My mindful journey towards better sleep

Xanax, I Love You but my Brain Needs to Break Up With You

Part of me is practically starry-eyed about Xanax. The stuff is the mercy of the gods. I started taking it one night five years ago, during an episode of particular intensity in my life. I hadn’t slept the night before, and the upcoming night wasn’t looking good either. My sister-in-law delicately asked if I’d like to try a Xanax. She had them around but didn’t take them herself, using them as a “if I ever got anxious enough, I could take them” crutch. Apparently, that helps stave off panic attacks. And that night, she figured, I was anxious enough.

I had never tried a psychotropic drug before. (Psychedelic, yes, but pharmaceuticals affecting your mental and emotional state, no). In fact, I had a kind of holistically macho attitude about it: I don’t need no stinking meds. I’m healthy and wholesome and strong. But that night, I was fragile and desperate and small. Anyone who has ever felt helpless as a parent can relate. In short, my daughter was entering a full-blown depressive episode, which in adolescents often manifests in severe acting out behaviors. Two nights before, she had left home with her boyfriend. I did not know where she was. And, I knew I needed to sleep in order to be functioning well enough to address the situation.

Like I said, the first night I didn’t sleep at all. I took a Xanax the second night and slept six or seven hours. (With my daughter missing – it still blows my mind). I was mercifully clear and not-disoriented the next day, having been rested, ready to collaborate with police and family and community. We found my daughter the following day; she is now safe and seemingly winning her battle with depression. And I now fall into the ranks of Xanax users. From that one night on, I worshipped the stuff.

I’ve gratefully used it for my regular bouts of insomnia and for my light-sleeper-itis, like moments when I’m trapped in a hotel room with my sweetie who snores and have no extra room to escape to. There is plenty of questioning online about whether Xanax is efficacious for insomnia. I can tell you definitively that it is for me. But its use has issues. I am trying to quit – or very greatly reduce my use of – Xanax for sleep.

I would say I was hooked by my experience with Xanax, but I’m using that term loosely. I don’t require it to sleep or to function in any way, except of course on the not so occasional nights that it’s the only thing that will get me to sleep. I’ve been careful over these five years to space out my use so that I do not become dependent. I’ve mostly been successful, but during rougher patches, I’ve relied on other drugs to make sure that the dependence doesn’t happen. I’ve alternated Xanax with Trazodone, until I built a tolerance and had to increase my dose of the latter to a level at which my heart pounded at an alarming strength in my chest. I tried over-the-counter sleep aids and my nervous system just laughed. Lately I’ve alternated Xanax with Ambien, but based on what I’m reading, Ambien is a pretty questionable choice. For one thing, I take it one night, and I seemingly sleep worse the whole rest of the week: a rebound effect. This whole thing has felt like a balancing act.

I have also built some tolerance to the Xanax: it takes ¾ or one full .5mg pill to get me to sleep now, whereas it used to take ½ or one full .25mg pill five years ago. That’s a modest increase, but an increase nonetheless. As of this spring, I had never noticed any side effects, not even grogginess the next day. In fact, I would feel serene the day after taking it as if, even with the drug out of my system, things remained calmed to a more balanced state.

Some drugs my body clearly doesn’t like and does not want, like the Trazodone that made my heart feel like it wanted to explode. Allergy meds and caffeine make me wired, Ambien makes me feel vaguely nervous the next morning. Xanax, on the other hand, seems oddly regulating to my body, as long as I’m only taking it occasionally. I even seem to sleep better the following nights, after I take it one night. (I do start to feel weird in a way that’s difficult to articulate, if I take it too much in one week. Kind of like my head is clogged).

But what if things are happening, unseen, in areas of my body that I have less sensory awareness of than, say, my heart? The brain does not have pain receptors. I could be doing damage without knowing it, without getting any nerve signals. And doing a Google search on Xanax and brain damage brings up some alarming results. For a long time I was able to dismiss these warnings as meant for people who use a lot more of the drug than I do and/or a lot more often. For one thing, none of the long list of potential side effects of either use or misuse applied to me. Then I started to have a side effect that was unmistakable and disturbing: I could not retrieve familiar words.

It was during a time period of stress, so I was taking more than usual, feeling a little of that aforementioned vague cloudiness. And taking Ambien most nights that I didn’t take Xanax. This had gone on for about two weeks. I was feeling ditsy, having a hard time thinking of unimportant words I needed to use. But I would find an alternate word and dismiss it as being stressed. I shouldn’t need to be so precise in my language anyway, right?

Then one day I was in session with a client, feeling grounded and fully in my role as therapist. I was talking about a hormone I speak of occasionally, and regularly enough to be quite familiar to me. And I couldn’t think of the word for it. Oxycontin? Oxycodone? No, that’s not it! What the hell is the name of this chemical? It was embarrassing, and was no consolation when I thought of the word (oxycontin – the “cuddle” hormone) later in the session. I became immediately alarmed, refused to take sleep meds for the rest of the week, and the word retrieval difficulties went away within a couple of days.

The research on Xanax and cognitive function seemed quite suddenly relevant. A quick Google search yielded plenty of troubling stats about Xanax and memory issues. It seems these effects are largely considered temporary, will dissipate within months once discontinued. However, there’s a very glaring exception and this is the relationship between Xanax and Alzheimer’s disease.

I have never considered myself old enough to worry about Alzheimer’s disease. As of this writing, I am still in my late thirties. But I do no longer feel invincible. My mind, overall, is slightly less razor sharp than it once was. And after my experience with failure of the word retrieval processes in my brain, I have some experiential evidence that my gray matter is fallible. It can fail me, and that is not a matter of will or intelligence or engagement in the world. That knowledge is chilling.

A seemingly balanced and ethical psychiatrist from Wisconsin writes in his patient blog, “Anxiety essentially consists of too much attention to a problem or fear. Benzodiazepines treat anxiety by preventing the brain from attending, attaching, and remembering.” This seems reflective of my experience of using Xanax for sleep. I do way too much “attending,” in the form of getting easily and often intensely worked up about things. At bedtime, my body is still poised to attend, if you will, whether I am mentally wrapped up in anything or not. Xanax relieves my body of duty, apparently beginning with the brain, by enhancing the efficacy of the neurotransmitter GABA. GABA is an inhibiting neurotransmitter that reduces excitability throughout the entire nervous system.

The problem may be then that the brain begins to lose the skill of “attending, attaching, and remembering.” It’s confusing, because the regular use of Xanax supposedly reduces the brain’s natural production of GABA, which intuitively one would think might have an increased effect of attending, etc. It is very difficult to find these answers online, and perhaps that is because so much of the information does not exist. It’s clear that the quest to investigate, or not, the effects of benzodiazepines on the brain has been quite political. This is a frustrating and familiar scenario. The powers that be who make money from this stuff would rather us not know what it does to us, or at least for the issue to be murky.

In the realm of Alzheimer’s research, though, there’s a 2014 Canadian study that broke through the wall of suppression. Here’s the actual study and here’s a good blog post from the New York Times that discusses its implications.  The part that really hit me was the finding that even those who did not take the drugs regularly or often were at risk, as long as you cumulatively took a lot of it over time. According to this research, my once or twice a week method is not safe. It adds up over the weeks and months and years; apparently, I can’t outsmart a powerful drug.

And the influence of benzos on Alzheimer’s was pretty staggering: for people who have used that large cumulative dose, an 84% increase in incidence of the disease! Although this is in people over 65, A) I will get there someday in the increasingly not-so-distant future and so may as well address the issue now and B) the effects on people under 65 were not studied, which doesn’t mean that it’s safe, just means we don’t know. Sounds highly questionable to me.

The other thing that sounds highly questionable to me is the objectivity of the American researchers who in 2016 supposedly countered the study above with one showing no relationship between benzos and Alzheimer’s. The following verbiage is taken directly from the study itself, in a discreet section imbedded within the footnotes called Competing Interests: SD received a Merck/American Geriatrics Society New Investigator Award; EB receives royalties from UpToDate; RW received funding as a biostatistician from a research grant awarded to Group Health Research Institute from Pfizer; OY received funding as a biostatistician from research grants awarded to Group Health Research Institute from Amgen and Bayer. Hmm… Merck? Pfizer? Amgen? Bayer? These are not institutions that I trust to fund unbiased research. A German doctor and scientist discusses these thorny issues in a guest blog post for Scientific American.

I’m quite curious why my fairly holistic prescribing doctors, one of which has even begged me to go vegan, have never discussed any of this research with me. People are telling me that, when they ask, their doctors’ explanations center around the idea that it’s worse for your body to miss out on sleep than to take the drugs. That sounds like potentially solid reasoning. There’s tons of research on the negative effects of chronically poor sleep. But who is monitoring the point of diminishing returns from the use of the drugs? I don’t want to slide into the “f*ck it, I just need to sleep” mode. That’s a large part of how I got here.

And so I march into a new chapter in my sleep life. What can I do to improve my sleep naturally? That’s my question to myself, to other insomniacs, to the experts that I will visit with, to the Internet, to the cosmos. I’m honored by all those who will come along with me for the journey.