Anxiety and insomnia are among the most common disorders in the country, affecting between 40 and 50 million Americans. Many people will find themselves struggling with an anxiety attack and a sleep disorder, at the same time, and are kept awake all night.
With this in mind, the idea of using one medication to treat both problems does not seem all that far-fetched. Xanax, the brand name of the drug alprazolam, was first released onto the pharmaceutical market in 1981 to treat symptoms of anxiety and panic disorders. It remains one of the most commonly prescribed medications in the United States.
Xanax can help people with anxiety disorders function normally in their daily lives without the fear of a debilitating panic attack.
Therefore, it is not unreasonable for a Xanax user struggling with insomnia or other sleep issues to take an extra dose of Xanax, hoping its sedative effects can help them fall asleep and stay asleep.
So: Is using Xanax to sleep, a use for which it has not been approved, a safe thing to do? If it is, does Xanax help with sleep?
What Is Xanax Used For?
The U.S. Food and Drug Administration (FDA) first approved Xanax in 1981. The prescription medication is specifically approved for treating anxiety and panic disorders. As a benzodiazepine, Xanax works in the brain and nervous system to slow down activity, which leads to anxiolysis (anti-anxiety). However, it achieves these effects by working with a neurotransmitter in the brain called gamma-Aminobutyric acid (GABA). GABA is a chemical messenger that creates rest and relaxation. It binds to its receptors and releases a negative charge that starts to shut things down, like turning off the lights before closing a store.
However, people with anxiety and panic disorders may have a mental or biochemical issue that sends their central nervous systems into overdrive. Anxiety can cause mental and physical symptoms. You may worry and experience racing thoughts, but you may also experience heart palpitations, sweating, and even aches and pains. GABA isn’t enough to allow you to feel calm when you’re experiencing anxiety symptoms.
Xanax works by binding to GABA receptors and making GABA more potent. It allows more of that negative charge to slow down the central nervous system activity. This can help people with panic disorders calm down when they’re experiencing an attack. It can also help them manage anxiety symptoms throughout the day.
Anxiety symptoms can cause other symptoms like insomnia and sleep problems. In many cases, addressing an anxiety disorder can help you get better sleep. However, like other depressants, Xanax can also directly facilitate sleep. GABA is closely tied to sleep, and it helps people wind down before sleeping. Xanax may have direct applications as a sleep aid.
As mentioned earlier, the U.S. Food and Drug Administration (FDA) has approved Xanax for treating anxiety and panic disorders. However, physicians prescribe it for “off-label” use, meaning that, while it has not been approved for a specific purpose, which in this case is inducing sleep, it has been found to be useful in doing so.
Xanax is part of a class of drugs called benzodiazepines, medications that work against symptoms of anxiety by depressing the central nervous system and producing feelings of sedation and relaxation. Benzodiazepines are widely prescribed in the United States despite their fairly high risk for abuse and potential addiction. Benzodiazepines work by mimicking a neurotransmitter known as gamma-aminobutyric acid (GABA). GABA regulates how the body responds to feelings of stress, fear, and yes, anxiety, and generally calms brain activity and inhibits nerve signals.
By mimicking GABA and binding to the brain’s GABA receptors, benzos activate the receptors and greatly increase GABA production, depressing the central nervous system in a way that the body would never be able to do naturally on its own.
In comparison, non-benzodiazepine sedatives like Ambien and Lunesta, commonly known as “Z-drugs,” are more discriminating in what GABA receptors they activate, strictly activating the receptors that induce sleep. Because benzos have a more widespread effect on the central nervous system, they are much stronger than Z-drugs, but they also have far more side effects, some of them more dangerous than others.
Sleep Hangover and Other Side Effects
If someone is taking Xanax for their anxiety, meaning only occasional use, and they decide to take Xanax to sleep, then they are extremely likely to experience what is known as a “hangover effect,” which can include feelings of grogginess, reduced motor skills, impaired coordination, and even amnesia.
These effects can persist from anywhere between eight and 12 hours, which means someone taking Xanax for sleep could wake up feeling more tired than they would have without it, or, if they take Xanax late at night, such as after midnight, and then wake up at six in the morning, they could potentially be dealing with sleep-hangover side effects for the next six to seven hours.
Another part of this issue is that, as has been stated, Xanax’s main purpose is to treat anxiety, and so when someone takes Xanax while experiencing an anxiety or panic attack, the medication is working against chemicals in the body, counteracting them by mass-producing GABA.
When someone takes Xanax for sleep rather than for the symptoms of anxiety, because there is nothing for the Xanax to counteract, they will experience even more intense sleep-hangover effects. This could prove to be extremely dangerous if someone has to drive or do other activities that require alertness in order to be safe.
Not Worth the Withdrawal
While taking Xanax to sleep will most likely not have any immediate harmful effects, falling into a pattern of use presents many possible problems. Perhaps most important is that someone regularly taking Xanax can become tolerant to its effects very quickly. Just one to two weeks of nightly Xanax use is enough to build up a tolerance and start requiring more of it to achieve the same insomnia-fighting effects.
As a person’s tolerance grows and they need to take more Xanax, they are likely to begin misusing it, and misuse is a short road to abuse, which can then progress to dependence and addiction. Once someone has become dependent on Xanax, especially needing Xanax to sleep, it becomes extremely difficult to stop using. This is in part because the withdrawal symptoms for Xanax, as well as benzodiazepines in general, can be unpleasant, painful, and sometimes even dangerous.
Any attempts to stop using Xanax should be done under the supervision of a medical professional, ideally at a medical detox center. There, generally, an individual will be put on a tapering schedule to slowly lower their Xanax dosage until it is safe for them to stop using.
The worst thing someone can do is try to stop using Xanax all at once. Not only can this bring about difficult to manage symptoms like rebound insomnia, which is typically worse than the initial insomnia someone would have been dealing with before taking Xanax, it can also cause life-threatening seizures.
In short, while Xanax does, technically speaking, work against insomnia and can help someone fall asleep, the side effects and potential for abuse and addiction make it far too risky a choice, especially when considering that someone using it is just as likely to wake up as groggy and unrested as they would be without it.
Other Options Besides Xanax for Sleep
Xanax may be used to treat sleep problems off-label, but it’s usually not a first-line medication for sleep. There are medications that facilitate hypnosis without the same risks of dependence and addiction that come with Xanax. In many cases, antihistamines, which are used to treat allergies, are used to facilitate sleep because they can cause drowsiness as an added effect. Some are sold over the counter, but your doctor may prescribe a better medication for your needs.
Antidepressants are also used to address sleep problems in some cases, especially when sleep issues occur alongside mental health problems. However, antidepressants may be less useful if your sleep issues aren’t necessarily tied to mental health issues.
Several types of sedative medications that work similarly to Xanax are called non-benzodiazepine sedative-hypnotics. A group of these drugs is sometimes called Z-drugs because they often start with the letter Z. Drugs like Ambien (zolpidem) are commonly prescribed to help people get to sleep. However, they may cause similar side effects to Xanax, like next-day drowsiness.
Does Xanax Keep You Awake?
As a benzodiazepine, Xanax can cause drowsiness, sedation, and hypnotic effects. When you take it, it’s much more likely to make you feel sleepy than it is to keep you awake. However, if you use it regularly for a few weeks or take it in high doses, you may become chemically dependent on the drug. After you develop chemical dependence, you may experience uncomfortable withdrawal symptoms when you try to cut back or stop using it. One of the most common withdrawal symptoms is rebound insomnia. In some cases, insomnia can be worse than when you were using the drug for the first time.