Sleep Safety: Drowsy Driving, Breathing Problems and Sedating Products

Urgent help first

• Someone is in danger, has taken too much of a sleep product, or has a severe allergic reaction. In the US call 911; elsewhere use your local emergency number.
• Poisoning or possible overdose of any sleep aid, melatonin or herbal product, including by a child. In the US call Poison Help at 1-800-222-1222. See Poisoning: what to do first and Poison help by country.
• Thoughts of suicide. In the US call or text 988, the Suicide & Crisis Lifeline, free and available 24/7; elsewhere use your local emergency number.
• A serious allergic reaction. The NHS lists swelling of the lips, mouth, throat or tongue, fast breathing or struggling to breathe, a tight throat, or fainting as reasons for an emergency call (UK number 999; use your local emergency number). [1]
• Falling asleep while driving, or nearly doing so. Pull over safely when you can and stop driving until you have been checked. The NHS says not to drive when you feel sleepy. [2]

Drowsy driving and dangerous sleepiness

Sleepiness while driving, not related to alcohol, is responsible for serious car crash injuries and death. [3] Sleep deficiency is also linked to a higher chance of injury in adults, teens and children, and to falls and broken bones in older adults. [3] Untreated sleep apnea can lead to a higher chance of serious accidents caused by tiredness. [4]

Narcolepsy can cause falling asleep suddenly, and people should avoid activities that could be dangerous if they sleep or fall unexpectedly. [5] In the UK, people must tell the DVLA if they drive and have narcolepsy, and must not drive with confirmed sleep apnea and excessive sleepiness until symptoms are under control. [5][4] Driving rules differ by country and state, so ask your clinician. Naps can boost alertness, but they do not replace a night of sleep. [6]

Breathing problems at night

Breathing that stops and starts, gasping, snorting or choking noises, loud snoring and extreme daytime tiredness can be signs of sleep apnea, which needs assessment. [4] See Sleep apnea. Sleeping pills can make sleep apnea worse. [4]

Sedating products and combinations

• Sleep medicines. The NHLBI notes that some prescription sleep medicines can cause rare complex sleep behaviors such as walking, eating or driving while asleep. [7] Benzodiazepines can interact dangerously with other medicines and are habit-forming. [7]
• Zopiclone (UK example). The NHS advises not driving for 12 hours after a dose, not stopping suddenly, and calling NHS 111 if more than the prescribed dose was taken. [8]
• Antihistamine sleep aids (diphenhydramine). The NHS says it can cause sleepiness, dizziness and trouble concentrating, you can become dependent on it, and alcohol raises the risk of side effects. [9] Side effects may be more likely if you are over 65. [10] Diphenhydramine is also mixed into some cough and cold products, so check labels. [9]
• Melatonin. Many medicines can add to its sedating effects, and herbal remedies that make you sleepy should not be taken with it. [11]
• Herbal and supplement products. Valerian, lavender, kava and others are not risk-free; kava has been linked to severe liver damage and L-tryptophan to serotonin toxicity with some medicines. [12]
• Alcohol adds to drowsiness and disrupts sleep. [9] See Caffeine, alcohol, nicotine and sleep.

Rule of thumb from the sources: do not combine more than one sedating product without asking a pharmacist or doctor, and tell every clinician what you use. [11][12] See How interactions work and Interactions by drug class.

Older adults: sleep medicines may help in the short term but carry risk and the potential for dependence, and may leave you not clearheaded the next day. [13] See Older adults.

Safe sleeping environment

The NIA lists installing smoke alarms on each floor, locking doors and windows, keeping a phone with emergency numbers near the bed, a reachable lamp and nightlight, not smoking in bed, and removing trip hazards. [13] For sleepwalking, see Parasomnias.

When to see a clinician about sleep

• Changing your habits has not helped, you have had trouble sleeping for months, or it makes daily life hard. [2]
• You fall asleep suddenly in the day, feel tired all the time for no reason, or have worrying sleep problems. [5]
• Your breathing stops and starts in sleep or you gasp. [4]
• Frightening sleep behaviors cause injury risk or are frequent. [14]
• You find yourself relying on alcohol or sleeping products to sleep. [2]