How to take alprazolam for sleep and why

More than 10% of people have insomnia. One night of poor sleep can be bad enough, but if you’re struggling to doze off on a regular basis, it can feel like torture. If you’re looking for relief, you may be wondering how to take alprazolam for sleep. 

Alprazolam is the generic version of Xanax. While Xanax is an anti-anxiety medication, it can be prescribed off-label for insomnia. But, there are some downsides to taking alprazolam for sleep that you should know about. 

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What is alprazolam?

Alprazolam is the active ingredient in, and generic name for, Xanax. Xanax is approved by the U.S. Food and Drug Administration (FDA) to treat generalized anxiety disorder and panic disorder (with or without agoraphobia) in adults. It may be prescribed off-label for insomnia, premenstrual syndrome (PMS), and depression. Off-label prescribing is when a physician prescribes a medication for an indication other than the FDA-approved ones (in this case, sleep). 

Alprazolam belongs to a group of medications known as benzodiazepines (“benzos” for short). Benzodiazepines are central nervous system (CNS) depressants. They work by amplifying a brain chemical called gamma-aminobutyric acid (GABA). This creates a calming, anti-anxiety and sedative effect, which slows down your nervous system and relaxes your muscles.

Alprazolam comes in a few different forms, including regular- and extended-release oral tablets, dissolvable tablets, and a liquid solution. The dosing depends on what you’re taking it for.

• For generalized anxiety disorder, the starting dose is 0.25–0.5 milligrams, taken 3 times a day. The maximum dose is 4 milligrams a day.
• For panic disorder, the starting dose is 0.5 milligrams, taken 3 times a day. The maximum dose is 10 milligrams a day.
• For sleep, the dosage depends on your doctor’s discretion, as it is an off-label use of alprazolam. Typical starting doses may range from 0.5–1.0 milligrams per day, and are prescribed on a short-term basis (see more below).

Benefits of alprazolam for sleep

Xanax (alprazolam) has a calming effect on your brain and your body, which may help relax you to sleep. After taking Xanax for sleep for the first time, one Reddit user suffering from insomnia called it “the best sleep of [their] life in years.” Others say alprazolam helps them go back to sleep if they wake up in the middle of the night, or resets their “rhythm” after a bad bout of anxiety or insomnia.

Roughly 1 in 2 people with anxiety — which alprazolam treats — also suffer from insomnia. Alprazolam may help them sleep better by treating their anxiety.

In early studies of alprazolam for sleep, it was shown to be an effective short-term use and treatment for insomnia. In this case, “short-term” means a few days to a week. Participants reported that they fell asleep faster, and slept better overall. However, alprazolam’s sleep-inducing effects wore off after a handful of days. By the end of a week, it was about 40% less effective.

Side effects of alprazolam for sleep 

Like many prescription drugs, alprazolam can cause common and serious side effects. When taking alprazolam for sleep, side effects like difficulty controlling emotions with others can present after just a few days.

Sleep analyses also show that taking alprazolam messes with your sleep cycles. People taking alprazolam tend to spend more time in light sleep, and less time in both deep sleep and REM sleep. As a result, you might experience effects like trouble concentrating, remembering things, and weight gain.

Alprazolam is a Schedule IV controlled substance, which means that you can develop a physical dependence on it — and experience withdrawal symptoms once you stop taking it, like “rebound insomnia.” 

One meta-review found that people taking alprazolam experienced even more anxiety and sleep problems after stopping treatment, even when they tapered off slowly per their provider’s guidance. And, it’s worth noting that some studies have found that melatonin — a common over-the-counter sleep aid — beats alprazolam when it comes to better sleep quality and less intense insomnia.

How to take alprazolam for sleep disorders

As an off-label use, there’s no official dosing guidance when taking alprazolam for sleep. In one study, the most commonly reported dose of alprazolam for sleep was 0.5 milligrams once a day before bedtime. In another, participants were given a 1.0-milligram dose for 7 nights. But, your health provider will provide specific dosing instructions for you.

Take alprazolam exactly as prescribed by your provider. Alprazolam can be taken with or without food, but if you find it upsets your stomach, take it with food. 

What to know about alprazolam for sleep

While alprazolam can help you sleep, it may not be the safest, or most effective, treatment option to relieve insomnia. Here are the side effects and drug warnings you should know about.

Side effects 

Drowsiness is the most common side effect of alprazolam, which explains why it can be helpful for insomnia. Other side effects can vary, depending on your dosage, with people taking a higher dosage for panic disorder generally experiencing more side effects than those taking a lower dosage for anxiety. Besides drowsiness, common side effects of alprazolam can include:

• Lightheadedness or dizziness
• Confusion
• Gastrointestinal issues, such as dry mouth, increased salivation, or constipation
• Changes in mood, including increased irritability
• Changes in sex drive
• Changes in appetite or body weight
• Difficulty with coordination, memory, speaking, or focus
• Low blood pressure
• Skin rash

Given alprazolam’s effects on your brain and coordination, you should avoid driving or operating machinery when taking it. 

Warnings, drug interactions, and contraindications

Alprazolam is a Schedule IV controlled substance. That means it has a lower potential for misuse than other drugs, but it’s still possible to develop a dependence if you don’t take it as prescribed. It comes with a boxed warning for abuse, misuse, and addiction. This is the FDA’s strongest safety warning for a medication. Using alprazolam other than — or more than — prescribed can lead some people to develop a tolerance and need more of the drug, more often to get the same effects, which can result in dependence.

Alprazolam also carries a boxed warning for withdrawal symptoms, including seizures, insomnia, and anxiety. To reduce your risk, healthcare providers will gradually taper your dose when you’re ready to stop taking it.

Additionally, alprazolam comes with a boxed warning for use with opioids. Taking alprazolam with opioids can cause a dangerous level of sedation, respiratory depression, coma, and even death. Besides opioids, alprazolam should not be used with:

• Other central nervous system depressants (including alcohol)
• Digoxin
• CYP3A inhibitors (except ritonavir), such as clarithromycin, ketoconazole, and erythromycin
• CYP3A inducers such as lumacaftor, phenobarbital, and rifampin

Alprazolam has a long list of drug interactions. Tell your healthcare provider about all prescription and over-the-counter (OTC) medications you take, so they can ensure alprazolam is safe for you. People who are pregnant or breastfeeding shouldn’t take alprazolam. 

Alternatives to alprazolam for sleep

If you can’t sleep at night when you’re tired, you have options besides alprazolam. For example, various prescription sleep aids that may be a good fit for you, including:

• Other benzodiazepines, including Halcion (triazolam) or Restoril (temazepam)
• Non-benzodiazepines (Z-drugs), including Ambien (zolpidem), Sonata (zaleplon), or Lunesta (eszopiclone) 
• Dual orexin receptor antagonists (DORAs), including Dayvigo (lemborexant)
• Tricyclic antidepressants, including Silenor (doxepin)
• Melatonin agonists, including Rozerem (ramelteon)

As with Xanax, to get a prescription for Ambien or another sleep aid, you need to make an appointment with a healthcare provider. If you’re interested in something over-the-counter, melatonin is an effective (and often cheaper) option. In studies, people taking OTC melatonin fell asleep faster, stayed asleep longer, and reported better overall sleep quality.

You can also work on improving your sleep hygiene habits, such as:

• Sticking to a regular sleep schedule, going to bed and waking up at the same time every day
• Limiting daytime naps
• Avoiding heavy meals or consuming alcohol or caffeine late in the day
• Improving your diet
• Adopting a regular exercise routine
• Relieving anxiety through breathing exercises, meditation, or yoga

Cognitive behavioral therapy for insomnia (CBT-I) has proven very effective for treating sleep problems. This is a specialized type of therapy that focuses on the habits, thoughts, and behaviors that may be contributing to your sleep issues, and giving you the tools to recognize and combat them. It usually takes about 6 sessions over a period of weeks.

How to get alprazolam for sleep

As a prescription medication, you need to meet with a licensed healthcare provider if you want to take alprazolam for sleep. To get a prescription for Xanax for sleep, you can make an appointment with your primary care provider or a sleep specialist. You can also find a provider on Klarity Health.

During your appointment, the provider will determine whether alprazolam is an appropriate treatment for your insomnia, or if another approach would be better. 

Key takeaway

• Alprazolam (brand name Xanax) is an anti-anxiety medication that can be prescribed off-label for sleep.
• While alprazolam can help you fall and stay asleep, it should only be used on a temporary basis for insomnia. Its sleep-inducing effects start to wear off after a few days.
• As a benzodiazepine, alprazolam is a controlled substance that can cause dependence or lead to a substance use disorder. It should only be taken as prescribed, under the supervision of a healthcare provider.
• Alprazolam can cause withdrawal symptoms once you stop taking it, including rebound insomnia.
• There are other alternatives for treating insomnia, which can be more effective without the risk of dependence. These include prescription sleep medications, over-the-counter sleep aids, therapy, and lifestyle changes.

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You deserve a good night’s sleep. Insomnia is treatable, with the right treatment plan. Find a provider on Klarity Health today to discuss your symptoms and get the right treatment for you.