Evie Summers
Sleeping pills are a common intervention for insomnia and other sleep disorders, and they come in both over-the-counter and prescription forms. While they are generally safe when used as directed, it is possible to overdose on these medications, and this can be life-threatening. An overdose can occur when an individual takes more than the recommended dose or combines sleeping pills with other substances like alcohol or opioids, which amplify their effects. This can lead to slowed or stopped breathing, loss of coordination, confusion, unconsciousness, and even death. Preventing overdose involves following prescribed dosages, avoiding mixing with other substances, and storing medication securely.
| Characteristics | Values |
|---|---|
| Definition of overdose | An overdose occurs when a person takes a sleeping pill in a quantity that exceeds the prescribed or recommended dose, leading to adverse health effects. |
| Risk factors | Taking a higher dose than prescribed or recommended, taking pills more often than prescribed, combining with other substances like opioids or alcohol, prolonged use, history of substance abuse or mental health disorders, older age, and dependence. |
| Signs and symptoms | Mild: excessive sleepiness, memory loss, strange behavior, sleep-induced injuries, impaired judgment and coordination. Severe: extreme lethargy, abdominal pain, breathing trouble, clumsiness, slowed heartbeat, unconsciousness, seizures, coma, cardiac arrest. |
| Treatment | Call 911 or emergency services immediately. Provide rescue breathing if trained and ensure the person's airway is clear. In the hospital, treatment includes activated charcoal, fluids, medications, CPR, and flumazenil (for benzodiazepine overdoses). |
| Prevention | Follow dosage instructions, be aware of side effects, seek help for substance use disorders, and increase access to life-saving overdose reversal medications like naloxone. |
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What You'll Learn
Accidental overdose
An accidental overdose on sleeping pills can occur when an individual takes too much of the drug or combines it with other drugs that enhance its depressive effects. Accidental overdoses are likely to occur due to the following reasons:
Dependence
A person may become dependent on sleeping pills, but over time, the drug has less of an effect. In a desperate attempt to get sleep, the person may end up taking too many pills. Regular, long-term use of prescribed sleep medication often leads to dependence, a condition where a person experiences extreme insomnia if they do not take the medication.
Mixing with other drugs
The majority of sedative-related overdose deaths happen when sleeping pills are mixed with other drugs, especially opioids. Mixing sleeping pills with alcohol can also be dangerous and can cause the person to stop breathing, which may result in death. Mixing sleeping pills with opioids can also lead to death.
Injecting the drug
People who use sedatives recreationally may switch from taking the pills to injecting the dissolved drug and miscalculate the dosage.
Age
Older adults are at a greater risk of overdose from sleeping pills due to decreased drug metabolism rates.
Prolonged use
Prolonged use of sleeping pills can also be a risk factor for accidental overdose. Some medications for insomnia are recommended only for short-term use.
If you think that someone has overdosed on sleeping pills, call 911 immediately. While waiting for the paramedics, turn the person in the coma position with the body face down, the head turned to one side, and one knee bent slightly. Check the person’s airway to make sure it’s clear and that they are breathing regularly. If they are not breathing, and you are trained, provide rescue breathing by tilting the person’s head back, pinching their nose closed, and giving two slow breaths, followed by one breath every 5 seconds. Watch for the chest to rise, indicating air is entering the lungs. If the person has a seizure, keep them safe from injury, but do not restrain them or put anything in their mouth. If the victim has also used opioids, naloxone may be administered to reverse the opioid overdose.
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Mixing with other substances
Mixing sleeping pills with other substances can increase the risk of overdose and death. Sleeping pills are central nervous system depressants, and when combined with other CNS depressants, the effects are magnified. This includes alcohol, opioids, and other narcotic medications. Mixing sleeping pills with alcohol can cause the person to stop breathing and may result in death.
Combining sleeping pills with other substances can amplify the sedative effects of the pills. This can lead to slowed breathing, unresponsiveness, severe drowsiness, and confusion, among other symptoms. The risk of overdose is especially high when sleeping pills are combined with opioids. For example, benzodiazepines alone rarely cause fatal overdoses, but when mixed with opioids, the risk of overdose and death increases significantly.
In addition to opioids, alcohol, and narcotics, sleeping pills should not be mixed with other medications without a doctor's approval. This includes antidepressants, antihistamines, and supplements like melatonin. Even over-the-counter sleep aids can contain antihistamines or melatonin, which can interact with sleeping pills to increase the risk of overdose. It is important to be aware of all the substances an individual is taking to avoid potentially dangerous interactions.
While overdose from sleeping pills alone is not common, it is important to recognize the signs of overdose and have a plan for emergency response. This includes calling emergency services, checking for symptoms, and administering naloxone or flumazenil if trained. Flumazenil is a benzodiazepine antagonist that can help reverse benzodiazepine binding and inhibit the activity of substances that act on benzodiazepine receptor sites. However, it carries some risks, and routine use is not recommended in cases of mixed or unknown substance overdoses.
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Side effects and symptoms
Overdosing on sleeping pills can lead to a deep state of sedation. In severe cases, it can slow down the nervous system to the point where critical functions like breathing slow down or even stop. This is why taking too many sleeping pills or taking them in combination with other central nervous system depressants can be life-threatening.
The symptoms of a sleeping pill overdose can vary depending on the individual's tolerance, body weight, age, overall health status, and whether other substances like alcohol or opioids have been consumed. Generally, the signs of a sleeping pill overdose include slowed or shallow breathing, clumsiness or loss of coordination, confusion or delirium, and unconsciousness or coma. In some cases, an overdose can occur when a person takes 60–90 times the intended dose.
Parasomnias, which are rare but complex sleep behaviours that occur during sleep, can also be a side effect of taking sleeping pills. This can include sleepwalking, eating, talking, or even driving while asleep. These behaviours are more likely to happen if the dosage is increased, hence the recommendation to only take the prescribed amount.
Mixing sleeping pills with alcohol or other drugs is extremely dangerous and can lead to death. From 2002 to 2015, the rate of overdose deaths from combining sedatives and opioids doubled, and the majority of sedative-related overdose deaths happen for this reason. Additionally, older adults are at a greater risk of overdose from sleeping pills due to decreased drug metabolism rates.
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Treatment and prevention
Sleeping pill overdose can be prevented by following prescribed dosages, avoiding mixing pills with alcohol or other drugs, and storing medication securely. It is also important to understand the risks associated with sleeping pills and to be aware of side effects. Patients should be advised against combining sleeping pills with alcohol or other central nervous system depressants, which can increase the risk of overdose.
If you suspect someone has overdosed on sleeping pills, call emergency services immediately. Keep the person awake and talking if possible until help arrives. If the person is unconscious, place them in the recovery position—on their side, with one leg forward of the other—and wait for help. As an overdose may be a deliberate suicide attempt, it is important to get support and assistance from a trained counselor if you or someone you know is experiencing suicidal thoughts or tendencies.
Treatment for sleeping pill overdose may include supportive care, with doctors monitoring the patient's breathing and cardiovascular system while the body works the drug out of its system. In some cases, activated charcoal, hemodialysis, or whole bowel irrigation may be used to treat an overdose. Flumazenil can also be used to reverse the effects of benzodiazepines, although it carries the risk of seizure and heart rhythm disorders. If the victim has also used opioids, naloxone may be administered to reverse the opioid overdose.
To prevent overdose, it is important to follow safe usage guidelines and prescribed dosages. Responsible prescribing practices and patient education are crucial in preventing sleeping pill overdose. Additionally, individuals can reduce the risk of overdose by seeking professional treatment for drug or alcohol addiction and understanding and practicing preventive strategies for safer use of sleeping pills.
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Addiction and withdrawal
Sleeping pills can be highly addictive, and users can become dependent on them within just a few weeks of use. They are both physically and psychologically addictive, with the body becoming reliant on them to function. Withdrawal symptoms can be moderate to severe and dangerous or even life-threatening.
The withdrawal process and duration are different for each user. Symptoms can start within a few hours or weeks after quitting the drug, and they generally fade after about a week or two. However, psychological symptoms can last for several weeks. These persistent symptoms are known as post-acute withdrawal symptoms (PAWS) and include insomnia, anxiety, irritability, agitation, mood swings, and poor concentration.
Typical withdrawal symptoms include trouble sleeping, restlessness, anxiety, shivering, dizziness, circulation problems, and seizures. These symptoms are similar to the issues the sedative was meant to address, which can create a vicious cycle, with many people relapsing and taking the pills again to relieve these symptoms. To avoid this, it is recommended to gradually reduce the dose over several weeks, with the guidance of a doctor. Medical detox is always the safest way to withdraw from sleeping pills, as doctors can monitor vital signs and address any health concerns.
To prevent addiction and withdrawal, it is important not to take sleeping pills nightly and to only use them occasionally. They should also be taken as prescribed, and not at higher doses or more frequently than recommended. Mixing sleeping pills with alcohol or other drugs can also increase the risk of overdose and addiction.
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Frequently asked questions
A sleeping pill overdose occurs when an individual takes more than the recommended dose or when sleeping pills are combined with other substances like alcohol or opioids, which amplify their effects.
Signs of a sleeping pill overdose include slowed or shallow breathing, clumsiness or loss of coordination, confusion or delirium, and unconsciousness or coma.
If you suspect someone has overdosed on sleeping pills, seek emergency medical attention immediately. Treatment may involve administering medication to reverse the effects of the overdose, such as flumazenil or naloxone, and ensuring the person's breathing is adequate.
