Contents
This article has been written and medically reviewed by Darshan Shingala (M.D, MPH) – a qualified and practicing medical doctor – for maximum factual accuracy and reliability.
Benzodiazepines are a class of medications that are mainly used to treat anxiety, seizures, depression, panic attacks, and insomnia.
However, benzodiazepines can be highly addictive and result in side effects such as aggression, headaches, confusion, and even cause the conditions they can potentially treat – such as depression and sleep disturbances.
A common symptom of stopping benzodiazepines is ‘rebound insomnia’ – where it becomes harder to get to and remain asleep in comparison to before starting the medication.
So how do you get to sleep without depending on benzodiazepines?
The most effective way to get to sleep without benzodiazepines is to ask your doctor if switching to a sleep medication like zolpidem, zopiclone, or zaleplon is appropriate. However, cognitive behavioral therapy, melatonin, exercise, and meditation are safer alternatives.
The rest of this article provides you with 8 actionable strategies that you can apply to help you get to sleep without depending upon benzodiazepine medication.
But this article comes with a serious warning:
You should only stop taking benzodiazepines under the supervision of your doctor because benzodiazepine withdrawal can be fatal – death can occur due to lethal side effects including seizures, convulsions, and acting upon suicidal ideation – the risk of which increases if opioids, alcohol, or other substances are taken concurrently.
So although this article was written by a qualified and practicing medical doctor, you should seek professional supervision when discontinuing benzodiazepines.
Also, buying a new mattress is an excellent way to combat insomnia in general – click here to see the best mattresses for stopping insomnia that I have personally slept on and tested.
8 Ways to Sleep Better Without Benzodiazepines
Here are 8 strategies that you can try to sleep better without depending on benzodiazepines:
1: Ask Your Doctor to Prescribe Non-Benzo Sleep Meds
You can discuss with your doctor or sleep therapist if non-benzodiazepine sleep medications are a better choice for treating your insomnia.
A few examples of these non-benzodiazepine drugs are zolpidem, zopiclone, and zaleplon (5).
Studies show that they do not tend to alter the sleep architecture as much as benzodiazepines, which is why upon their discontinuation, rebound insomnia and withdrawal symptoms tend to be less frequent (6, 7).
These are a relatively newer class of medications that may potentially have a lower risk of dependency compared to benzodiazepines.
However, it is absolutely essential that you consult with your healthcare provider first because these medications carry their own side effects too – for example, some zolpidem (Ambien) users have reported engaging in activities like driving their car, making phone calls, and sleepwalking with little or no subsequent recollection (source).
Inclusion or exclusion of any medications from your prescription must be at the discretion of your doctor because only your healthcare provider can conduct a detailed assessment of the drug-associated risks and benefits for you.
Speaking as a licensed medical doctor, I can say that the unique mechanism of action of the Z-drugs allows the physician to develop a more individualized treatment plan for the management of a variety of sleep problems, including insomnia (9).
2: Treat Your Insomnia With Cognitive Behavioral Therapy
Recent scientific studies suggest that Cognitive Behavioral Therapy could serve as a more long-term, sustainable, and effective solution for persistent insomnia (1).
Cognitive Behavioral Therapy for Insomnia – which is usually abbreviated as CBT-I – is often recommended as the first line of treatment for patients with chronic sleep problems (4).
In my professional experience, Cognitive Behavioral Therapy for Insomnia is definitely worth a try for the majority of patients because it can really help them identify and deal with the underlying root cause of their sleep problems – unlike sleeping pills or sedatives such as benzodiazepines which tend to provide symptomatic short-term relief (3).
CBT-I is a structured therapeutic program that is aimed at identifying and rectifying disruptive sleep habits and behaviors.
There are several components of the CBT-I program, including sleep hygiene, biofeedback, maintaining a sleep diary, and relaxation training.
It is highly recommended that you discuss with your healthcare provider or sleep therapist the pros and cons of CBT-I as a non-pharmacological treatment option either individually or in conjunction with a pharmacological treatment – whichever is best-suited to you as per your physician (2).
3: Switch to Melatonin for a Safer Sleep Aid
Melatonin is a hormone that is naturally produced in our body by the pineal gland and is responsible for the regulation of our biological clock and sleep-wake cycle.
Synthetically produced melatonin can be used as a supplement to recalibrate the biological clock and it is most commonly available in a pill formulation.
Supplementation with melatonin is most commonly indicated for patients who tend to struggle with falling asleep due to low levels of melatonin in their body (8).
And I have personally experienced success taking melatonin before bed to combat my insomnia.
Although melatonin is considered to be generally safe for most people – and it has comparatively fewer side effects compared to benzos – you could still experience headaches, dizziness, an upset stomach, general anxiety, mood swings, crankiness, daytime sleepiness, and a feeling of heavy headedness.
Hence, it is imperative that you consult with your doctor prior to taking melatonin.
It is also important that you notify your doctor about any other health conditions that you have – including pregnancy – since melatonin has been reported to cause issues for some pregnant individuals (12).
In general, melatonin is a prescription-only drug in most countries and its dosage varies from patient to patient.
Typically, a dose in the range of 0.5 mg to 2 mg taken up to two hours before bedtime is effective and well-tolerated by the majority of patients (17).
Click here for 6 tips for taking melatonin safely when you are sick with a fever.
4: Improve Your Sleep Hygeine for Better Sleep
The importance of a healthy sleep routine that fits your lifestyle cannot be stressed enough.
Regardless of the amount of added effort you contribute in terms of medications, supplements, dietary intake, and sleeping aids to achieve a good sleep at night, nothing may seem to work unless you adopt a healthy sleep routine.
Whatever your current sleep routine may be, try to include as many of the following recommended steps as possible so that you can fall asleep quicker and stay asleep for longer hours (16):
Try a Relaxing Activity Before Bed (Avoiding Screens)
Try to establish a bedtime routine that helps you to unwind and relax.
This can be achieved in several ways, such as reading a calming/boring book before going to bed.
Or you may prefer to meditate for about 20 minutes.
However, I think it is important to make sure that none of your chosen activities are screen-dependent so that your body does not feel stressed, melatonin production isn’t inhibited, your eyes do not get strained, and you can limit your average daily screen time in general.
Avoid Napping (Or Nap Before 15:00)
Ideally, avoiding naps completely is the best way to ensure that you are not too awake at night.
But if you really do need to nap in the day, then this is best done before 15:00 and never after.
Doing so can help you to regulate your circadian rhythm – also known as the sleep-wake cycle – of your body.
To better calibrate your sleep-wake cycle, I also recommended that you try to go to sleep and wake up at the same time continuously for at least one week.
Avoid Heavy Meals, Alcohol, Nicotine, Caffeine and Excessive Water Intake Before Bed
You should be careful about the drinks and meals you consume before going to bed.
I would recommend that you try to avoid large, heavy, fatty, and sugary meals for dinner.
It is also important that you avoid the consumption of any caffeinated drinks and alcoholic drinks right before bedtime.
The consumption of products with nicotine must also be avoided before going to bed (click here for 4 ways to get to sleep after consuming nicotine).
Please also be careful about how you schedule your water intake throughout the day.
In my opinion, it would be best if you try to consume most of your daily water intake during the daytime and as the day progresses, you slowly decrease your water intake so that you avoid waking up in the middle of the night to use the toilet.
Create a Comfortable Sleeping Environment
Try to create a comfortable sleeping environment in your bedroom that meets your needs.
For example, if you know that you need total darkness to sleep, then you should check out these 19 ways to make your bedroom pitch black for better sleep.
You may also want to consider redecorating your room so that it fits with your personality (for example an indie theme).
If you have autism, then you should choose autism-friendly wall colors to avoid over-stimulation.
If possible, try to maintain the temperature in your bedroom at around 65 degrees Fahrenheit (18.3 degrees Celsius) and ensure that the lighting is dim for at least 20 minutes before going to bed.
If your bedroom is too hot, then try these 31 ways to cool down your bedroom and make it less stuffy.
5: Exercise Earlier in the Day to Avoid Sleep Disruption
It is a well-known fact that exercising daily can benefit us physically, mentally, and emotionally.
However, it is important to ensure that you are doing the right kind of exercise at the right time of the day.
To sleep better at night, it is recommended that you schedule your exercise hours during the daytime so that you feel less sleepy during the day and obtain a more restorative sleep during the night.
Exercise and sleep quality are closely associated and in general, doing low-impact exercises like stretching or yoga can help you to sleep better.
In order to experience the sleep-promoting benefits of exercise, it is imperative that you exercise regularly and consistently (13).
To achieve this, I recommend that you start slow and choose a form of exercise that you really enjoy.
For instance, in my professional experience, most people like to begin building their exercise habits with just 15 minutes of walking daily.
6: Try Deep Breathing to Relax
In addition to increasing your physical activity through daily workouts, I suggest that you also consider including some deep breathing exercises in your routine so that you can unwind and relax.
Check out the 4-7-8 breathing technique in the video above, or try the following routine below if you’d prefer something simpler (14, 15):
- Lie comfortably in your bed with your eyes closed and begin to focus on your breathing pattern.
- Start to closely recognize your breath and slowly begin counting each inhalation and exhalation.
- Relax your muscles and place one hand on your chest and the other had on your belly.
- Make sure you are breathing through your nose and try to hold your breath for 5 seconds before you exhale slowly.
- Repeat these steps until you feel relaxed and sleepy.
7: Release Stress With a Body Scan Meditation
The body scan is another mindfulness exercise that can help you focus your attention by redirecting and releasing the stress from your body and helping you achieve a night of better sleep.
The idea behind this exercise is that you slowly and mindfully scan your body for stressors and release each one at a time.
The steps of this exercise are as follows:
- Lie comfortably in your bed on your back with your eyes closed, arms by your sides, and legs straight.
- Start focusing on your breathing pattern for approximately 2 minutes before you begin to mentally scan your body.
- Shift your focus gradually to each part of your body and notice if you feel any muscle tension or changes in your breathing pattern. You can begin with the soles of your feet and slowly shift your focus upwards.
- Pay attention to each body part for at least 3 seconds before you switch your focus to the next body part.
- It is important that you recognize all stressors of your body, especially in the areas where we tend to hold the most tension such as the back, the shoulders and the neck.
- After you complete the scan, notice how your breathing has changed and how relaxed you feel.
- To optimize the benefits of this exercise, do it every night before going to sleep.
8: Sleep on a Suitable Mattress
It’s surprising how switching to a mattress that’s ideally suited to your dominant sleeping position, body weight, and body type can help you to get a better night’s sleep.
For example, I have personally found through my testing that a softer mattress like the Puffy Lux Hybrid with adaptive memory foam in the upper comfort layer is better for side sleepers and lighter weighted sleepers because it dissipates pressure better than a firmer mattress.
Conversely, a firmer and more responsive mattress like the DreamCloud is better for front, back, combination, and heavier weighted sleepers because it provides more bounce and support to help you stay in good posture and not get stuck in the materials as you move around.
Click here to see the best mattresses for insomnia that I have personally tested.
How Benzodiazepine Withdrawal Can Affect Sleep
Coming off benzodiazepines can cause insomnia and anxiety at night.
Below is a short guide that explains in more detail the points that you need to consider before you stop taking your benzodiazepine medication:
Benzodiazepines Are Commonly Prescribed for Insomnia
A study shows that the use of benzodiazepines has increased by 67% over the years from 1996 to 2013 in the United States (20).
Benzodiazepines, such as alprazolam (Xanax®), chlordiazepoxide (Librium®), diazepam (Valium®), and lorzepam (Ativan®) are tranquilizers or sedative drugs that tend to have a calming physical and psychological effect on the body (19).
Benzodiazepines are available by prescription and they relieve stress, anxiety, seizures, and muscle spasms (19).
They also tend to promote sedation and hypnosis which is why they are commonly prescribed for sleep problems, including insomnia (19).
Benzodiazepines Can Be Addictive
Benzodiazepines are habit-forming, addictive drugs, and can cause dependency (21).
The other common problem associated with the use of benzodiazepines that they are hard to discontinue because of the withdrawal symptoms they present.
If your benzodiazepine treatment is stopped abruptly, you may develop withdrawal symptoms.
If you were taking high doses of benzodiazepines for a long time, then you are likely to experience increased severity of the withdrawal symptoms (18).
So if you are looking to come off benzos, I recommend that instead of going cold turkey, you should consider tapering your dosage while planning the cessation of treatment with your doctor.
Benzodiazepine Withdrawal Can Be Life Threatening
The most common symptoms of benzodiazepine withdrawal include anxiety, difficulty in sleeping, mood swings, muscle spasms, restlessness, anxiety, irritability, nausea, weakness, blurry vision, night sweats, tremors, nightmares, seizures, hallucinations, and ringing in the ears – also known as tinnitus (22).
The neuroadaptive processes that are responsible for the symptoms associated with benzodiazepine withdrawal include the GABAergic and the glutamatergic systems in the central nervous system.
While almost all of the aforementioned symptoms can be debilitating to one’s health and wellbeing, including the quality of their sleep, some of the symptoms can unfortunately even be life-threatening.
Stopping Benzodiazepines Can Cause Insomnia
Persistent anxiety and rebound insomnia are the most common symptoms of stopping benzodiazepine consumption.
Rebound insomnia is a very specific symptom of benzodiazepine withdrawal and it is characterized by an intense worsening of sleep above baseline levels.
In other words, as a result of discontinuation, the insomnia becomes worse than it was before starting benzodiazepines (24).
I think that this is a very traumatic side-effect for patients because it seems to put them in an endless loop of benzodiazepine use leading to dependence and even abuse.
Some studies have reported that Cognitive Behavioral Therapy can be effective for patients dealing with rebound insomnia (25).
I have personally experienced rebound insomnia when I stopped taking quetiapine – this eventually went away on its own after a few weeks but it was a very unpleasant experience.
It May Take Up to 1 Year to Get Over Benzo Discontinuation
Many times, patients are worried about the long-term impairments associated with both benzodiazepine use and benzodiazepine discontinuation.
Although it is quite difficult to assess this dimension of the treatment, a study had reported that after 1 year of complete abstinence from benzodiazepines, the cognitive, neurological, and intellectual capacities of the participants had returned to normal levels (26).
Your Doctor Must Supervise Your Benzo Discontinuation
The management of benzodiazepine withdrawal syndrome is very challenging and varies from patient to patient depending on their age, comorbidities, and psychological status.
In my professional experience, I have observed that instead of a standard approach towards all patients dealing with benzodiazepine withdrawal syndrome, a personalized approach seems to work better and substantially improves the outcome (23).
I strictly recommended that you must be under the supervision of your doctor when you plan to get off benzodiazepines.
To ease and reduce the severity of your withdrawal symptoms, your doctor will gradually reduce the strength of your prescription dose and may add some other pharmacological therapies such as melatonin, paroxetine, trazodone, or valproate.
Some studies have shown that these adjunct drugs can improve the success rate of your benzodiazepine discontinuation process.
An Inpatient Detox May Be Required
Depending on your clinical condition, your doctor may also recommend that you attend an inpatient drug detox and rehabilitation facility.
During your medical detox, your treatment provider will devise an individualized plan for you to minimize your physical and psychological discomfort through several treatment strategies, including benzodiazepine reduction and substitution methods.
You may be prescribed different kinds of treatment drugs which can be administered both orally and intravenously.
Psychotherapy May Be Beneficial
Most therapists and doctors would encourage you to combine your pharmacological treatment with psychotherapy to achieve the best health outcomes.
Throughout your journey of discontinuation of benzodiazepines, it is important that you are surrounded by people who can support you and those who you can trust.
This includes your friends, family, and healthcare provider so that you can deal with the emotional concerns that tend to arise during this difficult process.
Click here to discover 8 ways to get to sleep when suffering from intrusive OCD thoughts.
Conclusion: Doctor Supervision is Essential
Due to the life-threatening potential of benzodiazepine withdrawal, you must only discontinue the use of this medication under the supervision of your doctor or a suitably qualified medical professional.
You may be told to switch to a sleep medication like zolpidem, zopiclone, or zaleplon to combat your insomnia in the short term.
However, these medications have side effects of their own, so replying upon more natural techniques to get to sleep such as meditation, exercise, and deep breathing may be advised.
Melatonin is a less addictive and potentially safer supplement that your doctor may prescribe to you to treat insomnia when coming off benzodiazepines.
The crucial and take-home message here is that you must not try to discontinue benzodiazepine consumption without expert medical supervision.
Beyond this, I have personally found that sleeping on a mattress that’s ideally suited to my dominant sleeping position, body type, and body weight is an effective way to treat my insomnia.
Click the button below to see the best mattresses that I have personally tested to combat insomnia now.
Sources and References
[1] Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial: https://pubmed.ncbi.nlm.nih.gov/19454639/ Accessed 14/7/21.
[2] Therapeutic options in the treatment of insomnia: https://pubmed.ncbi.nlm.nih.gov/16336038/ Accessed 14/7/21.
[3] Behavioral and pharmacologic management options for insomnia: https://pubmed.ncbi.nlm.nih.gov/19667688/ Accessed 14/7/21.
[4] Cognitive behavioral therapy alone and with medication for persistent insomnia: https://pubmed.ncbi.nlm.nih.gov/19738086/ Accessed 14/7/21.
[5] Non-benzodiazepines for the treatment of insomnia: https://pubmed.ncbi.nlm.nih.gov/12531036/ Accessed 14/7/21.
[6] Benefit-risk assessment of zaleplon in the treatment of insomnia: https://pubmed.ncbi.nlm.nih.gov/15783240/ Accessed 14/7/21.
[7] New drugs for insomnia: comparative tolerability of zopiclone, zolpidem and zaleplon: https://pubmed.ncbi.nlm.nih.gov/12608888/ Accessed 14/7/21.
[8] Facilitation of Benzodiazepine Discontinuation by Melatonin: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/485174 Accessed 14/7/21.
[9] Drugs for Insomnia beyond Benzodiazepines: Pharmacology, Clinical Applications, and Discovery: https://pubmed.ncbi.nlm.nih.gov/29487083/ Accessed 14/7/21.
[10] Exercise can improve sleep quality: a systematic review and meta-analysis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045928/ Accessed 14/7/21.
[11] Interrelationship between Sleep and Exercise: A Systematic Review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385214/ Accessed 14/7/21.
[12] The effectiveness of melatonin for promoting healthy sleep: a rapid evidence assessment of the literature: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4273450/ Accessed 14/7/21.
[13] Effects of physical activity programs on sleep outcomes in older adults: a systematic review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003368/ Accessed 14/7/21.
[14] Mindfulness, Interoception, and the Body: A Contemporary Perspective: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753170/ Accessed 14/7/21.
[15] Self-Regulation of Breathing as an Adjunctive Treatment of Insomnia https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361823/ Accessed 14/7/21.
[16] Sleep hygiene education as a treatment of insomnia: a systematic review and meta-analysis https://pubmed.ncbi.nlm.nih.gov/29194467/ Accessed 14/7/21.
[17] Optimal dosages for melatonin supplementation therapy in older adults: a systematic review of current literature https://pubmed.ncbi.nlm.nih.gov/24802882/ Accessed 14/7/21.
[18] The benzodiazepine withdrawal syndrome https://pubmed.ncbi.nlm.nih.gov/7841856/ Accessed 14/7/21.
[19] Benzodiazepines: https://www.dea.gov/sites/default/files/2020-06/Benzodiazepenes-2020_1.pdf Accessed 14/7/21.
[20] Benzodiazepines and Opioids: https://www.drugabuse.gov/drug-topics/opioids/benzodiazepines-opioids Accessed 14/7/21.
[21] Benzodiazepines: https://www.rxlist.com/benzodiazepines/drug-class.htm Accessed 14/7/21.
[22] Chronic benzodiazepine usage and withdrawal in insomnia patients: https://pubmed.ncbi.nlm.nih.gov/15003439/ Accessed 14/7/21.
[23] Sedative-Hypnotic Drug Withdrawal Syndrome: Recognition And Treatment: https://pubmed.ncbi.nlm.nih.gov/28186869/ Accessed 14/7/21.
[24] Rebound Insomnia and Rebound Anxiety: A Review: https://www.karger.com/Article/Abstract/137794 Accessed 14/7/21.
[25] Strategies for discontinuing long-term benzodiazepine use: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/strategies-for-discontinuing-longterm-benzodiazepine-use/A621F84B59360136930230C63AC97959 Accessed 14/7/21.
[26] Neuropsychological changes during steady-state drug use, withdrawal and abstinence in primary benzodiazepine-dependent patients: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0447.1995.tb09786.x Accessed 14/7/21.
Medical Disclaimer
No part of this article offers medical advice – always consult with a qualified professional for such guidance.
Image Attribution and Licencing
Main image: ‘Woman Sleeping’ by Yuganov Konstantin – used with permission under the terms of Canva’s One Design Use License Agreement.
Dan is the founder and head content creator at Bedroom Style Reviews.
He has been working as a professional online product reviewer since 2015 and was inspired to start this website when he ended up sleeping on a memory foam mattress that was too soft and gave him backache.
Through in-depth research and analysis, Dan’s goal with this website is to help others avoid such pitfalls by creating the best online resource for helping you find your ideal mattress, bedding, and bedroom furniture.
Dan is a qualified NVQ Level 2 Fitness Instructor with 6 years’ experience helping clients improve their health through diet, exercise, and proper sleep hygiene.
He also holds several college and university-level qualifications in health sciences, psychology, mathematics, art, and digital media creation – which helps him to publish well researched and informative product reviews as well as articles on sleep, health, wellbeing, and home decor.
Dan also has direct personal experience with insomnia, anxiety, misophonia (hypersensitivity to sounds), and pain from both acute and long-standing sporting injuries – he enjoys writing insightful articles around these subjects to help fellow sufferers of such conditions.
Learn more about Dan here.