Rebound

Discontinuation of many hypnotics is often followed by worsening of sleep compared with pretreatment levels. In practical terms, insomniac patients find that their sleep is disturbed for a night or two after abrupt discontinuation of what appeared to be effective medication. (65) Some of this rebound is subjective as patients taking sleeping pills tend to overestimate their sleeping time (compared with sleep laboratory recordings); on withdrawal, they underestimate their sleep. (66) The intensity of rebound insomnia is strongly related to dose but less clearly to the duration of use, and marked individual differences exist. The risk of rebound is greater with short-half-life compared with the long-half-life compounds. Tapering off medication lessens the likelihood of rebound. However, despite clinical impressions that rebound insomnia might lead to the resumption of medication, little evidence for this is extant. (67)

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