How to Recognize Overdose from Sedatives and Sleep Medications

Someone you care about takes a sleeping pill to help them rest. The next morning, they don’t answer your calls. You knock on their door. No response. You find them slumped on the couch, breathing slowly, lips slightly blue. You think, They’re just really tired. But that’s not tiredness. That’s an overdose. And every minute counts.

What Happens When Sedatives Overdose?

In 2021 alone, over 12,500 people in the U.S. died from overdoses involving benzodiazepines like Xanax or sleep drugs like Ambien. These numbers have more than doubled since 2010. What’s worse? Many of these deaths happen because no one recognizes the signs until it’s too late.

Sedatives include prescription drugs like zolpidem (Ambien), eszopiclone (Lunesta), temazepam (Restoril), and benzodiazepines like diazepam (Valium) or alprazolam (Xanax). They also include older drugs like barbiturates and even some over-the-counter sleep aids with diphenhydramine (like Tylenol PM or Benadryl). All of them can cause overdose if taken in excess, especially when mixed with alcohol or opioids.

The Warning Signs: What to Look For

1. Unresponsiveness
Can you wake them up? Shout their name. Shake their shoulder. Try a sternal rub-firm pressure on the center of their chest. If they don’t open their eyes, move, or respond at all, that’s a red flag. Normal sleep doesn’t mean you can’t rouse someone. If they’re completely unresponsive, it’s not sleep. It’s depression of the central nervous system.

2. Slowed or Shallow Breathing
Count their breaths for 30 seconds. Normal breathing is 12 to 20 breaths per minute. If they’re taking fewer than 8 breaths per minute, they’re in danger. If they’re taking less than one breath every 5 seconds, they’re not getting enough oxygen. Their chest may rise barely at all. This is the most dangerous sign. Respiratory failure causes 92% of deaths in pure sedative overdoses.

3. Bluish Lips or Fingertips
Cyanosis means your body isn’t getting enough oxygen. Look closely at their lips, nail beds, and fingertips. If they look gray, purple, or blue, it’s a sign of severe oxygen deprivation. This often comes after breathing slows down. It’s not subtle. It’s visible.

4. Slurred Speech or Incoherence
They might mumble, speak slowly, or say things that don’t make sense. They can’t follow simple instructions. This isn’t drunkenness-it’s neurological shutdown. Studies show 87% of benzodiazepine overdose cases involve slurred speech.

5. Loss of Coordination
They can’t stand up. They stumble. Their hands shake or can’t hold a cup. This is called ataxia. It’s not just being clumsy. It’s your brain losing control over muscle movement. The Cleveland Clinic describes this as “drunken-like” behavior-even if they haven’t had alcohol.

6. Cold, Clammy Skin and Low Body Temperature
Their skin may feel cold and damp. Their body temperature drops below 95°F (35°C). This is hypothermia caused by slowed metabolism. It’s a sign the body is shutting down.

7. Vomiting or Nausea
About 63% of overdose cases involve nausea. Vomiting happens in 41%. If they’re unconscious and vomiting, they’re at risk of choking. Never leave them lying flat. Turn them on their side.

8. Coma
If they’re completely unresponsive, not reacting to pain, and breathing very shallowly, they’re likely in a coma. A Glasgow Coma Scale score below 8 means they’re in a life-threatening state. This is not a sleepover. This is an emergency.

Different Drugs, Different Risks

Benzodiazepines and Z-drugs (Ambien, Xanax, Lunesta)
These are the most common today. They cause deep sedation but often leave heart rate and blood pressure relatively stable until the very end. That’s deceptive. People think, “Their pulse is okay, so they’re fine.” But breathing can stop before their heart does. Isolated overdoses on these drugs are less likely to be fatal-but when mixed with alcohol or opioids, the risk skyrockets.

Barbiturates (phenobarbital, secobarbital)
These are older, rarely prescribed now, but still found in some homes. They’re far more dangerous. Even a small overdose can cause rapid respiratory arrest. They depress breathing more deeply and quickly than benzodiazepines.

Over-the-Counter Sleep Aids (diphenhydramine)
Drugs like Benadryl or Tylenol PM can be deadly in large doses. Symptoms include extreme drowsiness, dry mouth, urinary retention, and sometimes hallucinations or seizures. It’s easy to underestimate these because they’re sold without a prescription. But taking 10 or 20 pills? That’s poison.

Melatonin
This is the exception. Even at very high doses-like 240 mg (60 times the normal dose)-it rarely causes breathing problems. The worst you’ll see is headache, dizziness, or nausea. It’s not life-threatening like prescription sedatives.

Why People Miss the Signs

A 2022 study of 1,247 overdose cases found that 68% of bystanders waited to call 911 because they thought the person was just sleeping. The average delay? 47 minutes. That’s enough time for oxygen levels to drop to fatal levels.

Reddit threads from r/OverdoseHelp are full of stories like:

• “I thought my roommate was just really tired from work.”
• “I assumed the slurred speech was from drinking.”
• “I didn’t want to make a big deal. I thought they’d wake up.”

These aren’t careless people. They’re loving people who didn’t know what to look for. That’s why education matters.

What to Do Right Now

Step 1: Check Responsiveness
Shout their name. Shake their shoulders. Try a sternal rub. If no response, move to step two.

Step 2: Check Breathing
Look at their chest. Count breaths for 30 seconds. Multiply by two. If it’s less than 12 breaths per minute, call emergency services immediately. If it’s less than 8, or if breathing is irregular or shallow, start rescue breathing now.

Step 3: Call Emergency Services
Dial 999 (UK) or 911 (US). Say: “I think someone has overdosed on sleeping pills.” Tell them if you know the drug name, how much was taken, and if alcohol or other drugs were involved.

Step 4: Start Rescue Breathing if Needed
If they’re not breathing or breathing very little, begin rescue breaths. Tilt their head back, pinch their nose, give one breath every 5 seconds. Don’t stop until help arrives or they start breathing on their own.

Step 5: Put Them in the Recovery Position
If they’re breathing but unconscious, turn them onto their side. This keeps their airway open and prevents choking if they vomit.

Do NOT give them flumazenil.
This is a drug that reverses benzodiazepine overdose-but it’s dangerous outside a hospital. It can trigger seizures in people who are dependent on these drugs. Leave it to paramedics.

What Makes It Worse

Alcohol and sedatives together double the risk of respiratory depression. Opioids? Even worse. In 2021, 23% of benzodiazepine-related overdose deaths also involved fentanyl. That combination is lethal. It’s why so many overdose deaths now involve multiple drugs.

Other risk factors:

• Taking more than prescribed
• Using someone else’s prescription
• Having liver disease (slows drug breakdown)
• Being over 65 (body processes drugs slower)
• Using multiple prescriptions from different doctors

Empty pill bottles, multiple prescriptions, or a history of substance use are big warning signs. Don’t ignore them.

What’s Being Done to Help

Emergency rooms are now using screening tools like the 8-item Benzodiazepine Dependence Self-Report Questionnaire to catch at-risk patients before it’s too late. Johns Hopkins research shows that wearable devices detecting early oxygen drops could give 15-20 minutes of warning before full collapse.

But none of this helps if no one notices the signs.

Final Reminder

If someone is unresponsive, breathing slowly, or turning blue-call for help immediately. Don’t wait. Don’t hope. Don’t assume. Your action could save a life.