Sleeping Pill Overdose Risk

Though millions rely on sleep aids for a restful night, tolerance and dependence can develop. Taking too many sleeping pills can lead to overdose.

Perhaps one of the most significant hazards of sleeping pills is the frequency of use. Individuals with a prescription or over-the-counter antihistamines could assume it is safe to use these substances nightly. However, the development of tolerance and dependence can lead to unintended results.

There are many reasons people seek help falling asleep or staying asleep, but people may resort to misusing medications to feel their effects. Due to the likelihood of abuse, it is vital to understand the dangers that come with sleeping pills, including the risk of overdose.

Some individuals may intentionally use sleep-aid medications to commit suicide. If you or someone you love is experiencing suicidal thoughts or tendencies, immediately call the National Suicide Prevention Hotline at 1-800-273-8255.

Why Do People Use Sleeping Pills?

Between 50 and 70 million Americans suffer from sleeplessness, and 4% of the country uses medication to help ensure a good night’s sleep. Each year, millions of individuals use sleep aids to achieve longer, better-quality sleep cycles every night. These sleeping pills and aids range from high-concentrated prescriptions to over-the-counter remedies.

Physicians prescribe a wide variety of drugs to combat insomnia. Some common brands include Ambien, Lunesta, and Rozerem. In addition, certain benzodiazepine sedatives and antidepressants have been known to provide similar treatment, but these drugs come with the added worry of potential dependence.

How Long Do Sleeping Pills Take to Kick in?

Most prescription sleeping pills start working within half an hour. These medications are FDA-approved for sleep and are well-studied:

• Eszopiclone’s (Lunesta) onset is within 30 minutes and it lasts for eight hours.
• Zaleplon’s (Sonata) onset is within 30 minutes and it lasts for four hours.
• Zolpidem’s (Ambien, Edluar, Intermezzos) onset is within 20 to 30 minutes and it lasts for four to eight hours.
• Suvorexant’s (Belsomra) onset is within 30 minutes and it lasts for at least seven hours.
• Ramelteon’s (Rozerem) reaches peak levels in your body within 45 minutes.

Benzodiazepines are prescription medications that are also sometimes used for sleep, and can also start working quickly. Common benzodiazepines for sleep include temazepam (Restoril).

Melatonin is an over-the-counter sleep aid and synthetic hormone that kicks in within 30 minutes and lasts 4–8 hours.

Other prescription medications are used off-label for sleep due to sedative side effects. For this reason, these drugs are less studied when it comes to determining the exact timing of their sedative effects:

• Doxepin
• Gabapentin
• Mirtazapine
• Ramelteon
• Trazodone

Can You Overdose on Sleeping Pills?

It is possible to overdose on sleeping pills. This is because all sleeping pills are central nervous system depressants that slow down your brain’s activity in order to help you rest. For this reason, it is important to take sleeping pills only as prescribed. Taking a higher dose than prescribed or taking pills more often than prescribed can increase your risk of an overdose. This is especially true if you take other substances like opioids or alcohol along with your sleeping pills.

What Happens If You Overdose on Sleeping Pills?

Overdosing on sleeping pills can lead to many different outcomes, depending on the type of medication and dose. For example, while benzodiazepine overdose is rarely fatal on its own, it can be deadly if the benzodiazepine is mixed with other substances like opioids.

In the past, barbiturates, including sleep aids, were used as a tool to attempt suicide. Researchers have made sleeping aids safer to use, and the likelihood of fatal overdoses decreased as barbiturates became less common.

Can You Overdose on Melatonin?

A melatonin overdose is highly unlikely. Scientists have extensively studied melatonin and have found that there is no evidence of melatonin overdose even at extremely high doses taken over a period of weeks. 

That said, taking too much melatonin may cause some side effects. These may include:

• Headache 
• Low or high blood pressure
• Drowsiness 
• Vomiting 
• Worsened alopecia areata, an autoimmune disorder that causes hair loss

What Are the Side Effects of Sleeping Pills?

The dangerous side effects of misusing sleeping pills can begin long before an overdose occurs. Sleep-induced injuries are one such consequence. Some users have gotten in vehicle accidents due to impaired judgment and coordination caused by sleep medications. Crimes and self-harm have also been reported. These events occur due to unawareness of one’s actions.

Several physical signs may be present if a sleeping pill overdose occurs, including:

• Excessive lethargy: People who take sleeping pills likely do so often, so they should be able to differentiate typical sleepiness from something more serious.
• Unanticipated behaviors or actions: Tiredness leads to clumsiness, and clumsiness leads to mistakes. People act differently when lethargic, but pay close attention to excessive, drunk-like behavior.
• Breathing irregularities: Slow or dysfunctional breathing may indicate an overdose and should be closely monitored. Administer CPR and call 911 if the victim appears to be gasping for air, or if breathing ceases and consciousness is lost.

Usually, an overdose victim is unable — or in the case of intentional overdose, unwilling — to contact the proper authorities. Sleeping pills have overwhelming sedative effects; a victim may fall asleep before taking precautionary measures. The situation may require an onlooker to get the necessary help.

Which Sleeping Pill Is Most Dangerous?

Modern sleeping agents are safer than their predecessors and death from outright sleeping pill use is less likely to occur than in the past, but it’s still possible. Still, there are dangerous ranges of misuse at which life-threatening consequences are more likely.

Ambien, for example, is typically taken at a 10mg dose. At 600 mg, a user is entering overdose limitations, and serious damage is likely. Death is reported at doses higher than 2,000 mg, but a lethal dose may still occur at lower amounts.

An overdose on Lunesta can happen at approximately 90 times an intended dose. This would require upwards of 270 mg of the drug. Fatal overdoses typically only occur when mixed with depressants like benzodiazepines or alcohol. Similarly, it generally takes around 200 mg of Sonata to overdose.

What Are the Strongest Sleeping Pills?

It is difficult to determine the strongest sleeping pill since most have not been directly compared and many sleep medications are used off-label without extensive research. However, Lunesta is one of the strongest sleeping pills, while Restoril, Ambien and Sonata are weaker but about equally as strong as each other.

Sleeping Pill Overdose Treatment

Sleeping pill overdoses are usually treated with supportive care, meaning that the doctor monitors the patient’s breathing and cardiovascular system while the body works the benzodiazepine out of the system. In some cases, activated charcoal, hemodialysis or whole bowel irrigation may play a role in helping to treat an overdose.

Rarely, a physician may choose to administer flumazenil. It reverses sedation caused by benzodiazepines to bring a victim back to their normal state. However, due to the risk of seizure and heart rhythm disorders, the risks of flumazenil generally outweigh the benefits.

If you or a loved one is struggling with sleeping pill misuse or dependence, The Recovery Village can help. Contact us today to learn more about treatment plans that can work for your needs.

Editor – Erica Weiman

Erica Weiman graduated from Pace University in 2014 with a master's in Publishing and has been writing and editing ever since. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more