Insomnia During Recovery
For the estimated 21.7 million people each year who seek substance use treatment, the journey is long and full of challenges. As many people in recovery know, the path forward typically involves mild to severe interruptions in your sleeping patterns. We’ll walk you through the science behind why, and provide strategies and resources to support you along the way. For those who are supporting a friend or family member through recovery, this insight can be invaluable in understanding what’s going on in your loved one’s life right now.
Table of Contents
Recovery and Sleep
There are multiple links between recovery and sleep disturbances. For one, those in recovery have increased sleep disturbances, which seems to be a commonly shared experience regardless of the substances they used before recovery took place.
Individuals who are in recovery may also have previously found drug and alcohol use helpful in treating underlying sleep problems due to the sedative effects of substances like alcohol and cannabis. The Drug and Alcohol Center and the Cleveland Clinic conducted a survey completed by those admitted for substance abuse treatment. The study focused on sleep behaviors and found that 46% of alcoholic patients who were surveyed used substances to help them medicate their sleep patterns. By taking that substance away, the body is forced to reach sleep in different ways, which can result in issues like weird dreams, rapid limb movements, and or insomnia.
As we’ll discuss in this article, sleep disturbances during recovery can also increase the risk of relapse. The experience of sleep deprivation can be so difficult that some may turn back to their original substances to find reprieve.
Taking the significant correlation between sleep patterns and substances used into consideration, it’s important to understand how the recovery process may impact sleep.
According to a study published by the NCBI, “the effects of chronic use on sleep are similar among both CNS stimulants and depressants.” They found that chronic substance abuse, regardless of the drug (opiates, cocaine, cannabis, or alcohol), commonly leads to a decline in time spent asleep, an increase in time spent trying to fall asleep, and a decrease in non-REM sleep or slow-wave sleep.
REM vs. SWS Sleep
There are two patterns of sleep people encounter, with slow-wave sleep (SWS) being the most common and frequent type of sleep. This is where the brain waves are lower. Slow wave sleep is very deep sleep, essential for those in recovery to feel refreshed in the morning and prepared to take on the day, especially at a time like this.
Then there’s Rapid Eye Movement (REM) sleep. As its name suggests, the subject’s eyes remain closed but there’s much movement during this time, as the person dreams. This is less common sleep, as young adults are in REM 25% of the time.
Sleep problems and relapse
By removing the substances an addict previously used to help them sleep, many find that they cannot sleep or that the sleep they get is not restful. It is incredibly hard to function when sleep-deprived, let alone when you’re also making major changes to rebuild your life and reconnect with loved ones in recovery. Some find it unbearable, resulting in relapse.
With that said, drugs and alcohol do not actually fix the problem of getting good sleep as substances can actually interrupt your sleeping patterns. Taking alcohol an hour before going to sleep can help people fall asleep quicker because of the sedative effect. However, the second half of the night can be disrupted, with fitful sleep and dreams that wake you up and make it difficult to return to bed. In fact, over time the sedative effect of alcohol may decrease, while the disruptive effect can increase.
Here’s a closer look at how specific substances impact sleep quality.
When an alcoholic chooses to stop drinking, there is significant disruption to their sleeping patterns, including a reduction in restful slow-wave sleep. This leads to increased wakefulness and an inability to fall back asleep after waking up. Not surprisingly, many experience more fatigue the next day because they didn’t get a great night’s sleep.
Another factor that impacts how recovering alcoholics sleep is their age. Those who are middle-aged encounter more severe sleep disruption during all stages of withdrawal, according to a study by the NCBI. They also encounter diminishing slow-wave sleep, resulting in them waking up restless and fatigued — even more so than younger recovering alcoholics.
Those recovering from alcoholism are also more likely to experience limb movements throughout the night, which could awake them from their sleep. Clinical Psychiatry News states that regular drinking can result in restless leg syndrome at night — even more so in women. In fact, the Clinical Psychiatry News found that “recovering alcohol-dependent patients have significantly more periodic limb movements associated with arousals (PLMA) from sleep than controls.”
Learn more about how alcohol affects sleep in our research-based guide on alcohol and sleep.
Those who used stimulants such as cocaine experience many of the worst sleep problems at the beginning of withdrawal. The first few days throughout the first week of recovery tend to be the worst, as experiences can vary from sleep disturbances, hyper insomnia, bad dreams, increased hunger, and a depressed mood. It isn’t uncommon during the early withdrawal period for people to sleep only five to five and a half hours per night, per the NCBI.
The good news, though, is after the initial withdrawal, these symptoms tend to go away, unlike the experience of other types of drug users. The NCBI notes that those who have been in withdrawal for several weeks tend to have much better sleep measured in deep sleep quality and alertness during the day.
Opioid withdrawal can be a particularly difficult time, with many getting lower-quality, less restorative sleep. According to the NCBI, sleep problems in opioid recovery typically exist for only the first 6 to 12 months during therapy. After this point, the subject’s sleep is regulated to healthier levels.
A special note of caution for those who opt for methadone treatment: the NCBI reports between 30% and 90% of subjects receiving chronic opioid therapy show signs of central apnea that varies with dosage. In fact, sleep apnea can be life-threatening in methadone users, causing irregular breathing, higher carbon dioxide rates, and less arterial oxygen saturation during sleep.
Cannabis is similar to alcohol in that small doses can help subjects fall asleep quicker. However, they also make it difficult to sustain lasting sleep. Thus, a pattern emerges where the person uses cannabis more to try to help them go to sleep, discounting the fact the cannabis is contributing to their overall poor quality of sleep.
One of the problems with some cannabis is its formulation. The THC in cannabis produces a calming effect, acting as a sedative that can help a user fall asleep. However, formulations containing cannabidiol (CBD) can promote alertness. So, while an individual might not have trouble falling asleep after using cannabis, the CBD component in cannabis may be counterproductive and contribute to increased alertness and less restfulness during sleep.
In the case of cannabis withdrawal, people report experiencing an inability to sleep well, strange dreams, and insomnia. It isn’t uncommon for subjects to experience weird dreams one to three days after withdrawing with the peak being days two through six. In some studies, patients find themselves having strange dreams for up to 45 days after withdrawal.
Strategies for Sleeping
What Addiction Science Says About Recovery Insomnia
The road to recovery takes strength and perseverance. Needless to say, the increased likelihood of experiencing sleep problems when quitting can be a major obstacle. And while the internet has a ton of resources available, it’s important to note not all information is accurate or helpful — quick fixes to sleep problems may be especially frustrating for those in recovery who need sleep the most. In fact, the NCBI discovered that traditional sleep-promoting measures can be counterproductive to helping those who are experiencing insomnia during recovery.
Sleep Treatment vs. Sleep Hygiene
There’s also a distinct difference in practicing good sleep hygiene versus receiving treatment for insomnia. Sleep hygiene is a set of education-based best practices patients employ daily which can help them sleep better at night. This includes regular exercise, abstaining from drinks that contain caffeine, employing a regular, early bedtime, and more. Even having a comfortable sleeping space and a supportive mattress can help. In essence, they are routine and behavioral changes in the small decisions a person makes throughout the day, which add up to better sleep.
Focusing on proper sleep hygiene during recovery is a great first line of defence, but be advised that the duration and consistency of your efforts are key to seeing results.
For those who need additional support in coping with recovery insomnia, there are more structured treatment options. We recommend speaking with a healthcare provider about your experiences and whether or not you should proceed with more formal treatment, as long-term insomnia can encounter daytime impairment, which could also be a trigger for relapse.
One of the more successful treatment options is cognitive behavioral therapy for insomnia. The NCBI notes that of non-alcoholic patients who undergo cognitive-behavioral treatment for insomnia therapy (known as CBT-I) up to 80% remark having improved sleep. CBT-I can be performed in a variety of settings (group, individual) or session durations, though studies show that shorter bouts of therapy may be promising.
This treatment is multi-faceted. Its primary purpose is to target those factors that contribute to insomnia by disrupting the circadian timing. Along with this, the study looks into factors that contribute to poor sleep quality such as excessive consumption of caffeine, and other behaviors.
A critical part of CBT-I is sleep restriction. This is where the subject spends less time in bed and avoids napping to increase the need to sleep. The theory is if someone has only a certain amount of time to sleep, they’ll be much more incentivized to do so.
Another element of CBT-I is stimulus control, or managing the environment surrounding your sleep. Patients cannot watch TV, eat, or read before going to bed; the only exception to the rule is sex. By avoiding doing “wakeful” activities in bed, you train the brain to associate the bedroom only with sleep, thus your brain will more readily sleep there. Subjects only go to bed when they’re sleepy, and if they cannot sleep within 15 to 20 minutes, they must get out of bed and go to another room.
Alternatively, those in recovery might opt to try melatonin, a hormone naturally found in the brain that helps regulate your body’s sleep-wake cycle.
A deficiency in melatonin levels is prevalent among those who drink alcohol regularly, especially as they try to fall asleep. Melatonin typically does not kick in as early in alcoholics as it does in other people, which results in a lack of a healthy sleeping pattern.
A Note on Sleeping Pills
Be advised that prescription sleeping pills are known to have addictive qualities that may not be the right option for recovery. In fact, American Addiction Centers note that sleeping pills have shown to only add 8 – 20 additional minutes of sleep per night for patients. Speak with your healthcare provider about what options are the best for your circumstances.
What loved ones need to know
Recovery is a process, and sleep disorders are a very common part of this process. For some friends and family, unexpected insomnia can be difficult to cope with on top of all the other changes your loved one is going through. Not to mention, weeks, months or even years of insomnia can take their toll on both parties. You might feel frustrated, helpless and many other conflicting feelings, prompting you to ask questions such as:
- Is my loved one’s insomnia normal?
- What can I do to help my friend or loved one fall asleep?
- Is my loved one’s inability to sleep my fault?
- How long will my loved one suffer from sleep disturbance?
You Are Not Alone
Your loved one is taking steps right now to lead a physically and mentally healthier life in the long-term. But just like they are taking steps to take care of their needs, you need to ensure you tend to your needs as well. The psychological experience of supporting someone in recovery is immense.
Keep in mind you’re never alone as there are others out there who have gone through similar experiences. Oftentimes, there are local support groups in your community that can provide a fresh perspective on what you’re going through and give you encouragement.
We’ve listed a few below to get you started. Click here for a downloadable PDF version.
- Al-Anon: a resource for people whose lives are affected by another person’s drinking. Al-Anon groups are a way to talk about your experiences and get support from others who understand what you’re going through, without judgment.
- Nar-Anon: similar to Al-Anon, Nar-Anon is a support group for those whose lives are affected by another person’s drug use.
- 211: a comprehensive database of local social services, call this number or visit the website to find mental health and addiction support services.
- DrugAbuse.gov: to learn more about drug addiction and treatment, visit this website for reliable and trustworthy information.
- Psychology Today “Find a Therapist” tool: to reach out for mental health support, this therapist locator tool is an easy way to find services in your area.
- Crisis Text Line: if you or your loved one is in crisis and needs support, this option allows you to speak to a trained Crisis Counselor and know that you are not alone.
Remember to keep in mind that insomnia is a common part of the recovery process. However, as the recovery process goes on, insomnia abates. There are also proven treatment solutions such as melatonin, CBT-I, or stimulus control, all of which have proven to work in reducing the instances of insomnia.
While there will be some difficult days, especially at first things do become better with time. Again, you’re not alone through this and the love and support you’re providing now means the world to the person in recovery.