According to SAMHSA sleep problems are a common complaint for folks that fighting a substance use disorder (SUD). Sleep issues can even last during detox and well into years of recovery.
Sleep Issues & Substance Abuse
Substance induced sleep disorders are recognized by the DSM5. Sleep problems can vary based on substances used and can include insomnia, the time it takes total asleep, disturbances in sleep cycle and sleep continuity or hypersonic (being sleepy during the day).
With alcohol abuse, insomnia and other sleep disturbances are quite common. Many people with AUD report insomnia before entering treatment. Some people in recovery report continual insomnia or sleep disorder sleeping (such as sleep apnea) for weeks or months. People who use opioids have reported that have difficulty sleeping during detoxification and afterwards report insomnia. Similar finding are reported with cocaine users and with other types of drugs.
Sleep loss can have significant negative effects on the physical, mental, and emotional well-being of people in recovery. It can also interfere with substance abuse recovery. Persistent sleep complaints after withdrawal are associated with relapse to alcohol use. “Poor sleep quality before a quit attempt from cannabis use is a risk factor for lapsing back into use within 2 days.”
Assessing Sleep Disorders
If a patient initiating withdrawal from a substance or recovering from an SUD complains of a sleep disturbance, the healthcare provider should assess for causes by doing the following:
- Determine the duration of recovery and medications used for SUD treatment.
- Ask questions about difficulty falling asleep, waking during the night, amount of sleep per night, snoring, sleep apnea, excessive movements during sleep, uncontrollable movements that are relieved by getting up and walking, and excessive daytime sleepiness.
- If possible, ask significant others the same questions about the patient.
- Rule out other causes of the sleep problem, such as stress, a life crisis, or side effects of medications the patient is taking.
- Ask the patient to write in a sleep diary or log immediately on awakening. The patient should record total time in bed, time of sleep onset, number of times awakened, and total time spent awake.
- Determine the frequency and duration of symptoms of insomnia. If difficulties occur two or three nights per week and last for 1 month or more, the patient warrants a diagnosis of insomnia.
***Note that some patients tend to overestimate the quality and duration of their sleep on self-report questionnaires and in sleep logs. If warranted, a referral for an objective sleep study in a sleep laboratory can be made.
Treatments
The association between insomnia and relapse calls for treatment that addresses insomnia during recovery. The first step in treating insomnia should focus on the status of the patient’s recovery. Patients should be receiving treatment from an appropriate substance abuse treatment program. It is important to address other psychological, social, and medical problems that may contribute to insomnia, such as co-occurring mental and medical disorders, use of medications that disturb sleep, and nicotine use.
What Healthcare Providers Can Do (SAMSHA)
- Screen for insomnia among people in recovery from SUDs.
- Include questions about sleep during the routine patient history.
- Rule out other causes of sleep problems (e.g., stress, medications).
- Educate patients about sleep hygiene, and make referrals to a specialist if necessary.
- Conduct a careful evaluation, and consider risk factors, before prescribing sedative–hypnotic medications to treat insomnia.
- Monitor patients for signs of abuse or diversion of scheduled medications prescribed to treat insomnia and other sleep disorders.
Non-pharmacological Treatments
These are non-pharmacological treatments often used for Sleep Disturbances:
- Mindfulness meditation – The patient moves into a state of restful, present-moment alertness, which reduces stress and improves self-control.
- Progressive muscle relaxation – The patient concentrates on tensing and relaxing groups of muscles.
- Biofeedback – The patient becomes aware of physiologic stress responses and how to control them
- CBT for insomnia – The patient’s dysfunctional beliefs and behaviors are modified to improve his or her emotional state
- Stimulus control – The patient reassociates the bedroom with the rapid onset of sleep.
- Exercise – Regular physical activity relieves stress and tires the patient.
- Sleep restriction therapy – The patient limits sleep to a few hours and progressively increases it until the desired amount of sleep time is achieved.
- Bright-light therapy – Exposure to a natural bright light while awake helps promote normal sleep patterns
- Dental devices and continuous positive airway pressure machines – These devices help the patient with obstructive sleep apnea breathe more easily during sleep
There are of course prescription and non prescription over the counter drugs that can be used to help with sleep disturbances and it is best to work with a board certified addiction medicine physician or psychiatrist for recommendations.
If, however, you are working with someone who is having sleep challenges here are 10 tips to help promote good sleep habits.
10 Tips From SAMSHA for Getting a Good Night’s Sleep
- Go to bed and get up at the same times each day.
- Use natural light (that comes through a window) to remind yourself when it’s time to be asleep and awake. This can help you set a healthy sleep–wake cycle.
- Exercise regularly.
- If you take naps, keep them short and before 5 p.m.
- Don’t eat or drink too much when it is close to bedtime.
- Avoid caffeine (in coffee, tea, chocolate, cola, and some pain relievers) and nicotine for several hours before bedtime.
- Wind down before going to bed (e.g., take a warm bath, do light reading, practice relaxation exercises).
- Keep the bedroom a relaxing place—avoid working or paying bills in bed.
- Sleep in a dark, quiet room that isn’t too hot or too cold.
- Don’t lie in bed awake. If you can’t fall asleep within 20 minutes, get up and do something relaxing.