With 23.5 million Americans (or 1 in 10 people over the age of 12) suffering from addictions to drugs and alcohol, addiction and sleep have a close relationship. It is common for people with addictions to have sleep disorders and for people to use substances like drugs and alcohol to treat their sleep problems, which oftentimes results in addiction. People may use drugs and alcohol to self-medicate, or to help promote sleep or wakefulness. Similarly, people in recovery from addiction experience sleep problems, which can make the recovery process difficult and symptoms may trigger relapse.
According to Dr. Kima Joy Taylor, director of the Closing the Addiction Treatment Gap (CATG) initiative, only 11 percent of Americans seek treatment for addiction, leaving 20 million Americans untreated. Common signs of addiction, according to the National Council on Alcoholism and Drug dependence, include:
- Using drugs or alcohol longer than a person wants to or than intended
- Neglecting activities because of time spent with drug and alcohol use
- Hiding substance use
- Having issues with relationships
- Needing more of the substance because of an increased tolerance
- Feeling the effects of withdrawal from drugs or alcohol
- Taking risks to obtain alcohol or drugs
- Showing physical signs of not taking care of one’s self
- Continuing to use substances despite the problems associated with use
Symptoms of addiction include:
- Intense urges to use
- The feeling that you need to use regularly
- Making sure you have enough of a supply
- Needing more of the substance to get the same feeling
- Continuing to use even though you know the consequences
- Spending a lot of time getting the substance
- Spending money and oftentimes more than you have on the substance
- Doing things you know could cause damage to obtain the substance
- Failing to stop using
- Going through withdrawal symptoms when you try to stop using
In this guide, we will explore the relationship between addiction and sleep, and will discuss:
- How addiction can contribute to sleep loss or sleep deprivation
- How feeling rested helps in recovery
The connection between addiction and sleep
People with addictions experience sleep problems and sleep loss or deprivation, which has a negative impact when it comes to recovery from substance abuse. Sleep loss and poor quality of sleep can affect emotions, memory, and the brain’s ability to think, problem solve, concentrate and be alert, which can ultimately result in depression, mood disorders, and poor decision making. Ultimately, sleep deprivation can trigger substance use, dependence, and abuse. This coupled with the symptoms of withdrawal put addicts at risk for relapse. Plus, lack of sleep can also cause health issues like heart disease, and stroke, among others.
This Huffington Post story summarizes a study by Idaho State University that looked at how sleep problems in teenagers may help predict alcohol and drug use. Scientists have found that sleep issues are “a significant predictor” of alcohol and drug problems, such as:
- Interpersonal issues related to alcohol
- Binge drinking
- Getting high or drunk
- The use of illicit drugs
- Driving under the influence of drugs or alcohol
- Engaging in sexual activity that they regret later
When people go through withdrawal, they lose sleep because of the following reasons:
- The time it takes to fall asleep increases
- Total sleep time decreases
- Sleep becomes fragmented
According to one study, sleep disruptions can last for 1 to 3 years after a person is sober, so getting enough sleep and healthy sleep is crucial for recovery and for maintaining sobriety. Poor sleep and sleep disturbance are linked to higher risk of relapse, which can be detrimental to the entire recovery process. View this infographic that details the link between sleep and addiction.
For people in recovery, sleep is especially important because it contributes to overall health (physical and mental), including memory and mood, which are critical for recovery. Healthy sleep promotes better moods, decision making, concentration, and problem solving — all key in the recovery process. Healthy sleep also helps reduce the risk of accidents and allows the body to rest and heal.
Substance abusers are 5 to 10 times more likely to have sleep disorders. The ability to treat sleep disorders does have a significant impact on a person’s ability to recover.
Source: Canada Drug Center
About 20 percent of Americans use alcohol as a sleep aid, because of its drowsy effects. While it may help induce sleep, it prevents users from getting deep and REM sleep, keeping them in a lighter sleep state. Due to the sleep disturbances associated with alcohol use, alcohol addiction can cause insomnia, restless leg syndrome, and sleep apnea. These sleep disorders and disturbances and problems may be directly linked to an increased risk for relapse.
Sleep disorders are also common for those addicted to drugs. Insomnia, sleep apnea, and restless leg syndrome are the most common sleep disorders caused by substance abuse in one study.
How drugs and alcohol affect sleep
The use of drugs and alcohol interfere with the natural sleep rhythms, and cause lack of sleep or sleep deprivation, poor sleep, and sleep disorders. Some substance users rely on drugs and alcohol to stay asleep or awake, and these substance abuse patterns disrupt the sleep-wake cycle interfering with everyday life.
Sleep disorders related to substance abuse that impacts daily life are called “substance-induced.” As drugs and alcohol wear off, and users go into withdrawal, they may use more substances to promote sleep or wakefulness. Studies show that sleep problems are associated with the use of illicit drugs, and most alcohol users report insomnia issues.
In this section of the guide, we will explore how the different kinds of substances affect sleep and are associated with sleep disorders:
Alcohol is known to trigger sleepiness by producing a sleep chemical in the brain called adenosine. It may help people fall asleep faster, but it does wear off quickly. Alcohol interrupts the circadian rhythm that is responsible for keeping the body in sync (hormones, body temperature, digestion, internal clock, and more). It also blocks true restorative sleep (the REM cycle), keeping sleepers in a lighter state of sleep. This sleep disruption can cause insomnia and restless leg syndrome. Lack of sleep and poor sleep caused by alcohol use also affects a person’s mood, concentration, and decision making, and makes people more prone to snore, and can cause sleep apnea. It can also make sleepers urinate, have night sweats, and nightmares.
Marijuana is used as a sleep aid because of its similar effects to alcohol. Although total sleep time is not affected, the drug is known to reduce the amount of deep sleep (REM sleep), which can cause insomnia because users are in a lighter state of sleep. This article discusses the different kinds of marijuana and THC strains, which can produce different effects on the mind and body. The drug’s psychedelic impact may also cause anxiety or paranoia, which can worsen depression, anxiety disorders, and sleep disorders like insomnia. Users might have vivid dreams after quitting when they experience an REM rebound that can last up to several months.
Source: Center for Disease Control
Opioids are used by more than 2 million Americans who are addicted to the prescription drugs, according to the Center for Disease Control. These drugs are prescribed to people to help with pain management and are widely abused because of their highly addictive nature. They block pain and promote a relaxed, calm state. These drugs, when abused, give users a feeling of high and euphoria. Opioid overdose is a large cause of death, especially linked to methadone, oxycodone, and hydrocodone.
For chronic users, opioids cause fatigue and reduce deep sleep and REM sleep, keeping sleepers in a lighter sleep state. This lack of sleep can affect mood, decision making, memory, and prevents the mind and body from healing and resting. The drug also impacts sleep rhythms and can result in anxiety, fatigue, depression. This drug abuse can cause insomnia, restless leg syndrome, and sleep apnea. Withdrawal in the recovery process, which can last a week or more, can cause many symptoms like vomiting, sweating, diarrhea, insomnia, anxiety, and muscle aches. When users experience these sick feelings, the risk of relapse is common.
Cocaine use causes people to experience a high or euphoria. When used, cocaine gives the brain a big dose of dopamine, which helps cause that pleasurable feeling. The drug has a negative effect on sleep and causes sleep disturbances. It disrupts the circadian rhythm, which can prevent the body to sleep well permanently if used chronically. The drug naturally promotes wakefulness, which causes sleepers to get less deep or REM sleep, which causes insomnia. It can also make depression worse, and users also experience confusion and fatigue.
Amphetamines (including methamphetamine) are highly addictive drugs that can either be prescribed for conditions like ADD or ADHD or used recreationally (methamphetamines). Amphetamines can be abused to create a high. Symptoms of use include agitation, hallucinations, fever, high blood pressure, confusion, and sweating, among others. The drugs are stimulants that release dopamine to enhance physical and mental abilities, increasing alertness and energy. This also results in dry mouth and reduced appetite, and makes anxiety worse. Users experience sleep problems similar to those who use cocaine like insomnia, because of the disruption to the circadian rhythm.
Hallucinogens are drugs that cause hallucinations to distort a person’s reality, and can be man-made or found in some plants and mushrooms. They stimulate brain activity, which is not conducive to healthy sleep. Use of these drugs can cause insomnia, and users have a hard time falling asleep. Insomnia is especially common among LSD users. It makes sleep difficult, because it increases restlessness and wakefulness at the same time. The drugs promote confusion and disrupt the brain-body connection that is responsible for sleep, mood, sensory perception, hunger, body temperature, and more.
MDMA use can affect sleep for days after use because it disturbs the body’s natural sleep cycle. The drug interferes with serotonin and melatonin, which is the sleep hormone. MDMA gives users energy and causes sleep deprivation and increased restlessness. This can impair a person’s brain cognitive function which can make performance worse and increase impulsiveness. MDMA use can also cause insomnia, depression, and anxiety.
Behavioral addictions (including gambling)
Behavioral addictions can include gambling, food, sex, or digital devices and the internet, among others. Although the signs and symptoms are not exactly the same as those people addicted to drugs or alcohol, there are some commonalities. The biggest issues for people with behavioral addictions are sleep issues. Anxiety and poor and unhealthy sleep, insomnia, and mood problems are common among gamblers, for example. The lack of sleep can result in poor decision making, mood issues, and sleepiness during the day, all of which make them more likely to make bad choices (bets). People who are addicted to digital devices and the internet experience sleep problems related to anxiety and depression. Some of these behavioral addictions can cause hypersomnias, promote daytime sleepiness, and may make falling asleep and staying asleep difficult.
Sleep disorders and addiction
Addiction to alcohol and drugs can cause a number of sleep disorders and is known to worsen conditions like anxiety and depression, among others. There is a natural cycle involved with addition and sleep disorders: substance abuse causes sleep problems which in turn, can cause relapse.
Sleep problems and disorders can occur during withdrawal and into the first few years of recovery. Many times, people experience the withdrawal of the substance and it’s the symptoms of that withdrawal, including sleep problems, that can trigger relapse. Other triggers of relapse include anxiety, irritability, and mood swings, all of which are enhanced by sleep deprivation.
Below are some of the common sleep disorders that are caused by addiction:
Insomnia is a sleep disorder that occurs that makes it hard to fall asleep even when you feel tired. The timeframe and frequency does vary. For example, acute insomnia happens on occasion for a short period of time and chronic insomnia is an ongoing consistent disorder that occurs at least 3 nights each week for a month or more. In one study, 56% of substance users had insomnia as compared to only 10-15% among the general population. Insomnia is common among substance abusers, due to the sleep deprivation and a reduced amount of deep or REM sleep. The brain and body aren’t able to achieve healthy, restful, and restorative sleep. Oftentimes the insomnia causes substance abusers to increase their dependence, consumption, and frequency.
Hypersomnia is a disorder that causes a person to fall asleep during the day time and have ongoing daytime sleepiness. Narcolepsy is an extreme form of hypersomnia, in which a person falls asleep all of the sudden without any notice. Even though they are very sleepy and sleep a lot and sometimes late, when they wake up they don’t feel rejuvenated. To sleep more or get better sleep, it is common for them to resort to substances. Addiction can cause this hypersomnia and bouts of excessive sleepiness and sleep deprivation.
Parasomnia is a sleep disorder that involves odd behavior during sleep just as a person is falling asleep or at any point in the sleep cycle. These can include sleepwalking, night terrors, and nightmares, which are all common among hallucinogen users. This physical or verbal activity is induced by drugs of abuse, and cause these parasomnias. These events can also worsen anxiety, which can also have a negative impact on sleep.
Restless leg syndrome (RLS)
Restless leg syndrome (RLS) is a disorder that causes an uncontrollable urge to move the legs when resting or sleeping. This condition causes legs to feel tingly or numb, and makes the urge to move feel uncontrollable. RLS makes falling asleep very difficult, because of the painful and nagging symptoms. For those with addiction, RLS is very common, especially for those who abuse opioids and alcohol.
Sleep apnea is a sleep disorder that occurs when breathing stops and starts again during sleep. This can occur hundreds of times during the night. The condition occurs when the back of the throat and airway is blocked, and reduces the amount of oxygen going to the brain and body. This can cause snoring, tossing and turning, gasping, headaches, and more. Many people with addictions suffer from sleep apnea, especially those who use alcohol because of its muscle-relaxing abilities. The throat relaxes and that causes the airway to be blocked. The condition can worsen anxiety and even cause panic attacks. Read more about our sleep apnea guide.
Learn more about these common sleep disorders and others in our comprehensive guide to sleep disorders.
Addiction to sleep medication
Source: New York Times
More than 9 million people use sleeping medication to help them sleep, according to the CDC, and 4% of American adults over the age of 20 used sleeping aids in the last month. Doctors prescribe sleeping pills for conditions like insomnia — either short-term or long-term — and many people become addicted to sleeping pills.
Sleeping pills are similar to opioids in that they are addictive because they are so effective. If people have trouble sleeping without the sleep medication, it may mean a physical or mental dependence has developed. In turn, users increase their dose, much like with opioids and other substances.
Sleeping pills include barbiturates, hypnotics, and benzodiazepines, which all help promote sleep. Benzodiazepines are anti-anxiety medications that can help with sleep and insomnia — and help people fall asleep and stay asleep. Three common examples of sleep medications prescribed include Sonata, Lunesta, and Ambien. According to the Addiction Center, an addiction to Ambien or benzodiazepines can happen within days to weeks of taking the drugs.
Signs that sleeping pill use is a problem are:
- Failed attempts at quitting the pills
- Cravings for sleeping pills
- Using pills even though there are negative consequences
- Visiting several doctors to get prescriptions filled
- More memory loss associated with the pills
Short-term side effects can include dizziness, heartburn, unusual dreams, appetite changes, constipation, among others. Sleeping pills can also cause breathing problems (especially for those with chronic lung conditions), affect memory and attention, and trigger parasomnias.
The recommended recovery from sleep medication is a weaning off or tapering down method, in which a user will reduce the dose steadily and slowly, while consulting with a doctor. Extreme symptoms of withdrawal can include seizures.
Sleep aids for those in recovery
Source: National Sleep Foundation
Besides prescription sleep medications, there are a variety of natural and over-the-counter sleep aids and therapies that can help people recovering from addiction. Because healthy sleep is crucial for people in recovery, these remedies can be helpful in promoting restful and restorative sleep. The goal is for people to adjust to the new lifestyle and that includes putting routines and tools into place that will promote continued sobriety.
Because sleep problems go hand-in-hand with addiction, they may still occur into the recovery phase for weeks, and months, and even years.
Here we will explore the different kinds of sleep aids for people in recovery from addiction:
Natural sleep aids
Natural sleep aids are considered as behavior modifications or routines that people can establish that promote healthy sleep.
- Rely on your support system: Don’t forget to look to your loved ones to help support you and keep you accountable. If you’re feeling low or overwhelmed, talk to your friends and family and have regular meetings.
- Meditation: Regular meditation can help people have less insomnia, depression, and fatigue through a mind-calming exercise that encourages people to focus on the present moment. Other relaxation techniques like breathing exercises, and guided imagery can also be effective.
- Acupuncture: Acupuncture has been known to help with anxiety and sleep problems, especially insomnia. The treatment works to increase serotonin in the brain to help promote sleep and relaxation.
- Regular exercise and Yoga: These exercise routines are known for helping to increase the length of sleep, decrease the time it takes to fall asleep, improve mood, and decrease stress.
- Create a healthy sleep routine and environment: Creating an environment where sleep is a priority and sticking to a sleep routine can help improve sleep. To promote healthy sleep make the following true for your bedroom each night:
- Make your bedroom for sleeping only
- Create a calm, relaxing environment that makes you think of sleep when you enter the room
- Take a warm bath before bed
- Keep temperature cool
- Make sure your mattress, pillows, and bedding are right for you and are kept clean
- Keep your room dark, with no lights to distract from rest and sleep, including light from TVs, phones, and tablets
- Prevent noise pollution from disrupting sleep, and consider a white noise or nature sound maker
- Make your bed in the morning
- Also, avoid these things in your bedroom:
- Loud noises
- Bright lights
- Distractions like work, TV, or activities
- Eating healthy foods and avoiding nicotine and caffeine: Eating a diet of healthy food may help with anxiety, sleep, and mood. Nicotine and caffeine can make anxiety worse and interfere with sleep patterns, so avoiding them will help promote healthier sleep.
Cognitive behavioral therapy (CBT)
Cognitive behavioral therapy (CBT) is a form of psychotherapy treatment that focuses on boosting happiness by working on changing dysfunctional emotions, thoughts, and behaviors, according to Psychology Today. It is used widely for disorders like anxiety, insomnia, and more.
Negative thinking is common for people who are recovering from addiction. CBT is designed to help people recognize habits and thought processes that are harmful, and teaches them tools to cope, ultimately changing or replacing patterns of thinking and reducing harmful behavior. It is proven to be an effective treatment for addiction — by focusing on the problem, goals, and the present moment.
Several common CBT techniques include:
- Sleep restriction therapy: This is important for keeping people in recovery on a consistent sleep schedule, with a specific bed and wake-up time. Outside of those times, those in recovery are not to be in bed. The goal is to develop a consistent, healthy sleep routine.
- Stimulus control therapy: This method focuses on retraining the brain to think about sleep differently, and to only use the bedroom for sleep activities. This encourages people to only use the bedroom when they are engaging in sleep-related activities.
- Biofeedback: This is a method that focuses on the person’s heart rate and muscles, evaluating the person’s physical and biological reactions that occur that may have a negative impact on sleep.
- Passive wakefulness: This technique is designed to help the person avoid any stress or anxiety about going to sleep, by promoting them laying in bed being comfortable. The goal is to prevent people from worrying about sleeping, and to get to sleep on their own naturally.
Over-the-counter sleep aids
These kinds of sleep aids include herbal remedies that may help improve the quality of sleep, increase feelings of sleepiness and relaxation, and shorten the time it takes to fall asleep.
Some of those include Melatonin, Kava, Valerian, Passionflower, Theanine, and St. John’s Wort.
Melatonin is one of the more common sleep aids. It is always advised that people consult their doctor before taking any sleep aids or medications, as there may be side effects for some people. Melatonin is a hormone produced by the pineal gland, located in the brain. It is inactive during the day — and is triggered after sunset to release melatonin. This hormone increases the feeling of sleepiness and stays in the blood throughout the night. The cycle repeats every day and night.
Tips for sleep when you’re in recovery
Recovery means a lot of change for people with addiction. With the changes associated with recovery ranging from emotions to behaviors, come challenges and the risk of relapse. Sleep loss or deprivation is especially associated with symptoms that can trigger a relapse, which is why lifestyle changes including a healthy sleep routine are so critical for people in recovery.
Consider these top sleep tips for getting enough sleep and healthy sleep during recovery and beyond:
- Pick a sleep schedule and stick with it. This means people need to pick a sleep time and wake time and keep it consistent, to help the body and mind know when it’s time to sleep. This consistent schedule should also be followed on the weekends.
- Create a relaxing bedtime routine. Consider a hot bath, warm tea, or a relaxing activity before bed that helps promote sleepiness. These activities should not induce any stress or anxiety that would make it difficult to fall asleep or stay asleep.
- Avoid naps. Try to avoid naps that will prevent you from falling asleep at your regular bedtime. Daytime naps can throw off your schedule.
- Exercise regularly. Try to get good and vigorous exercise each day and at a time that makes sense to be able to get to sleep. Light exercise is also beneficial as long as you’re getting some activity.
- Make your room sleep-friendly. Keep the room dark and cool, and choose comfortable bedding and the right pillows and mattress for you. Consider this guide for the best mattresses. The room should also be quiet — and you can consider white noise machines, ear plugs, eye masks, and even special curtains to block light.
- Avoid bright light at night. Help your body’s circadian rhythm and make sure you only see bright light during the day.
- Avoid nicotine and caffeine. These will disturb sleep and can make it difficult to fall asleep.
- Avoid drinking and eating before bed. Consider a light snack before bed, but don’t eat large meals within three hours of sleeping.
- Avoid digital devices before or in bed. The light of digital devices and electronics can prevent sleepiness and may make getting to sleep difficult.
- Get out of bed and come back if you can’t sleep. Use your bedroom only for sleeping, and if you can’t get to sleep, get out of bed and do something that makes you sleepy before returning to bed.
- Communicate with your doctor. Speak with your doctor if you’re having sleep problems.
- Start a sleep diary. This will help you track your sleep patterns, and you can share this diary with your doctor.
Consider these additional online resources for information about addiction treatment, drugs, and help. Also, get tips for living with sleep disorders and addiction, and find support groups (local and national).
- The National Helpline (1-800-662-HELP) by the Substance Abuse and Mental Health Services Administration is a free resource that is available 24/7 every day of the year. People and families facing mental and substance abuse can call to get treatment referrals and information.
- This Substance Abuse and Mental Health Services page details the different kinds of treatments available and commonly used for substance abuse disorders.
- The National Institute on Drug Abuse offers information about different treatment approaches for addiction on its website.
- More information on addiction and treatment is available through Psychology Today. People can also search for a therapist through the website directory.
- The Mayo Clinic provides an overview of substance abuse and addiction disorders, along with information about diagnosis, treatment, detox, and more.
- Consider this New York Times article on effective treatment for addiction. It explores programs that have failed and other options for successful treatment.
- WebMD explores drug abuse and dependence and treatments on this page. The page addresses treatments, causes, and symptoms.
- This WebMD page “Why Therapy is Essential in Treating Addiction” talks about the benefits of therapy for treating substance abuse. It explores the different kinds of therapy options and benefits associated with each therapy.
- For behavioral addictions, the American Addiction Centers offers information on different kinds of addictions, including gambling, sex, and food, as well as information on treatment options.
- The American Psychological Association “Breaking free from addiction” story discusses how researchers have developed both pharmaceutical and behavioral therapies for addiction treatment, and how psychologists can help.
Living with Sleep Disorders and Addiction
- WebMD offers a guide on living with and managing sleep disorders. The guide explores tests and treatments for sleep disorders, including diagnosis and sleep trials.
- This WebMD article is all about living with sleep apnea. It discusses how to know if you’re at risk and possible treatments and tips for getting better sleep.
- The Cleveland Clinic features this article about living with disruptive sleep disorders like parasomnia. The article dives into the different kinds of parasomnias and other disruptive sleep disorders, and how they affect sleep.
- For people who suffer from sleep disturbances and problems associated with alcohol use, this study explores the disorders and the treatment process.
- This Addiction Blog article is helpful for people who struggle with sleeping pill addictions. It explores what the addiction is and what it’s like to go through withdrawal, along with tips for treatment and getting help.
- This guide from the Substance Abuse and Mental Health Services is a resource for learning more about sleep problems associated with substance abuse.
- Learn more in this article from the National Institute on Drug Abuse about the link between inadequate sleep and substance abuse for adolescents.
- The New York Office of Alcoholism and Substance Abuse Services breaks down sleep and sleep disorders in this guide. It also explores how sleep issues can be a risk for successful recovery.
- Partnership for Drug-Free Kids features an article titled “Sleep Problems and Substance Use Disorders: An Often Overlooked Link” that explores the direct correlation between addiction and sleep problems.
- Search by state on Recovery.org for local support groups and programs.
- Psychology Today offers a support group and therapy locator directory that you can search by city, name, or zip code.
- For families and friends of addicts, NarAnon offers a “Find A Meeting” locator that you can search by city, state, or zip code.
- This free SAMHSA helpline (1-800-662-HELP) is available 24/7 and 365 days a year, and people can call to find a support group and learn more about the support groups available nationwide.
- This locator will help you find “Self-Help, Peer Support, and Consumer Groups – Self-Help Groups (Addiction)”.
- The Addiction Center details all of the different support groups nationwide, and offers a free 24/7 phone number to call (877) 286-6352 to get help or find a treatment center or a support group.
- The American Addiction Centers covers all of the most well-known treatment programs across the nation and links to more information about each one.
- This page is all about self-help and recovery support groups via the National Council on Alcoholism and Drug Dependence.