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Mixing Alcohol & Sleeping Pills: The Dangerous Side Effects

June 2, 2022

Table of Contents

People who drink heavily often have issues with insomnia. Conversely, people with insomnia may often use alcohol to help fall asleep. These people may also be using other medications to help with sleep. This can become a dangerous situation when sleep medications are mixed with alcohol. Most sleeping pills are central nervous system depressants — just like alcohol. Combining two of the same types of drugs leads to over-sedation, dizziness, risk of falls, respiratory depression, and even death. 

Is Alcohol Actually Helpful for Sleep? 

No, most medical professionals think that alcohol is actually quite bad for sleep over time. While it is true that some people find that alcohol initially helps them to fall asleep faster, sleep studies show that the actual quality of sleep is poor when a person is intoxicated, leading them to more fatigue and insomnia the next day. 

Which Sleeping Pills are Commonly Misused With Alcohol?

About 4% of American adults use prescription sleep medications.[4] Most of these drugs come with inserts warning of interactions and dangers. People should know not to take their pills with alcohol. And yet, many people do.

Common prescription sleeping pills mixed with alcohol include:[5]

  • Ambien (zolpidem)
  • Lunesta (eszopiclone)
  • Prosom (estazolam)
  • Restoril (temazepam)
  • Unisom (doxylamine) 

If you don't see your prescription sleeping medication on this list, don't think you are safe. Most prescription solutions for insomnia are sedatives, and most will interact with alcohol in a negative way. Any time you are taking a medication for sleep, ask your doctor before mixing it with alcohol. 

What Can Happen When You Mix Alcohol With Sleeping Medications?

About 15% of people with chronic insomnia also have substance misuse or substance use disorders (SUD).[7] As the nights wear on and they can't get the sleep they need, they look to solutions. These can lead them to take sleeping pills, either prescribed or not prescribed. It can also cause them to use alcohol or other illicit substances to induce sleep. In severe cases, using multiple substances, even over the counter substances, in conjunction with alcohol can cause serious side effects including overdose, accidents or the development of other substance use disorders  

Overdose 

Drinking heavily reduces your body’s respiratory drive, and can cause you to spontaneously stop breathing, which can lead to overdose and death. 

Similarly, taking too much of most sleeping medications can cause respiratory suppression.. Researchers found that overdoses of sleeping pills rose threefold between 2008 and 2018.[1]

Combining sleeping pills and alcohol substantially increases the risk of an accidental overdose. 

Accidents 

Some sleeping medications, such as Ambien and Lunesta, cause episodes of strange sleeping behavior. You might eat, drive, shop, or walk around your neighborhood. These episodes are so common that manufacturers were forced to disclose them in patient flyers starting in 2007.[2] Combining alcohol with these types of medications increases the risks for accidents: driving, falling, or other forms of physical injury. 

Substance Use Disorders 

The risks of alcohol addiction are well known. However, some people don’t realize that certain Sleep medications can also be habit forming and even physiologically addicting. Researchers say zolpidem (Ambien) can cause euphoria at high doses, and people can develop physical and psychological attachments to the drug.[3] 

Mixing alcohol and sleeping pills may increase the risk of physical addiction to one or both of these substances. 

Over the Counter (OTC) Meds: Are They Safer?

The pharmacy aisle in your grocery store is packed with substances that are advertised to help with sleep.  Since you don't need a doctor's permission to take them, they may seem safer to mix with alcohol. 

Unfortunately, even over the counter pills can be quite dangerous when mixed with alcohol Even herbal remedies can interact with alcohol.[5] 

Sleep Safely With These Tips

Mixing alcohol and sleeping medications can be risky. If you are experiencing insomnia, try some of these suggestions: 

Wait Between Substances

Most people can process a drink of alcohol in about an hour.[11] If you have a nighttime cocktail, wait an hour or more before taking a sleep aid. 

If you drink more than one drink per hour, you're overwhelming your body with alcohol. Wait even longer before using your pills. 

Don't Solely Rely on Sleeping Aids

The pills you reach for aren't worth the risk. Only about a third of people who take sleep medications report a noticeable improvement in  sleep.[12] If you are experiencing insomnia, non-pharmacological methods often work as well or even better for improving sleep.

Talk With a Doctor

Underlying conditions like depression and chronic pain can rob you of a good night's sleep.[13] Treating these issues could help you avoid having to rely on  substances, including alcohol and sleeping pills. 

Sleep Therapy

A good night's sleep can clear your mind and help you work on the rest of your recovery. Cognitive Behavioral Therapy (CBT) programs for sleeping problems might help you to do the following:[14]

  • Assign spaces for sleep. Use your bedroom for sleep and sex only. If you can't sleep within 20 minutes, get up again. In time, you'll break associations with poor sleep and your bed. 
  • Limit time in bed. Understand how much sleep (not tossing and turning) you get each night. Determine when you must get up. Go to bed to ensure you're only in bed during the time you've set aside for sleep. You might feel more tired at first. 
  • Control your breathing. Use relaxation techniques to breathe through feelings of anxiety and tension. 
  • Change your thoughts. Understand the thoughts and attitudes that keep you awake. Work with therapists to change them. 
  • Design your sleep space. Make your bedroom a perfect place for sleep. Make sure it is dark, cool, and free of distractions.

Can't Stop Mixing Alcohol & Sleeping Pills? 

You've tried to limit your alcohol intake. You've attempted to cut pills out of your life. But you can't. This might be a sign of an alcohol use disorder, and it might be time to consider getting some professional help. 

Alcohol Use Disorder Therapy

Medication for Addiction Treatment (MAT) programs combine prescription drugs and conventional therapy techniques. MAT is proven to help people stay sober, and it works better than treatments that don't involve medications.[15] Talk to your treatment team about whether MAT is appropriate for your alcohol use disorder.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Overdose Deaths Involving non-BZD Hypnotic/Sedatives in the USA: Trends Analysis. The Lancet. https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(22)00007-2/fulltext. January 2022. Accessed May 2022. 
  2. FDA Warns of Sleeping Pills' Strange Effects. The New York Times. https://www.nytimes.com/2007/03/15/business/15drug.ready.html. March 2007. Accessed May 2022. 
  3. Zolpidem Dependence, Abuse, and Withdrawal: A Case Report. Journal of Research in Medical Sciences. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3906775/. November 2013. Accessed May 2022.
  4. Prescription Sleep Aid Use Among Adults: United States 2005 - 2010. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db127.htm. August 2013. Accessed May 2022. 
  5. Harmful Interactions. National Institute on Alcohol Abuse and Alcoholism. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines. Accessed May 2022. 
  6. Alcohol and the Sleeping Brain. Handbook of Clinical Neurology. https://pubmed.ncbi.nlm.nih.gov/25307588/. 2014. Accessed May 2022. 
  7. Disturbed Sleep and Its Relationship to Alcohol Use. Substance Abuse. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775419/. November 2009. Accessed May 2022. 
  8. Antihistamines. National Health Service. https://www.nhs.uk/conditions/antihistamines/. February 2020. Accessed May 2022. 
  9. Melatonin for Treatment-Seeking Alcohol Use Disorder Patients with Sleeping Problems: A Randomized Clinical Pilot Trial. Scientific Reports. https://www.nature.com/articles/s41598-020-65166-y. May 2020. Accessed May 2022. 
  10. Valerian Root and Alcohol/Food Interactions. Drugs.com. https://www.drugs.com/food-interactions/valerian,valerian-root.html. Accessed May 2022. 
  11. Alcohol Metabolism. Bowling Green State University. https://www.bgsu.edu/recwell/wellness-connection/alcohol-education/alcohol-metabolism.html. Accessed May 2022. 
  12. The Problem with Sleeping Pills. Consumer Reports. https://www.consumerreports.org/drugs/the-problem-with-sleeping-pills/. December 2018. Accessed May 2022.
  13. CDC Analysis Finds Low Rate of Prescription Sleep Aid Use in U.S. American Academy of Sleep Medicine. https://aasm.org/cdc-analysis-finds-low-rate-of-prescription-sleep-aid-use-in-u-s/. August 2013. Accessed May 2022. 
  14. What is Cognitive Behavioral Therapy? American Academy of Sleep Medicine. https://sleepeducation.org/patients/cognitive-behavioral-therapy/. October 2020. Accessed May 2022. 
  15. Medication-Assisted Treatment for Alcohol-Dependent Adults with Serious Mental Illness and Criminal Justice Involvement: Effects on Treatment Utilization and Outcomes. American Journal of Psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6032529/. January 2019. Accessed May 2022. 

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