Alcohol and Sleeping Pills Interactions: From Homeopathic to Prescription

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Types of Sleep Aids

Sleep aids can be over the counter (OTC) or prescribed by your medical provider.

Over the Counter Sleep Aids

Taking an OTC remedy when you have trouble sleeping may seem harmless, but they are not recommended for long term use. While they are generally safe, they still come with risks, like building up a tolerance or having multiple active ingredients.

Many OTC sleep aids, including Unisom, ZzzQuil, Medi-Sleep or Nytol, contain an antihistamine as their main active ingredient. These medications block certain neurotransmitters, which causes a sedating effect. You can become tolerant to the effects of these medications fairly quickly, which means that if you take them regularly, they stop working for you.

Common OTC painkillers are also sold with the addition of an antihistamine to assist with sleep. These medications include Advil PM, Tylenol PM, and Excedrin PM.

OTC sleep aids also include homeopathic aids like melatonin. Homeopathic medicine uses natural ingredients that come from plants, minerals or animals, as opposed to manufactured drugs. Sleep aids like melatonin are considered dietary supplements, meaning melatonin is not technically a sleep medication. It is produced in a lab to be similar to the naturally occurring melatonin hormone that helps regulate your sleep wake cycle. Melatonin makes you a little sleepy, but mainly it shifts the timing of your sleep phase. Therefore, it is best to take it before bedtime if you are trying to shift your sleep cycle. For example, you are going to be working a night shift or are dealing with jet lag.

Chamomile is another homeopathic sleep aid. It is a flower that is often consumed as tea and helps make you drowsy. It is mild and generally safe, but some people can have an allergic reaction to it, particularly those allergic to ragweed.

You should note a few things when considering homeopathic treatments:

Because homeopathic sleep aids are dietary supplements and not medications, they are not subject to the research, medical trials and testing that prescription medications must undergo before approval for use. Therefore, there are no qualitative data to document their efficacy.
Many homeopathic sleep aids have side effects such as headache, dizziness and nausea. These aids can also have contraindications with OTC and prescription medication and they may increase the effects of alcohol.
The Food and Drug Administration (FDA) has fewer regulations for dietary supplements compared to prescription medications. The amount of the active ingredient in each tablet may differ and some ingredients may not be declared on the label.

Prescription Sleep Aids

Several families of medication are commonly prescribed for sleep disturbances, insomnia and sleep disorders.

The most commonly used prescription hypnotics or sleep aids in the United States include Ambien (zolpidem), Sonata (Zaleplon), Lunesta (Eszopiclone) and Rozerem (Ramelteon). This class of drugs slows down brain activity to encourage sleep.

Trazodone is an antidepressant medication that medical providers often prescribe for sleep problems. It works by blocking certain neurotransmitters that influence sleep.

Benzodiazepines are often prescribed for anxiety disorders because they slow down brain activity. The benzodiazepines clonazepam (Klonopin), lorazepam (Ativan), triazolam, and estazolam are sometimes prescribed for insomnia and difficulty falling asleep because they produce even greater sedative effects. The use of benzodiazepines, especially long term can lead to dependence and should be used with caution.

Risks of Combining Alcohol and Sleeping Pills

Alcohol and sleeping pills, prescribed or OTC, can interact in two primary ways. The potential risks of mixing alcohol and sleep aids result from:

Alcohol interferes with the digestion of the medication and keeps it from working as it should.
Alcohol amplifies the effects of the medicine in the brain.

Short Term Effects of Mixing Alcohol and Sleeping Pills

Like alcohol, sleep aids slow brain activity, causing a sedating effect. This effect is intensified when using both at the same time, leading to serious side effects that can be potentially life-threatening. For example, drinking alcohol while using herbal sleep remedies such as chamomile can cause even more drowsiness compared to using alcohol or chamomile alone.

As of yet, no scientific studies have explored what happens when melatonin and alcohol are combined. However, it is known that alcohol disrupts your sleep-wake cycle. Therefore, alcohol could inhibit melatonin’s function. Additionally, since both cause drowsiness, combining them could lead to severe drowsiness.

Short term effects of taking OTC or prescription sleep aids with alcohol include:

Increased drowsiness or dizziness
Slowed heart rate or lowered blood pressure
Slowed breathing or difficulty breathing
Impaired motor control
Unusual behavior
Overdose and death

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Overdose

An overdose occurs when you ingest a toxic amount of a substance or medication. An overdose is a medical emergency that requires immediate attention. Overdose symptoms can depend on factors such as the type of drug, how much you take, how you take it, your health history and your age.

Signs of overdose, including alcohol poisoning and overdose from a combination of alcohol and sleeping pills or another substance, may include:

Nausea and vomiting
Diarrhea
Severe stomach pains or cramps
Chest pain
Dizziness
Loss of coordination
Being awake but unresponsive
Limpness
Seizures
Confusion
Agitation or paranoia
Slow or erratic pulse
Hallucinations
Choking sounds
Blue lips or fingernails
Pale or clammy face
Unconsciousness

If you or someone you know experiences any of these symptoms, seek medical attention right away by calling 911.

Long Term Effects of Mixing Alcohol and Sleeping Pills

No scientific data shows the impact of OTC antihistamine-based sleep aids like Unisom if you use them long-term. This lack of long-term research is one reason why they are recommended only for occasional sleep problems. Antihistamines are known to cause side effects for older adults, such as confusion and falls.¹

Misuse of alcohol and sleep aids can increase the potential for significant long term problems with the brain. Combining alcohol and prescription sedative hypnotics regularly and over a period of time can lead to memory problems. Misuse of other prescription sleep aids, such as benzodiazepines, can also cause neurological problems and addiction to the medication.

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Populations at High Risk for Adverse Effects

Combining alcohol and sleep aids can happen both unintentionally and intentionally. Some may inadvertently combine alcohol and sleep aids because they are unaware of their interactions or they have not waited long enough after using alcohol before taking a sleep aid.

Some people may take a sleeping pill and drink alcohol at the same time, knowing that doing so will amplify the sedating effects. This should never be done, as combining these substances can be life threatening.

Certain populations are at a greater risk of the adverse effects of combining alcohol with sleeping pills. These populations include:

Older adults—Changes in body composition and neurobiology can make older adults more sensitive to the effects of alcohol, which could potentially amplify the combined effects of alcohol and sleeping pills.
Those born female—Studies indicate that those born female reach higher blood alcohol concentrations compared to those born male. This is due to body composition differences generally associated with gendered characteristics, including body fat and lower body water composition.
Those taking blood thinners—Blood thinners, such as warfarin (Coumadin), increase the risk for severe bleeding in the stomach or brain when combined with alcohol. Alcohol keeps the body from properly digesting this type of medication.
Those taking anxiety medication in addition to a sleep aid—Many of the medication types used to assist with sleep are also used to control the physical symptoms of acute anxiety. For example, doctors prescribe both benzodiazepines and antihistamines for anxiety, as well as other depressants like beta-blockers. Combining these medications with alcohol can cause profound drowsiness or breathing difficulties. If you are prescribed anxiety medication or a sleep aid, talk to your medical provider about how the two may interact and follow the alcohol use guidelines while on the medication.

Precautions to Take

Given the dangers associated with combining alcohol and sleeping pills, you can take steps to minimize your risks of mixing the two.

Before trying a sleep aid, talk with a medical provider or mental health professional about healthy sleep hygiene activities to try first. Many sleep problems can be handled without medication.
If you are struggling with more than occasional sleeplessness, speak with a medical or mental health provider about what might be the underlying issue, as sleep problems can be caused by many things.
While speaking with a medical provider about possible sleep medication, inform them if you are struggling with an alcohol use disorder (AUD) or are concerned about your alcohol use.
Speak with your medical provider before taking any OTC medications to ensure that they won’t interact with any medications you are already taking.
If you take prescription sleep medication, follow the advice and directions of your medical provider. Do not make any changes to your medication dose or regimen before consulting your doctor.
If you choose to take an OTC sleep aid, follow the directions carefully, including those related to alcohol use.

If you are concerned about your use of alcohol and sleep medications or that of a loved one, consider scheduling an assessment with a mental health professional for polysubstance use disorder or alcohol use disorder.

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