From the Guidelines
Alternating between Temazepam, Ambien, and Dayvigo for sleep is not a recommended strategy to prevent addiction, as all three medications can cause physical dependence despite their different mechanisms of action. This approach, sometimes referred to as "drug cycling," does not effectively reduce the risk of addiction. Temazepam, a benzodiazepine, has a high potential for addiction, while Ambien, although not a benzodiazepine, also carries a significant risk of dependence 1. Even Dayvigo, which works on orexin receptors, can lead to dependence.
The most effective strategy for managing insomnia includes using these medications for short-term periods (generally 2-4 weeks maximum) at the lowest effective dose, as part of a comprehensive treatment plan that includes cognitive behavioral therapy for insomnia (CBT-I) 1. Addressing underlying causes of sleep problems, practicing good sleep hygiene, and regularly consulting with a healthcare provider about medication use are more effective strategies for preventing dependence while managing sleep issues.
Key considerations for managing insomnia include:
- Using medications at the lowest effective dose and for the shortest duration necessary
- Incorporating CBT-I into the treatment plan
- Practicing good sleep hygiene
- Regularly reviewing medication use with a healthcare provider to minimize the risk of dependence and other adverse effects. Given the potential for dependence and other adverse effects associated with long-term use of sleep medications, it is advisable to select one medication and use it judiciously, rather than alternating between multiple medications.
From the Research
Alternating Sleeping Medications
- The practice of alternating between different sleeping medications, such as Temazepam, Ambien (zolpidem), and Dayvigo (lemborexant), to prevent addiction is not a widely recommended approach in the medical literature 2, 3.
- Studies have shown that benzodiazepines, such as temazepam, can be effective for short-term treatment of insomnia, but long-term use can lead to tolerance, dependence, and withdrawal effects 3.
- Non-benzodiazepine hypnotics, such as zolpidem, have also been shown to be effective for short-term treatment of insomnia, with a low propensity to cause clinical residual effects, withdrawal, dependence, or tolerance 4.
- There is no evidence to suggest that alternating between different sleeping medications is an effective strategy for preventing addiction or improving sleep outcomes 2, 3, 5, 4, 6.
Risks and Benefits
- The use of multiple sleeping medications, including benzodiazepines and non-benzodiazepine hypnotics, can increase the risk of adverse effects, such as psychomotor impairment, cognitive dysfunction, and dependence 3, 5.
- The addition of cognitive-behavioral therapy (CBT) to pharmacological treatment has been shown to reduce the amount of medication used and the incidence of adverse effects, while improving sleep outcomes 5.
- The choice of sleeping medication should be based on individual patient needs and medical history, rather than a strategy of alternating between different medications 2, 3, 4.
Clinical Guidelines
- Clinical guidelines recommend that benzodiazepines and non-benzodiazepine hypnotics be used for short-term treatment of insomnia, with careful patient selection and monitoring for adverse effects 3, 4.
- The use of sleeping medications should be tailored to individual patient needs, with consideration of factors such as age, medical history, and lifestyle 2, 3, 5, 4, 6.