Temazepam (Restoril) is a benzodiazepine prescribed for the short-term treatment of insomnia, specifically difficulty falling asleep or staying asleep. As a psychoactive drug, it works by depressing the central nervous system. This medication is typically reserved for severe, debilitating sleeplessness and is not intended as a long-term solution for chronic sleep disorders. Due to its pharmacological properties and potential for misuse, Temazepam is regulated as a Schedule IV controlled substance, acknowledging its medical use alongside the risk of abuse and physical dependence.
How Temazepam Works
Temazepam slows down activity within the central nervous system, promoting the sedation and hypnosis necessary for sleep. It achieves this by interacting with gamma-aminobutyric acid (GABA), the brain’s main inhibitory neurotransmitter that reduces neuronal excitability. Temazepam acts as a positive allosteric modulator, enhancing GABA’s natural effects by binding to the GABA-A receptor complex.
This binding increases the flow of chloride ions into the neuron, which significantly decreases the cell’s likelihood of firing an electrical impulse. This generalized decrease in brain activity provides the drug’s therapeutic effects, including muscle relaxation, reduced anxiety, and powerful sedation to initiate and maintain sleep. Its relatively short half-life, ranging from 8 to 20 hours, makes it suitable as a nighttime sleep aid without causing excessive lingering effects the following day.
Weight Changes and Metabolic Impact
Clinical evidence does not support Temazepam as a direct cause of weight gain. Controlled studies have not reported significant weight changes as a common metabolic side effect, as the drug’s mechanism focuses on brain activity, not hormone regulation or energy metabolism. Any perceived change in body weight is likely an indirect consequence of the drug’s primary effects.
Temazepam induces profound sleepiness and sedation, which naturally reduces daytime physical activity. When a person is less active, their overall daily caloric expenditure decreases, which can contribute to weight gain over a prolonged period if dietary intake remains constant. While appetite changes are subjective, these effects are not consistent or metabolically driven. Temazepam does not appear to alter how the body processes or stores energy at a cellular level. Patients concerned about weight fluctuation should focus on maintaining their diet and managing the reduction in physical activity caused by the drug’s sedative nature.
Common Adverse Reactions
The majority of adverse reactions are a direct result of Temazepam’s CNS depressant properties, reflecting the generalized slowdown of brain activity. The most frequently reported side effect is daytime drowsiness or sleepiness, often called a hangover effect, which impairs mental alertness and physical coordination. Dizziness and lightheadedness are also common, increasing the risk of falls, especially in older adults.
Other frequent neurological complaints include headache, generalized fatigue, and impaired coordination (ataxia). Gastrointestinal issues, such as nausea, are also reported. Patients should avoid operating heavy machinery or driving until they understand how the medication affects them. Some individuals may experience confusion or impaired concentration, especially when waking up during the night.
A more serious, though rare, set of reactions are paradoxical reactions, which involve effects opposite to the intended sedation. These can include increased agitation, restlessness, hallucinations, aggression, and overstimulation. These unexpected behavioral changes require immediate medical attention and are particularly noted in elderly patients or those with pre-existing psychiatric conditions.
Risks of Dependence and Withdrawal
Temazepam carries a significant risk of developing tolerance and physical dependence, which is why it is strictly recommended for short-term use, typically no longer than 7 to 10 consecutive nights. Tolerance occurs when the body adapts to the drug, requiring progressively higher doses to achieve the initial therapeutic effect. Physical dependence develops when the body requires the drug to function normally, leading to withdrawal symptoms upon cessation. The risk of dependence increases with both the duration of use and the dosage taken.
Abruptly stopping Temazepam after regular use can trigger a withdrawal syndrome, ranging from uncomfortable to life-threatening. Common symptoms include a rebound of insomnia (often worse than before treatment), heightened anxiety, irritability, and restlessness. Physical symptoms may include tremors, muscle cramps, sweating, and nausea. In severe cases, abrupt discontinuation can lead to life-threatening reactions such as psychosis and seizures. To safely discontinue the medication and mitigate these risks, a supervised medical tapering plan is necessary to allow the central nervous system to readjust slowly.