Is Xanax (alprazolam) good for sleep?

Is Xanax (alprazolam) good for sleep?

Xanax (alprazolam) can you tired and is sometimes prescribed for sleep issues—but it isn't a sleeping medication and comes with drawbacks.

Reviewed by:
Michael Roman, MD
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May 22, 2024
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Key takeaways

Tossing and turning for hours, struggling to fall asleep, and having trouble staying asleep can have significant impacts on your quality of life since sleep deprivation can make you feel terrible the next day. Up to 15% of the general population has insomnia, and many of these people turn to sleep aids––both prescription and over-the-counter––to help them sleep.  

In some cases, the sleep aid in question is Xanax, the brand name for alprazolam. Although Xanax is technically an anti-anxiety medication, doctors sometimes prescribe it to people who struggle with insomnia. But Xanax comes with negative consequences and potential for misuse, and other treatments for both insomnia and anxiety, can be a better choice.


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In this article we’ll talk about these risks, as well as how Xanax works, its efficacy for insomnia, and side effects.

How does Xanax work?

Xanax, the brand name for alprazolam, belongs to a class of drugs called benzodiazepines, which are conversationally called “benzos.” Only available with a prescription, Xanax is also a controlled substance, which means there are typically state regulations regarding how and when it’s prescribed as well as how much.  

Benzodiazepines like Xanax are central nervous system (CNS) depressants, which work by slowing down your brain activity. CNS depressants can also help the muscles in your body relax and may be referred to as sedatives. (More on why that can be a potentially negative consequence later.)

Xanax works by boosting the effects of gamma-aminobutyric acid (GABA), which is a brain chemical that makes your nervous system less active. This results in an overall calming effect, reducing anxiety.  

Does Xanax make you sleep? For how long?

Since Xanax can cause drowsiness and sedation, it’s possible that it can make you sleep.  In some cases, doctors prescribe alprazolam for sleep troubles, but this is an “off-label” use. Off-label means using a medication for something other than its originally intended indication based on scientific evidence. So, while the FDA has not approved Xanax as a treatment for insomnia, it can still be prescribed for that purpose.

However, there is some conflicting evidence surrounding how effective Xanax is for sleep. Early research on alprazolam for sleep found that on the first few nights of taking the medication, it was very effective in helping people fall asleep and stay asleep. However, after a week of use, the effectiveness was about 40% less. Additionally, after stopping the medication, the participants experienced “rebound insomnia,” having even more trouble sleeping than before.  

It’s generally agreed upon that benzodiazepines like alprazolam for sleep are only effective for short-term use, up to a few weeks, before the effects wear off. So, if you struggle with long-term, chronic insomnia, Xanax likely isn’t the best fit for you.  

If you think you have insomnia, know that it’s treatable, and there are non-habit forming medications that can help you sleep. The first step is getting a clinical diagnosis from a qualified mental healthcare professional, like a psychiatrist.  

Does Xanax help with anxiety?

Xanax is FDA-approved to treat generalized anxiety disorder (GAD) and panic disorder and can provide fast relief for your symptoms of anxiety. Xanax typically works within 30 minutes) so it can be helpful in managing panic attacks or acute episodes of heightened anxiety.  

However, Xanax (and benzodiazepines in general) are not recommended for long-term use in treating these disorders since they have a potential for misuse and addiction, and have been linked to an increased risk of dementia. Other medications like Vistaril (hydroxyzine) and Inderal (propranolol) can also treat physical symptoms of anxiety quickly and don’t have the same risks.  

Xanax dosage for anxiety  

Recommended Xanax dosages for anxiety per the FDA are as follows—but remember that ultimately the dosage will depend on your circumstances and your doctor’s advice. Everyone responds to medications differently, and some people may experience relief from a lower dose, while others might need a higher dose to feel the same effect.  

Starting dosage Maximum dosage
For generalized anxiety disorder 0.25 mg to 0.5 mg, 3 times a day 4 mg a day total, in divided doses
For panic disorder .5 mg, 3 times a day 10 mg a day total, in divided doses

Your doctor will start you on a low dose, and if needed, slow and carefully increase it, likely in three or four day intervals. If you’re taking Xanax as needed, this will likely be for panic attacks or other highly anxiety-inducing scenarios where you need some extra help to calm down.  

Remember that Xanax is only meant for short-term use since it can be habit-forming, has a high risk for dependence, and a risk for misuse and addiction. Many psychiatrist’s primary choice for treating anxiety are antidepressant medications like SSRIs (selective serotonin reuptake inhibitors).

For other options, check out these alternatives to Xanax.

What are the risks of taking Xanax?

Taking Xanax comes with risks. Here are some precautions and considerations you should take into account before taking it.

Risk of misuse and addiction  

The risk of dependency and misuse is typically the biggest concern among providers. Xanax has a high rate of abuse and addiction because it works so quickly to make you feel better. The combination of Xanax's rapid onset and its short duration of effects contribute to the drug’s potential for misuse. People may find themselves building up a tolerance and seeking out more frequent, higher doses to get the same desired effects or even to alleviate the withdrawal symptoms they feel.  

Part of this is because Xanax has a short half-life, which refers to the amount of time it takes for your body to metabolize or get rid of half the original dose of medication. Once the Xanax levels in your blood drop, you might experience a rebound effect of your initial symptoms returning, possibly even more intensely. Then, you might feel like you need to take more of it to relieve those symptoms, and the cycle continues. The risk for misuse and addiction of Xanax is even higher in people with a history of substance abuse.  

It’s crucial that Xanax prescriptions should only be obtained from a doctor and you should closely follow their dosing instructions.  

Drug interactions

Many medications interact with Xanax in potentially harmful ways. Using Xanax with other central nervous system depressants is especially dangerous since this increases the risk of low blood pressure and trouble breathing due to respiratory depression. his can be dangerous and even fatal.

Examples of these medications include:

  • Opioids
  • Certain prescription cough medications
  • Other benzodiazepines
  • Sleep medications
  • Muscle relaxants
  • Barbiturates
  • Antipsychotics
  • Alcohol is not a medication, but it is a central nervous system depressant, which also makes it highly dangerous to combine with Xanax.  

Other medications that can interact with Xanax are:

  • Certain antifungal medications
  • Certain antibiotics
  • Certain antidepressants  
  • Antihistamines (allergy medications)
  • St. John's wort (a herbal supplement)  

This is not an exhaustive list of CNS depressants or other medications that can result in drug interactions. Before prescribing Xanax, your doctor will ask you about other prescriptions, over-the-counter medications, and supplements that you’re taking to make sure you can take Xanax safely.  

Withdrawal  

Withdrawal occurs when your body becomes dependent on Xanax, and then you experience uncomfortable symptoms when you stop using the medication. Compared to other benzodiazepines, Xanax may result in the most severe withdrawal symptoms. These symptoms can range from bothersome and mild to severe and dangerous. On the mild end, you may have rebound anxiety or insomnia, irritability, sweating, tremors, nausea, and headaches. Seizures are a more dangerous potential withdrawal symptom.  

This is why it’s so important to gradually taper off your medication rather than stopping it cold turkey. When you come off of Xanax gradually, you will minimize your risk of withdrawal symptoms and keep yourself safe.  

Pregnancy and breastfeeding risks

Taking Xanax during pregnancy, especially in the later stages of pregnancy, can pose risks such as sedation and respiratory depression. Another risk is neonatal withdrawal, which means the baby can experience withdrawal symptoms after being born.

Since Xanax can pass through breast milk, the FDA advises against breastfeeding while taking Xanax. Whether you’re pregnant or breastfeeding, it’s important to talk with your doctor, especially your OB/GYN, to determine the safety of your unique situation and to see if the benefits outweigh the risks.  

Side effects of Xanax  

As with all prescription medications, Xanax does come along with potential side effects. According to the FDA, drowsiness and lightheadedness are the most common adverse effects of Xanax.

More Xanax side effects include:

  • Drowsiness or sleepiness
  • Dizziness or lightheadedness
  • Trouble concentrating  
  • Headaches
  • Nausea
  • Constipation  
  • Feeling irritable
  • Talkativeness  
  • Changes to appetite (increased or decreased appetite)
  • Changes to weight (gaining weight or losing weight)  
  • Changes to libido (increased or decreased libido) and/or sexual dysfunction  
  • Changes in salivation (increased saliva or decreased with dry mouth)
  • Trouble urinating
  • Joint pain  

These side effects may be worse when you first start the medication and lessen with time. If your side effects worsen or are not tolerable, make sure to tell your doctor. Some side effects could be a sign of something more serious. If you experience any of the following adverse effects, seek medical attention.

  • Confusion
  • Trouble with balance and coordination
  • Slurred speech
  • Shortness of breath
  • Seizures
  • Yellow eyes or skin
  • Rash  

Is Xanax right for me?  

Xanax can be effective for treating certain conditions but it can be habit-forming and comes with negative consequences that should be seriously considered. Whether you’re curious about Xanax for sleep, anxiety, or both, only a doctor can determine if the medication is right for you. They will take your medical history and symptoms into account before deciding to prescribe you Xanax.

If you’re looking for a psychiatrist, consider Talkiatry. We’re a national psychiatry practice that treats insomnia, anxiety disorders, and more. Our psychiatrists will work with you to find a treatment plan that best fits your needs. To get started, complete our free online assessment to get matched with a psychiatrist.  

FAQs

Here are more answers to your questions about Xanax.

Does Xanax make you tired?

Yes, Xanax can make you tired. Drowsiness is one of the most common side effects of Xanax, so it should never be taken with alcohol or other medications that have an affect on your nervous system.  

Is Xanax better than Ambien?  

One medication is not inherently “better” than the other. However, Ambien (the brand name for zolpidem) is FDA-approved for the short-term treatment of sleeplessness, while Xanax is not. Ambien is primarily prescribed for insomnia, whereas Xanax is primarily prescribed for anxiety. Neither medication is ideal for long-term use. Talk to your doctor if you have concerns about either medication.

What are alternatives to Xanax for sleep problems?  

There are many options for treating sleep problems. Aside from Xanax and other benzodiazepines, examples of prescription sleep medications include  

  • Non-benzodiazepines AKA “Z drugs”  
  • Dual orexin receptor antagonists (DORAs)
  • Melatonin receptor agonists
  • Anti-seizure medications or sedating antidepressants  

Over-the-counter sleep aids are also an option, but you should check with your doctor first. You can also take a non-medical approach to insomnia treatment by implementing lifestyle changes and/or seeking therapy, especially cognitive behavioral therapy for insomnia (CBT-I).

The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.

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Frequently asked questions

Does Talkiatry take my insurance?

We're in network with major insurers, including:

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The best way to get a detailed estimate of your cost is to contact your insurance company directly, since your cost will depend on the details of your insurance.  

For some, it’s just a co-pay. If you have an unmet deductible it could be more.  

Call the number on your insurance card and ask about your plan’s coverage for outpatient psychiatric services.

What kind of treatment does Talkiatry provide?

At Talkiatry, we specialize in psychiatry, meaning the diagnosis and treatment of mental health conditions. Your psychiatrist will meet with you virtually on a schedule you set together, devise a treatment plan tailored to your specific needs and preferences, and work with you to adjust your plan as you meet your goals.

If your treatment plan includes medication, your psychiatrist will prescribe and manage it. If needed, your psychiatrist can also refer you to a Talkiatry therapist.

What's the difference between a therapist and psychiatrist?

Psychiatrists are doctors who have specialized training in diagnosing and treating complex mental health conditions through medication management. If you are experiencing symptoms of a mental health condition such as depression, anxiety, bipolar disorder, PTSD, or similar, a psychiatrist may be a good place to start.  

Other signs that you should see a psychiatrist include:  

  • Your primary care doctor or another doctor thinks you may benefit from the services of a psychiatrist and provides a referral    
  • You are interested in taking medication to treat a mental health condition  
  • Your symptoms are severe enough to regularly interfere with your everyday life

The term “therapist” can apply to a range of professionals including social workers, mental health counselors, psychologists, professional counselors, marriage and family therapists, and psychoanalysts. Working with a therapist generally involves regular talk therapy sessions where you discuss your feelings, problem-solving strategies, and coping mechanisms to help with your condition.

How does Talkiatry compare to face-to-face treatment?

For most patients, Talkiatry treatment is just as effective as in-person psychiatry (American Psychiatric Association, 2021), and much more convenient. That said, we don’t currently provide treatment for schizophrenia, primary eating disorder treatment, or Medication Assisted Treatment for substance use disorders.

Who can prescribe medication?

All our psychiatrists (and all psychiatrists in general) are medical doctors with additional training in mental health. They can prescribe any medication they think can help their patients. In order to find out which medications might be appropriate, they need to conduct a full evaluation. At Talkiatry, first visits are generally scheduled for 60 minutes or more to give your psychiatrist time to learn about you, work on a treatment plan, and discuss any medications that might be included.

About
Michael Roman, MD

Dr. Michael Roman is currently a Staff Psychiatrist at Talkiatry. He completed his adult psychiatry residency training at the University of Pennsylvania. Dr. Roman is a board-certified Adult Psychiatrist and a diplomate of the American Board of Psychiatry and Neurology (ABPN).

Dr. Roman’s clinical practice centers primarily around medication management and psychopharmacological treatment approaches. He also specializes in a variety of psychotherapeutic modalities which he utilizes in conjunction with medication management in order to provide patients with the best possible treatment outcomes.

Dr. Roman’s curiosity for the studies of the human mind began with pursuing a bachelor’s degree in psychobiology at the University of California, Los Angeles (UCLA). He was intrigued by the way our mind, body, emotions, and behavior were intertwined to comprise our everyday life experiences. His interest in the intricacy of the human mind was deepened in medical school, and he received his medical degree from the David Geffen School of Medicine at UCLA. He completed his adult psychiatry residency training at the University of Pennsylvania.

Dr. Roman treats a wide spectrum of patients, but his primary clinical focus is treating mood disorders, ADHD, anxiety disorders, and PTSD. Dr. Roman also specializes in treating substance use disorders and possesses clinical expertise in implementing high quality motivational interviewing and motivational enhancing therapy.

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