Alprazolam for Sleep: How It Works, Side Effects & Risk Factors

October 28 , 2022

Alprazolam, sold under the brand name Xanax, is a prescription drug commonly used for the short-term treatment of panic disorder and generalized anxiety disorders. However, benzodiazepine medications like Xanax are also used for treating one of America’s most common health issues: insomnia.

Millions of Americans suffer from poor sleep quality and other sleep issues. According to the Centers for Disease Control and Prevention (CDC), a third of Americans don’t get the necessary amount of sleep each night. Poor sleep quality is associated with numerous chronic disorders and ailments, including type two diabetes, heart disease, obesity, and depression, that threaten our nation’s health. Insomnia can also lead to traffic collisions and workplace accidents, which annually result in many injuries and disabilities. Adequate sleep should not be a luxury; it’s necessary for good health and quality of life.

Therefore, it’s essential to seek medical attention to address the condition as soon as possible. However, is Xanax an effective treatment for insomnia? Please continue reading to learn more about Xanax for sleep, its adverse effects, and its risk factors.

What Is Xanax?

In 1981, the U.S. Food and Drug Administration (FDA) approved Xanax as an effective anti-anxiety medicine. Since then, it has become one of the most prescribed benzodiazepines on the market today, with over tens of millions of prescriptions written in the United States alone. Since Xanax is classified as a Schedule IV controlled substance with a high risk of abuse and physical dependence, it is not approved for long-term use.

Xanax is a fast-acting benzodiazepine that begins working within an hour of administration. It reaches peak concentrations within one to two hours and has a half-life of about 11.2 hours. Xanax is available as disintegrating tablets, immediate-release tablets, extended-release tablets, and oral liquid.

How Does Xanax Work?

The active ingredient, alprazolam, works by binding to your brain’s gamma-aminobutyric acid (GABA) receptors. GABA is an inhibitory neurotransmitter that reduces neuronal activity. When your body produces more GABA, it signals the nerve cells to slow down activity, causing you to feel calm and less anxious. As a result, alprazolam can cause severe drowsiness, which is why Xanax is sometimes recommended off-label as a treatment for insomnia, despite not being FDA-approved for this use.

In addition, Xanax also enhances the effects of dopamine, which is a neurotransmitter connected to the brain’s pleasure and reward system, thus improving your mood and overall well-being. Artificial enhancement of dopamine is linked with the risk of dependency. Therefore, follow your healthcare provider’s instructions precisely when using an addictive medication like Xanax for medical conditions.

Is Xanax the First-Line Treatment for Insomnia?

Although Xanax is frequently used as a first-line treatment for anxiety and panic disorders, it is not the case for sleep disorders. There are many alternative treatment options for insomnia. The first step is to investigate sleep hygiene, which refers to healthy habits that enhance sleep quality. You may also have to engage in behavioral therapies to address sleep issues. If pharmacological treatment is required, your healthcare professional may initially start you on a non-benzodiazepine medication.

One of the most common alternative medications for sleep disorders is zolpidem (Ambien). If these sleep aids do not yield the desired results, healthcare professionals may prescribe a benzodiazepine, such as Xanax, estazolam, flurazepam (Dalmane), temazepam (Restoril), triazolam (Halcion), or quazepam (Doral).

While Xanax is not a first-line treatment option for sleep disorders, it may be helpful for people who have tried other options with little success. It may also be useful for treating sleep problems associated with anxiety or panic attacks. Anxiety disorders and sleep problems often occur simultaneously. It may be difficult to get proper sleep if you experience anxiety symptoms, such as nervousness, irritability, and paranoia. Hence, addressing the underlying anxiety disorder can help you improve your sleep quality.

Is Xanax an Effective Sleep Aid?

As a potent depressant that can induce feelings of sedation, hypnosis, and fatigue, alprazolam for sleep can certainly be effective when taken 20 to 60 minutes before bedtime. However, it may not be a viable long-term solution due to its potential to cause chemical dependence after a few weeks of consistent use. Individuals may also build a tolerance to the drug’s sedating effects after consistent use, making it ineffective for sleep after some time.

Furthermore, Xanax has a half-life of around 11 to 13 hours in immediate-release formulations. Its anti-anxiety effects may wear off after six hours, but you may feel some effects for longer. If you are using it as a sleep aid, this could mean feeling groggy or sedated the next morning after taking it. Hence, other sleep aids may be better to avoid drowsiness the next day.

What Is the Pittsburgh Sleep Quality Index?

Few questionnaires have been developed to measure sleep quality in clinical populations, even though sleep complaints are common among mental health patients. Pittsburgh Sleep Quality Index (PSQI) is a self-administered questionnaire that evaluates sleep quality and disruptions over 30 days. Nineteen items yield seven “component” scores: subjective sleep quality, sleep latency, sleep length, habitual sleep efficiency, sleep disruptions, usage of sleeping medications, and daytime dysfunction. The combination of these seven component scores results in a global score.

This questionnaire aims to assess your sleeping patterns, sleep disturbances, and level of motivation and attention while awake. The Pittsburgh Sleep Quality Index is utilized in clinical examination of sleep difficulties and as a research instrument, such as when medications or other factors that impact sleep are evaluated in experimental studies.

Side Effects of Xanax

Xanax has a few negative effects, but that’s to be expected from any medicine. Some of the common side effects include:

  • Drowsiness
  • Light-headedness
  • Weight loss
  • Confusion
  • Headache
  • Fatigue
  • Slurred speech
  • Impaired coordination
  • Decreased ability to concentrate
  • Irritability
  • Restlessness
  • Low blood pressure

Most common side effects usually improve over the first couple of weeks as you continue taking the medication. However, if they do not show any sign of improvement or become worse, consult your healthcare provider immediately.
Severe side effects may include:

  • Allergic reaction
  • Increased heart rate or irregular heartbeat
  • Depression
  • Seizures
  • Hallucinations
  • Dependence
  • Tolerance of the medication

Chronic Xanax abuse has also been linked to liver disease and jaundice. Given that this is not an all-inclusive list of possible Xanax side effects, you must seek medical attention from your healthcare practitioner if any unusual or dangerous symptoms arise while taking this medication.

Xanax Abuse and Addiction

Xanax is one of the most commonly abused benzodiazepines in the world. Most people abuse it in large doses or combine it with other substances like alcohol or opioid medicines to induce a euphoric effect. This practice is dangerous and can increase the risk of physical dependence, addiction, and overdose.

Individuals with a Xanax addiction may experience withdrawal symptoms when trying to quit the medication abruptly.

Xanax withdrawal symptoms may include:

  • Blurred vision
  • Anxiety
  • Concentration problems
  • Panic attacks
  • Headache
  • Sweating
  • Restlessness
  • Irritability
  • Nausea
  • Vomiting
  • Poor memory
  • Hand tremors
  • Depression
  • Racing pulse
  • Muscle pains
  • Seizures
  • Delirium

Rebound symptoms of anxiety and insomnia can occur between one and four days following the last dose of Xanax. During the withdrawal period, rebound insomnia and anxiety are often worse than before. As a result, it is recommended that you seek the assistance of a medical practitioner to taper off the medicine properly.

Xanax Overdose

Another potential risk of Xanax abuse is an overdose. Individuals who take large doses of Xanax within a short period or combine it with other substances, such as alcohol or opioid medications, may increase their risk of a fatal overdose.

Some of the symptoms of a Xanax overdose include:

  • Confusion
  • Labored or shallow breathing
  • Lack of coordination
  • Slow reflexes
  • Muscle twitches
  • Chest pain
  • Seizures
  • Loss of consciousness
  • Coma

Xanax overdose is a medical emergency that requires immediate medical attention. Call 911 or head to the nearest emergency room if you or someone you know is experiencing any of these symptoms.

Alternative Medications to Xanax for Sleep

Several FDA-approved alternatives to Xanax are available for treating sleep problems, with a low risk of adverse effects, dependence, and withdrawal. Alternative medications to Xanax may include:

  • Ambien – This is a popular sleep medication containing the active ingredient zolpidem. Like alprazolam, Ambien works by binding to the body’s GABA receptors. It also takes effect sooner, making it a great choice for instant insomnia relief. Zolpidem has less addictive properties than alprazolam. However, it has its own set of side effects, including sleepwalking and sleep driving.
  • Doxepin – This is a tricyclic antidepressant approved by the FDA to treat insomnia. In small doses, doxepin can increase your sleep duration and help you stay asleep longer. It is non-addictive and reports no next-day drowsiness, which means you will wake up feeling well-rested and energized instead of groggy. However, doxepin can cause a few side effects. These are often mild and rare and generally include an upset stomach, dry mouth, and dizziness.
  • Melatonin and Chamomile – If you are looking for a more natural way to treat insomnia, you may want to try melatonin. Melatonin is your body’s natural sleep hormone. When you don’t produce enough of this hormone naturally, you can take melatonin supplements as capsules or liquids to help balance your body’s circadian rhythm and promote healthy sleep.

Chamomile is another popular herbal remedy that acts as a sleep inducer. Chamomile is also considered a mild tranquilizer due to its impressive calming effects. It contains an antioxidant called apigenin, which attaches to specific brain receptors to help ease anxiety symptoms and facilitate sleep.

Although alprazolam can make you sleepy, it is not the best medication for everyone. It’s also not recommended for long-term usage due to its potential negative effects, abuse, and dependency. Consult your healthcare provider about alternate, more effective, and safer therapy options.