Lorazepam for sleep: Can lorazepam help with sleep?

Lorazepam can be prescribed off-label as a sleep aid. Learn how lorazepam works, who can take it, and possible side effects.

By Keith Gardner, R.Ph. | Jun. 16, 2023

For many, falling asleep at night isn’t always as simple as lying down and closing one’s eyes. Worries from the day may race through the mind, or getting comfortable may be impossible. Although it is normal to have trouble falling asleep and maintaining sleep occasionally, chronic insomnia can take its toll physically and mentally on one’s daily life. When relaxation techniques don’t work, many people with sleep problems look for medications to aid in the process.

While taking over-the-counter (OTC) sleep aids and supplements may help some, many times, people seek medical professional help and may be prescribed sleeping pills. Benzodiazepines, which include Valium (diazepam) and Xanax (alprazolam), are one of the most widely prescribed drug classes for the short-term treatment of insomnia. While several benzodiazepines are approved by the U.S. Food and Drug Administration (FDA) for treating insomnia, lorazepam, a benzodiazepine also known by the brand name Ativan and FDA-approved to treat anxiety, is often prescribed off-label as a sleep aid. Continue reading to learn how lorazepam works, who can take it, and possible side effects.

Lorazepam for sleep

Benzodiazepines are a class of medications that work by making the central nervous system (CNS) less active. This decrease in nervous system activity makes these medications helpful for various medical conditions, such as daytime anxiety disorders and seizures. Clinical studies have shown them to be safe and effective for the treatment of insomnia since their first approval in the 1970s. Lorazepam, approved by the FDA in 1977 under the brand name Ativan, is indicated for the short-term relief of anxiety symptoms. It is often prescribed off-label for the short-term treatment of insomnia.

Many prescription drugs are prescribed off-label to treat conditions other than those for which they were approved. Since lorazepam has calming effects similar to the benzodiazepines approved to treat insomnia, it is often considered by prescribing healthcare professionals to be an effective option. A clinical trial has also shown that lorazepam is as effective as other benzodiazepines in the short-term treatment of insomnia in trial subjects.

Who can take Lorazepam as a sleep aid?

Lorazepam is considered safe and effective for use in those 12 years of age and older, although off-label use as a sleep aid is usually reserved for adults. Those aged 65 and over may respond to lorazepam with an increase in the incidence of sedation and unsteadiness, therefore, dosing in older patients should start at lower doses and be increased cautiously.

Taking lorazepam may not be suitable for some people with any of the following medical histories or conditions:

Known hypersensitivity to the active drug or any ingredient
Liver or kidney disease
Lung disease or breathing problems (e.g., sleep apnea or COPD)
Have depression, mood problems, or suicidal thoughts or behavior
Have a history of drug or alcohol abuse or substance use disorder
Are trying to get pregnant, are already pregnant, or are breastfeeding
Have glaucoma (a condition of increased pressure within the eye)

How long does lorazepam take to work

Doses of lorazepam oral tablets are well absorbed after swallowing and will typically start to work in about 30 minutes, with peak effects lasting two to three hours. This means that lorazepam can be taken just before bedtime for most people.

Lorazepam is a federally controlled substance (Schedule IV) because it can be abused or lead to physical dependence. Because of this, it is recommended to use the lowest effective dose for the shortest period of time. It is usually prescribed for no more than four weeks at a time and is not recommended for use beyond four months. Lorazepam may be taken daily or as needed, depending on your doctor’s or other healthcare provider’s instructions.

Lorazepam dosage for sleep

For short-term treatment of insomnia, a single dose of 2 to 4 mg is taken at bedtime.

For a person over 65, the initial dose should be reduced to 0.5 to 1 mg at bedtime to achieve the desired effect. Changes to this low dose may be made as needed and tolerated.

Lorazepam alternatives

Many non-drug methods can help those who have trouble falling asleep that may be tried at home, including:

Physical activity early in the day can improve the quality of sleep, however, avoid exercising within two hours of bedtime
Stick to a regular sleep schedule
Eat a healthy diet, but avoid big meals within a couple of hours of bedtime
Avoid watching TV or using a phone or tablet right before going to bed

The chart below includes some common brand-name medications and OTC products that may be used for insomnia.

Alternatives to lorazepam for sleep
Medication	Drug class	Standard dosage	Savings options (coupon)
Ambien (zolpidem) Rx	Sedative-hypnotic	5 mg for women, 5-10 mg for men before bedtime	Ambien coupon
Lunesta (eszopiclone) Rx	Sedative-hypnotic	1 to 3 mg at bedtime	Lunesta coupon
Restoril (temazepam) Rx	Benzodiazepine	15 mg at bedtime	Restoril coupon
Silenor (doxepin) Rx	Tricyclic antidepressant (TCA)	6 mg for adults, 3 mg for older adults before bedtime	Silenor coupon
Melatonin OTC	Natural hormone	1-2 mg daily for adults, 0.5 mg daily for children 3 and older	Melatonin coupon
Unisom OTC	Antihistamine	25 mg at bedtime	Unisom coupon

Lorazepam side effects and warnings

Like any medicine, lorazepam may cause side effects in some people. Some of the more common side effects when taking lorazepam for insomnia include the following symptoms:

Dizziness
Lightheadedness
Unsteadiness
Decreased ability to concentrate
Muscle weakness
Dry mouth

Rare but more serious side effects that may require medical help include the following symptoms:

Shuffling walk
Tremors or inability to sit still
Fever
Breathing problems
Difficulty swallowing
Skin rash or hives
Yellowing of skin or eyes
Irregular heartbeat
Memory loss or memory problems
Disorientation
Sleep apnea or worsening of sleep apnea

Taking lorazepam for a long time, particularly at high doses, may result in long-term effects, usually seen as exaggerated versions of the side effects listed above.

Withdrawal from benzodiazepines, including lorazepam, can be potentially dangerous. The rate of drug withdrawal, the strength of the dose taken, and the longer use time will contribute to how severe the withdrawal symptoms might be. The most common withdrawal symptoms include a significant worsening of sleep, headaches, sweating, tremors, increased blood pressure, GI effects (e.g., nausea, cramps, vomiting), tension, irritability, anxiety, mental confusion, and even seizures in rare cases. Lorazepam should be gradually stopped under medical supervision.

Lorazepam has a black box warning, also known as a boxed warning, regarding the combined use of lorazepam and opioid medications, a class of drugs used to reduce pain. Combining the two medications can worsen adverse reactions caused by lorazepam alone and may result in medical emergencies such as profound sedation, respiratory depression, coma, and death. Following a physician’s or other healthcare professional’s medical advice, is important in order to avoid risks when combining lorazepam with another sedating drug.