Substance Abuse and Sleep

A staggering 50-70 million Americans live with a sleep disorder in the U.S., and 10% of Americans report chronic insomnia. Many people turn to a “nightcap” or some other substance to sleep. Using substances to relax can make things worse. (1)

Using alcohol as a sleep aid is a problem; it may make people sleepy, but it will also disrupt their sleep later in the night. The only benefit of using alcohol is that a person may fall asleep faster.

But then the person will have to contend with frequent awakenings, poor quality sleep, less deep sleep, and earlier waking times – making them feel tired and groggy the following day, which completely defeats the purpose of having that nightcap in the first place. (2)

Almost every mental disorder, from PTSD to depression, is associated with sleep problems, and substance use disorder (SUD) is no exception. The relationship between SUD and insomnia (or other sleep issues) is particularly complex.

Inadequate sleep may lead to substance misuse, leading to increasing sleep problems. Troubles with sleep can intensify one’s dependence on alcohol or other substances. It’s something of a paradox – a dangerous one.

Substance Abuse and Sleep

What is an intervention?

An intervention is an opportunity for the friends and family members of a loved one suffering from addiction to discuss the addiction and its possible consequences. Often, an intervention is conducted under the oversight of a trained professional. An intervention may lay out the dangerous behaviors observed by friends and family members, including specific consequences of the addictive behaviors and what actions friends and family members might take if the individual continues with the addictive behaviors.

The Importance of Sleep

Sleep affects all aspects of our health, mentally and physically. It’s essential to every process that occurs in our bodies. It affects our ability to function well, immune systems, and risk of developing chronic diseases.

During a typical quality night of sleep, you will go through 4-5 sleep cycles, each made up of 4 individual sleep stages:

Stage 1: The act of dozing off or transitioning from wakefulness to sleep. Heart rate, breathing, and eye movements slow down during this stage.

Stage 2: The body and mind slow down further. The person’s body temperature drops, and eye movements cease. These first two stages are the easiest time to be woken up.

Stage 3: Also known as “deep sleep,” the body is entering “recovery mode.” This is the sleep that makes people feel rested in the mornings.

Stage 4: In REM (rapid eye movement) stage, the brain is almost as active as when the person is awake. People’s eyes move rapidly from side to side, their breathing becomes faster and irregular, and their heart rate and blood pressure are nearly at wakefulness levels. This is when intense dreaming occurs, and the leg and arm muscles are temporarily paralyzed, so people don’t physically act those dreams out. (4)

While the biological role of sleep isn’t completely understood, research shows that it supports the cardiovascular and immune systems and helps to regulate metabolism.

During sleep, several of the core bodily processes change their rhythms depending on the sleep stage:

Breathing slows down during non-REM sleep; it’s slowest during stage 3 in a deep sleep. It speeds up and may become irregular during REM sleep.

Heart Rate also begins to slow down during stage one, with its slowest rate being in stage 3, and during REM sleep, the pulse rate increases to the same rate as wakefulness.

Muscles gradually relax during all three non-REM stages, then become mostly paralyzed during the REM stage. This is called atonia, which keeps you from flailing about while you dream. Your respiratory and eye muscles stay active during this period, called REM, or rapid eye movement.

Brain Activity measurements show obvious patterns with each of the four stages, with considerable slow-down at first and then quick bursts of brain activity during stages 2 and 3. During REM sleep, the brain becomes very active and is known for its connection to vivid dreaming. It is thought that REM sleep plays a critical role in the processes of learning and memory. (5)

Dreaming can occur during four sleep stages but tends to be more intense, bizarre, and fanciful during REM sleep.

Hormone Levels fluctuate during the different sleep stages, and lack of quality sleep may affect daytime hormone production. Hormones affected include:

A person’s waking hours pay the price when they don’t get consistent quality sleep. Symptoms of sleep deprivation include but aren’t limited to:

It makes sense that we would do whatever it takes to get a good night’s sleep; our bodies, minds, and lives depend on it. We’ve all had those nights when sleep eludes us, which isn’t pleasant. Experience has taught us that a rough night of sleeping ensures a rough day of everything, and we can’t usually afford not to be at our best.

So, we have a glass of wine or maybe smoke or eat cannabis. And it may seem to help, at least temporarily. But remember, falling asleep faster does not equal quality sleep. Using substances to fall asleep will eventually defeat the purpose.

Alcohol and Sleep

The tricky thing about alcohol is that it is a sedative, so it can make people feel sleepy. It is a depressant, and it causes the brain to slow down, which might help them fall asleep faster. Once the alcohol starts to wear off, however, so do the sedative effects.

As the sedation dissipates, so does the body’s ability to achieve the deep and REM sleep they need to feel rested. The alcohol keeps the body in those earlier, lighter stages of sleep, meaning people wake up more quickly and often.

And the more often a person uses alcohol to sleep, their tolerance increases, and the more alcohol they will need to acquire the sedative effects. People can see how the cycle can quickly become dangerous.

Other issues caused by consistently using alcohol as a sleep aid may include:

Vivid dreams or nightmares

Drinking alcohol before bed may lead to particularly intense dreams or nightmares that the person may or may not remember. They may feel lucid or as if they are half asleep and half awake – and they might very well be.

Sleepwalking/Parasomnias

Alcohol in the system while sleeping may hinder the atonia (muscle paralysis) part of your sleep, causing people to act out their dreams physically, talk in their sleep, or even sleepwalk. This keeps people from getting the rest they need and can be dangerous.

Parasomnias include abnormal movements, talk, emotions, and actions during sleep. They can be so intense a partner may think you’re awake.

Breathing Problems/Sleep Apnea

The sedative aspect of alcohol extends to all the muscles in your body, including your airway. This can cause it to close more quickly, making you struggle to breathe or snore. This can increase your chances of developing sleep apnea.

Cannabis and Sleep

There is still much research on the effects of marijuana as a sleep aid. As more states legalize cannabis for recreational use, more people are using it to sleep, and scientists aren’t sure that’s a good thing.

Marijuana may work temporarily as a sleep aid, but people who use it regularly (daily) report more sleep problems than those who use it occasionally or not at all. (7)

THC decreases the time people spend in REM sleep, which is the time they spend processing emotions and incorporating new memories.

Like alcohol, long-term use of cannabis leads to tolerance, and people will need more of it to achieve the same effects as time goes on. This can lead to dependence and addiction, making sleep problems worse than they were to begin with.

Long-term heavy marijuana use may cause:

Marijuana comes in many different strains and affects everyone differently. It can also cause symptoms like dizziness, nausea, fatigue, dry mouth, confusion, anxiety, or paranoia – none of which are beneficial to a good night’s sleep.

Opioids and Sleep

Opioids are a class of drugs found naturally in the opium poppy plant. They work in the brain to produce several effects, most notably pain relief. They can be found in prescription medication, such as Morphine or Vicodin, as well as in the street drug heroin. (8)

Opioids can be incredibly addictive, and many people who start using them for pain management in the form of a prescription become so dependent on the drug that they eventually turn to heroin when the prescription runs out.

Like alcohol, opioids may make you sleepy and fall asleep faster, but they also disrupt REM sleep.

Opioids can cause sleep disruptions such as:

Insomnia (Trouble falling or staying asleep, or not feeling rested from sleep)

Parasomnias (Abnormal sleeping behavior, such as talking or sleepwalking)

Daytime sleepiness

Perhaps the most dangerous risk of using opioids as a sleeping aid (besides addiction) is the risk of sleep-disordered breathing (SDB). Parts of the brain controlling breathing are susceptible to opioids, particularly dangerous while sleeping.

Like alcohol and cannabis, using opioids as a sleep aid can eventually lead to tolerance and addiction. The more a person uses it, the more they think they need it, and the less quality sleep they will be getting. And opioids are highly addictive.

If someone feels they may be dependent on opioids for sleep, please reach out for help as soon as possible.

Stimulants and Sleep

Stimulants are drugs that temporarily increase energy, alertness, heart rate, and respiration. There are legal medications, such as Adderall and Ritalin, and street drugs, such as cocaine and methamphetamine.

Taking stimulants at bedtime to get to sleep would be counterproductive, but taking them during the day (even as prescribed) can also affect the body’s ability to get the rest a person needs. And don’t forget, caffeine is a stimulant too.

If a person “binges” on stimulants during the day, they may “crash” later, sleeping for long periods. But again, this isn’t going to facilitate the quality sleep that allows the body the restoration it requires to function optimally.

The consistent use of stimulants will disrupt sleep cycles with:

Reduced time asleep
Poor sleep quality
Lack of REM sleep
Poor nutrition (which contributes to poor sleep)
Insomnia
Paranoia, anxiety, or stress

Sleeping Well: Benefits and Tips

Good sleep habits are sometimes referred to as “sleep hygiene.” With consistency and the willingness to try a few different things through trial and error, it is possible to develop a sleep routine that doesn’t require nightcaps or other substance use.

The body deserves it, and efforts will be highly rewarded—nothing quite like a fantastic night of sleep, especially when someone can have them regularly.

Here are just a few of the benefits of good sleep:

Healthy Heart While a person sleeps, their heart rate and blood pressure decrease, allowing their cardiac and vascular systems to rest. These systems work 24/7 for the entirety of their life; not allowing them the restful periods they require increases the risks of heart disease, heart attacks, and even heart failure.
Regulated Blood Sugar Insulin is a hormone necessary for regulating your blood glucose (sugar) levels. Sleeping allows the glucose to move into the body’s cells, which are then used for energy. When someone doesn’t get enough sleep (at least 7 hours), the body starts to resist insulin which leaves too much sugar in the bloodstream. This can lead to Type 2 diabetes.
Better Mental Function “Brain Plasticity” is the theory that sleep is essential to the brain’s ability to grow, reorganize, restructure, and make new neural connections. The brain learns further information and forms memories during sleep.
Strong Immune System Babies and children sleep more, partly because the body produces growth hormones. Those same hormones also benefit adults; they repair tissues and cells. Cytokines help the body fight infections and are also produced during sleep. Sleep is necessary for fighting infections, and prolonged lack of sleep or poor-quality sleep may lead to immunodeficiency.
Stress Relief When someone feels rested and on top of their game, managing the hurdles life will inevitably throw their way is more manageable. Problem-solving, critical thinking, and expending energy are much more manageable when the body and mind get enough sleep. This, in turn, makes it less likely they will struggle with anxiety and depression attributed to high stress. (11)

If a person struggles with sleeping well, they are certainly not alone. It’s a problem in our current culture; people have trouble winding down from crazy schedules and constant information flow through computers and smartphones. It’s become increasingly difficult to “disconnect” from the demands of the day – we’re constantly wired in and it’s difficult to disconnect.

Here are some tips for creating a better sleep schedule:

Make a Schedule: Our brains and bodies look for patterns, and we can create beneficial ones. Going to bed and getting up at the same time each day is a great place to start getting the body in tune with what the person needs. If someone naps during the day, keep it to 20 minutes so they will still be sleepy at night. Long naps can defeat the purpose if someone is not tired enough to sleep later that night.

If a person absolutely can’t fall asleep, do something relaxing. This does not mean scrolling on the phone, reading a book, doing light stretching, or taking a warm shower. Do something comforting besides lying there stressed out about not being able to sleep. But do try and go to bed and get up at the same time each day for a week or two, and see how sleep improves with this practice.

Quality Sleep Environment: Different people have different needs for a quality sleep environment, but in general a cool, dark, quiet bedroom is most helpful. A lot of noise and light can hinder sleep. Consider blackout curtains, earplugs, an eye mask, or a white noise machine if these are issues for you.

Treat oneself to a quality mattress, pillows, and bedding. The proper support for your neck and back will make you more comfortable, making it easier to relax and feel sleepy.

Keep the bedroom as clear of clutter and distractions as possible. Having a very clear sense of “this is where I sleep” will make it easier to wind down and emotionally detach from the stressors of your day.

No Caffeine, Nicotine, or Alcohol Before Bed: Caffeine is a stimulant, so avoid it for as many hours as possible before bed. Nicotine is tricky as it’s both a stimulant and a relaxant, but it will act as a stimulant when you are trying to fall asleep. And alcohol, of course, creates all sorts of problems for sleeping when you drink it too late. Avoiding all three for several hours before bed will increase the ability to fall asleep and stay asleep.

Avoid Screens: There’s nothing wrong with winding down with a favorite Netflix show or a good movie, but turn off the TV before getting ready for sleep. Give the brain some time to decompress from all the screens it’s been exposed to throughout the day.

Some people keep their phones and laptops in a separate room, so they’re “out of sight out of mind” in the bedroom. Take some time to read a book, sketch, journal, or just sit in quiet meditation. Don’t just turn off the TV, roll over, and hope to drift off.

Exercise Each Day: Exercise produces serotonin and endorphins, which make people feel good. Don’t exercise right before bed (unless it’s yoga or light stretching), but if a person does get some exercise each day, they will start to notice that their body and brain feel more relaxed; not just during the workout but throughout the rest of the day, up to and including bedtime.

People don’t have to train for a marathon. Still, daily fresh air, sunshine (if possible), and some bodily movement work wonders for the quality of life, including the ability to sleep. (11)

Replacing an evening nightcap or cannabis cigarette might not be easy initially, but the benefits will make it worthwhile. Try chamomile tea for a few weeks instead.

Create a calming ritual that you look forward to each evening. With some dedication and consistency, people can create a quality sleeping schedule that will benefit their nights and their entire quality of life.

When to Get Help

If someone has tried all of the suggestions and still cannot get regular sleep or can’t seem to stop drinking – they should seek help. Mental health professionals can help people achieve a peaceful sleep and manage their alcohol use. There are more advanced solutions medical professionals can suggest to help a person recover from poor sleeping patterns.

Sources

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