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Picture this scene: You’re lying wide awake at 2 a.m. despite having gone to bed four hours earlier. You toss and turn. But no matter what sleep position you attempt or how many guided meditations you listen to, you just can’t catch a break.
Maybe that post-dinner espresso you drank is to blame, or it could be the anxiety buzzing in your head from this week's mile-long to-do list, but you can’t be sure. What you can be sure of though, is that your alarm will be sounding off in mere hours. But in the meantime, the only thing to do is wait for your brain to finally call it quits.
Sound familiar? Not being able to fall asleep is a special type of torture almost everyone can relate to. Millions of adults battle insomnia — a sleep disorder that can affect your blood pressure, ability to concentrate, memory and more — as well as other sleep difficulties every day. In fact, the CDC reports that 35 percent of American adults clock in less than seven hours of sleep a night. That’s not ideal.
To cope with their sleep struggles, some people turn to caffeine-free tea, listen to calming music or read a book until they’re able to hit the hay. Some prefer to hit up the drugstore for over-the-counter supplements like melatonin. And others use benzodiazepine medications like alprazolam (sold under the name Xanax®) for sleep relief.
You might’ve heard of people using benzodiazepines like Xanax® to treat anxiety disorders, but sometimes, people use them when they have trouble falling or staying asleep. The truth is, while they certainly can help you doze off when you need to, they’re not the best choice for this problem for a number of different reasons.
In this article, we’ll unpack those reasons and explain how benzodiazepines work, their risks, common side effects (depression can be one of them) and alternative treatment options you can seek out if you want a healthier and more effective sleep aid.
First things first: How does alprazolam, or Xanax®, work?
Alprazolam belongs to a group of psychotropic medications called benzodiazepines, often shortened to “benzos.” It is frequently used to treat panic disorder and anxiety disorders, like generalized anxiety disorder (GAD).
Unlike other common anxiety medications — like antidepressants — which can take weeks for your body to fully feel its effects, benzodiazepines provide immediate relief.
These medications work by binding themselves to the GABA-A (gamma-aminobutyric acid) receptor. GABA is a type of neurotransmitter — aka a chemical that helps regulate your central nervous system — that calms your body down so you feel less anxious and more relaxed. Basically, by attaching to your body’s GABA receptors, benzodiazepines signal you to chill out.
Since benzodiazepines help your body to slow down and decompress, it makes sense that they might also cause some sleepiness. And while alprazolam was not originally developed as a sleep medication and isn’t technically approved by the Federal Drug and Alcohol Administration (FDA) for that purpose, medical professionals sometimes prescribe it off-label anyway.
So yes, alprazolam can make you fall asleep more easily. But that doesn’t mean it should become part of your evening routine, like brushing your teeth. There are legitimate concerns and potentially harmful consequences when it comes to using alprazolam as a tool for sleep — we’ll get into them below.
We’ve established that alprazolam will make you want to doze off, which, at surface level, may sound great. However, there are some serious side effects of Xanax and other risks that should be taken into consideration.
Here’s a few that you should be aware of:
Alprazolam for sleep isn’t a long-term solution. Something to take into account is that, as mentioned, alprazolam was never designed to be a sleeping aid. So, if you use it to fall asleep often, it eventually might not be as effective as it was when you first started taking it. One review of studies from 2018 found a general lack of research on the long-term effectiveness of alprazolam and other benzodiazepines for sleep. Moreover, the small amount of research out there has found that effectiveness can decrease in as little as one day to several months. And while it may help at first, alprazolam can actually make your sleep worse with long-term use. This phenomenon is known as “rebound insomnia” when medications like alprazolam and other benzodiazepines are at first helpful, but later become increasingly harder to sleep without them.
It can impact your deepest phase of non-REM sleep. Known as slow-wave sleep, this phase of non-REM sleep is the deepest one, and is especially key for memory processing, cognitive function and learning. In this restorative stage, a growth hormone is released and helps in regenerating tissues. When you use benzodiazepines like alprazolam, it interferes with the amount of time your brain has in this important sleep stage.
There’s a high risk of dependency and addiction. There’s a reason why alprazolam is typically prescribed for short-term use — because when used for a longer period of time, it can potentially become addictive. It’s important that people are carefully evaluated before being prescribed alprazolam, especially people who are prone to substance abuse, elderly patients and those who have lung, liver or kidney issues.
There might be effects of withdrawal. If you’re using alprazolam regularly and then suddenly stop, there’s a chance you could have withdrawal effects. This might look like insomnia, weakness, dizziness, irritability and anxiety, among other symptoms. Depending on the dosage you were using and the amount of time you were on the medication, symptoms of withdrawal might even last for weeks. It’s crucial that if you choose to stop using alprazolam — or any medication for that matter — that you talk to your healthcare provider so you can come up with a plan to taper yourself off as safely as possible.
You might experience common side effects. There are common side effects associated with most medications, including alprazolam. Some adverse effects to be aware of are:
Dizziness or lightheadedness
Changes in appetite resulting in weight gain or loss
Difficulty sleeping or insomnia
Nausea and/or vomiting
Hypomania (a milder version of mania)
Trouble with balance and/or coordination
Now that you know the downsides of using alprazolam as a sleep medication, you might be wondering what medications are safe to use.
We’re glad you asked. The good news is that there are a handful of options you can look into that are effective, yet don’t come with the same risks of dependency and intense withdrawal symptoms as alprazolam. These alternatives include:
Over-the-counter sleep aids
How do they work? Let’s find out.
Doxepin belongs to a group of medications called tricyclic antidepressants or TCAs. Though it was originally approved by the FDA in 1969 to treat depression, it can help with other mental health disorders at lower dosages, including insomnia. It can also be used to treat people who have general difficulty with falling asleep or frequently wake up after falling asleep.
Based on several studies that examined doxepin as an insomnia treatment, a 2013 scientific review suggests that when prescribed at low doses of 3mg and 6mg, doxepin is effective and well-tolerated. And while some medications have side effects like drowsiness, doxepin is less likely to make you feel like a zombie the next day.
If you haven’t heard of zolpidem, the word Ambien® — the brand name it’s commonly sold as — probably rings a bell. Zolpidem isn’t a benzodiazepine, but works similarly to alprazolam in that it also binds to GABA receptors. It’s most commonly used for short-term treatment of insomnia for patients who have trouble falling asleep at night.
Although it’s not as habit-forming as alprazolam and is found to be effective when paired with cognitive behavioral therapy (CBT), there are some rather severe side effects associated with zolpidem, like hallucinations, sleepwalking and driving cars while asleep.
Lastly, over-the-counter medication might be an option to consider if you have mild insomnia or at least, fewer occurrences of it. While these kinds of supplements don’t have the same impact as prescription medications, many are effective in helping people to relax, which can ultimately help you to fall asleep.
One of the major benefits of natural sleep aids is that you don’t need a healthcare provider’s sign-off in order to purchase them. Some of the more popular natural products (you might already have a few of ‘em in your kitchen pantry) include chamomile tea, lavender, L-theanine supplements, magnesium and melatonin.
Melatonin supplements, in particular, have proven to be very safe, with some experts saying they can be used by people who have insomnia to curb chronic benzodiazepine use.
For more natural alternatives that you can try in lieu of alprazolam, check out our list.
Here’s the deal: Yes, alprazolam will likely expedite the train to your Sleep City destination, but that doesn’t mean you should use it. Not only can it interfere with your deep sleep cycle, but it can have intense side effects, withdrawal symptoms and addictive qualities that may be problematic in the long run.
But we know that sleeplessness can have a major impact on your mental health. So if you’re struggling with a sleep disorder like insomnia or other types of sleep issues, the best course of action is to connect with a healthcare provider. But in the meantime, there are other things you can do to help improve your sleep hygiene like:
Therapy. Living with a condition like insomnia can literally be exhausting and have the ability to take a toll on everyday life. While prescription drugs recommended by a healthcare provider can certainly be part of your treatment plan, so can opening up to a mental health professional such as a therapist. There’s many kinds of therapy to explore, be it psychotherapy (aka talk therapy) or cognitive behavioral therapy (CBT), which has been shown to have a positive impact on insomnia. Not in the mood to chat in-person? Online therapy is an equally effective tool that can be done from any location that’s most convenient for you.
Limiting your time on social media. How many times have you promised yourself you’d only scroll through TikTok for five minutes before bed, only for an entire hour to magically disappear? We’re guilty, too. You’ve probably heard that screen time before bed isn’t good but there’s an actual scientific reason why: the blue light emitted from your phone tricks your body into producing less melatonin (aka the hormone that helps regulate sleep). This disruption makes it harder to fall asleep. Consider designating your social media time — and your screen time in general — for other parts of the day to help curb sleep problems.
Cutting back on caffeine and alcohol. Certain substances like caffeine and alcohol can deeply impact your sleep quality. To make sure you’re getting the best rest possible, consider cutting back on your cold brews and/or post-work happy hour beers. While these types of beverages might make you feel good when you’re consuming them, they may end up being the reason why you’re staring at your bedroom ceiling at 2 a.m.
For more resources and tips for prioritizing your well-being, our mental health services are always available for you to check out.
Kristin Hall is a board-certified Family Nurse Practitioner with decades of experience in clinical practice and leadership.
She has an extensive background in Family Medicine as both a front-line healthcare provider and clinical leader through her work as a primary care provider, retail health clinician and as Principal Investigator with the NIH.
Certified through the American Nurses Credentialing Center, she brings her expertise in Family Medicine into your home by helping people improve their health and actively participate in their own healthcare.
Kristin is a St. Louis native and earned her master’s degree in Nursing from St. Louis University, and is also a member of the American Academy of Nurse Practitioners. You can find Kristin on LinkedIn for more information.
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