What is the best course of action to discontinue temazepam (generic name) 7.5mg at bedtime for sleep during the menstrual period due to sleep issues?

Discontinuing Temazepam for Menstrual-Related Sleep Issues

The best course of action is to implement a gradual taper of temazepam 7.5mg to minimize withdrawal symptoms while transitioning to non-pharmacological sleep interventions. 1, 2

Tapering Protocol for Temazepam 7.5mg

1. Initial Taper (Weeks 1-2):

   • Reduce dose to 3.75mg (half tablet) nightly for 1-2 weeks
   • Monitor for withdrawal symptoms including rebound insomnia, anxiety, or irritability

2. Final Discontinuation (Weeks 3-4):

   • Take 3.75mg every other night for 1 week
   • Then completely discontinue

This gradual approach is essential as the FDA label specifically warns that abrupt discontinuation of temazepam can precipitate withdrawal reactions, which can be life-threatening in some cases 2. The American Academy of Sleep Medicine guidelines emphasize that even at low doses, benzodiazepines require proper tapering to prevent rebound insomnia 1, 3.

Non-Pharmacological Alternatives

After discontinuation, implement these evidence-based alternatives:

1. Cognitive Behavioral Therapy for Insomnia (CBT-I):

   • First-line treatment recommended by the American Academy of Sleep Medicine 3
   • Components include sleep restriction, stimulus control, and cognitive restructuring

2. Menstrual-Specific Sleep Hygiene:

   • Maintain consistent sleep-wake schedule even during menstruation
   • Avoid caffeine and alcohol, particularly during premenstrual and menstrual phases
   • Create a cool, dark, quiet sleeping environment

3. Relaxation Techniques:

   • Progressive muscle relaxation
   • Mindfulness meditation before bedtime
   • Deep breathing exercises

Rationale for Discontinuation

Benzodiazepines like temazepam are associated with significant risks that outweigh benefits for periodic use:

• Risk of dependence and tolerance even with intermittent use 1
• Associated with cognitive impairment, reduced mobility, and falls 1
• Current consensus guidelines advise benzodiazepine use only on a short-term basis 1
• Even low-dose temazepam (7.5mg) can lead to dependence with regular use 2

Monitoring During Discontinuation

• Schedule follow-up within 7-10 days after initiating taper
• Assess for withdrawal symptoms: rebound insomnia, anxiety, irritability
• If severe withdrawal symptoms occur, slow the taper further by extending each step to 2 weeks

Special Considerations

• If sleep disturbance persists after complete discontinuation, consider time-limited use of non-benzodiazepine alternatives during menstruation only
• Avoid diphenhydramine as the American Academy of Sleep Medicine specifically recommends against its use for insomnia due to poor efficacy and side effects 1, 3
• Consider evaluation for underlying conditions if insomnia persists beyond 7-10 days after discontinuation 2

This approach prioritizes patient safety by minimizing withdrawal risks while addressing the underlying sleep issues with evidence-based non-pharmacological interventions that have better long-term outcomes for periodic sleep disturbances.