[Main Page][GHB FAQ][Meta-FAQ][Supply FAQ][Therapy FAQ]
[References][Glossary][Link To the Outside World]
[Quick answers from the GHB FAQ Crisis Center]
GHB and Sleep
One must wonder what the FDA would think if they knew of all the people who take this hazardous "party drug" and don't even stay awake to notice the effects. GHB is an excellent tranquilizer, and is unique in its freedom from the side effects of more traditional drugs.. Before going into the specifics of its use, let me address the specifics of this heady claim:
The most commonly used sedative drugs today are the benzodiazepenes (notably Valium) and alcohol. Occasionally the barbiturates (eg, Librium) are still used, but I will not discuss them here. Their negative effects are similar to those of the benzodiazepenes, but generally more severe.
Overdose Potential
Tranquilizers have a somewhat sordid image in our culture. Their use in suicides doubtless plays a large role in this. Both alcohol and the benzodiazepenes create a general body-wide depression of activity, including respiration. People who lethally overdose generally die because they simply stopped breathing[156].
GHB brings about sleep by a mechanism which, while poorly understood, is much closer to the body's natural process. Breathing and pulse are no more reduced than they are in normally sleeping people (breaths per minute may decrease, but oxygen intake is unaffected). High doses may make sleep deeper, to the point of unarousability, but once the GHB is metabolized subjects awaken unharmed[151].
Sleep Quality
Everyone knows that alcohol will put users out, but this is a highly unnatural substitute for real sleep. Rapid Eye Movement sleep (REM), the stage at which dreaming occurs, is heavily suppressed, as is Slow Wave Sleep (SWS), the "deepest" and most relaxed phase. Regular REM is vital to psychological stability, and may be involved in the consolidation and organization of memory as well. SWS is the only time during which certain biological processes take place, such as the secretion of growth hormone. Proper growth hormone levels are necessary for good health, and reductions have been linked to many of the destructive effects of aging[20].
The benzodiazepenes, while less severe, have the same effects. After an initial low period, REM may return to normal[156].
GHB induces a sleep that is entirely natural. The duration and organization of the sleep stages is preserved, and growth hormone release is actually increased[20]. In fact, abnormal sleep patterns like those of narcoleptics* and insomniacs* become more typical[77]. While users of other tranquilizers may be difficult to awaken, GHB users (at low doses) remain completely responsive to ordinary stimulus, from pain to bladder pressure[4].
Hangover*
Alcohol's well-known hangover is created by many factors, including toxic metabolites, dehydration, and the brain's own opponent processes (hangover can be seen as a foretaste of withdrawal, should the sufferer become addicted). Excessive users awaken with mental impairment, irritability, and physical symptoms like headache and nausea.
The benzodiazepenes are in some sense more insidious than alcohol; while moderate drinkers can avoid hangover, benzos can create a similar syndrome even when used as directed. Some of these substances have a half-life* of many hours. Subjects may still have active quantities in their blood the next morning, and thus remain groggy and "drugged."[156]
GHB, in comparison, has a very short half-life and no active metabolites. After about 4 hours it is entirely consumed, changed into simple carbohydrates and thence expelled as carbon dioxide and water, no differently from bananas and birthday cake[82]. In fact, its effects are so short-lived that it has been judged inappropriate for subjects who awaken easily and need something that will keep them sedated throughout the night[4].
Tolerance, Addiction, and Withdrawal
The addictive potential of alcohol is well-known and need not be documented here. Tolerance* also develops to its effects, as seen when users need ever-greater quantities to get drunk. Withdrawal produces a variety of nasty effects, including depression, nausea, insomnia, and in severe cases the syndrome known as delirium tremens*.
Long-term users of benzodiazepenes show a variety of withdrawal symptoms, ranging from nervousness and insomnia to life-threatening seizures (this latter type only in heavy users withdrawn suddenly). Another common condition is "REM rebound," in which REM, apparently increased to compensate for the benzo's suppression, slingshots to much higher levels than normal. This can create disturbing nightmares and uneven, fitful sleep[156].
While withdrawal symptoms have been observed in GHB users, this seems to apply to people who take high doses multiple times each day and exist in a perpetually sedated state[33]. Repeated experiments have shown no adverse reactions when users of multiple low or single daily doses discontinue use[4],[12],[151]. Some difficulty sleeping may be noticed, but bear in mind that the user was someone who felt a need for a sleep aid in the first place.
Enhancing Sleep With GHB
People with difficulty getting to sleep may find GHB very valuable. While there is no accepted dosage regimen, I will provide typical experiences, as well as suggestions on maximizing its utility and safety.
No combinations!
Surely any reader of the FAQ already knows that GHB must not be combined with alcohol. However, people with trouble sleeping may already be on one or more tranquilizers, so I reiterate that any depressant drug may interact dangerously with GHB. Speak with your doctor if at all possible, and find out about discontinuing any current sedatives. It is important to ask rather than just stopping, since some drugs may remain in the body long enough to combine effects with GHB even after you are no longer taking them. If you can't get this information, a week's non-use should be an adequate safety margin.
Take the lowest effective dose
GHB is a relaxant and can be used to help fall asleep even at levels which would be of no use for recreation. Even a half-gram may be sufficient to nudge a tired, relaxed user to sleep. If this proves ineffective, increase by half-grams on subsequent nights. Once you've found a comfortable level of sedation, try decreasing the dose every once in a while. It is a general principle of psychopharmacology that the less drug one uses, the better.
Learn to handle it while awake
Before trying to sleep on GHB, make sure you know how it works while you are conscious. Some people become nauseous when they first try it; this will ruin your relaxation and may even become dangerous. There has never been a single reported case, either in pro- or anti- GHB material, of a user vomiting while asleep. Nonetheless, if there is even a hair's breadth of a chance, we should be cautious. A small carbohydrate snack (a piece of bread or a few crackers) and a drink of water can work wonders. After a few doses, this symptom may disappear spontaneously.
Moderation
Don't make a habit of taking GHB whether you need it or not. Unless you are a chronic insomnia sufferer, it's better to wait until you are having trouble falling asleep. It may seem harmless to use it regularly - GHB is not dangerous and does not interfere with natural sleep. On the other hand, neither of these is true of your bed or your ceiling, yet many people have trouble falling asleep in a strange room. There's no reason to make GHB a bedtime ritual. Besides, developing your natural ability to induce relaxation has its own rewards.
More on Dosages
The conservative recommendations above are for people with no major difficulties sleeping. Experiments usually use much more, in the neighborhood of 2.5g, probably because they don't want to waste the time necessary to work up to a minimum effective dose. If you are unable to sleep due to stress, chronic pain, or irregular scheduling, you may need several grams of GHB to get to sleep. As long as you work slowly up to this level and occasionally try to decrease it, there is no danger in doses up to 3-4g. Unexplained insomnia*, however, may be indicative of a more serious medical condition, and so I close with with the advice which should attend everything I tell you here:
Get a doctor's advice.
Anyone with stories of GHB as a sedative invited to share.
Index to the GHB therapy FAQ
[Main Page][GHB FAQ][Meta-FAQ][Supply FAQ][Therapy FAQ]
[References][Glossary][Link To the Outside World]
[Quick answers from the GHB FAQ Crisis Center]
Created and maintained by Michael Cohn - michaelc@medscape.com. © 1998