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Reviewed by Kristin Hall, FNP
Written by Our Editorial Team
It’s a common situation: after going to bed at your normal bedtime, you’ve spent hour after hour tossing and turning, waiting patiently for your brain to throw in the towel on awakeness and just let you fall asleep.
Millions of adults are affected by varying levels of insomnia and other sleep difficulties, with data from the CDC showing that 35 percent of American adults get less than seven hours of total sleep per night.
People take a variety of steps to deal with sleep difficulties. Some make a cup of chamomile tea and wait to doze off. Others use over-the-counter products like melatonin. Some wait it out and try their hardest to doze off, even if their body isn’t totally in agreement with their mind.
Others temporarily turn to benzodiazepine medications like alprazolam (the active ingredient in Xanax®). While these medications can and often do help you fall asleep, they’re far from the best option, both from an effectiveness and a health perspective.
Below, we’ve explained how benzodiazepine medications like Xanax work to help you feel tired and sleepy. We’ve also looked at the potential side effects they can have, as well as the risks using medications like these to fall asleep at night.
Finally, we’ve listed a range of safer alternatives to drugs like Xanax that you can talk about with your healthcare provider if you often find it difficult to sleep.
Alprazolam, the active ingredient in Xanax, is a type of medication called a benzodiazepine. It’s used as a short-term option to treat anxiety disorders, especially in people prone to anxiety and panic attacks.
Like many other benzodiazepines, alprazolam is quite an old medication. It was first patented in the 1970s and received approval by the FDA in the early eighties.
In the decades since, it has become very popular as a prescription medication, with more than tens of millions of prescriptions in the US alone.
However, just because it’s a popular prescription doesn’t mean it's the safest of drugs.
More recent studies have shown us that alprazolam has a high addiction potential, significant side effects and has been reported to have withdrawal symptoms.
As a treatment for anxiety, alprazolam works by binding to the body’s gamma-aminobutyric acid (GABA) receptors.
GABA is a neurotransmitter — a type of messenger used by the nervous system to relay signals between nerve cells. Neurotransmitters function like the body’s internal communications system, informing nerve cells and muscles of what they should do at any given time.
GABA is an inhibitory neurotransmitter that reduces neuron activity. When your body produces more GABA, it signals to nerve cells that they should slow down activity. In simple terms, GABA is a relaxation neurotransmitter that causes you to feel less anxious and more relaxed.
Benzodiazepines like alprazolam work by binding to your body’s GABA receptors, causing you to feel calm, relaxed and less anxious.
You also feel sleepy. Although alprazolam was never designed as a sleep medication and isn’t approved by the FDA specifically for treating insomnia, it’s sometimes prescribed off-label as an insomnia treatment.
In a short study from 1987, researchers noted that alprazolam was “highly effective in inducing and maintaining sleep” in people with insomnia. Another study from 1986 noted that alprazolam reduced sleep onset latency (the amount of time required to fall asleep) — however, it’s worth noting the sample side was very small, with only 12 volunteers.
In short, alprazolam appears to make sleeping easier. The problem is, as we’ve covered below, there are lots of downsides to using alprazolam as a sleep aid.
If you can’t sleep, using alprazolam will make you feel tired. However, there are significant Xanax side effects that you should be aware of, as well as a serious risk of developing a dependence if you use alprazolam or other benzodiazepines frequently.
Let’s start by looking at an immediate problem: alprazolam just isn’t very effective as a sleeping pill over the long term.
In the 1987 study mentioned above, people with difficulty falling asleep experienced noticeable improvements after using alprazolam. However, they didn’t last. By the end of one week of use, the researchers stated that alprazolam had “lost about 40 percent of its efficacy.”
The researchers also noted a “significant increase in sleep difficulty” within three nights after the patients stopped using alprazolam, meaning that many of the people that initially benefited from the alprazolam slept worse after they stopped using it than they did before treatment.
This is called “rebound insomnia,” and it’s a common problem among people who use Xanax and other benzodiazepines to treat sleep difficulties. While these drugs work in the beginning, it can become more and more difficult to sleep without medication after using them repeatedly.
Benzodiazepines like alprazolam can also reduce the amount of time you spend in slow-wave sleep — the deepest phase of non-REM sleep, which is important for restoring energy, immune health, as well as processes such as cellular regeneration and tissue repair.
In addition to its relatively poor performance as a sleep aid, alprazolam also has other potential risks that you should be aware of.
As we mentioned above, alprazolam is intended for use as a short-term treatment for anxiety and panic disorders. When it’s used frequently over the long term, it has a serious potential to cause dependence and addiction.
Because of this risk, the FDA advises that addiction-prone people should be kept under careful supervision when using Xanax.
Finally, alprazolam and other benzodiazepine medications can cause withdrawal effects. If you use alprazolam frequently — even if only as a sleep aid — and suddenly stop, you may experience symptoms like anxiety, difficulty concentrating, poor memory, sleep issues and others. More seriously, patients can also encounter seizures if stopping alprazolam suddenly.
These symptoms can vary in severity depending on how long you’ve used alprazolam, as well as the dosage you’re accustomed to. Many people experience withdrawal symptoms for weeks after stopping benzodiazepine use.
Even when used as prescribed without long-term dependence, alprazolam has a range of side effects. Common side effects of alprazolam include:
Akathisia (movement disorder often affecting the legs)
Hypotension (low blood pressure)
Muscular rigidity and tremors
As we’ve explained above, although alprazolam will make you feel sleepy, it usually isn’t a good medication to use as a sleep aid, as aside from not having a consistent body of scientific research behind its use as a sleep aid, it also comes with an elevated risk of abuse and addiction.
However, there are several medications available that can treat insomnia and make it easier for you to fall asleep, all without the side effects, risk of addiction or withdrawal symptoms of drugs like alprazolam.
Doxepin is a type of medication called a tricyclic antidepressant. It’s approved by the FDA as a treatment for insomnia. Studies show that small doses of doxepin increase total sleep duration (the amount of time you spend asleep) and make it easier to stay asleep.
Unlike alprazolam, doxepin is non addictive and isn’t habit-forming. It also doesn’t appear to be linked to next-morning drowsiness, meaning you should wake up feeling relatively normal after using it to treat sleep difficulties.
Like all medications, doxepin can cause side effects. However, these are uncommon when it’s used at a low dose to treat sleep conditions. As a prescription medication, you’ll need to talk to a healthcare provider before you can use doxepin to treat insomnia.
Like alprazolam, zolpidem works by binding to GABA receptors within the body. It causes you to feel drowsy and ready to sleep, with a fast onset that can make it an effective option if you often struggle to fall asleep quickly at night.
Although zolpidem isn’t a benzodiazepine and is less addictive than drugs like alprazolam, it can still be habit-forming. It’s also linked to unusual side effects, including a risk of doing things while asleep without any memory of these events in the morning, like sleep-walking or sleep-driving.
Like doxepin, zolpidem is a prescription medication, meaning you’ll need to discuss your sleep difficulties with a healthcare provider before you can purchase and use it.
Although over-the-counter products usually aren’t effective as prescription treatments, they may help you fall asleep and stay asleep if you only have mild or occasional insomnia.
Some over-the-counter sleep aids — like melatonin — may be effective at treating insomnia and a range of other sleep issues. There are also countless other natural sleep aids, many of which are supported by scientific evidence.
We’ve covered these products in more detail in our guide to natural sleep aids, which looks at everything from melatonin and valerian root to options like chamomile tea, 5-HTP, L-theanine and others.
Although alprazolam, the active ingredient in Xanax, will probably make you feel tired, it isn’t a good medication for treating insomnia. Not only does it reduce the amount of time you’ll spend in deep sleep (causing you to function poorly the next day), but it’s also potentially addictive.
Instead of using alprazolam to fall asleep, it’s best to talk to your healthcare provider about safer and more effective treatments such as doxepin. If you only have mild or occasional issues sleeping, you may also benefit from over-the-counter treatments such as melatonin.