How Addiction Affects SleepUpdated on May 15, 2018
The quality of your sleep is affected by everything. From your habits and the food you eat, to the medications you take and drinks you ingest. So, it’s no surprise that if a person has developed an addiction—to an over-the-counter drug, alcohol, or other type of substance—that addiction could affect their sleep quality, too.
Sleep disorders and addiction have a bidirectional relationship: Each individual issue—alcohol dependence, insomnia, etc.—relate to and effect the other issue. The nature of this intricate relationship requires a person seek treatment for both issues to find a healthy, sustainable resolution.
Keep reading to discover how various forms of addiction affect sleep. This guide also will delve into various types of substance-induced sleep disorders, substances that can cause or lead to sleep disorders, and information concerning how an individual can recover from addiction.
The relationship between sleep and addiction
How do various substance addictions upset the body’s brain chemistry and disrupt the natural sleep rhythm? The answers vary. Each substance type has different characteristics, and affects an addicted person’s sleep in various ways.
Cocaine affects the brain’s limbic system. The system consists of interconnected regions that regulate motivation and pleasure. Cocaine’s short-term effects immediately cause a buildup of dopamine, which can cause euphoria. This euphoria can make a person want to take the drug again.
Because cocaine increases wakefulness, it can disrupt REM sleep. And cocaine withdrawal can lead to disturbed sleep and unpleasant dreams (also known as a parasomnia).
Amphetamines stimulate the central nervous system. Although amphetamines are used to treat multiple medical issues, such as depression and attention deficit hyperactivity disorder (ADHD), people can develop a psychological amphetamine dependence.
Use of amphetamines can decrease the amount of time a person spends in REM sleep periods.
Hallucinogens are a group of drugs that can alter a person’s perception, and cause sensations or create images that aren’t real. A few examples of hallucinations are as follows:
- D-lysergic acid diethylamide (LSD)
- Peyote (Mescaline)
- 4-phosphoryloxy-N,N-dimethyltryptamine (psilocybin)
In general, hallucinogens can interfere with serotonin. Serotonin regulates sleep and other major bodily functions. When a person takes a hallucinogen, they can experience short-term sleep problems. A study in the journal Therapeutic Advances in Psychopharmacology also states LSD users often experience a loss of sleep.
Sleep loss, which sometimes presents as insomnia, can either be chronic (difficulty falling or staying asleep at least three nights a week for three months or more) or short-term (lasts less than three months, or presents when a person has trouble falling or staying asleep).
MDMA, also known as 3,4-methylenedioxymethamphetamine or ecstasy, is a specific type hallucinogen and stimulant. It’s a synthetic drug. MDMA can make a person feel energized, and distort their perceptions and how they experience time.
People who use a lot of MDMA can experience persistent sleep disturbances. MDMA also can affect the human body’s monoamine neurotransmitters. These neurotransmitters greatly affect sleep and daytime alertness (also known as hypersomnia).
Marijuana dependence is similar to other substance abuse disorders. People who have issues with this substance face social, psychological, and physical impairments. Dependent users also have sleep problems.
A study that appeared in the journal Sleep Medicine Reviews reports that people who smoke marijuana have a hard time falling asleep, and have strange dreams when they experience marijuana withdrawal.
Another study in the journal Addiction Science & Clinical Practice found that chronic cannabis use can negatively affect sleep during withdrawal. Insomnia, sleep withdrawal, and strange dreams were reported.
People often assume alcohol can help them sleep because it causes drowsiness. Although alcohol can help a person fall asleep, it causes disrupted sleep. Disturbances can occur during sleep stage transitions. These disturbances can worsen the effects of insomnia and cause sleep apnea.
The previously mentioned study in the journal Addiction Science & Clinical Practice also reports that alcohol users can experience:
- A hard time falling asleep
- Awakening during the night
- Daytime sleepiness
- Abnormal sleep quality
Also, insomnia is the most prevalent complaint from alcoholics after they quit drinking.
Opioid drugs come in illegal and legal forms. Heroin, for example, is illegal, and other opioids, such as the synthetic drug fentanyl, and pain relievers, such as oxycodone, hydrocodone, codeine, and morphine, are available via prescription.
All opioids interact with opioid receptors on nerve cells in the body and brain. According to the U.S. government’s National Institute on Drug Abuse, 21 to 29 percent of patients who are prescribed opioids misuse the drugs.
Although most prescription opioids are safe to take for a short period of time, long-term opioid use can cause addiction. Addiction can occur because these pain-relieving drugs also can cause euphoria.
The longer a person takes an opioid, the greater the chance they could develop an addiction. Addiction to opioids also can arise from prescription misuse.
Sadly, opioid addiction can lead to death. The CDC searchable database, CDC Wonder, reports that 20,000 overdose deaths in 2016 were related to fentanyl and synthetic opioids.
Why opioids are addictive
Environmental and individual factors impact how a person reacts to opioid drug affects. In general, however, opioids affect a person when the drug enters the bloodstream and travels to the brain.
A study in the journal Science & Practice Perspectives found that proteins that opioids attach to, which are called mu opioid receptors, are located on brain cells. This chemical/receptor interaction triggers the same biochemical brain processes that give people pleasurable feelings via “brain circuits” in the mesolimbic (midbrain) reward system.
According to the article, this “system” creates signals in the brain’s ventral tegmental area (VTA). This “area” releases the chemical dopamine (DA) in another part of the brain, which is referred to as the nucleus accumbens (NAc). Dopamine creates “pleasurable” feelings.
Opioids and sleep
Opioids are a well-known sleep disrupter. A study in the journal Anesthesiology explains that opioids can block the human body’s access to rapid eye movement (REM) sleep. These drugs also can block access to the deeper, restorative stages of non-REM sleep. A lack of sleep can actually make any pain a person may feel—for example, the pain they are taking opioids for—worse.
Opioids, withdrawal, and sleep
When a person ceases using opioids, she can experience sleep issues. An article in the journal Psychiatry Research examined the quality of sleep in people who had “heroin use disorder” who were going through “early methadone maintenance therapy” (MMT). The study participants experienced less sleep and daytime sleepiness.
Another study in the journal Drug Alcohol Dependence also found that people in the early stages of methadone detox had issues getting enough sleep. Their sleep quality was poor, too.
When sleep deprivation leads to drug use
Although heavy drug use can lead to sleep issues, sleep issues, such as insomnia, can also lead to drug use.
A study published in the Journal of Youth and Adolescence found that lower levels of weekday sleep were related with substance use, specifically alcohol. An association also was found between alcohol and cigarette use and weekend oversleep, which is defined as “wake time on the weekends as compared to weekdays.” The study also posits that lower sleep times could also lower an individual’s inhibition, and their ability to regulate their emotions, which can lead to substance abuse.
Although the study examined youths’ relationship with the previously mentioned substances, the findings may relate to adults, as the study also discovered that after a follow-up, which occurred two years after the study, alcohol use was associated with weekend sleep delay (defined as a person’s time to bed on the weekends compared to weekdays). Alcohol use also was associated with greater weekend “oversleep”, too.
Sleep medication addiction and overuse
Oftentimes, medications—over-the-counter and prescription—meant to help a person fall asleep, can become problematic if a person overuses the remedy.
According to 2013 CDC statistics, 4 percent of U.S. adults have used a prescription sleep aid during the past month. Also, one and six adults with a diagnosed sleep disorder, and one in eight adults who have trouble sleeping have reported using sleep aids.
People use over-the-counter sleep aids, too. A study in the Journal of Substance Abuse found that 11.4 percent of college-aged women who experience sleep issues at least one day a month use OTC sleep aids. The study also discovered that 6.4 percent of men use OTC sleep aids.
Plenty of over-the-counter sleep aids are available. Common options include:
- Diphenhydramine (Benadryl, Aleve PM, others) is a sedating antihistamine
- Doxylamine succinate (Unisom SleepTabs) is a sedating antihistamine
- Melatonin is a hormone that helps control a person’s natural sleep-wake cycle
- Valerian is a plant-based supplement
A plethora of prescription sleep medications are available, too. They include:
- Doxepin (Silenor), helps patients stay asleep
- Estazolam, helps patients fall and stay asleep, and can lead to dependence
- Eszopiclone (Lunesta), helps patients fall and stay asleep, and can lead to dependence
- Ramelteon (Rozerem), helps patients fall asleep
- Temazepam (Restoril), helps patients fall and stay asleep, and can lead to dependence
- Triazolam (Halcion), helps a person fall asleep and can lead to dependence
- Zaleplon (Sonata), helps a person fall asleep and can lead to dependence
- Zolpidem (Ambien, Edluar, Intermezzo, Zolpimist), helps a person fall asleep and can lead to dependence
- Zolpidem extended-release (Ambien CR), helps patients fall and stay asleep, and can lead to dependence
- Suvorexant (Belsomra), helps patients fall and stay asleep, and can lead to dependence
However, most people can build-up tolerance to OTC and prescription sleep aids. This can occur when people:
- Take pills more than the recommended or prescribed time period
- Don’t consult their doctor
- Take the pills in a different way than they were prescribed
- Take a higher dose of medication than prescribed
If addiction does occur with a sleep medication, people may:
- Try and fail to quit their drug of choice multiple times
- Have a dependence on (crave) medications
- May turn to multiple doctors to obtain the amount of drug needed to sustain the patient’s addiction (if that drug is a prescription drug).
Once a person stops taking a sleep aid, they can experience withdrawal symptoms. Symptoms include:
- Trouble sleeping
- Circulation problems
The best way to avoid withdrawal symptoms is to reduce your dose gradually with the guidance of a doctor.
Although anyone is at risk for developing an addiction to sleep aids, some people, especially recovering addicts, are possibly at a greater risk for developing an addiction to a sleep aid medication. Although a patient may withhold their addiction history from their doctor, doctors can help identify addiction warning signs by:
- Screening for substance misuse and substance use disorders
- Engaging in care coordination
- Delivering “prevention intervention”, which can help prevent substance abuse
Recovering from addiction
When a person is recovering from substance abuse, their sleep can be affected. However, getting good sleep is essential for people who are undergoing addiction recovery.
A study in the journal Psychiatry found that diagnosing and treating a person’s sleep disorder can greatly help the person avoid falling into their addiction again. This may be true because people with sleep disorders often turn to substances to help induce sleep.
Another study in the Journal of Addictive Diseases reports that sleep disturbances can increase the chance of a person experiencing alcohol addiction relapse. Therefore, it’s beneficial for a person to address and target sleep problems during recovery.
The study also found that if a person sticks with alcohol abstinence, their sleep will improve. However, if a person’s alcohol abuse was chronic, their brain’s sleep centers may become altered. If this is the case, a person could benefit from sleep treatment. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2936493/)
As the research in the previously mentioned studies suggests, treating sleep issues and creating a sleep plan is a vital component for successful addiction recovery. A few sleep plan staples include:
- Sticking with a sleep schedule
- Monitoring the foods a person eats and liquids they drink
- Creating a calm, restful environment
- Limiting daytime naps
- Exercising regularly
- Managing anxiety
In addition to incorporating a “sleep plan”, other treatment options, such as cognitive behavioral therapy (CBT), are helpful. People who undergo CBT for insomnia follow a structured program that helps the person undergoing treatment replace thoughts and patterns that hurt sleep with sleep-promoting actions.
In the next section, we’ll examine some of these sleep plan suggestions and therapies in detail.
How to treat addiction-related sleep issues
As previously mentioned, it’s incredibly important to treat sleep issues that are related to a person’s addiction during treatment. There are various ways, such as making a sleep plan and diet changes, as well as talking to a doctor about sleep therapy and natural sleep aids, that can help a person manage their sleep issues and addiction recovery.
Please remember that while our guide is thorough and well-researched, it is not a replacement for medical advice. Always consult your doctor or qualified physician with any questions or concerns you have regarding medical conditions, treatments, and advice.
Natural sleep aids during recovery
Thankfully, there are plenty of natural ways a person can help improve their sleep.
First, a person should consider the foods they consume. Foods that contain certain ingredients—tryptophan, carbohydrates, calcium, magnesium, melatonin, and vitamin B6—can help promote quality sleep. Thankfully, foods with these ingredients are plentiful.
Tryptophan is an amino acid that helps the body produce serotonin. Serotonin induces deeper, restful sleep and create melatonin. Melatonin regulates the sleep-wake cycle.
The following foods contain Tryptophan:
Carbohydrates also help tryptophan production. Research suggests that pairing carb-heavy food with fat can encourage sleepiness. And when carbohydrates are paired with proteins, blood sugar will remain stable during the night. Also, carbohydrate-rich foods with a high-glycemic index also correlate with faster sleep times. The following are carbohydrates:
- Dairy products
A study in the European Neurology Journal found that disrupted REM sleep is due to calcium deficiency. Once subjects’ calcium levels returned to normal, their sleep became undisrupted.
The following foods are calcium-rich:
- Kale and other leafy greens
Melatonin, a hormone that’s released by the body’s pineal gland prior to sleep, is found in the following foods:
Vitamin B6 helps the body create neurotransmitters, which can help the body produce melatonin. B6-rich foods include:
- Fish, especially salmon, tuna, halibut
- Raw garlic
Magnesium-rich foods can help a person sleep, too. A study in the Journal Orthomolecular Medicine discovered that low levels of magnesium deficiency disrupt sleep. Try to consume whole grains (bulgur and barley) and almonds.
Next, a person should take up an exercise routine. Exercise can help a person fall asleep faster and will help eliminate any excess time they spend lying awake in bed. The types of exercise that seem to help induce sleep include weight lifting and light aerobic exercise.
We should note that the National Institute of Health states that exercising before bed—5 to 6 hours before—can disrupt sleep. However, this finding is subjective. Different people respond to exercise in various manners.
Create a sleep-friendly environment
Another action a person can take to improve their sleep is by creating a welcoming sleep environment. Small bedroom changes can help encourage a better night’s sleep.
First, a person should turn their clock around. Looking at the time when you can’t sleep just makes it more difficult to fall asleep. Another common sleep disrupter in blue light. Many devices, such as smartphones, laptops, and tablets, emit a blue light that can hurt your body’s melatonin production. Avoiding this light, turning on your device’s “night shift” function, or downloading a blue light reduction app can help a person limit their blue light exposure before bed.
A person should never underestimate the comfort gained from a quality mattress, breathable bed linens, and supportive pillows. Before buying a new mattress, a person should consider their sleeping style and consult comprehensive mattress reviews and comparisons.
A cool bedroom temperature also can promote a better night’s sleep. Something between 60 and 67 degrees is ideal. Sleeping in a cooler bedroom helps a person sleep better by allowing their body temperature to drop. This temperature drop is something that naturally happens before a person falls asleep.
Also, it never hurts to eliminate technology before bed. As stated previously, most modern technology emits blue light, which is a sleep disrupter. In addition to emitting blue light, tech devices also can cause unwanted nighttime arousal. For example, games and other social media interactions could cause stimulation that could disrupt sleep. Also, smartphones and other devices’ notifications can disrupt sleep.
Cognitive behavioral therapy (CBT) is a great option for people who want to treat their insomnia. CBT, in general, is a type of talk therapy. Through talking, a therapist and a patient discuss the patient’s inaccurate or negative thoughts.
The specific type of CBT people who have insomnia undergo is referred to as CBT-I. This therapy has been proven to be effective and is typically the “first line of treatment” that insomnia sufferers go through.
CBT-I teaches the patient to recognize and then change the thoughts they have that affect their ability to sleep. By doing so, the patient can learn how to control and eventually eliminate the negative thoughts and anxieties that cause them to lay awake. Various types of CBT-I therapy include:
- Stimulus control therapy: This technique helps a patient remove the things, or thoughts, that make their mind resist sleep. An example: A therapist may suggest that a patient follow a consistent sleep-time, wake-time schedule.
- Sleep restriction: This technique requires a patient to reduce the time they spend in bed. It’s a form of partial sleep deprivation that allows the person to become more tired for successive nights.
- Sleep hygiene: This technique requires a patient to change their lifestyle habits that hurt their sleep. This could be drinking less caffeine late in the day, getting more exercise, etc.
- Sleep environment improvement: This technique requires a person to better their sleep environment. A therapist may recommend the patient remove a television from a bedroom, or request that the patient keep their bedroom dark and free from distractions.
- Relaxation training: This technique requires the patient to actively calm their mind and body. This can be done via meditation, muscle relaxation, etc.
- Remaining passively awake: This technique, also called paradoxical intention, requires that the patient make no effort when falling asleep. For example, a patient must let go of the worry of not sleeping in order to sleep.
- Biofeedback: This technique allows a patient to observe the biological signals that keep them awake. These signals could be something like heart rate or muscle tension.
Over-the-counter sleep aids
We previously mentioned some over-the-counter sleep aids. We do not recommend that anyone who is in recovery for an addiction use any type of sleep aid. However, a person who is in recovery could ask their physician about natural over-the-counter sleep aids, such as melatonin.
Again, no one should take a sleep aid, such as melatonin, without consulting their doctor. But if the patient’s doctor thinks that melatonin could benefit a patient’s sleep, without hurting their addiction recovery, this supplement could be beneficial.
Melatonin is a hormone that’s responsible for sleep. Although the body naturally produces melatonin, it can be bought in supplement-form in most drug and grocery stores. As stated previously, if you are considering taking melatonin, talk to your doctor first. If she thinks you’d respond well to the supplement, she will have specific brand recommendations for your to seek out and try.
Additional addiction resources
Addiction and sleep issues are wide-ranging topics. So, we’ve included additional resources concerning both topics below.
Addiction and recovery resources
The Substance Abuse and Mental Health Services Administration (SAMHSA) is described as a free, confidential service that’s available every day, all day, throughout the entire year. The organization employees professionals who are trained to provide people with treatment referrals and information. In addition to online services, SAMHSA also has a National Helpline, 1-800-662-HELP (4357).
Recovery.org is an online service that directs people to information and resources concerning substance abuse and behavioral disorders. The organization’s website features an addiction treatment directory and a helpline (1-888-319-2606) that’s manned by “caring advisors” that give people treatment options.
Sleep resources for recovery
The American Alliance for Healthy Sleep is a patient-based membership organization that provides information on sleep medicine and sleep disorders. In addition to sleep medicine and disorder information, the website also provides information concerning the following:
- Sleep disorder support groups
- Patient stories
- American Academy of Sleep Medicine-accredited Sleep Center information
The American Psychiatric Association has a page dedicated to sleep disorders. The Association’s page has information about various sleep disorders, blog posts about sleep issues, a sleep disorder event calendar, an expert Q&A, and a “find a psychiatrist” feature.
Other helpful resources
The U.S. government’s National Institute of Neurological Disorders and Stroke features a comprehensive guide concerning sleep. The site’s page is filled with information about sleep and sleep research.
The Association for Addiction Professionals (NAADAC) is an association for addiction counselors, educators, and addiction-focused health care professionals. The association’s site also has information about addiction, advocacy, and more.