Kajak jain profile image
By Kajal Jain

M. Pharm

02 December 2022
Medically reviewed by
Sumayya Salam
Pharm D
lorazepam-for-sleep
Table of Contents

Anxiety, stress, and chronic pain are most adults' leading causes of insomnia and sleep disturbances. Sleep deprivation can elevate the risk of Anxiety disorders or prevent its recovery. Proper sleep during the night helps nurture both mental and emotional resilience.

According to Harvard Health Publishing, sleep problems affect more than 50 % of adults with Generalised Anxiety disorder. In the United States, approx. 30% to 40% of adults report insomnia symptoms at some point in a year. An estimated 9.5% suffer from short-term insomnia in the United States, but nearly 1 in 5 short-term insomnia transitions to chronic insomnia, which can persist for years.

Lorazepam offers a dual approach by treating underlying anxieties and insomnia. Here we’ll take a closer look at the active ingredients in Lorazepam and how this benzodiazepine can help ease insomnia symptoms and related triggers.

What Is Lorazepam?

Lorazepam (Ativan) is a prescription medication belonging to the class of benzodiazepines. You might hear it called an anxiolytic or sedative-hypnotic drug. This medicine was approved for use in 1977 by the U.S. Food and Drug Administration (FDA).

Therapeutic indications

For Short-Term by adults (2-4 weeks only)

  • Symptomatic relief of severe, disabling Anxiety or subjecting an individual to unacceptable discomfort occurring alone or in conjunction with insomnia.
  • Lorazepam may be used to control symptoms of acute alcohol withdrawal or for other conditions.
    Pre-medication by children (> 5 years) or adults before operative dentistry and general surgery.
    Check with your healthcare professional if you are unsure why you are given this medication.

How Does Lorazepam Work?

Lorazepam is a prescription medicine from the benzodiazepine class used to manage Anxiety. It acts on the brain and nerves (CNS) to produce a soothing effect that relieves Anxiety symptoms.

Lorazepam shows its effect by acting on the Gamma-aminobutyric acid receptors (GABA) neurotransmitter in the brain, which is partly responsible for regulating the sleep cycle and feelings of calmness and Anxiety.

This medication may also be used as a treatment for short-term insomnia. Insomnia is a medical condition involving poor sleep quality and quantity of sleep. Ativan is a rapid-acting drug, making it an effective medication for temporarily managing panic symptoms. It enters your biological system relatively fast and lasts for a few hours.

Benzodiazepines, even if taken as prescribed, might produce emotional or physical dependence (addiction). The physical dependency might develop after 2 or more weeks of regular use. For this reason, Lorazepam should not be consumed for more than 4 weeks. 

Is Lorazepam A Controlled Substance?

In 1970, the United States officially recognized certain medications' potential for abuse and dependence. To prevent misuse, Congress enacted the Controlled Substances Act (CSA) as a comprehensive plan to gain better control over habit-forming substances and medicines. The CSA categorizes known substances and drugs into “Schedules” to define their potential for abuse and regulate their use.

Lorazepam (Ativan) is a benzodiazepine, most commonly used as an anti-anxiety medication, but it may also be used to treat seizure disorders such as epilepsy. Lorazepam is considered a controlled substance (Schedule IV) because it has a relatively high potential for abuse compared to other substances.

There are strict rules regarding how your provider prescribes Lorazepam (Ativan) (limits on refills, limits on the number of tablets, etc.) and how your pharmacy dispenses it (photo ID might be required to pick it up, prescription expires sooner, etc.).

Significantly less evidence could determine the effect of Lorazepam on fertility. Speak to your doctor if you are trying to get pregnant or are pregnant.
There are strict restrictions on consuming alcohol with Lorazepam, as its consequence can be deadly.
Lorazepam is a prescription benzodiazepine drug that is not recommended for use for more than 4 weeks.

Is Lorazepam Effective For Sleep?

Lorazepam (Ativan), a sedative-hypnotic or anxiolytic drug, was evaluated in a 2 mg dose using a 16-night protocol, including seven nights of a drug trial. With its continued use, it was identified initially that the drug was moderately effective in inducing and maintaining sleep. 

Side effects included episodes of memory impairment and confusion in two subjects and group mean increases in daytime Anxiety with the continued drug use. Following drug withdrawal, there was a significant worsening of sleep above baseline levels (rebound insomnia) on the third night and significant increases in tension and anxiety the next day. The peak degree of withdrawal sleep disturbance was several times the peak degree of sleep improvement with drug administration.

Dosage: How Much Lorazepam Should You Take For Sleep?

It is available in two forms, which are used to treat the following conditions:

Tablet, used by children (>12 years) and adults to treat:

  • Insomnia (trouble sleeping)
  • Anxiety symptoms

Solution form, given parenterally to adults to treat:

  • Status epilepticus (a type of severe seizure)
  • Before surgery, to make you sleep

An adequate dosage regimen is crucial for achieving the desired therapeutic efficacy and avoiding undesired effects. Taking a dose too early could lead to higher drug levels, and omitting a dose or waiting too long between doses could reduce the amount of drug in the body and keep it from working correctly.

Lorazepam is available in 0.5mg, 1mg, and 2.5mg tablets. Its liquid formulation constitutes 1mg/ml of Lorazepam. This medication should be taken in the exact manner prescribed by your pharmacist or doctor. 

It is prescribed for a short period, from a few days to four weeks. Your dose may vary until your doctor is satisfied you are on the correct dose. The doctor will gradually reduce your dose at the end of treatment before stopping completely.

The recommended dose for:

  • Insomnia – 1 to 2 mg before bedtime 
  • Anxiety – 1 to 4 mg daily
  • Pre-med for adults – 2 to 3 mg to be taken the night before the procedure. Later, 2 to 4mg should be taken 1 to 2 hours before the procedure.
  • Elderly and debilitated patients: For such patients, reduce the initial dose by 50% and adjust the dosage as needed and tolerated.

A doctor may recommend a lower dose if you are older than 65 or have hepatic or renal disorders. 

How Long Does Lorazepam Take To Work?

Lorazepam starts to work within an hour of its administration. Symptoms of Anxiety or insomnia should improve quickly after a dose. It reaches its peak sedating effect after 1 to 1.5 hours of administration and lasts for around 6 to 8 hours. 

When to take Lorazepam and how often you need it will depend on the medical condition you are treating. A Lorazepam injection works much faster and lasts around 6 to 8 hours.

Possible Side Effects Of Lorazepam

Adverse reactions are usually seen towards the start of treatment and usually decrease in severity with continued use or upon reducing the dose. Frequently reported adverse effects of benzodiazepines include dizziness, daytime drowsiness, ataxia, and muscle weakness. Other side effects include-

Common Side Effects

Severe Side Effects

Muscle weakness

Impaired memory

Daytime sleepiness and fatigue

Slow or shallow breathing

Dizziness/lightheadedness

Hallucinations or delusions

Difficulty controlling movements

Liver disorder

Inability to concentrate

Extreme mood swings

Severe drowsiness

Sleepwalking

Precautions Of Lorazepam

Lorazepam (Ativan) is not suitable for everyone. Ativan shall be taken by children (>12 years) and adults for Anxiety. It can also be taken by children (>5 years) and adults as a "pre-medication."  

To make sure this drug is safe for you, inform your doctor before starting with Lorazepam if you:

  • have liver or kidney problems
  • had an allergic reaction to Lorazepam medicine in the past
  • have been diagnosed with personality disorder
  • have myasthenia gravis
  • have breathing or chest problems
  • are planning to get pregnant, are already pregnant, or breastfeeding
  • have arteriosclerosis
  • have sleep apnoea
  • have glaucoma
  • have (or have had) problems with alcohol 
  • are going to have a general anesthetic for an operation or dental treatment 

Withdrawal Symptoms Of Lorazepam 

When an individual consumes larger doses of Lorazepam for more than two or three weeks, an individual can become addicted to the medication. After developing a dependency on this drug, they will likely experience withdrawal symptoms if they stop taking Ativan abruptly. The two stages of Lorazepam withdrawal include acute and prolonged withdrawal.

Acute withdrawal symptoms of Lorazepam include:

  • Hand tremors
  • Sleep disturbance
  • Irritability
  • Difficulty concentrating
  • Excessive sweating
  • Dry heaving and nausea
  • Increased Anxiety, resulting in panic attacks

Prolonged withdrawal symptoms from Lorazepam include:

  • Anxiety and restlessness
  • Rebound insomnia
  • Changes in the mood

The seriousness of the symptoms felt during Lorazepam withdrawal depends on the severity of the individual’s consumption. The severity of withdrawal symptoms typically peaks four to seven days after the last dose administration.

After reaching peak severity, withdrawal symptoms usually taper off about two weeks after the previous dose. By this time, any rebound symptoms the individual experiences should also subside.

Treatment For Lorazepam Withdrawal 

Lorazepam withdrawal can be difficult, but with the assistance of a professional benzo addiction treatment program, you can traverse it and start the way to recovery.

The initial step to treat Lorazepam withdrawal symptoms is to detox from the substance. During detox, individuals gradually taper off their dose over a few months until they no longer depend on the mentioned drug.

If a patient receives a prescription for Lorazepam to address Anxiety or any mental health condition, they might require dual diagnosis treatment to determine the issues. 
Several therapies are also helpful in treating Lorazepam addiction. These include-

  • Family therapy
  • Cognitive-behavioral therapy
  • Trauma therapy
  • Dialectical Behavior Therapy (DBT)
  • Group therapy

 

Drug Interactions With Lorazepam 

If your doctor has prescribed Lorazepam, your pharmacist or doctor may already be aware of any possible drug interactions, health risks, or potential problems and may monitor you for them.

Talk to your medical practitioner before starting with Lorazepam if you consume any of the following:

  • Anticonvulsants used to treat epilepsy
  • Sedating antihistamines, such as chlorphenamine or promethazine
  • Antipsychotics and antidepressants drugs
  • Analgesic drugs, such as codeine, morphine, methadone, pethidine, tramadol, or oxycodone
  • Proton Pump Inhibitors (PPIs) such as esomeprazole or omeprazole 
  • HIV medicines, such as ritonavir, saquinavir, atazanavir, or efavirenz
  • Antifungal drugs such as fluconazole
  • Rifampicin, a medicine for bacterial infections
  • Theophylline, a medication for asthma or other breathing problems
  • Muscle relaxants, such as baclofen and tizanidine
  • Isoniazid, a drug for tuberculosis
  • Disulfiram, a medicine for alcohol addiction

Apart from the medications mentioned earlier, other drugs might interfere with the efficacy of Lorazepam. However, there's minimal information about taking supplements and herbal remedies with Lorazepam.

Herbal medicines for insomnia or Anxiety, such as passionflower or valerian with Lorazepam, can increase drowsiness and may also have other side effects.

Bottom Line From Practical Anxiety Solutions

Currently, over 40 million adults struggle with insomnia and Anxiety. If you are considering Lorazepam to help treat both conditions, it is a practical treatment choice. Although this medicine risks Abuse and physical dependence, a withdrawal reaction may occur when stopping Lorazepam.

However, this risk can be reduced slowly by gradually reducing the dose of Lorazepam when stopping. While this medication has proven successful for numerous individuals, you must speak with your healthcare provider before adopting this treatment plan.

What's on your mind?

Start a conversation, Post with kindness.