For many, issues with falling asleep or staying asleep can result in an over-reliance on sedative-hypnotic medications—or prescription sleeping pills—for help. In a health survey published by the Centers for Disease Control and Prevention, roughly 4% of adults aged 20 and older reported over-using prescription sleep aids in the last 30 days.1
When used as prescribed, these medications can be helpful in the short-term; but when overused or combined with drugs and/or alcohol, serious side effects, physical dependence, or overdose can occur.
Historically, there have been several types of sedative and hypnotic medications used to manage insomnia, including:2,3
- Non-benzodiazepine hypnotics; aka Z-drugs (e.g., Ambien, Lunesta, Sonata).
- Benzodiazepines (e.g., Ativan, Halcion, Restoril).
- Barbiturates (e.g., Seconal; very rarely used).
Other classes of medications have also been used to help with sleep issues, as they make people drowsy. Examples include:
- Over-the-counter antihistamine sleep aids (e.g., Benadryl, Unisom).
- Trazodone (an antidepressant; off-label use).
- Rozerem (a melatonin receptor agonist).
It is advised to never mix sleeping pills with alcohol because the interaction can be dangerous or, in some cases, potentially fatal.3 Even small amounts of alcohol combined with certain sedating medications, such as prescription sleep aids, can result in serious symptoms such as over-sedation, confusion, dizziness, fainting, as well as slowed heart rate and breathing.3,4
Side Effects of Mixing Sleeping Pills and Alcohol
Because there are so many different types of sleeping pills, their exact interactions with alcohol may differ slightly, with some being more dangerous than others. In general, it is advised to never mix sedatives or hypnotics with alcohol. Combining sleeping pills with alcohol can increase the sedating effects of both, thus seriously increasing the risk of overdose.3,4
Drinking even one alcoholic beverage in combination with sleeping pills can be dangerous. Some sleeping pills have adverse and/or unusual effects such as memory loss and sleepwalking, even when taken on their own.3,4 People have reported engaging in behaviors such as eating, talking on the phone, and sometimes even driving a motor vehicle with no recollection after taking a sleeping pill.5
The side effects of mixing alcohol and sleeping pills include:3,4
- Memory problems.
- Unusual behavior.
- Impaired motor control.
- Slowed heart rate.
- Lowered blood pressure.
- Slowed or difficulty breathing.
- Increased risk of overdose.
Link Between Alcohol Use and Sleep Issues
In 2018, approximately 11.0 million adults aged 26 or older had an alcohol use disorder (AUD) in the past year.6 And according to the American Sleep Association, 50-70 million Americans have a sleep disorder.7 The most common specific sleep disorder is insomnia, with around 30% of adults experiencing symptoms of it and 10% having chronic insomnia.7
While sleep disorders and alcohol abuse can occur separately, the comorbidity is common, suggesting a potential bidirectional link between the two in some instances.8 At times, those with sleep disorders may self-medicate with alcohol and tranquilizers to promote sleep.8 While on the other hand, those abusing alcohol may begin to suffer from sleep disturbances which can result in a continued use of sleeping pills and alcohol.8
Several studies have shown that the majority of patients entering treatment for alcoholism reported insomnia-related symptoms, such as difficulty falling and staying sleep.8 Additional research evidence suggests that, after controlling for other factors (such as depression), disturbed sleep may be a significant predictor of relapse for those in recovery.8 In a similar study population, the risk of both relapse and severe alcohol dependence was greater in those with an alcohol use disorder and insomnia than in those with alcohol use disorder but no insomnia.8
Treatment for Addiction to Sleeping Pills and Alcohol
Frequent or regular use of both sedative sleeping pills and alcohol can result in polysubstance dependence. Significant physiological dependence to both substances can result in even more severe, or complicated withdrawal when attempts are made to quit using them. In such instances, it is important that people trying to quit do so under the care of physician.
Symptoms of withdrawal from sedative-hypnotic type sleeping pills may include restlessness, anxiety, trouble sleeping, and tremors.9 As part of a physician-supervised detox or medical withdrawal management plan, the dose of these types of sleeping pills may be gradually decreased over several weeks rather than abruptly quitting.9 Doing so can help to minimize withdrawal symptoms and lessen the chance of relapse.9
The acute alcohol withdrawal syndrome may range from mild to physically dangerous and include symptoms such as irritability, anxiety, agitation, increased heart rate, high blood pressure, seizures and in rarer cases, delirium tremens.10 A supervised, medical detox can help people avoid unnecessary discomfort or life-threatening withdrawal complications.
Though polysubstance addiction may necessitate additional treatment attention, integrating detox and treatment efforts for both substances, and any related issues can facilitate a safer, smoother recovery. For instance, when you stop using sleeping pills and alcohol, rebound insomnia is likely to develop.9 In cases of recovery from co-occurring addiction to alcohol and sleeping pills, continued sedative-hypnotic treatment may not be a viable therapeutic option; in such instances, a more behavioral treatment focused approach may be required.9,11
Fortunately, there are several non-pharmacological treatment options that can help with rebound insomnia, including:11
- Relaxation therapy.
- Sleep hygiene education.
- Cognitive behavioral therapy.
- Stimulus control (e.g., no watching TV or reading in bed, no exercise, smoking, warm baths just before bed).
- Sleep restriction (e.g., minimizing sleep outside of set hours, etc.).
Inpatient and Outpatient Treatment
Treatment for poly-substance addiction is available on both an inpatient and outpatient basis. Inpatient treatment takes places in a residential facility. Residential programs commonly offer 24/7 treatment attention for periods of time ranging from 30 to 90 days.12 In such a therapeutic setting, patients may have limited access to the outside world so that they can focus exclusively on recovery and minimize the chance of relapse due to external triggers.
Outpatient treatment can take place in a variety of settings, including hospitals, counselor’s offices, community mental health clinics, or even shared space within an inpatient/residential rehab facility.13 Attendance requirements vary by program, with some requiring meeting 1 to 3 times per week and others daily sessions.13
Outpatient treatment protocols may be similar to those offered during inpatient rehabilitation but are generally less time intensive. This level of care might be a good fit for those who’ve already gone through a more intensive program first, such as a residential.
Whether on an inpatient or outpatient basis, treatment for alcohol and sleeping pill addiction typically consists of some combination of:9,11,14
- Medical detox.
- Co-occurring disorder treatment or other mental health care, when needed.
- Rebound insomnia treatment.
- Individual, group, and family therapy.
- Behavioral interventions (e.g., cognitive behavioral therapy, motivational interviewing, contingency management, 12-step facilitation).
- 12-step meeting/support group attendance.
- Recreational therapy/art therapy.
- Relapse prevention skills training.
- Aftercare planning.
Find Help Now
If you’re concerned that concurrent use of alcohol and sleeping pills is impacting your health or that of someone close to you, substance abuse treatment programs can help. American Addiction Centers, parent company of Alcohol.org, is a nationwide provider of addiction treatment facilities. AAC’s admissions navigators are available 24/7 to discuss your treatment options today. Find out if you or your loved one’s insurance covers treatment at an AAC facility by filling out the form below.
. Chong,Y., Fryar, C., & Gu, Q. (2013). Centers for Disease Control and Prevention, Prescription Sleep Aid Use Among Adults: United States, 2005–2010.
. MedlinePlus. (2012). Medicines for Sleep.
. National Institute on Drug Abuse. (2016). Commonly Abused Drugs: Prescription Sedatives.
. National Institute on Alcohol Abuse and Alcoholism. (2014). Harmful Interactions: Mixing Alcohol with Medicines.
. U.S. National Library of Medicine. (2009). Zolpidem-induced sleepwalking, sleep related eating disorder, and sleep-driving: fluorine-18-flourodeoxyglucose positron emission tomography analysis, and a literature review of other unexpected clinical effects of zolpidem. Journal of Clinical Sleep Medicine, 5(5), 471–476.
. Substance Abuse and Mental Health Services Administration. (2018). National Survey on Drug Use and Health.
. American Sleep Association. (n.d.). Sleep and Sleep Disorder Statistics.
. Mahfoud, Y., Talih, F., Streem, D., & Budur, K. (2009). Sleep disorders in substance abusers: how common are they? 6(9), 38–42.
. U.S. National Library of Medicine. (2010). Using medication: What can help when trying to stop taking sleeping pills and sedatives?
. Bayard, M., Mcintyre, J., Hill, K.R., Woodside, J. Alcohol Withdrawal Syndrome. American Family Physician 69(6): 1443-1450.
. Arnedt, J., Conroy, D., & Brower, K. (2010). Treatment Options for Sleep Disturbances During Alcohol Recovery. Journal of Addictive Diseases, 26(4): 41–54.
. National Institute on Drug Abuse. (2018). Principles of Effective Treatment.
. Substance Abuse and Mental Health Services Administration. (2008). What Is Substance Abuse Treatment? A Booklet for Families.
. National Institute on Drug Abuse. (2016). DrugFacts: Treatment Approaches for Drug Addiction.