Discontinuation of an hypnotic may be followed by rebound insomnia.

The severity of rebound insomnia varies with different hypnotic agents. It tends:

(1) to be greater with certain agents such as short-acting benzodiazepines

(2) to be worse if discontinuation is abrupt


Complicating factors:

(1) dependence and withdrawal

(2) rebound anxiety

(3) depression


In general:

(1) continuous use of an hypnotic for a long period of time should be avoided

(2) non-pharmacologic interventions to improve sleep should be emphasized

(3) comorbid conditions (pain, depression, anxiety, sleep apnea) need to be addressed

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