Sleeping pills exert a depressant effect on the central nervous system. Small doses produce sedation, moderate doses induce sleep, and large doses can prevent seizures.Ingestion of 5–6 times the usual dose can cause poisoning. Affected individuals often have a history of sleeping pill use, presenting with deep unconsciousness, muscle spasms, lowered blood pressure, shallow and slow breathing, slow heart rate, weak pulse, and even deep coma with absent reflexes. Absorption of over 15 times the usual dose can lead to death from respiratory depression.
Manifestations of sleeping pill poisoning:
1. Nervous system: Dizziness, memory loss, drowsiness, ataxia, loss of sensation, absent tendon reflexes. Severe cases present with coma, convulsions, dilated pupils, and loss of light reflex.
2. Respiratory and circulatory systems: Initial slow, regular breathing progresses to slow, irregular breathing. Severe cases exhibit respiratory distress, cyanosis, tachycardia, hypotension, oliguria, and circulatory failure.
3. Skin manifestations: Rash, nausea, vomiting, constipation.
4. Death may occur in patients who ingest large doses over extended periods without detection.
Sleeping pill poisoning is classified into three degrees:
1. Mild poisoning: Drowsiness, impaired judgment and orientation, unsteady gait, slurred speech, nystagmus.All reflexes present; normal body temperature, pulse, respiration, and blood pressure.
2. Moderate poisoning: Superficial coma; may be aroused by strong stimuli but cannot respond to questions, quickly returning to unconsciousness. Tendon reflexes absent; respiration shallow and slow, blood pressure still normal; corneal and pharyngeal reflexes present.
3. Severe poisoning: Deep coma; early stage shows increased muscle tone in limbs, hyperactive tendon reflexes, and positive pathological reflexes. Later stage exhibits generalized muscle flaccidity with loss of all reflexes. Pupils dilated, blood pressure drops, pulse rate increases, urine output decreases, and circulatory failure occurs.

3. Severe poisoning: Deep coma. Early stage: Increased muscle tone in limbs, hyperactive tendon reflexes, positive pathological reflexes. Late stage: Generalized muscle relaxation, loss of all reflexes. Pupillary light reflex present, pupils alternately dilate and constrict. Breathing shallow and slow, irregular or Cheyne-Stokes. Pulse weak and rapid, blood pressure decreases.
How to diagnose?
1. A history of oral or injectable barbiturate overdose, accompanied by the following symptoms, facilitates diagnosis. Mild poisoning presents with drowsiness, dizziness, nausea/vomiting, slurred speech, and rash.Severe poisoning presents with slowed, irregular breathing, constricted pupils, decreased blood pressure, and coma.
2. Symptoms include oliguria, jaundice, bleeding, respiratory paralysis, and death from heart failure.
Emergency Treatment
1. Hemodialysis may be used for severe poisoning.
2. Position the patient supine with minimal head movement.
3. Administer hepatoprotective agents to safeguard the liver and enhance metabolism.
4. Induce vomiting by stimulating the pharyngeal reflex, or perform gastric lavage with 1:5000 potassium permanganate solution or plain water. Magnesium sulfate may be used for catharsis.
5. For hypotension, administer intravenous norepinephrine or methoxamine. For seizures, use pentobarbital. In cases of coma, administer stimulants such as methylphenidate hydrochloride (Ritalin) or apomorphine.
Important Note: Acute sleeping pill poisoning symptoms vary in severity based on dosage, time elapsed, fasting status, and individual constitution. Poisoning victims should be rushed to the hospital for treatment.
Long-term use of sleeping pills:
1. Easily leads to habit formation and even addiction. The longer the medication is taken, the more severe the rebound effect upon discontinuation. Some individuals experience intolerable withdrawal symptoms, developing a mistaken belief that they must continue taking the medication, thus forming drug dependence.
2. It can lead to dangerous tolerance. During the day, the drug stimulates the liver to produce more enzymes that break down the medication. This causes the drug to be rapidly metabolized, gradually weakening its hypnotic effect and leading to tolerance. Consequently, some individuals require increasingly higher doses, which can have serious consequences.
III. They possess inherent toxicity. Since most sleeping pills are metabolized by the liver and excreted by the kidneys, they inevitably impact liver and kidney function. Individuals with pre-existing liver or kidney issues should carefully select medications with minimal side effects. Otherwise, they risk liver enlargement, hepatic pressure pain, abnormal liver function, and even damage such as jaundice, edema, or proteinuria.
IV. Gastrointestinal disturbances may occur, such as nausea, loss of appetite, bloating, and constipation.Additionally, interactions with other medications may occur. Furthermore, certain sleep aids are excreted slowly. Long-term use can lead to cumulative toxicity over time. It is best to take them under a doctor's guidance to prevent addiction or drug accumulation poisoning. For treating insomnia and depression, do not rely solely on medication. Actively treat the underlying condition, strengthen psychological therapy, practice good sleep hygiene, and enhance medication management.