Sleeping pills may be habit-forming. Overdose is possible, especially when mixed with other central nervous system depressants, like alcohol or opioids.
In today’s society, the demand for increased productivity at work, responsibility to family and a variety of everyday stressors is progressively rising. These pressures can certainly affect the ability to sleep and the quality of sleep an individual has. As a result, the use of sleeping pills has soared, but there are risks associated with using these types of drugs, particularly on a regular basis.
Sleeping pills are available as a prescription or over-the-counter (OTC). The use of medications to address sleeping issues may be habit-forming, and overdose is possible, especially when mixing these types of medicines with other central nervous system depressants, like alcohol. If someone becomes dependent on or addicted to sleeping pills, they increase their risk of sleeping pill overdose. Thankfully, addiction treatment is available.
What Are Sleeping Pills Prescribed For?
Sleep aids are mainly prescribed for people suffering from insomnia — the inability to fall and/or stay asleep. They can also be used to treat sleep apnea, where breathing repeatedly stops and starts throughout the sleep cycle. People suffering from severe anxiety and PTSD usually suffer from poor sleep patterns and may use sleep medications to help. The CDC estimates that 4% or 9 million adults in the United States use sleep aids.
Sleeping pills are available over-the-counter (OTC) or with a prescription. OTC products include natural supplements, like melatonin or valerian, and synthetic sleep aids that contain an antihistamine, like ZzzQuil and Unisom. Prescription medications include benzodiazepines and sedatives, known as “Z drugs.” It is critical to point out that all of these medications are only meant for short-term use because using them long term causes the individual to become dependent on them in order to sleep, leading to potential abuse.
Natural Sleeping Pills
Melatonin is a hormone produced naturally in the body that helps promote sleep. It is available as a dietary supplement that is either extracted from animals or made synthetically. Melatonin comes in tablet form ranging from 1 mg to 10 mg. It is recommended for short-term use in cases like jet lag or insomnia lasting less than a month. Because it is considered a dietary supplement, it is not regulated as strictly by the FDA; therefore, the amount of melatonin in each tablet may vary from what is on the label. Also, various studies conducted on the effectiveness of melatonin have been unable to prove its effectiveness as a helpful sleeping agent.
Valerian is an herbal product sold as a dietary supplement. The root of this plant holds the sedative properties and is available in pill form. It is the most commonly used herbal product in the United States for sleep issues; however, the same problem exists with valerian as with melatonin. Because it is not highly regulated, the amount of the herb in tablets or capsules may differ from what is labeled on the bottle.
Over-The-Counter Sleeping Pills
Synthetic medications available over-the-counter for sleep generally contain one of the following two sedating antihistamines, diphenhydramine or doxylamine. Diphenhydramine is found in ZzzQuil and Tylenol PM products and doxylamine is found in NyQuil and Unisom. Although these two antihistamines cause sedation, they are associated with many side effects, including long-term effects that may lead to dementia and Alzheimer’s disease.
Prescription Sleeping Pills
Z drugs are a class of sedative-hypnotic medications that help an individual fall asleep and stay asleep. Two of the most common Z drugs are Ambien and Lunesta. These drugs are not meant to be used long-term because they can lead to dependence, requiring higher doses to produce the same sedative effect. This can actually lead to rebound insomnia.
Many people who suffer from depression have difficulty sleeping. Z drugs may worsen symptoms of depression, so they should generally be avoided in this population. The FDA added a warning to these drugs that includes sleepwalking, sleep driving and other dangerous actions that occur while not awake that can lead to severe injury and death.
Benzodiazepines, like Restoril, Halcion, Xanax and Ativan may also be prescribed for sleep. They can cause grogginess the next day and increase the risk of injury because they impair cognitive function. Also, these medications can slow respiration, which is dangerous, especially if an individual mixes them with alcohol or opioid medications. Stopping these medicines abruptly can lead to uncomfortable and potentially life-threatening withdrawal symptoms. If benzodiazepines are prescribed for sleep issues, it should only be the lowest effective dose possible and for short-term use.
How Do Sleeping Pills Work?
How sleeping pills induce sleep varies depending on which type of medication is used. Melatonin does not directly cause sleep. Instead, it helps to regulate the sleep-wake cycle. It begins to rise naturally in the body toward nighttime, letting your body know it’s time for sleep. Taking a melatonin supplement will prepare your body for sleep by lowering the stress hormone cortisol and slowing down respiration. Antihistamines work by blocking histamine receptors in the body. Histamine stimulation causes wakefulness, so by blocking these receptors antihistamines cause immediate sedation.
Benzodiazepines work by binding to GABA receptors in the brain, which slow activity and cause a calming and sedating effect. Similarly, valerian root also binds to GABA receptors. In addition, valerian affects a neurotransmitter called serotonin in the brain, which regulates mood and sleep. Z drugs, like Ambien, work by binding to GABA receptors as well. However, they differ from benzodiazepines because they selectively bind to a specific GABA receptor (BZ1), which explains why they are not used for anxiety or seizures like many benzodiazepines are.
How Long Do Sleeping Pills Take to Kick in?
When taking medications to help with sleep, it is important to know how quickly they will work and their duration of action. Melatonin is absorbed quickly after ingestion and reaches its peak effect in approximately one hour, so it may begin to work some time before this. Its half-life is short at 60 minutes, so it is generally eliminated from the body after five hours. Valerian has been shown to reach peak concentration in one to two hours, and its half-life is also 60 minutes.
The antihistamines have a very rapid onset of action. The effects of diphenhydramine, for example, can begin in approximately 36 minutes. However, unlike melatonin and valerian, these drugs have a long half-life. Dihphenhydramine’s half-life is estimated to be four hours; therefore, it is not eliminated from the system until about 20 hours. This would account for the drowsiness that can carry over into the next day.
The onset of action and half-lives of benzodiazepines vary depending on the particular drug. Halcion, Xanax and Ativan have a faster onset of action, usually less than or about one hour compared to Restoril, which may take longer than one hour to feel the effects. Of the benzodiazepines mentioned, Halcion has the shortest half-life of approximately three hours, meaning it is eliminated from the body after 15 hours. Ativan has the longest half-life of 20 hours, meaning it can stay in the system for over four days.
The Z drugs have similar onset of action times to benzodiazepines like Halcion and Xanax. Ambien can begin to work within 45 minutes after ingestion and has a short half-life. It is usually cleared from the body in 15 hours. Lunesta reaches peak concentrations in the blood after one hour, and its half-life is about six hours, so it is still present in the body for up to 30 hours.
Side Effects of Sleeping Pills
Although the specific classes of sleep medications can produce different adverse reactions, there are general effects that can be experienced with all of these drugs. Some of these effects include:
- Hangover effect into the next day
- Dry mouth
- Lack of coordination
The Z drugs, including Ambien and Lunesta, can cause sleepwalking and other sleep activities, such as sleep driving and sleep eating. Under these circumstances, the individual is not fully awake and is at risk of injuring themselves and others. This has the potential to be extremely dangerous and could lead to death. If sleep activity occurs, the medication should be immediately discontinued.
Can You Overdose on Sleeping Pills?
Although overdose from sleeping pills when taken alone is not common, it is possible in certain situations, depending on which sleep medicine is being used and other factors like simultaneous drug use. There is no clinical evidence of melatonin overdose; however, excessive drowsiness, headache and vomiting could be signs that too much melatonin has been consumed. The same is true for valerian. Although there have been several documented cases of high doses of this herb being ingested, symptoms were mild and resolved within 24 hours.
Antihistamines pose a greater risk. Because the active ingredient in many OTC cold and cough preparations includes an antihistamine, someone can take this along with an OTC sleep aid and not be aware they are taking the same medication. Generally, someone who ingests too much antihistamine can experience hallucinations, blurred vision, inability to urinate and increased body temperature.
Overdose from benzodiazepines when taken alone is possible; however, if taken with alcohol, opioids or other narcotic medications, the risk of overdose becomes much more prevalent. An overdose from benzodiazepines can cause altered mental status, slurred speech, difficulty with coordination and movement, and respiratory depression. The Z drugs, like Ambien, have the potential for overdose, which can lead to impaired consciousness and respiratory depression. The risk of overdose increases dramatically when these drugs are combined with alcohol, opioids and narcotics.
Sleeping Pill Overdose Symptoms
The possible overdose symptoms specific to each type of sleep medicine are above. However, a general list of signs and symptoms associated with sleeping pill overdose include:
- Slowed breathing/gasping for air
- Excessive sleepiness
- Difficulty controlling body movement
- Difficulty focusing
Which Sleeping Pills Are Dangerous?
Any sleeping pills may be dangerous when taken at high doses or when used in combination with other drugs. The greatest risk for overdose is with benzodiazepines and Z drugs when taken together with an opioid. Death certificate reports show that one-third of overdose deaths from an opioid also listed a benzodiazepine or a Z drug as the cause of death.
Sleeping Pill Overdose Treatment
If someone shows signs and symptoms of a sleeping pill overdose, 911 should be contacted immediately. If the overdose occurs as a result of taking benzodiazepines or Z drugs, a remedy is available to counteract the effects. The drug Flumazenil can be administered intravenously to reverse the binding of these drugs to GABA receptors.
What Causes a Sleeping Pill Overdose?
Overdosing from sleeping pills is a major issue if these medications are mixed with opioids and/or alcohol, particularly with drugs like Ambien, Lunesta and benzodiazepines. Because these medications lead to tolerance, meaning that larger amounts of the drug are required to produce the same effect, higher doses are used. Combining large doses of benzos and/or Z drugs with opioids can lead to overdose and death. In 2019, 16% of overdose deaths involving opioids also included the use of benzodiazepines.
Sleeping Pills and Alcohol
Taking sleeping pills with alcohol is a dangerous combination. Benzodiazepines and Z drugs, when taken with alcohol, can increase the central nervous system side effects like drowsiness and dizziness. A person’s judgment becomes extremely impaired, possibly leading to injury and accidents. The risk for addiction and abuse is higher, and a person’s respiration can become so slowed that death is possible.
Sleeping Pill Addiction
Gaining a tolerance to sleeping pills’ effects can lead to addiction. Many people who take sleeping pills for as little as a few weeks may be unable to sleep without them. This is one of the most important signs that someone is addicted to sleep aids. An individual dealing with addiction to sleeping pills may also experience irritability and anxiety. If someone is dependent on sleep medications and requires a higher dose to fall or stay asleep, that person is more likely to overdose.
Also, people who are on pain medications like opioids or who drink alcohol with these medications are at increased risk to abuse or misuse them. Mixing these medications increases the likelihood of overdose, serious injury and death.
Sleeping Pill Addiction Treatment
If someone becomes addicted to sleeping pills, treatment is available. The Recovery Village Cherry Hill at Cooper is an accredited facility equipped to help anyone dealing with an addiction to sleeping pills. The first step to recovery is detox. These drugs should not be stopped abruptly to avoid severe and uncomfortable withdrawal symptoms. Detox involves the slow removal of the substance from the body, often with medical support to treat withdrawal symptoms. This is performed under the direct supervision of a licensed medical professional.
Depending on the severity of addiction, and in direct consultation with the individual and our team of exceptional medical professionals, an inpatient or outpatient program may be appropriate. Several levels of care at our facility provide the person struggling with addiction with individual and group therapy, recreational therapy and access to numerous amenities offered by our facility, including:
- Fully equipped gym
- Volleyball court
- Basketball court
- Yoga studio
- Game room
We are conveniently located in the New Jersey suburb of Cherry Hill, just 20 minutes from Philadelphia. If you or someone you love is dealing with an addiction to sleeping pills, contact us today to learn more information on beginning the road to recovery.
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