Overcoming the Vicious Cycle of Substance Abuse and Insomnia

The tossing and turning of insomnia is hard for any person to handle long term. But when insomnia is accompanied by alcohol or drug addiction, it can create a vicious, life-altering cycle that makes it very difficult to function normally. In fact, not only does one almost always exacerbate the other, it’s very common for one to cause the other. So what is normal sleep? In a person without a sleep disorder, a typical period of sleep may last anywhere from four to nine hours, with two general phases: REM and non-REM sleep. It follows a predictable pattern, one that is essential in order for your body and brain to rest properly. The entire process is dictated by a complex interaction of brain chemicals, including norepinephrine and serotonin. Insomnia is a sleep disorder with real medical implications. When your body doesn’t get adequate, restorative sleep, it can cause a variety of problems including impaired concentration, elevated blood pressure, irritability, depressed mood, increased anxiety, a compromised immune system, and even weight gain. The condition also boosts your risk of injury from accidents due to sleep deprivation.

The Substance Abuse/Insomnia Cycle

For some, the vicious cycle of substance abuse and insomnia starts when a person begins to self-medicate bouts of insomnia. Alcohol is one of the most commonly used substances for insomnia because of its depressant qualities. Although it may initially produce sleepiness, it actually disrupts natural, healthy sleep patterns. People who drink before bed often wake up frequently and have trouble going back to sleep. Studies have shown that up to 28% of those who have insomnia have used alcohol to help them fall asleep. In one study, those who reported having two or more weeks of sleep problems were more likely to exhibit symptoms of alcoholism one year later 1. Alcohol isn’t the only substance contributes to and exacerbates insomnia. Drug addiction to stimulants can also wreak havoc with your sleep. Cocaine, amphetamines, crack cocaine, and MDMA (better known as Ecstasy) all disrupt sleep by producing a feeling of wakefulness and increasing energy levels. These effects are especially problematic when your body needs to rest. Regardless of the type of substance you may use to self-medicate your insomnia, it will generate a cycle that can be impossible to break on your own. For example, you might drink alcohol to fall asleep more readily, but drinking disrupts your sleep. As a result, you may consume even more alcohol in the hopes of finding relief. If you use stimulant drugs, they will reduce your need for sleep. However, your body still needs to rest, so it will start to slow down. When that occurs, you’ll likely reach for more drugs in order to stay alert or awake. Some popular prescription drugs used to treat sleep problems have the potential to create dependence and addiction as well. When used properly, prescription sleep medications, such as Ambien and Sonata, provide short-term relief for sleep problems. However, some individuals do develop an addiction to these medications. Benzodiazepines, like Ativan or Klonopin, are also occasionally prescribed for short-term relief of insomnia, especially when it’s caused by anxiety. However, benzodiazepines are not meant for long-term use. They have a very high potential for addiction if they are used more frequently, in higher doses, or for longer periods than prescribed. You may feel you can’t sleep without them, or you may require increasing amounts to get the desired effect.

Insomnia Threatens Recovery

If you’ve already begun treatment for alcohol or drug addiction, you may start having problems with insomnia as well. One review of studies that examined insomnia and addiction found consistently high rates of insomnia among people in recovery. For example, one study found that almost 75% of alcoholics reported sleeping problems immediately after detoxification. Additional research found that insomnia symptoms lasted as long as five weeks in recently abstinent alcohol abusers 2. In fact, scientists suggest the presence of insomnia may predict relapse. Alcoholics with insomnia were two times more likely to relapse than those without insomnia 3. As a result, it’s vital for alcohol or drug addiction treatment to address sleep disturbances as well.

Treatment for Insomnia and Substance Abuse

Many addiction recovery programs include some component of cognitive-behavioral therapy, or CBT, as part of treatment. By working with a therapist, you’ll learn to identify and change the negative thought patterns and emotions that trigger destructive behavior. CBT can also be used as a drug-free way to treat insomnia. A number of studies have shown that it can be an effective way to determine exactly why sleep is disturbed. Cognitive behavioral therapy can help you understand the reasons you are sleeping poorly. Common contributing factors include substance abuse, anxiety, depression, too much caffeine, or certain pre-bedtime activities – like watching the news, looking at a bright computer screen, or having an upsetting conversation with your spouse. Your therapist will also help you examine negative attitudes you may have about sleep. For example, you may have unrealistic expectations of how little sleep you need to function properly 4. Cognitive behavioral treatment for a person with insomnia and alcohol or drug addiction may also include the use of relaxation techniques. Your therapist may teach you relaxation methods like visualization or progressive muscle relaxation. These methods will help calm your mind and your body. Research suggests that biofeedback can also be an effective way to relax your body. Biofeedback makes you more aware of your body, which allows you to have more control over it 5. Prescription drugs are never the first line of treatment for substance abuse and insomnia, but they are sometimes used in combination with therapy to provide relief for sleepless nights. Since benzodiazepines pose an addiction risk themselves, recovery centers typically avoid prescribing these medications. If you have a substance abuse disorder and are seeing a primary care physician for sleep issues, it’s essential to let him or her know that you’re in recovery so potentially addictive medications are not prescribed for you. Other medications, such as low doses of tricyclic antidepressants (TCAs), are sometimes used to help treat insomnia. However, they may also present problems for addicts. Changes in the liver that can be caused by abusing substances, particularly alcohol, make it challenging to properly dose these medications. At least one study suggests that another drug, the antipsychotic quetiapine (Seroquel), has a sedative effect that may be beneficial for alcoholics with sleep problems 6. Keep in mind, however, that antipsychotics are powerful medications that come with a long list of serious potential side effects. They should be used with extreme caution. A melatonin supplement may be another option to help you sleep if you’re in recovery. In fact, some research shows that melatonin levels are decreased in alcoholics, which may contribute to the sleeplessness reported by many who abuse alcohol 7. Taking melatonin, which is a hormone that contributes to the natural sleep-wake cycle, can ease your body into sleep. Melatonin is not regulated by the FDA because it’s considered a dietary supplement, so be sure to talk to your addiction specialist or physician to find out if it’s an appropriate option for you. Living with insomnia along with an alcohol or drug addiction can be crippling. If you are living with these disorders, seek help as soon as possible. A substance abuse specialist will develop a treatment plan for you to help you get your life back on track. The vicious cycle can be broken with the proper treatment. You deserve a life that’s free from the burden of insomnia and the life-draining impact of addiction. Sources:  1 // 2 // 3 // 4 // 5 // 6 // 7 //

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