Sleep, Anxiety & Benzodiazepines: When Medications Help—and When They Harm

Host: Dr. Joseph Varon | Guest: Dr. Josef Witt-Doerring

For many people, benzodiazepines ease anxiety and bring sleep. That part isn’t in dispute. They work fast, they work reliably, and for someone who has been lying awake for weeks, the relief can feel like the first good thing to happen in a long time.

The trouble starts later. The occasional dose becomes the nightly one. The dose that worked stops working. And the drug that solved the problem becomes a second problem sitting on top of the first.

Dr. Josef Witt-Doerring has spent his career on both sides of that story. He reviewed adverse drug reactions at the FDA’s Division of Psychiatry. He now runs TaperClinic, the largest practice in the world devoted to helping people get off psychiatric medications. By his estimate, 9% of Americans are currently taking a benzodiazepine, drugs approved on trials as short as eight weeks.

All that begs the question: does this treatment address the root cause, or cover it up? Dr. Varon and Dr. Witt-Doerring unpack it in this episode.

1. Why the First Dose Works So Well

To understand why these drugs are so hard to stop, start with why they get prescribed.

Benzodiazepines act on the GABA system, which is the brain’s braking mechanism. That’s why a single class of drug can treat anxiety, insomnia, muscle spasms, and seizures. The names are familiar even to people who have never taken one:

• Xanax (alprazolam)
• Klonopin (clonazepam)
• Valium (diazepam)
• Ativan
• Temazepam

Dr. Witt-Doerring puts the Z-drugs in the same conversation, including Ambien, Sonata, and Lunesta. Different chemistry, same effect on the same system.

The effect lands within 30 to 40 minutes, he says, no matter what caused the problem.

“Short-term, they’re one of the most effective psychiatric medications. It’s almost like putting down three drinks or three shots.” — Dr. Josef Witt-Doerring

The drug doesn’t care whether you can’t sleep because of grief, a thyroid problem, or a job you’re dreading. It quiets everything, which means nothing underneath ever gets found.

Meanwhile your brain notices. Held down night after night, it dials back its own GABA receptors to restore balance. The drug keeps coming. The effect doesn’t.

2. Dependence Is Not Addiction, and You Can Get There as Prescribed

If I need this to sleep, does that make me an addict? A lot of people carry that question around without asking it.

The answer is no, and the distinction matters.

• Addiction describes drug-seeking behavior. Escalating doses, pills obtained outside the prescription, a life reorganized around getting more.
• Physical dependence is your body adapting to a drug it receives regularly. It happens with most psychiatric medications, SSRIs included. It requires nothing of you except taking what you were told to take.

For years, Dr. Witt-Doerring says, that difference was used to wave patients off. The drugs weren’t addictive, so the withdrawal people described couldn’t be real.

Dependence can develop within about a month of steady use. Stopping after a month is uncomfortable. Stopping after two years at a higher dose is a different situation entirely, because there’s far more adaptation to undo.

“You’re essentially stuck on a drug, and you’re between a rock and a hard place, because if you ever want to come off, now you’re dealing with withdrawal plus the original problem that got you on the drug in the first place.” — Dr. Josef Witt-Doerring

Two things arrive at once: the withdrawal, and the original insomnia, both landing on a person with less capacity to absorb either one. That combination is what keeps people on the drug for years.

Swapping pills doesn’t sidestep it, either. Dr. Varon asked whether switching to a longer-acting agent helps. In practice, Dr. Witt-Doerring says, it doesn’t. Trading one benzodiazepine for another keeps the same pressure on the same system.

3. You Slept Eight Hours. Why Do You Feel Terrible?

Dr. Varon put the question to Dr. Witt-Doerring directly, because patients ask it constantly.

Real sleep runs as a sequence: REM, non-REM, deep sleep, cycling through the night in a particular order. That sequence is when the maintenance happens. Growth hormone gets released. Blood sugar gets regulated. The body does the repair work that decides whether tomorrow feels survivable.

Sleep studies show benzodiazepines interrupt that sequence. Deep sleep and REM get suppressed. What’s left is lighter sleep that looks like rest from the outside.

“While you may be unconscious, it’s not the restorative type of sleep.” — Dr. Josef Witt-Doerring

So the hours are real. The sleep isn’t.

4. The Danger Isn’t Usually the Benzo Alone

Taken by itself, at a normal dose, a benzodiazepine rarely kills anyone. Combined with the wrong thing, it kills people regularly.

That’s why the class carries a boxed warning, the FDA’s strongest, for use alongside opioids. The mechanism is simple: breathing slows during sleep and doesn’t recover.

The version that shows up in ordinary life is quieter: the glass of wine with the nightly pill. Dr. Varon says he sees it all the time in patients who tell him it’s the only thing that puts them under. Alcohol works on the same system the drug does, so the two stack.

“These are incredibly dangerous drugs to mix. That’s why they have this boxed warning. It’s the highest warning that there is.” — Dr. Josef Witt-Doerring

The people most at risk are those already managing chronic pain or addiction, where a bad night and one impulsive extra dose turn fatal without anyone intending it. Dr. Witt-Doerring pointed to the documented cases: Heath Ledger, found with three benzodiazepines and two opioids in his system. Matthew Perry, with two benzodiazepines in his.

5. If You Take One Thing From This Episode, Take This

Never stop a benzodiazepine abruptly. And if you’re coming off one, go slower than you think you need to.

Alcohol and benzodiazepines are the only two drug classes where quitting suddenly can kill you. Pull the brake off a brain that has adapted to it and you get excitation, which can produce a seizure, and a seizure involving the brainstem can stop the heart. Most people aren’t quitting cold turkey, though. They’re coming off over two months, which still counts as fast after several years of use.

The FDA updated benzodiazepine labeling in 2019 to warn prescribers about protracted withdrawal. The 2025 American Society of Addiction Medicine guidelines adopted the same warning. Dr. Witt-Doerring estimates it affects 10 to 15% of people coming off.

“You can essentially develop a brain injury if you come off these medications too quickly.” — Dr. Josef Witt-Doerring

What separates it from ordinary withdrawal is that waiting doesn’t fix it. A month passes. Then two. Then three, and the person feels worse instead of better, because by then they aren’t in withdrawal at all.

Recovery runs about two years in his practice, which is why his taper method looks the way it does:

• Match the reduction to symptoms, not to a calendar. There is no correct number of weeks.
• Start small. His practice begins near a 5% reduction and increases only if the patient tolerates it.
• Keep withdrawal mild to moderate. If it interferes with work, family, or daily life, the taper is too fast.

None of this is something to attempt alone.

6. So What Actually Works?

Insomnia is a signal, not a diagnosis. Something is keeping the body in a state of arousal, and the work is finding out what. Dr. Witt-Doerring ranks the answers, and his top tier is deeply unglamorous:

• Lose weight. Extra weight is metabolically active and inflammatory, which pushes the body toward lighter sleep. It also drives sleep apnea, and roughly half of apnea patients still report poor sleep even on CPAP.
• Eat whole foods. Ultra-processed food adds inflammatory pressure, and whole food tends to reduce overeating on its own.
• Move every day. He puts the sweet spot at 7,000 to 10,000 steps.
• Deal with what’s actually wrong. It’s hard to reach a low-arousal state while a relationship or a career is genuinely on fire.
• Cut the stimulants. Caffeine, nicotine, and prescribed ADHD medications all put the body on a daily cycle of onset and overnight withdrawal.

Blue-light glasses, cooling mattresses, red light, vagal stimulation, melatonin, CBD: all of it sits lower, not because it’s harmful but because it doesn’t reach the cause.

This isn’t something he is guessing about. Dr. Witt-Doerring had severe insomnia for years and bought most of the gadgets himself, including a five-thousand-dollar cooling bed and an EMF-blocking beanie.

“Nothing works as well as losing 25 pounds and walking 10,000 steps a day.” — Dr. Josef Witt-Doerring

The nursing home is this framework at its bleakest. Immobility, poor food, no sunlight, no company: every arousal driver stacked at once, in a population least able to tolerate it. The answer is almost always a sedative.

“Listen to your symptoms. Your body is very wise.” — Dr. Josef Witt-Doerring

What This Means If You’re Already Taking One

Nothing here means you did something wrong, and Dr. Witt-Doerring is careful to say so. These drugs have real uses: jet lag, an acute panic attack, an emergency, and long-term use with genuine informed consent when everything else has been tried. What changes is the question you bring to your next appointment. Instead of asking for a refill, ask what’s driving the arousal in the first place. And if you want off, find someone who knows how to taper. TaperClinic operates in the fifteen most populous states, Dr. Witt-Doerring’s YouTube channel carries a free tapering course, and the Benzodiazepine Information Coalition keeps a directory of providers who do this work.

“It’s really easy to demonize the drugs, and I don’t want to do that. I want to demonize the system that we’re in right now.” — Dr. Josef Witt-Doerring

Related Reading

• Webinar: Rethinking Our Approach to Mental Health in 2026
• Webinar: Sleep Matters: Clinical Perspectives from Western and Eastern Medicine
• Guide: Managing Depression and Mental Health
• Protocol: Brain Health
• Courses: IMA Academy