Sleeping Pills: Can They Cause Suicide?

Sleeping pills are depressant medications that slow down the body's functions by acting on the central nervous system. While they can be effective in treating insomnia and anxiety, they also carry significant risks when misused or overused. Sleeping pills have been linked to increased mortality, with studies reporting a higher incidence of suicide and suicide attempts among those who take them. Mixing sleeping pills with certain substances, such as alcohol or opioids, can be particularly dangerous and even life-threatening. While modern sleeping pills are generally safer than older versions, death from sleeping pill overdose is still possible, especially when taken in high doses or combined with other drugs.

Insomnia and sleeping pills

Sleeping pills are often used to treat insomnia by making people feel drowsy and relaxed. They are available over the counter, as natural supplements, or by prescription. However, it is important to note that prescription sleeping pills are generally stronger than over-the-counter ones, and they come with a risk of dependence and addiction. While sleeping pills can be effective in treating insomnia, they should be used with caution due to their potential side effects and risks.

Side effects of sleeping pills may include constipation or diarrhoea, muscle weakness, digestive problems, and worsened snoring and sleep apnea. Additionally, sleeping pills can cause parasomnia, a disruptive sleep disorder where individuals may sleepwalk, eat, or even drive without being fully awake, which can be dangerous. Prolonged use of sleeping pills can lead to rebound insomnia, where the insomnia returns worse than before when the medication is stopped. Therefore, it is important to consult a healthcare provider before taking sleeping pills and to follow their recommendations for safe use and discontinuation.

In addition to the side effects, there is a concern regarding the association between sleeping pills and suicidal thoughts and behaviours. Several studies have found a link between prescription sleeping pills and an increased risk of suicidal ideation, plans, and attempts. This association is particularly strong with sedative-hypnotic drugs, including zolpidem and zaleplon, which are commonly prescribed for insomnia. While the studies do not establish a causal relationship, they highlight the importance of monitoring patients taking these medications for any signs of suicidality.

Furthermore, the combination of sleeping pills with other substances, such as alcohol or other sedatives, can lead to dangerous outcomes, including overdose and death. Mixing sleeping pills with alcohol can cause respiratory depression, leading to a person stopping breathing and potentially resulting in death. It is crucial to follow the prescribed dosage and avoid mixing sleeping pills with other substances to mitigate these risks.

While sleeping pills can be a short-term solution for insomnia, it is important to explore alternative treatments that may be more effective and carry fewer risks. Non-drug therapies, such as cognitive-behavioural therapy (CBT), can often provide better long-term improvements in sleep quality without the same level of side effects and risks associated with sleeping pills. Additionally, natural sleep aids like melatonin and valerian supplements offer a safer alternative to prescription medications, although they may still have some side effects and interactions with other medications.

Suicide risks and sleeping pills

Sleep disorders increase the risk of suicide by two to three times, excluding depression and other psychiatric illnesses. Insomnia, in particular, is linked to suicidal thoughts and behaviours in university students, active military and veterans, and community-dwelling adults. In the United States, insomnia is often treated with prescription medications, with an estimated 3% of adults receiving medication for insomnia in a given month.

Prescription sedative-hypnotics have been associated with suicide attempts and completed suicides in toxicological, epidemiological, and clinical studies. Z-drugs (zolpidem, eszopiclone, and zaleplon) are among the most commonly prescribed medications for insomnia, but there is evidence that they may also increase suicide risk. A case-control study in Taiwan established a dose-response relationship between Z-drug use and suicide risk, a finding later replicated in South Korea. This suggests that the use of Z-drugs for insomnia may be ill-advised among high-risk individuals.

While the pills currently on the market generally contain milder compounds that are not lethal, high doses can still be fatal. An overdose on sleeping pills may be deliberate to commit suicide, especially in cases of untreated mental illness. However, not all suicide attempts succeed because vomiting is common when the drug is taken in excess. In such cases, the person may survive but still sustain brain damage due to a lack of oxygen. Additionally, mixing sleeping pills with other substances, such as opioids or alcohol, can increase the risk of overdose and lead to death.

Mixing sleeping pills with other substances

It is important to note that the pills currently available on the market contain milder compounds that are not potentially lethal. Manufacturers claim that these modern formulas are safer and less potent, and ensure that a sleeping pill overdose is not an effective suicide method. However, while these newer sleep-inducing drugs are less potent, they are still not entirely safe. High doses can be fatal, and an overdose on sleeping pills may be deliberate to commit suicide.

Fatal overdoses typically only occur when sleeping pills are mixed with depressants like benzodiazepines or alcohol. For example, a fatal overdose on Lunesta, a sleeping pill, can happen at approximately 90 times the intended dose, which would require upwards of 270 mg of the drug. Similarly, death is reported at doses of Ambien, another sleeping pill, higher than 2,000 mg, but a lethal dose may still occur at lower amounts.

Additionally, the risk of addiction and dependence on sleeping pills is greater when they are taken in higher doses or combined with other substances. Dependence and withdrawal can also occur even when people take their medication as prescribed. People may experience symptoms of withdrawal if they reduce their dose or stop taking the medication.

If you or someone you know is struggling with sleeping pill misuse, dependence, or addiction, it is important to seek professional help. Treatment plans are available to address these issues and support individuals in their recovery.

Overdose symptoms and treatment

Sleeping pills are central nervous system depressants, meaning they slow down the body's functioning by mimicking the sedative state the body enters when falling asleep. An overdose of sleeping pills occurs when an individual ingests a quantity of medication that surpasses the prescribed or safe limit, leading to severe adverse effects or life-threatening situations. An overdose can occur accidentally or deliberately in an attempt to commit suicide.

Overdose Symptoms

Overdose symptoms can occur when a person takes a significantly higher dose than intended. Sometimes, an overdose can occur when a person takes 60-90 times the intended dose. However, the specific quantity that can lead to an overdose can vary based on the individual's tolerance, body weight, age, overall health status, and whether other substances like alcohol or opioids have been consumed. Respiratory depression is one of the most critical immediate risks, where inadequate breathing leads to hypoxia and potential brain damage or death. Cardiovascular issues can also arise, resulting in abnormal heart rhythms, low blood pressure, and potential heart failure. Excessive sedation can cause confusion and dizziness and can lead to comas or long-term cognitive impairment. Gastrointestinal distress, including nausea, vomiting, and abdominal pain, are common reactions to an overdose.

Overdose Treatment

If a sleeping pill overdose is suspected, it is crucial to seek immediate medical attention by calling 911 or the local emergency services hotline. While waiting for medical help to arrive, it is important to keep the person awake and check for symptoms of overdose. Treatment methods for sleeping pill overdose include:

• Gastric lavage (stomach pump): Inserting a tube down the patient's throat to pump out the stomach's contents.
• Activated charcoal: Absorbing sleeping pills in the stomach to prevent further absorption into the body. Charcoal is typically most effective if used within an hour of ingestion.
• Supportive care: This can include intravenous fluids for hydration, medications to manage symptoms like seizures or irregular heart rhythms, and potentially using a ventilator to assist with breathing.
• Naloxone: This medication can be administered if the person trained in its use.

Famous sleeping pill-related deaths

While sleeping pills can be effective in aiding sleep, they can also be dangerous and even life-threatening when misused. Here are some examples of famous sleeping pill-related deaths:

The Scripps Study

A study by researchers at Scripps Health, a nonprofit health system in San Diego, linked the use of popular sleeping pills such as Ambien and Restoril to a nearly fivefold increased risk of early death. The study, which followed 10,000 sleeping pill users and 23,500 non-users in Pennsylvania between 2002 and 2006, found that about 1% of non-users died during that time compared to 6% of sleeping pill users. This suggests that even people who took fewer than two pills monthly were three times more likely to die than non-users.

Columbia University Mailman School of Public Health Study

Researchers at Columbia University examined overdose deaths involving non-benzodiazepine sleeping pills and found that the proportion of overdose deaths involving these drugs increased more than threefold between 2000 and 2018, coinciding with exponential prescription increases. The findings highlighted that more than 67% of those who died from overdoses with these drugs between 2000 and 2018 also had opioids in their system, indicating the dangers of combining multiple substances.

Case of Lethal Concentrations of Over-the-Counter Sleep Aids

A case report detailed the death of a 21-year-old woman due to elevated concentrations of over-the-counter sleep aids, specifically diphenhydramine (DPH) and melatonin. The scene investigation revealed empty containers of DPH and a partially empty container of melatonin, along with a handwritten note of a suicidal nature. The death was certified as a suicide by acute combined DPH and melatonin toxicity, underscoring the potential lethality of sleep aid medications when misused.

While the specific individuals in these cases may not be famous, the studies and reports highlighting their sleeping pill-related deaths have gained notable attention and contributed to a growing awareness of the potential dangers associated with sleeping pill use and overdose.

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