Why do benzodiazepines cause blackouts rather than unconsciousness in higher doses

I’ve talked to some recreational drug users who have had blackouts on xanax where they did inappropriate things but have no memory of doing so. They take too much xanax (a few mg) and then they regain consciousness hours and hours later, and apparently they’ve been walking around doing stuff the entire time.

Why would xanax cause a blackout rather than unconsciousness?

I thought barbiturates caused unconsciousness or death if the dose was high enough. But high doses of benzos seem to more cause blackouts rather than unconsciousness. Or is that a misunderstanding, do a lot of people who take too much valium or xanax just fall asleep instead?

I understand the reason people don’t die from benzo ODs is because benzos increase the rate at which chloride channels open while barbiturates increase the duration of how long the channels are opened (thats my understanding at least), so barbiturate OD causes death but xanax OD doesn’t. But why does that difference seem to play a role in the effects on short term memory or unconsciousness, or even death?

I don’t have an answer to your whole question, but I can tell you something, which I will not tell you how I know, but it’s this: if you are person who takes a benzo fairly regularly, you can train yourself to stay awake through it. The first time, and subsequent times you take it the med, you do so sitting in bed, put the water right down on your bedside table, and go to sleep.

Then, one night, right after you take it, the phone rings, and you must answer. Someone you know is having an emergency. You body goes into “fight or flight” mode, with lots of adrenaline, and you hardly remember you are on the benzo.

When you get home, you can’t fall asleep, so you take another.

The next night, you take it right before you lie down, but this time, you lie in bed for a while before you start to feel sleepy.

After a few more nights like the one where you had to go out, you are now regularly taking twice as much benzo, and still not falling asleep right away.

You are headed for trouble. Trouble could include sleepwalking, or just about any sleep-verbing, none of which you will remember.

Benzos can and do cause unconsciousness fairly frequently. A frequent finding in benzo overdose is coma with normal vital signs. But it’s quite variable whether the patient will be found to be merely sedated, stuporous but arousable, stuporous and unorientable, or just plain unresponsive. One of those variables is benzo type and route. Oxazepam is less likely to cause stupor/coma, temazepam is more likely. A lot depends on how quickly the med builds up in the central nervous system, and that may in turn depend on route of administration (IV is quick, oral much less so and more variable given the vagaries of digestion).

All that applies only to pure benzo ingestion. Many patients evaluated turn out to have ingested multiple agents along with the benzos, such as alcohol, opioids, barbiturates, stimulants, etc. Teasing apart which drug caused which symptom is then far more difficult.

Benzo ingestion seldom cause death be cause they seldom cause respiratory depression or circulatory collapse/dysfunction. The drugs just don’t work that way, most of the time.

My understanding is, that when they have been implicated in drug deaths, it’s mostly because people take them, get disoriented, take more because they can’t remember if they took them, then also take an extra dose of something else more dangerous, because they don’t remember taking the earlier dose of that either.

For people who have them as prescriptions, especially as PRNs, doctors may say to put as much as they can have in one day in a special bottle, and do so some time when they are well-oriented, like in the morning when they’ve been up a little while, and have had breakfast. Put some brightly colored tape on the bottle Also, put their daily meds, especially any potential overdose meds, into those daily dose boxes-- or buy from a pharmacy that will bubble-pack them.

Could such people reliably read a digital display after dose one? If so, they might do well with these very special pill bottles meant for those of us with ADHD and people with other short-term memory impairment. I put my allergy meds in them because while I won’t OD on either medication, it’s still not a good idea to potentially double them.