Is it dangerous to knock yourself out before a long plane ride?
April 10, 2019 8:00 PM   Subscribe

I have a couple of plane rides coming up and this is a question I've always wondered about. If you take a sleeping pill to make you sleep, and the plane gets into some trouble, would your adrenaline system wake you up or could you be too impaired from whatever you took to escape?

I tried to google this and found a clickbait type article from an ex-Marine who said sleeping on the plane is bad for jet lag, which, okay, but I like to sleep to pass the time because otherwise I get seriously depressed from how bored I am and how much my butt hurts. But I am needing to up my game a little bit because the last few times just regular old Benedryl didn't cut it. I want to really be lights out start to finish.

But is doing this at all taking a risk that if something bad happened to the plane that I could theoretically escape from, I would not be in a position to do so?
posted by bleep to Health & Fitness (18 answers total) 5 users marked this as a favorite
Not if you're taking a standard sleeping aid like an Ambien. You will wake up at home if the smoke alarm goes off, so you'd be similarly fine on a plane.
posted by DarlingBri at 8:04 PM on April 10, 2019 [1 favorite]

Since you question is so specific it might be hard to google, but I did find some suggestion that some sleeping pills make it hard to wake to fire alarms which seems similar.

posted by aetg at 8:05 PM on April 10, 2019 [1 favorite]

I'm in a similar boat to you, with the addition of anxiety related to emetophobia (I'm terrified that someone near me on a plane will vomit. More terrified of that than the plane going down, ridiculous, but that's the brain I live with.)

This is a very big YMMV situation. Everyone has a different constitution and a different reaction to various medications.

The risk with sleeping pills is not that you will sleep through your death. I suppose for some people this might be possible, but the more common issue is the very effects you're taking the pills for. People who have taken a normal dose of sleeping pills will:

-Require more stimulation (e.g. louder alarms, more turbulence) to wake
-Be prone to confusion, vertigo, and amnesia
-Take a longer time (than a non-sedated person) to respond to questions and follow instructions
-Have reduced motor control/coordination

All this adds up to a person who will probably wake up in an emergency, and remains capable of escaping in a general sense given enough time, but who will be less capable than their non-drugged co-passengers, and sometimes that's what makes the difference. If we're looking at a situation where only the first 50% of passengers get out before the explosion, a heavily sedated person will likely not be in that group.

If you're really concerned about your personal reaction, why not test it at home before you fly? Take the drugs you're planning on taking, and then set a series of alarms on your phone -- say, one every 5 minutes, starting from midway through the night, each of which is more obnoxious than the last. Maybe even plan to perform some small, safe task when you wake up. See what your threshold for waking is and how comfortable you are with your performance level.

I actually did something very similar myself the last time I tried a sedative and needed to figure out how drowsy it would make me and for how long. It really set my mind at ease in the real situation because I knew what to expect.

(Personally? I've decided that flight is so safe, the minuscule risk of dying in a plane crash is nowhere near as important to me as being pleasantly unconscious. I take the pills.)
posted by gloriouslyincandescent at 8:20 PM on April 10, 2019 [9 favorites]

Hm OK so I guess as a follow up question, it's unlikely that your adrenaline system just kicks in and floods out all the sleepy chemicals? You wouldn't just be like ACTION HERO READY TO GO. That makes sense.
posted by bleep at 8:36 PM on April 10, 2019

I've taken both Ambien and Lunesta when I knew I would only have four hours or so to sleep. (Bad idea, I know, but when you've gone enough nights without sleeping you can get a little desperate.) The alarm woke me up most times. I was able to get up, get dressed, and go about my day, but I was super groggy and it's just didn't feel very good. HOWEVER. I really have no way of knowing if that was because of the medication, the cumulative effect of the missed sleep leading up to it, or a combination of both.

My doctor briefly tried me on Seroquel when neither Ambien nor Lunesta was having any effect anymore.that knocked me out so I slept through two alarms, the phone, and a human shouting at me.

No doctor has been willing to try an old-fashioned barbiturate, even for just two or three nights to see if it could reset my sleep pattern.

So, that's my experience if it's helpful in any way at all
posted by The Underpants Monster at 9:51 PM on April 10, 2019 [1 favorite]

As an extensive viewer of Air Crash Investigation / Mayday there are definitely air crash cases where being out cold with a sleeping pill would put you at a serious disadvantage you wouldn't be able to over come. There's also shock to consider, the adrenaline doesn't infuse everyone with the extra smarts they need to escape, often times even capable awake people are just too stunned to act fast.

But, disasters like this are so, so rare that I don't think it really matters.

(Also, I figure it might mean you get to pass gently from sleep into death without the trauma of being awake and not able to escape. I can think of worse ways to go.)

I personally don't knock myself out because I usually travel alone and I wouldn't want to be that vulnerable. With someone, I say go for it.
posted by kitten magic at 10:40 PM on April 10, 2019 [6 favorites]

Here's some stuff I dug up so if it's actually helpful for you to see some numbers, you can look at some numbers.

Main source is Survivability of Accidents Involving U.S. Air Carrier Operations, 1983–2000

So, indeed, air travel is pretty safe to begin with. Something like one in 200K flights (they actually count "departures" because IDK maybe they don't count as complete flights? "haha"?) have some kind of accident.

Of those about 12.5% have any fatalities at all; that's about one in every 1.6 million departures. And overall, 95.7% of people in an airplane accident survive. Basically, most people survive most crashes, there's a few crashes where hardly anyone survives (about 6% of crashes - one in 3 million departures), and a smidgen of crashes where people's alertness could reasonably be considered to be a factor in survivability.

I don't really have the interest level or the granularity of data to compute this rigorously, but after looking at all this data, my back-of-the-napkin estimate is the chance something like one in 30 million flights has an accident where a passenger's behavior and alertness plays any significant factor in their chance of survival.

So "Is it dangerous?" Being totally out-of-it on an airplane is probably safer than being totally out-of-it in your kitchen, but if you're choosing grogginess and being alert and calm and collected, during a plane crash, I guess there's a one in a bunch of million chance that the second choice is better.
posted by aubilenon at 10:50 PM on April 10, 2019 [15 favorites]

As kitten magic says, this kind of disaster is so rare that the rational thing is to try to put it to the back of your mind and go ahead and knock yourself out. Passengers could, I suppose, maintain themselves in an ever-vigilant state where they are ready to bolt for the exists for the whole flight: but the stress from the anxiety (or accidents the next day form lack of sleep) would be massively more likely to kill them than any accident on the plane.

If we do look at the various portions of the flight at which there might be a disaster we have: just after take-off, just prior to landing and somewhere in the middle. The probability of an accident is higher at the start and end of a flight - which is why the cabin crew will make efforts to make sure passengers are alert, night vision adjusted, and aware of the position of the exists at this point. It is, of course, super common for passengers to be asleep at both of those points, however - see "low odds of disaster" for explanation. I guess, to be a very small fraction safer, you would not take your pill until after take off.

There are some scenarios where very quick action would be beneficial: for example if there is cabin-depressurisation at cruising altitude you will only have about 20 seconds of useful consciousness in which to get your oxygen mask on. But these are very rare subset of an already rare event. Personally I would not worry.
posted by rongorongo at 10:59 PM on April 10, 2019 [3 favorites]

Personally I'd be more concerned about everyday scenarios that happen far, far more commonly than the plane crash type scenario--such as, you take your sleeping pill 20 minutes before departure time but then loading is delayed by an hour and you miss the next flight two hours later because you were conked out in an airport lounge. Or your plane develops mechanical problems on the taxiway and returns to unload everyone, and now you are tired and groggy through the multi-hour process of disemarking, getting your luggage, re-scheduling your flight for the next day, getting to a hotel, etc. Or you're groggy when you arrive and make some serious mistakes dealing with passport control and customs, etc.
posted by flug at 11:15 PM on April 10, 2019 [19 favorites]

Definitely practice with the sleep medication and see how you react when you wake up. Can you wake up enough to spend an hour on the phone rebooking your flight when your first leg is delayed to the point where you will miss or have missed your connection? Can you talk to border control?

I routinely take sleep aids and I can do these things with four hours sleep after dosing. Adrenaline does kick in and does help. Nothing like the thought of a 44 minute connection across terminals at LAX or the look on the face of the border guard while you mildly slur to give you some juice and get it together.
posted by crazycanuck at 11:56 PM on April 10, 2019 [1 favorite]

Flug makes a good point. I knew of someone knocking themselves out before the flight took off, it couldn’t take off, and his friends had to haul his dead-weight ass off the plane. He woke in a hotel room relieved to have survived his terror of flying. His friends broke the news that (a) they were still in home city and (b) they weren’t letting him near the pills again because it had been a massive pain in the neck. You need cooperation from your companions if you choose to incapacitate yourself!
posted by kitten magic at 12:29 AM on April 11, 2019 [12 favorites]

Fwiw, small sample. but I just took the redeye from LA to JFK Sunday night. Had an ambien washed down by two beers. Slept the whole time but woke up enough to get my bag and drive myself home from the airport in bumper to bumper traffic on the Van Wyck at 8:30am. YMMV.
posted by AugustWest at 12:51 AM on April 11, 2019 [4 favorites]

Look, your mileage will vary but that doesn't mean it can't be calibrated. I'm the idiot who took 2mg instead of .2mg of Xanax and slept for 19 hours. I was perfectly safe because there was another adult in the house, but I would not have heard a fire alarm or been able to respond to it effectively for many of those hours. I would not take 2mg or even .5mg of Xanax and get on a plane; I would happily take .2mg because I've taken it regularly for sleep at home and I'm very familiar with my response to it.

Same for Ambien, which is the most commonly prescribe sleeping aid, and has a vastly super short half-life.
posted by DarlingBri at 6:57 AM on April 11, 2019 [2 favorites]

Have you tried regular dramamine? I take it before every flight, and it lets me sleep but still be able to function when needed. (Plus no puking when the turbulence hits.)
posted by Orange Dinosaur Slide at 9:29 AM on April 11, 2019 [2 favorites]

If you're in a window seat so that people don't have to climb over you, it's probably harmless. I do take a half an Ambien on long plane rides, having established that it doesn't make me crazy otherwise. If I wake up before my desired sleep time, I'll take a modest dose of melatonin. As I understand it, not being in the position to give medical advice, there is a real risk, especially in people with poor circulation, of blood clots. Aka Deep Vein Thrombosis or DVT. I would never mix Ambien and alcohol, though, especially since it's already so difficult to stay hydrated on a plane. And wait until you are on the plane and it has taken off or at least pushed back from the gate. You don't want to risk being (rightfully) denied boarding for being impaired, or having to deplane and deal with rebooking in a fog if there's a problem with the flight.
posted by wnissen at 12:56 PM on April 11, 2019 [2 favorites]

There's a (probably slight) risk of being kicked off a plane if you take your sleeping pill before takeoff and the flight attendants decide they have concerns about your ability to achieve & maintain alertness. Read into that what you will.

B.C. man kicked off WestJet flight after falling asleep before takeoff
posted by Secret Sparrow at 2:09 PM on April 11, 2019 [2 favorites]

The active ingredient in Dramamine, which many people take before a flight for motion sickness, is also the active ingredient in Benadryl and is sold over the counter as a sleep aid.

I wouldn't worry about it.
posted by tacodave at 4:43 PM on April 11, 2019 [1 favorite]

Seconding that this is a bit of a YMMV situation
I do long plane flights pretty regularly and avoid Ambien (and similar sleep medications), but that's largely because I have very bad reactions to it (think memory blackouts, sleepwalking, etc).

My go-to has been a couple glasses of wine + a melatonin timed to my destination timezone (which takes some planning, but works well), usually taken during the first meal service an hour or so after takeoff. I dont really worry about being alert for issues because 1) the odds of a serious problem are vanishingly small, and 2) by an hour into the flight, the odds of running into a delay or other issue is unlikely.
posted by photo guy at 8:31 PM on April 12, 2019

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