Benzodiazepines are a group of central nervous system depressants that are prescribed for several purposes. They’re often used to treat anxiety and panic disorders, but they can also be prescribed as muscle relaxants and sleep aids. However, benzodiazepines may not be the first line of defense when it comes to sleep disorders like insomnia. Because the drugs can cause chemical dependence after a few weeks of use, other options may be better.
Still, they are sometimes used to treat sleep problems, especially in sleep issues that don’t respond to other options. But do benzodiazepines help sleep? Can they affect your sleep when you’re using it for other purposes like anxiety and muscle spasms? Learn more about benzodiazepines for sleep.
Benzodiazepines work in the brain and body by slowing down activity in your central nervous system. Like other drugs and medications, it does this by interacting with your brain’s chemical messaging system, and a specific chemical messenger called gamma-aminobutyric acid (GABA). GABA is a neurotransmitter that’s responsible for encouraging sleep, relaxation, rest, and anti-anxiety in the brain. GABA binds to its receptors and works to slow down nervous system activity, which can have many relaxing effects, including sleepiness and hypnosis.
People that have anxiety and sleep disorders may have a problem that makes it so GABA, and other natural processes, aren’t enough to achieve rest and relaxation. Benzodiazepines can help by binding to GABA receptors and increasing their effectiveness. When it comes to GABA, benzodiazepines work in similar ways to other depressants like barbiturates and alcohol. They bind to GABA receptors and increase the effectiveness of GABA’s depressant effects. Benzodiazepines can help people with sleep and anxiety disorders rest and relax.
Benzodiazepine Use
Benzodiazepines are sedative drugs that bind to the gamma-aminobutyric acid (GABA) receptors in the brain, making the GABA neurotransmitter more bioavailable to slow down communication between neurons. These drugs became popular alternatives to barbiturate sedatives starting in the 1950s because barbiturates led to higher levels of sedation, daytime fatigue, and dangerous muscle relaxation.
Currently, benzodiazepines are the most widely prescribed medications in the United States. According to IMS Health, in 2011, millions of prescriptions for benzodiazepines were given and filled, including:
- 49 million prescriptions for alprazolam (Xanax)
- 27.6 million for lorazepam (Ativan)
- 26.9 million for clonazepam (Klonopin)
- 15 million for diazepam (Valium)
- 8.5 million for temazepam (Restoril)
Common Benzodiazepines Used in Insomnia Treatment
Insomnia is a condition in which a person has trouble falling asleep or staying asleep through the night. This leads to daytime drowsiness, mood swings, weight gain, difficulty with learning or thinking clearly, and other problems. People who have chronic insomnia may not be able to fall asleep even when they feel tired.
While there are numerous types of benzodiazepine chemicals, about 15 have been approved by the U.S. Food and Drug Administration (FDA) for prescription use in the United States. Of these, only a few are used to treat chronic insomnia, including:
- Estazolam
- Flurazepam (Dalmane)
- Temazepam (Restoril)
- Quazepam (Doral)
- Triazolam (Halcion)
Most benzodiazepine drugs are used for the short-term or as-needed treatment of anxiety or panic attacks. Stronger benzodiazepines are used to manage seizure disorders like epilepsy, induce sleep in people who have conditions like narcolepsy, or manage anesthesia during surgery.
Because benzodiazepines are a sedative drug, they can have an impact on fatigue and sleep cycles. Using them as the main approach to insomnia treatment is no longer considered the most medically sound approach.
Problems With Using Benzodiazepines as Sleep Aids
As a treatment for chronic insomnia, benzodiazepines do not force the person to pass out or fall asleep. Instead, they reduce sleep latency, or how long it takes for the person to fall asleep.
One study found that sleep latency was reduced to four minutes, and there was an average of one more hour of sleep gained by taking a benzodiazepine as part of overall insomnia management. They also reduce the number of times a person may wake up during the night. Insomnia and anxiety are linked through GABA neurotransmitter management, so allowing the person to relax helps them fall and stay asleep.
Benzodiazepines change how the brain manages sleep cycles. While the drugs allow the person to fall into non-rapid eye movement (REM) sleep faster, they may change how many sleep cycles the person experiences, how long they stay in NREM sleep, and how often they enter REM sleep.
People who take benzodiazepines to treat insomnia may experience daytime sleepiness as a common side effect. This is because the brain does not move through a regular sleep cycle even though the person may have been asleep for an average timeframe of seven to nine hours.
Benzodiazepines are not recommended for consistent, long-term use anymore. These drugs are addictive, and even when taken as prescribed, they can quickly lead to physical dependence and tolerance.
After a couple of weeks, you will likely start to feel like you need a higher dose to help you fall asleep. This indicates tolerance to the substance.
Can Benzodiazepines for Anxiety Affect Your Sleep?
Benzodiazepines are primarily taken to treat anxiety disorders since there may be better options to treat issues like insomnia. However, if you’re taking benzodiazepines for anxiety, can they affect your sleep. Sleep problems are often a consequence of anxiety. Racing thoughts and worrying may make it difficult for you to fall asleep or stay asleep through the night. In some cases, treating anxiety with medications like benzodiazepines or therapy can improve your sleep quality.
However, taking a benzodiazepine for anxiety can also cause sleepiness or drowsiness as a side effect. For instance, the FDA says that side effects like drowsiness or light-headedness are common at the beginning of treatment with Xanax. You may be able to work with your doctor to adjust your dose or medication to avoid symptoms.
Alternatives
There are different medications that work better for managing insomnia, but few medical professionals will recommend a drug, including benzodiazepines, as a long-term method of managing sleep problems. Instead, a doctor may prescribe doses of benzodiazepines for a few nights, up to about two weeks at most.
These drugs may be recommended for use as needed, or to help the person get back into the habit of sleep alongside lifestyle changes called sleep hygiene. Making changes with the help of a counselor will help to manage anxiety and sleeplessness better than any medication can.
Your Doctor Can Help You Taper Off Benzodiazepines and Focus On Sleep Hygiene Changes. These May Include:
- Going to bed and getting up at the same time every day
- Turning off all the lights and distractions in your room
- Keeping your bedroom cool
Other alternatives could include:
- Z-drugs. Z-drugs are officially called non-benzodiazepine sedatives/hypnotics. Common Z-drugs include Ambien and Lunesta. They are depressants like benzodiazepines but they are generally milder and are less likely to cause serious side effects.
- Antihistamines. Antihistamines are generally used to treat allergies, but they have the added effect of causing drowsiness. These are sold over the counter and given as prescriptions. Your doctor may suggest trying them when you’re having trouble sleeping.
- Antidepressants. Antidepressants including SSRIs and SNRIs are primarily used to treat depression, but they can also be used to treat anxiety. If your sleep problems are rooted in mood or emotional problems, antidepressants may help.
- Light therapy. Light therapy involves the use of a device called a lightbox that’s designed to mimic sunlight. It’s used to treat seasonal affective disorder, but it may be useful in treating insomnia. If you live in a northern region and experience insomnia during times of the year with limited sunlight, this could help.
- Cognitive-behavioral therapy. Cognitive-behavioral therapy is an approach to therapy that’s used for several behavioral and mental health problems. It can help you address your thinking and it might relate to insomnia. You may be able to find better-coping strategies to help you sleep.
Withdrawal Symptoms Hurt Sleep
Withdrawal from benzodiazepines typically leads to a worsening of symptoms that the drug was initially prescribed to treat. For example, if someone has anxiety and takes benzodiazepines to manage this condition, then suddenly quitting the medication will cause rebound effects, or withdrawal symptoms, that include worse anxiety and panic attacks.
The Following are Other Withdrawal Symptoms:
- Depression
- Mood swings and irritability
- Apprehension or paranoia
- Agitation
- Tachycardia (rapid heartbeat)
- Muscle tension
- Tremors or shaking
- Hyperreflexia (over-response to stimuli)
- Sweating
- Fever
- Rebound insomnia
- Seizures
About 50 percent of people who take benzodiazepines develop this withdrawal syndrome, especially if they try to quit by themselves without tapering or medical oversight.
Physiological dependence occurs in about four to six weeks, but psychological dependence may begin immediately. People who take benzodiazepines for chronic anxiety or insomnia may associate the drug with feeling better, and they will have a difficult time quitting it when they no longer need it. They may increase their dose without consulting their doctor.
If they do attempt to quit on their own, the discomfort of withdrawal symptoms makes sleep and daily activity difficult, so they are more likely to quickly relapse.
The Importance of Medical Assistance
Both withdrawal symptoms and ongoing benzodiazepine abuse are dangerous. Medical oversight during detox can prevent severe, life-threatening symptoms like seizures.
The most common method for ending physical dependence on these sedatives is tapering, but an overseeing physician is needed to manage the process. Many rehabilitation programs will help you focus on sleep hygiene and other lifestyle changes to improve anxiety and insomnia symptoms. The goal is to avoid substance abuse and promote good sleep.
