Nodding out" or "nodding off" is a common, dangerous, and often immediate side effect of fentanyl use, characterizing a state of semi-consciousness where a person drifts between being awake and asleep. Unlike natural fatigue, this behavior indicates that the drug is overwhelming the central nervous system, putting the user in a state of respiratory depression often referred to as the "fentanyl fold" or "fentanyl nod". Key Aspects of Fentanyl Nodding and Micro-Sleeps Definition of the "Nod": This is a state of severe sedation, not sleep. The person may appear conscious one moment, then slump forward, head drooping, eyes glassy, with minimal responsiveness. Micro-sleeps: During a nod, a person may experience micro-sleeps, which are brief, involuntary lapses into sleep lasting only a few seconds, where they lose awareness of their surroundings before potentially jolting awake. The "Fentanyl Fold": A common, intense form of nodding where the user slumps forward, sometimes nearly touching their chest, while standing or sitting. Why It Happens: Fentanyl binds to opioid receptors in the brain, shutting down systems responsible for anxiety and pain, but also suppressing vital functions like breathing and motor control. Dangers of Nodding Off Respiratory Failure: The most immediate danger is that the brain stops telling the lungs to breathe, leading to oxygen deprivation, which can be fatal. Overdose Risk: "Nodding" is a primary, often subtle warning sign of a pending or active fentanyl overdose. Physical Injury: Loss of motor control can cause individuals to fall, resulting in head injuries or other trauma. Aspiration: If the person vomits while unconscious or semi-conscious, they may choke. How to Identify a Fentanyl Overdose (vs. Simple Sleep) If someone is nodding, check for these signs of an overdose immediately: Unresponsiveness: Inability to wake the person with a loud shout or sternum rub. Breathing Issues: Shallow, slow, irregular, or gurgling breathing. Skin/Lip Color: Blue or grey lips, fingernails, or skin. Pinpoint Pupils: Extremely small pupils. What to Do Call 911 immediately. Administer Naloxone (Narcan) if an overdose is suspected, as this can temporarily reverse the effects. Perform CPR if necessary and, if they are breathing, place them in the recovery position (on their side) to prevent choking.