common nonbenzodiazepine prescribed for insomnia, showed that it minimal risk of rebound insomnia (5):

Rebound insomnia was not observed on the first two and the seventh discontinuation nights... Some individuals did show rebound insomnia, approximately 30–40% of participants, but the percentage of ‘rebounders’ did not differ between the placebo and zolpidem groups.

It's an interesting note that many people who feel a placebo effect from something they were taking may experience rebound effects when discontinuing the behavior.

Finally, a class of drugs known as “Z-drugs” are sometimes prescribed for insomnia. The most common ones are zopiclone and zolpidem; current research suggests that these do not cause significant rebound insomnia (6).

Do Antidepressants Cause Rebound Insomnia?

Depression and insomnia are heavily related, many people who develop one go on to develop the other.

Antidepressants are often prescribed, as they also commonly have hypnotic side effects that improve sleep quality.

The most common drug is trazodone.

Many people find it difficult to sleep after stopping trazodone, but it is well tolerated in general.

There is some evidence that trazodone can cause some rebound effects during withdrawal (7):

It reduced the time spent in REM sleep, with a rebound above baseline levels after withdrawal

While most antidepressants carry some risk of rebound, research suggests that it’s typically much less than benzodiazepines (8).

Can Other Substances Like Benadryl Cause Rebound Insomnia?

People take all sorts of things in an effort to fix sleep issues.

We’re just going to look at a few of the most common ones to see if there’s a risk of rebound insomnia.

Benadryl

Some people take Benadryl for insomnia, as it contains the antihistamine diphenhydramine, which promotes sleep as a side effect.

However, most people quickly develop a tolerance to it, and it stops having an effect.

While there are no studies showing a risk of rebound insomnia from benadryl, there are potential side effects like daytime sleepiness that may impact the sleep quality of the following night.

Alcohol

While not really a medication, some people do drink alcohol because they think it helps them sleep.

In reality, alcohol is terrible for sleep quality, and can lead to insomnia.

In addition, many people experience insomnia after quitting drinking. One study found that 58% of men had insomnia during their first week of recovery, which could be interpreted as rebound insomnia (9):

On average, it takes 3-6 months for sleep to get back to a good level after quitting drinking.

References

  1. Minimal rebound insomnia after treatment with 10-mg zolpidem
  2. Melatonin Prolonged Release
  3. Rebound insomnia after only brief and intermittent use of rapidly eliminated benzodiazepines
  4. Benzodiazepine Withdrawal Insomnia
  5. Twelve months of nightly zolpidem does not lead to rebound insomnia or withdrawal symptoms
  6. Zopiclone to treat insomnia in older adults: A systematic review
  7. Trazodone enhances sleep in subjective quality but not in objective duration
  8. Antidepressants and Sleep: A Review
  9. Treatment Options for Sleep Disturbances During Alcohol Recovery

Medical Disclaimer: The information on SnoozeUniversity.com is not intended to be a substitute for physician or other qualified care. We simply aim to inform people struggling with sleep issues about the nature of their condition and/or prescribed treatment.


About the authorDale is the founder of Snooze University and a sleep researcher. I overcame my sleep issues and now I'd like to help you do the same by summarizing the latest sleep studies for you.