How Addiction and Substance Abuse Affect Sleep: A Guide to Sleep Health During Recovery
The 2018 National Survey on Drug Use and Health reports that approximately 20.3 million people aged 12 or older had a substance use disorder in the past year — 14.8 million of which had an alcohol use disorder and 8.1 million of which had an illicit drug use disorder. Preliminary research suggests that people who struggle with substance abuse are more likely to have a sleep disorder.
Substance use disorders aren’t the only form of addiction, though. Each year numerous behavioral addictions take control of individuals. They may form an addiction to gambling, shopping, video games, or social media, among other activities. While these may differ from substance use disorders, each of these addictions can become debilitating.
When drugs and alcohol, shopping, or social media take priority to work, school, or your relationships, it may be time to seek help.
The Correlation Between Addiction and Sleep
Substance abuse and sleep go hand-in-hand. Each influencing the other, it can be difficult to break the cycle. While drugs and alcohol negatively impact the sleep of active users, they can also affect those who have withdrawn.
Moreover, drugs and alcohol are sometimes self-prescribed for various sleep disorders.
Whether due to an addiction or not, this misconception may have drastic effects on one’s ability to get a good night’s rest.
Drugs and alcohol aren’t the only form of addiction interfering with sleep though. Gambling, the internet, video games, and other activities can become addictive behaviors and cause a disturbance to our bodies’ natural sleep cycles.
Common Sleep Disorders Associated with Addiction
- Insomnia: Insomnia is the inability to fall asleep and stay asleep.
- Hypersomnia: Hypersomnia is excessive daytime sleepiness that is not related to an underlying disease.
- Parasomnia: Parasomnia is a catchall term for any unusual behaviors experienced while asleep, before sleep, or while waking. This could include abnormal movements, sleep talking, or expressions of emotions, such as crying.
- Obstructive sleep apnea: Obstructive sleep apnea is when airflow is blocked during sleep and breathing temporarily stops.
- Restless legs syndrome: Restless legs syndrome is, as the name depicts it, the irresistible urge to move the legs. This condition is known to disrupt sleep as it typically occurs while lying down.
Types of Substances and their Effects on Sleep
Research suggests that the use of drugs and alcohol can disturb our circadian rhythm. This may result in a lack of sleep, sleep deprivation, poor sleep, or even sleep disorders — all of which could tempt users back to drugs and alcohol.
The circadian rhythm is a natural internal process regulating the way we sleep and wake. Operating on a 24-hour cycle, it is part of our body's internal clock. While natural factors in the body produce circadian rhythms, environmental factors can also play a role. Everything from working night shifts or jet lag to light exposure and consumption can alter our body’s sleep-wake schedule. Chronic disruption to the circadian rhythm may lead to serious health implications.
Below we will review different types of drugs and their individual effects on sleep:
Depressants, also referred to as sedatives or downers, suppress the central nervous system and lowers neurotransmission levels. Unlike their name suggests, they do not necessarily make a person feel depressed. Implications of depressants include reduced concentration and coordination, and in larger doses, drowsiness, vomiting, unconsciousness, and in the worst-case scenario, death.
They can typically be drunk as a beverage, injected, inhaled, or snorted. Their exact usage varies. While consuming alcohol, for instance, can be a healthy part of one’s social life, it can just as easily become an addiction. Depressants are also commonly used as prescription medications, but any of these have the potential to be abused.
Below we will explore three types of depressants:
Alcohol produces a chemical in the brain called adenosine that can trigger sleepiness. The chemical may help with falling asleep, but the effect doesn’t last long.
While alcohol may help people fall asleep faster, it reduces REM sleep. This can trick people into believing that alcohol is a sleep aid, but in reality, it is far from one. The more alcohol that is consumed, the greater the negative effect it has on sleep quality.
The classification of cannabis is not as straightforward as other drugs. While some argue it to be a sedative, others argue it to be a stimulant. Different strains have different effects on the body, causing these disagreements. Nevertheless, the heavy use of cannabis can impact sleep quality by reducing REM sleep.
Cannabis, however, can also have therapeutic effects on certain medical conditions. This drug is commonly used to treat pain, relax muscles, and lessen tremors, all of which could negatively impact sleep without something to counteract them.
Opiates can be legal or illegal. Common types of prescription opiates include oxycodone, hydrocodone, morphine, and methadone. Illegal opiates include heroin and fentanyl. Legal opiates, when taken as prescribed, can have beneficial effects on the body. Opiates are a mainstay in the treatment of pain following injuries and accidents. These drugs block pain and can create a relaxed state.
The abuse or overuse of opiates can cause sleep disturbances, as well as trigger relapse. Like other substances, it is associated with a reduced ability to enter REM sleep. Heavy or frequent users more often stay in the light sleep stage.
Lastly, sedatives can also come in the form of prescription medications. These include benzodiazepines, non-benzodiazepines sedative hypnotics, opiates, and barbiturates, among other prescription depressants. Sleep-inducing drugs such as Ambien, for instance, are sedatives. Some drugs used to treat anxiety, such as Xanax, are also sedatives.
When depressants are taken as prescribed by a doctor, they can have beneficial effects on the body and brain. The misuse of these drugs, however, can have the exact opposite effect. Taking this sort of drug to “get high” may lead to dependence, posing risks to your sleep and overall health.
Stimulants can negatively impact sleep; they are associated with an inability to fall asleep, longer latency to sleep onset, and shorter duration of sleep. This type of drug increases activity in the brain, such as elevating alertness, mood, and awareness.
There is a broad range of stimulants, including caffeine, nicotine, cocaine, amphetamines, and prescription stimulants.
Nicotine is an active ingredient in tobacco products. Smoking cigarettes, cigars, or other tobacco products are among the most well-known ways of consuming nicotine. The drug nicotine in any form can disrupt sleep, causing sleep fragmentation, insomnia, snoring, or sleep apnea.
Cocaine acts by binding to dopamine receptors in the brain, blocking its reuptake, and then increasing the amount of the chemical that you normally have in your body. Regular cocaine use can make your brain reliant on large amounts of dopamine. A drug that is known for promoting wakefulness, like other stimulants, cocaine reduces the REM cycle needed for a good night’s sleep.
Amphetamines are a synthetic, addictive type of stimulant that may be used legally or illegally. When prescribed, amphetamines are known for treating ADHD and narcolepsy. Similar to cocaine, amphetamines block dopamine reuptake and stimulate the chemical’s release. They promote wakefulness and decrease the body’s need for sleep.
Hallucinogens are a class of drugs that cause distortions in a person’s perception of reality, or as their name suggests, hallucinations. They can be divided into two broad categories: classic hallucinogens and dissociative drugs. Classic hallucinogens include LSD, peyote, and DMT. Dissociative drugs include PCP, ketamine, and salvia.
This type of drug may at times make it difficult to sleep, but hallucinogens do not appear to be as associated with sleep disorders as other substances are.
Types of Behavioral Addictions and Their Effects on Sleep
Behaviors can be just as addictive as substances and just as detrimental to sleep. While the word “addiction” may make you think of drugs and alcohol, various behavioral addictions exist. At the end of the day, all addictions share one thing in common: users have a dependency on them.
A few common behavioral addictions include gambling, sex, the internet (including social media), video games, shopping, plastic surgery, and food.
Below we will discuss a few of these behavioral addictions:
Gambling addiction is the uncontrollable urge to keep gambling despite the loss of money, time, employment, or social life. Although sleep has not yet been fully researched concerning this type of disorder, preliminary research finds that gambling addiction decreases sleep quality, especially among pathological gamblers.
The internet has become ingrained in American society so much that people have come to rely on it for work, school, calling a cab, ordering takeout, and many other common activities. But using the internet can be done in a healthy or unhealthy manner. An internet addiction is present when there is an uncontrollable urge to use the internet despite interference with your work, social life, or of course, sleep.
In one research study, internet addiction had a negative influence on sleep quality among adolescents.
Managing Sleep During Recovery: Tips and Advice
Insomnia is one of the most common and persistent symptoms of withdrawal from addictive substances and behaviors. Difficulty falling asleep, staying asleep, nightmares, and night sweats are other possible symptoms. Achieving a proper night’s sleep during the recovery process is a difficult feat, but something that must be done.
Below are a few tips and tricks for managing sleep during recovery:
Improve Sleep Hygiene
Your sleep hygiene refers to the habits and practices you have to get a good night’s sleep. Some common sleeping problems, such as insomnia, are occasionally caused by poor sleep hygiene. Establishing healthy sleeping pre-bedtime habits is the best start to managing sleep during recovery.
A few ways to improve sleep hygiene include setting a sleep schedule, following a nightly routine, maintaining healthy daily habits, and optimizing your bedroom. Healthy daily habits may mean fixing your diet, limiting caffeine, and regulating when you exercise. Optimizing your bedroom may mean having a comfortable mattress, pillows, and bedding build for your body type. Getting a mattress with the right dimensions is also key to comfort.
Learning about different sleeping positions, such as side-sleeping and sleeping on your stomach, can also help you get your sleep schedule under control. Certain sleep positions are better than others. Some positions promote better breathing and prevent back pain. Other positions may hinder breathing and cause soreness the following day.
Cognitive Behavioral Therapy Treatments
Cognitive behavioral therapy is a psycho-social intervention used to treat a variety of problems, such as those surrounding sleep and addiction. This therapy keens in on ways of thinking, learned patterns, and habitual behaviors, and then provides guidance on coping with, understanding, and restructuring those barriers.
Below is a list of cognitive behavioral therapies for sleep to discuss with your doctor:
- Sleep restriction therapy: Sleep restriction therapy involves resetting your sleep schedule by restricting how often you’re in bed.
- For example: if you want to get eight hours of sleep per night but are only getting four, you would restrict the amount of time you're in bed to four hours, plus 30 minutes. Once you spend a majority of your time in bed asleep then you gradually increase how much time you spend in bed.
- Sleep compression therapy: Sleep compression therapy is essentially just the opposite of sleep restriction therapy. It involves gradually reducing time spent in bed until it reaches the amount of time you’re sleeping.
- Stimulus control therapy: Stimulus control therapy involves restructuring your bedroom to be a haven for sleep. This means eliminating objects that may make it more difficult to fall asleep, such as phones, television, or food.
- Relaxation training: Relaxation training focuses on the techniques you can do to steady your breathing, relax your muscles, and ease racing thoughts. It encompasses breath work, progressive muscle relaxation, autogenic training, biofeedback, and meditation, among other relaxation techniques.
A common component behind each of these treatments is homework. For any treatment to work, practice is needed. Completing homework given by your doctor or psychologist is crucial to managing sleep while in recovery.
Holistic Sleep Aids
When healthy sleep habits and practices aren’t enough to get a full night’s rest, holistic sleep aids may help. Holistic sleep aids range from a proper diet and exercise to melatonin and chamomile. Any of these activities or supplements may help get to sleep and stay asleep. You may find a combination works best.
Some natural sleep aids include:
- Massage therapy;
- Regular exercise;
- Dietary changes.
Resources and Further Reading on Addiction Recovery and Sleep
Below is a list of general resources on addiction recovery for people of all ages, races, genders, or religions:
- SAMHSA: The Substance Abuse and Mental Health Services Administration (SAMHSA) is one of the most well-known recovery organizations available throughout the U.S. They offer several resources on addiction recovery, as well as a national helpline.
- American Addiction Centers: American Addiction Centers (AAC) offers several resources on addiction treatment, including mental health care.
- FindTreatment.gov: FindTreatment.gov is a government organization dedicated to helping individuals find recovery treatment programs in their area.
- Recovery.com: Recovery.com is an AAC resource providing information on finding treatment centers and other forms of information regarding addiction.
- Faces and Voices of Recovery: Faces and Voices of Recovery organizes community recovery groups for individuals recovering from addiction and their family members.
Below are population-based resources:
- Secular Organizations For Sobriety: Secular Organizations For Sobriety (SOS) is a nonprofit network of local groups dedicated to helping individuals in addiction recovery who are also secular.
- Smart Recovery: Smart Recovery offers science-based recovery programs for individuals recovering from addiction and their families. They provide support for both substance addictions and behavioral addictions.
- LGBT National Help Center: The LGBT National Help Center offers resources for LGBT individuals in crisis, including those recovering from addiction.
- The Trevor Project: The Trevor Project provides resources and information for LGBT individuals (25 and under) in crisis. They are most known for their suicide prevention resources.
Black, Indigenous, and People of Color (BIPOC):
- HealthCity: HealthCity, part of Boston Medical Center, provides physical and mental health resources for BIPOC, including resources on substance use and addiction recovery.
- Workit Health: Workit Health offers mental health and recovery resources for members of the BIPOC community.
- National Council on Seniors Drug and Alcohol Rehab: The National Council on Seniors Drug and Alcohol Rehab offers recovery resources specifically geared towards seniors.
- AAC Senior Resources: The AAC offers treatment and rehab options for older adults and seniors in recovery.
- National Institute of Drug Abuse For Teens: The National Institute of Drug Abuse For Teens offers information on where teens can seek help, how parents can support their children, and how teachers can guide their students.
- Tips For Teens, SAMHSA: Tips For Teens is a publication by SAMHSA featuring different fact sheets about certain drugs, drug use, and addiction geared towards teens.
- Substance Use, U.S. Department of Veteran Affairs: The U.S. Department of Veteran Affairs provides resources, programs, and services on substance use for veterans in need.
- Tobacco, U.S. Department of Veteran Affairs: The U.S. Department of Veteran Affairs also offers resources, programs, and services on tobacco use for veterans in need.
- Women For Sobriety: Women For Sobriety supports women throughout their addiction recovery process and provides resources and other information.
HealthCity, Women of Color: HealthCity provides a resource for women of color seeking substance use services, including women who are pregnant.
Further Reading on Sleep Health
Below is further reading on sleep health:
- Sleep Guide For Anxiety: The Sleep Guide For Anxiety provides information on the relationship between sleep and anxiety and what individuals can do to improve both.
- Caregiver’s Guide to Sleep: The Caregiver’s Guide to Sleep features information for both caregivers and seniors experiencing poor or interrupted sleep.
- Parent’s Guide to Sleep: The Parent’s Guide to Sleep offers tips and tricks for parents with children looking to establish healthy sleep habits.
- Technology For Sleep: This technology for sleep guide provides tips and tricks for using technology to help you get a good night’s rest, including meditation apps, sleep trackers, and sleep podcasts.
- Mindfulness For Sleep: This mindfulness for sleep guide offers information on how to use mindfulness for a better night’s sleep.