I have been suffering with health anxiety for about 6 months. i have noticed that my anxiety intensified right before i go to sleep. my 0.5 mg ativan (lorazepam) doesn't seem to help me anymore.. why is that? should i request a new medication?

Tolerance: Your body will develop tolerance to narcotics like opioid pain meds and benzos like Ativan (lorazepam). That means the dose becomes less effective over time. However, benzos are really meant to be short-term helps while the underlying problem is being addressed. There are safer meds that can be used long-term to control anxiety, that won't cause tolerance. Counseling can be very effective for this too.

Try going back to: the prescribing physician. Anxiety can spike before sleep as your defenses to background stress, past thoughts/memories of trauma, recall of current negative conditions begin to seep into awareness. Anxiety is an early warning of bad things to come into awareness. Read: http://www.psychologyproductsandservices.com/page2.html

Increased tolerance: Most likely you have just developed an increased tolerance for the meds. I suspect that your increased anxiety just before bed has to do with a lessening of activity that distracts you at that time. Try setting up a bedtime ritual of meditation, yoga, calming music, no TV or electronics. I would avoid increasing your meds because ativan (lorazepam) is very addictive.

Two things: In situations such as this you need to do two things. One is have a complete physical exam so you know if your health is ok and if there is problem you understand it. Then if the anxiety persists you should see a psychiatrist for therapy to try to determine if there are underlying issues causing the symptoms. The doctor may prescribe some medication also.