How does Xanax impact sleep?

As an acute and chronic anxiety sufferer I have used Xanax since around 1980. It's the only anti-anxiety med I've ever been able to tolerate. I take it on a PRN basis and am very careful about how much I take. Typically I'll take .25 mg an hour before bedtime, and barring an episode that's it for the day. I feel like it does help me relax a bit and drift off to sleep.

Lately I've read a few opinions on the internet that say Xanax interferes with stage 3 sleep and REM sleep. But I haven't seen anything about this published by a reputable source, nor have I seen a scientific study. My sleep doc says he's never heard of such a thing.

But it occurs to me that if it does interfere with deep sleep it could skew one's AHI numbers into being artificially low by only allowing lighter sleep.

Do any of you have an opinion? And I'd appreciate it if you'd spare me the admonitions about how addictive it is-it's as necessary to me as my diabetic meds.

Thanks all.

I just did a Google search for "Xanax impact on sleep stages" and got these results.
https://www.google.com/search?q=Xanax%2 ... &source=hp
No time for me to read through them but you might give them a look to see if you have seen those hits.

Personally...I wouldn't worry about it. It's a tiny dose and the impact isn't going to be a much as if you were taking larger doses or multiple doses during the day and it's not like you are going to stop taking it anyway anytime soon.
There's always a risk vs rewards for any medication we take.
If you didn't take it...there's a good chance that the problem you take it for would also negatively impact your sleep.

With all due respect to both of you (and to the original poster's doctor)--you need be be Googling "Xanax REM suppressant" or "Xanax sleep architecture" or "Xanax REM latency." (Substitute the generic name, Alprazolam,if you wish) for the results you're looking for. Its negative effects on slow wave sleep and REM are fairly well represented in scholarly articles and medical textbooks. That being said, unless you're already dealing with screwed up sleep architecture (in which case it can be deadly in terms of restedness and functioning), whatever it's doing may not have much impact. (I'm terribly jealous of folks with high AHIs who still manage to test at normal, double-digit REM percentages.)

BTW, you're instincts are right about low REM = low AHI for some. When I feel especially well rested, I'm usually recording a higher AHI. (To give you some perspective, I get 2-4% REM and SWS--so xanax is a huge no for me, as are antihistimine sleep aids.)

There was a pdf document that wouldn't load in the search results I found but I had seen it before.
There are lots of meds that affect sleep architecture or sleep stages. It's all about which is worse...the possible side effects from whatever med we are taking or the problem the med is supposed to help fix.

Did you have an in lab sleep study? If so did you get a copy of the results that should include the various sleep stages and percent of time in each stage to see if there is any marked reduction from normal percent ranges?
Did you take the Xanax the night of the sleep study?

I take a couple of meds that are known to affect sleep architecture...but if I didn't take them I wouldn't get much sleep at all for reasons unrelated to OSA.
For me it's better to get some sleep even if it isn't "perfect" sleep than it is to not get sleep or wake up 50 times a night.

Pugsy wrote:There was a pdf document that wouldn't load in the search results I found but I had seen it before.
There are lots of meds that affect sleep architecture or sleep stages. It's all about which is worse...the possible side effects from whatever med we are taking or the problem the med is supposed to help fix.

Did you have an in lab sleep study? If so did you get a copy of the results that should include the various sleep stages and percent of time in each stage to see if there is any marked reduction from normal percent ranges?
Did you take the Xanax the night of the sleep study?

I take a couple of meds that are known to affect sleep architecture...but if I didn't take them I wouldn't get much sleep at all for reasons unrelated to OSA.
For me it's better to get some sleep even if it isn't "perfect" sleep than it is to not get sleep or wake up 50 times a night.

I am absolutely an outlier with the sleep stage stuff. For the vast majority of people, Xanax is like missing out on the second helping of a meal and leaving the table a tiny bit hungry (but much better than not eating); for me, it's like taking away the the entire little bread crust I had on that plate. (My unusual sleep deep sleep stage deprivation and greatly prolonged REM latency--literally just 10% of what it should be--has been confirmed in and out of the lab, and the effect of REM suppressants on my health have been robustly, medically confirmed as well--in my case. So this is all just a caveat for people in my situation. Believe me, I love the drifting off experience of these no-no (for me) aids as well and am terribly jealous that I pay for it in the longer term and therefore can't use them like most can.

I think that any med that has the potential to mess with sleep in one manner or the other ...needs to be discussed with a person's doctor. Mine were. I know the pros and cons and I can live with the results.
People react differently to lots of meds and this is why I think that the patient should always discuss any concerns they have with their doctor especially when it comes to meds like Xanax.

Just because I personally might have a problem with a certain med doesn't mean that everyone else will.
Heck...Melatonin in the smallest dose available gave me horrible, horrible vertigo that started about 30 minutes after I took it and wasn't quite gone by the next morning. I won't ever take one again but there are lots of people who manage to have great success with it.

If someone has bee taking Xanax or something similar for over 20 years with their doctors approval...not my place to tell them to stop. I just try to answer the questions that get presented. In this case an attempt to find some additional documentation that was requested. Also, included the standard risk vs rewards thing which goes with every med out there.

Pugsy wrote:I think that any med that has the potential to mess with sleep in one manner or the other ...needs to be discussed with a person's doctor. Mine were. I know the pros and cons and I can live with the results.
People react differently to lots of meds and this is why I think that the patient should always discuss any concerns they have with their doctor especially when it comes to meds like Xanax.

Just because I personally might have a problem with a certain med doesn't mean that everyone else will.
Heck...Melatonin in the smallest dose available gave me horrible, horrible vertigo that started about 30 minutes after I took it and wasn't quite gone by the next morning. I won't ever take one again but there are lots of people who manage to have great success with it.

If someone has bee taking Xanax or something similar for over 20 years with their doctors approval...not my place to tell them to stop. I just try to answer the questions that get presented. In this case an attempt to find some additional documentation that was requested. Also, included the standard risk vs rewards thing which goes with every med out there.

I totally agree! In case it wasn't clear, I wasn't making any medical recommendation for the original poster or anyone else, just sharing on my (rare) experience, since he asked "if anyone had an opinion" if it could effect sleep stages, and qualifying that it will not be most people's experience. I try to be conscious to not offer medical directives since I am short 12 years of medical education and a few hours of chart reading and patient interviewing for everyone here. (Just as gluten can be poison for a few, irritating for a few more, and perfectly safe and pleasant for the vast majority....and only you and your doctor and maybe some testing can determine where you fall, not anyone telling you whether or not they themselves can or can't eat that cupcake without getting sick...but simply stating, "Yes, I myself have been determined Celiac's because wheat can make some people with a preexisting condition sick, but the majority of people can eat bread and I wish I could too" is not telling anyone that bread is contraindicated for everyone....unless you're one of those dreadful food fascists). I've spent a lot of archive time here, and having a diversity of responses regarding experiences can be helpful on the off chance that you end up being that other medical snowflake on something.

I appreciate the thoughtful responses and there is a lot there to digest.

As far as a copy of my sleep study, I got a 3/4 page written summary/interpretation from the doc, but nothing with graphs, charts, hard numbers etc. Perhaps I need to call his office and see if there is more. Having said that I'm not certain there's much data there given the very short duration of any sleep during the study, and as I have mentioned before I really question the results of the study for any number of reasons. I sort of see it as a vehicle by which I was introduced to PAP therapy and it caused me to wind up with a pretty good machine. Beyond that, you folks here have done most of the work helping me fine tune my therapy into yielding some pretty good numbers.

Good luck! Note that if you're having a less than optimal response to your initial titration--especially if you've only had one study and it's been over 6 months--many insurance carriers will cover a second titration. If you didn't sleep for very long the first time around, you might want to talk to your doctor about this (my initial titration was 7; the retitration showed I needed to be at 11 to 14; when I could finally self-pay for the bipap my doc recommended, my final numbers ended up being 15 exhale, 18 inhale!).

mellabella wrote:Good luck! Note that if you're having a less than optimal response to your initial titration--especially if you've only had one study and it's been over 6 months--many insurance carriers will cover a second titration. If you didn't sleep for very long the first time around, you might want to talk to your doctor about this (my initial titration was 7; the retitration showed I needed to be at 11 to 14; when I could finally self-pay for the bipap my doc recommended, my final numbers ended up being 15 exhale, 18 inhale!).

My experience was equally weird if not worse. The doc said my AHI was 131 and socked me with BiPAP pressures of 17/13, resulting in a terrible time with leaks from various FFMs. With kind help from the forum I've worked my way down in pressure to 11/7, with AHI normally < 1.0 when in my usual sleeping position. Each step I lowered pressures, my AHI improved!

After reviewing data and my complaint that I was pulling the mask off in my sleep possibly b/c I wasn't getting enough air, my pressure was changed to 6/9. I've never slept better. AHI of less than .9 and minimal leaks. This is with a .5 xanax or occasionally a 1mg.

old dude wrote:

mellabella wrote:Good luck! Note that if you're having a less than optimal response to your initial titration--especially if you've only had one study and it's been over 6 months--many insurance carriers will cover a second titration. If you didn't sleep for very long the first time around, you might want to talk to your doctor about this (my initial titration was 7; the retitration showed I needed to be at 11 to 14; when I could finally self-pay for the bipap my doc recommended, my final numbers ended up being 15 exhale, 18 inhale!).

My experience was equally weird if not worse. The doc said my AHI was 131 and socked me with BiPAP pressures of 17/13, resulting in a terrible time with leaks from various FFMs. With kind help from the forum I've worked my way down in pressure to 11/7, with AHI normally < 1.0 when in my usual sleeping position. Each step I lowered pressures, my AHI improved!

Yes--that's the case for a lot of people too! (That's why some people end up on BiPap--they feel like they are suffocating on straight CPAP at high pressure and "flex" style exhalation relief on CPAPs isn't sufficient to lessen the sensation of struggling--and you'll find warnings here and in doctors' offices that for some, higher pressures will actually raise apnea events) Thank god for forum help and data-capable machines. That's a very dramatic improvement for you.