Xanax (Alprazolam) for Sleep: How it Works, Side Effects & Alternatives

Picture this scene: You’re lying wide awake at two 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 doze off.

Those desperately in need of some shut-eye might turn to Xanax® for sleep.

You might’ve heard of people using benzodiazepines like Xanax (or generic alprazolam) to treat anxiety disorders. But sometimes, people use them when they have trouble falling or staying asleep. The truth is, while these prescription medications certainly can help you drift off, they’re not the best choice for this problem for a number of reasons.

In this article, we’ll unpack those reasons and explain how benzodiazepines like Xanax work, their risks, common side effects (depression can be one of them), and alternative treatment options for those interested in a healthier, 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’s often used to treat panic disorder and anxiety disorders like generalized anxiety disorder (GAD).

With other common anxiety medications, namely antidepressants, it can take weeks for your body to fully feel the effects. Meanwhile, benzodiazepines provide almost immediate relief.

Xanax works by binding to the GABA-A (gamma-aminobutyric acid) receptor. GABA is a neurotransmitter — a chemical that helps regulate the 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 they might also cause some sleepiness.

While alprazolam wasn’t originally developed as a sleep medication and isn’t approved by the U.S. Food and Drug Administration (FDA) for that purpose, medical professionals sometimes prescribe it off-label, although this was more common in the past when the serious risks associated with this practice were less well understood. (Off-label use is when a drug is prescribed to treat something it’s not FDA-approved for.)

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 could make it easier 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.

It’s also worth noting that research suggests healthcare professionals are more likely to prescribe benzodiazepines to women than men. 

Regardless of your gender, here are a few considerations you should be aware of.

Alprazolam for Sleep Isn’t a Long-Term Solution

Something to consider is that, as mentioned, alprazolam was never designed to be a sleep 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 found a general lack of research on the long-term effectiveness of alprazolam and other benzodiazepines for sleep. Moreover, a small amount of research 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. Known as “rebound insomnia,” this phenomenon is when medications like alprazolam and other benzodiazepines are at first helpful but later make it increasingly harder to sleep, especially 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. It’s especially key for memory processing, cognitive function, and learning.

In this restorative sleep mode, growth hormone is released and helps regenerate tissues. When you use benzodiazepines like alprazolam, it reduces the amount of time your brain has in this crucial unconscious state.

There’s a High Risk Of Dependency and Addiction

There’s a reason alprazolam is typically prescribed for short-term use — when used for a longer period, it can potentially become addictive.

It’s vital that patients are carefully evaluated before being prescribed alprazolam, especially those prone to substance abuse, elderly patients, and folks with 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 how long you were on the medication, symptoms of withdrawal might even last for weeks.

If you choose to stop using alprazolam — or any medication for that matter — it’s crucial you talk to your healthcare provider to come up with a plan to taper yourself off as safely as possible.

Using Xanax for Sleep Has Side Effects

Last but not least, you might experience adverse effects. There are common side effects associated with most medications, including alprazolam.

Some adverse effects to be aware of are:

• Drowsiness or reduced alertness

• Depression

• Irritability

• Dizziness or lightheadedness

• Trouble concentrating or memory issues

• Changes in appetite resulting in weight gain or loss

• Difficulty sleeping or insomnia 

• Headaches 

• Nausea or vomiting

• Hypomania (a milder version of mania)

• Trouble with balance or coordination 

• Slurred speech

• Muscle weakness

• Dry mouth

Not everyone will experience all of these Xanax side effects, and they could become less noticeable over time. But if you rely on this medication for sleep, it could make it harder to drift off without it.

Maybe it’s the post-dinner espresso you drank or the anxiety buzzing in your head from this week’s mile-long to-do list, but you can’t be sure. In the meantime, the only thing to do is wait for your brain to finally let you get some sleep.

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 blood pressure, the ability to concentrate, memory, and more — as well as other sleep difficulties.

Research shows that women, in particular, struggle with sleep issues like sleep deprivation and insomnia. The CDC (Centers for Disease Control and Prevention) reports that over 21 percent of women have trouble staying asleep, while 17 percent have trouble falling asleep. For men, those percentages are 15 and 12 percent, respectively.

To cope with sleep struggles, some people drink a calming tea, listen to chill music, or read a book until they’re able to fall asleep. 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.

Now that you know the downsides of using alprazolam as a sleep medication, you might be wondering what medications or remedies are safe to use.  

We’re glad you asked. The good news is that there are a handful of effective options that don’t come with the same risks of dependency and intense withdrawal symptoms as alprazolam.

Some alternative to Xanax for sleep:

• Trazodone

• Doxepin

• Zolpidem (Ambien®)

• Over-the-counter sleep aids

How do they work? Let’s find out.

Trazodone

An FDA-approved drug for major depressive disorder, trazodone is an antidepressant that also has sedating (calming or sleep-inducing) effects and may be prescribed for insomnia.

Trazodone is in a group of medications called serotonin modulators. It works in two main ways to affect serotonin. First and most importantly, it blocks specific serotonin receptors called 5-HT2A. Second, it mildly prevents the reabsorption of serotonin, but this effect is much weaker than selective serotonin reuptake inhibitors (SSRIs), a common type of antidepressant.

When prescribed for sleep disorders, it’s usually taken at a lower dosage than for depression. Unlike Xanax, trazodone isn’t addictive or habit forming. Trazodone has actually been prescribed more often for sleep than for its FDA-approved treatment of depression.

All that said, trazodone isn’t without potential drawbacks. Possible side effects include headaches, fatigue, and dizziness.

Doxepin

Doxepin belongs to a class of drugs 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. It can also help with insomnia at lower dosages.

This TCA medication can be used to treat people who frequently wake up in the middle of the night, but it doesn’t seem to help people fall asleep.

A 2013 scientific review looked at several studies examining doxepin as an insomnia treatment. It suggested that when prescribed at low doses of 3 or 6 milligrams (mg), doxepin is effective and well-tolerated.

And although some medications have side effects like drowsiness, doxepin is less likely to make you feel like a zombie the next day. 

Zolpidem (Ambien)

If you haven’t heard of zolpidem, 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. Like benzodiazepines, zolpidem is classified as a controlled substance by the DEA (Drug Enforcement Administration).

Ambien isn’t as habit-forming as alprazolam and has been found to be effective when paired with cognitive behavioral therapy (CBT). But there are some rather severe side effects associated with zolpidem, like hallucinations, sleepwalking, and driving cars while asleep.

Over-the-Counter Sleep Aids

Over-the-counter medication or supplements might be an option to consider if you have mild insomnia or at least fewer occurrences of it. While these sleep aids may not have the same impact as prescription medications, they may work well enough for some people.

One of the major benefits of over-the-counter products is that you don’t need a healthcare provider’s sign-off to purchase them.

A few of the more popular natural products (you might already have a few of ’em in your kitchen pantry) include:

• Chamomile tea

• L-theanine supplements

• Magnesium

• Melatonin

Melatonin supplements, in particular, have proven to be very safe, with some research showing they can be used by folks with insomnia to curb chronic benzodiazepine use.

Sleeping pills that block histamine, such as ZzzQuil (diphenhydramine) or Unisom (doxylamine), are also sold over the counter as sleep aids. 

Here’s the deal: 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 dangerous side effects, withdrawal symptoms, and addictive qualities that may be harmful in the long run.

We know sleeplessness can have a major impact on mental health. So, if you’re struggling with a sleep disorder like insomnia or other sleep problems, the best course of action is to seek medical advice from a healthcare provider.

In the meantime, there are other things you can do to help improve your sleep like: 

• Therapy. While prescription drugs can certainly be part of your treatment plan, so can opening up to a mental health professional such as a therapist. Kinds of therapy to explore include CBT — a type of psychotherapy (i.e., talk therapy) that has been shown to have a positive impact on insomnia.

• Limiting time on social media. How many times have you promised yourself you’d only be on TikTok for five minutes before bed, only for an entire hour to magically disappear? We’re guilty too. Screen time before bed could hurt your shut-eye because not only does it usually eat up far more time than you planned, but in addition, the blue light emitted from your phone tricks your body into producing less melatonin (the hormone that helps you sleep).

• Cutting back on caffeine and alcohol. Certain substances like caffeine and alcohol can deeply impact sleep quality. To make sure you’re getting the best rest possible, consider cutting back on the cold brews or 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 you’re staring at your bedroom ceiling at two a.m.

For more resources for prioritizing your well-being, explore the mental health products and services on our telehealth platform.