Discussion: DMT & Sleeping pills

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DMT & Sleeping pills ​

DMT (N,N-Dimethyltryptamine) is a powerful psychedelic substance found in various plants and animals, including humans. Its psychoactive effects are primarily mediated through its agonistic action on serotonin (5-HT) receptors, particularly the 5-HT2A receptor. This receptor is crucial for the regulation of mood, anxiety, and perception. DMT's interaction with these receptors leads to the profound alterations in perception, mood, and thought commonly reported by users. Additionally, DMT might affect other neurotransmitter systems, but its serotonergic action is the most prominent and well-studied.

Sleeping pills, or hypnotics, are a diverse group of medications designed to facilitate sleep for individuals with insomnia or other sleep disorders. These medications are classified based on their chemical structure and mechanism of action. They can be classified into several categories, including:

• Benzodiazepines are sedative-hypnotic drugs that enhance the effect of the neurotransmitter GABA (gamma-aminobutyric acid), which is the primary inhibitory neurotransmitter in the brain. They are used for treating insomnia, anxiety, and sometimes for induction of sleep before surgical procedures. Lorazepam (Ativan), Temazepam (Restoril), Diazepam (Valium), and Flurazepam.
• Non-benzodiazepine hypnotics, also known as Z-drugs, act on the same GABA-A receptors as benzodiazepines but are structurally different and tend to have fewer side effects, particularly less daytime sedation and dependency issues. Zolpidem (Ambien), Eszopiclone (Lunesta), and Zaleplon (Sonata).
• Melatonin receptor agonists work by mimicking the action of melatonin, a hormone that regulates the sleep-wake cycle. They are particularly useful in treating sleep onset insomnia and circadian rhythm sleep disorders. Ramelteon (Rozerem), and Tasimelteon (Hetlioz).
• Orexin receptor antagonists target the orexin system, which plays a significant role in wakefulness. Blocking orexin receptors helps in the promotion of sleep. Suvorexant (Belsomra), and Lemborexant (Dayvigo).
• Some antidepressants have sedative effects and can be used to treat insomnia, especially when the patient also suffers from depression. They are not primarily classified as sleeping pills but are prescribed off-label for sleep problems. Trazodone (Desyrel), Doxepin (Silenor), and Amitriptyline.
• Barbiturates were once common for treating anxiety and inducing sleep but have largely been replaced by benzodiazepines and other classes due to their high risk of dependency and overdose. Phenobarbital and Secobarbital.

Each class of sleeping pills has a distinct mechanism but generally works by promoting GABAergic activity or influencing the body's circadian rhythms, leading to sedation or sleep induction.

It's important to note that while these medications can be effective for treating sleep disorders, they are typically recommended for short-term use due to risks of dependency, tolerance, and withdrawal.

Combining DMT with sleeping pills can lead to unpredictable effects due to the contrasting actions of the substances - DMT being primarily excitatory through the serotonin system, and sleeping pills being inhibitory through the GABAergic system or melatonin pathways. The interaction could potentially:

1. Diminish the psychoactive effects of DMT: Due to the sedative properties of sleeping pills, they might dampen the intensity of DMT experiences.
2. Increase risks of adverse reactions: The sedation from sleeping pills could interact unpredictably with DMT's intense psychoactive effects, possibly leading to cognitive impairment, confusion, anxiety, or panic in vulnerable individuals.
3. Respiratory Depression: Some sleeping pills, especially benzodiazepines and Z-drugs, can cause respiratory depression. When combined with DMT, which may also affect breathing patterns, there's a risk of compounded respiratory issues.
4. Certain classes of sleeping pills may carry additional risks. Thus, antidepressants can increase serotonin levels, which in combination with DM creates conditions for the development of dangerous serotonin syndrome.
5. Alter the pharmacokinetics of either substance: The presence of one substance could affect the metabolism of the other, potentially leading to prolonged effects or increased side effects.

We have not come across confirmed data on acute and fatal conditions associated with this combination. At the same time, there is no evidence of worthwhile positive recreational effects that could cover the risks of this combination. Given the mechanism of action of sleeping pills, they can be taken in minimal doses before the trip (to reduce anxiety) and after the trip (to ensure smooth falling asleep).

Considering the above, we recommend treating this combination with great caution.