Yes. Prescription sleeping pills and over-the-counter sleep aids can cause an overdose. The effects range from severe drowsiness and poor coordination to seizures, dangerous heart rhythms, slowed breathing, coma, and death. The risk depends on the medicine, the amount taken, the person's health, and whether alcohol, opioids, or other sedating drugs were also used 1 2.
If a sleeping pill overdose may be happening now
Call 911 immediately if the person has collapsed, is having a seizure, has trouble breathing, or cannot be awakened 3.
If none of those emergency signs is present, contact Poison Control right away:
- In the United States: Call 1-800-222-1222. The service is free, confidential, and available 24 hours a day.
- Online: The webPOISONCONTROL tool can assess a single, unintentional exposure when the person does not have life-threatening symptoms.
- Outside the United States: Call your local poison center or emergency service.
Call instead of using the online tool if more than one substance may be involved. An intentional overdose or suspected self-harm needs immediate evaluation in an emergency department 3.
Do not wait for symptoms. A person can look well shortly after taking a dangerous amount, especially when a product contains more than one active ingredient 4.
What counts as a sleeping pill?
"Sleeping pill" is not one type of drug. It can refer to:
- Prescription hypnotics such as zolpidem, eszopiclone, and zaleplon, sometimes called Z-drugs.
- Benzodiazepines prescribed for insomnia, such as temazepam or triazolam.
- Other prescription medicines that have a sedating effect.
- Over-the-counter antihistamine sleep aids containing diphenhydramine or doxylamine.
- Nighttime combination products that contain a sedating ingredient plus a pain reliever, cough medicine, or decongestant.
These products do not behave the same way in an overdose. Even two boxes with "PM" or "nighttime" on the front may contain different active ingredients. Check the Drug Facts panel or prescription label rather than relying on the brand name.
Combination products deserve particular care. Some nighttime medicines contain acetaminophen. Too much acetaminophen can seriously injure the liver, and a person may have few or no symptoms at first 4.
Warning signs of a sleeping pill overdose
Sedating medicines commonly cause changes in alertness and coordination 1. Possible warning signs include:
- Unusual or extreme sleepiness
- Difficulty waking or loss of consciousness
- Confusion, slurred speech, or unusual behavior
- Poor balance or inability to stand safely
- Slow, shallow, irregular, or difficult breathing
- Vomiting, especially in someone who is very drowsy
Over-the-counter antihistamines can look different from a typical sedative overdose. Diphenhydramine toxicity may cause agitation, hallucinations, delirium, enlarged pupils, a rapid heartbeat, difficulty urinating, seizures, or coma rather than sleepiness alone 5 6.
Do not use this list to decide that an exposure is safe. Symptoms vary by drug and may be delayed. Contact Poison Control after an extra, uncertain, or unintended dose even if the person feels normal.
What to do while help is on the way
- Stay with the person. Watch their breathing and responsiveness. Do not let them drive or walk around without support.
- Do not make them vomit. Do not give activated charcoal or another home treatment unless a poison specialist or emergency clinician instructs you to do so 3 5.
- Follow the 911 dispatcher's instructions. If the person is unresponsive but breathing, place them on their side in the recovery position if you can do so safely. If they are not breathing or are only gasping, begin CPR and use an AED according to your training and the dispatcher's directions 7.
- Gather useful information without delaying the call. Have the package or prescription bottle ready. If possible, note the product name, active ingredients, strength, approximate amount taken, time of the exposure, and any alcohol, supplements, or other medicines involved. Poison specialists can still help if some of this information is unknown 5.
How many sleeping pills cause an overdose?
There is no universal number. A dangerous amount cannot be calculated from the phrase "sleeping pills" because products differ in strength, formulation, and toxicity. Risk also changes with age, body size, liver or kidney disease, breathing conditions, other medicines, and whether several substances were taken together.
A dose that caused limited symptoms in one person does not establish a safe threshold for someone else. Zolpidem overdose reports, for example, have included effects ranging from profound sleepiness to coma, breathing or cardiovascular compromise, and fatal outcomes, particularly when other central nervous system depressants were involved 8.
If you accidentally took an extra dose or cannot remember how much you took, do not guess based on how sleepy you feel. Call Poison Control with the exact product and strength. They can determine whether home observation is appropriate or whether you need medical care.
Why alcohol and other sedatives raise the risk
Alcohol, opioids, benzodiazepines, and many other sedating medicines can compound one another's effects on alertness and breathing. The FDA warns that combining benzodiazepines with opioids, alcohol, or other central nervous system depressants can cause profound sedation, severe respiratory depression, coma, and death 2.
A person may not think of every substance as a sedative. Opioid pain medicines, some cough medicines, anxiety medicines, muscle relaxants, and certain antihistamines can all add to drowsiness. When calling for help, report everything taken, including alcohol, cannabis, supplements, and nonprescription products.
How sleeping pill overdoses are treated
There is no safe home antidote. Emergency treatment depends on the active ingredients, timing, symptoms, and other substances involved. Clinicians may monitor breathing, heart rhythm, blood pressure, temperature, and alertness. Treatment can include airway and breathing support, intravenous fluids, and medicine-specific care 5 8.
Treatments sometimes mentioned online, including activated charcoal or reversal medicines, are not appropriate for every drug or every patient. Some carry serious risks. They should be used only by clinicians or under direct poison-center guidance.
Reducing the risk of an accidental overdose
- Take the dose on the prescription label or Drug Facts panel. Do not take more because the first dose does not seem to be working.
- Ask a pharmacist before combining a sleep medicine with any other medicine that causes drowsiness.
- Avoid alcohol while using a sleep medicine unless the prescriber or pharmacist has specifically confirmed that the combination is safe.
- Read the active ingredients on nighttime and "PM" products so that you do not take the same drug twice.
- Store medicines locked, in their original containers, and out of children's reach.
- Use a written medication list or pill organizer if missed or repeated doses are a concern.
- Do not abruptly stop a benzodiazepine taken regularly. Sudden discontinuation can cause dangerous withdrawal, including seizures. Ask the prescriber for an individualized taper 2.
If the prescribed dose no longer helps you sleep, talk with the prescriber rather than increasing it. The safer next step may be a medication review or a non-drug insomnia treatment, not a higher dose.
