Connection Between Sleep and Substance Misuse

Medically Reviewed by Carol DerSarkissian, MD on March 10, 2024
Written by Keri Wiginton
5 min read

If you have trouble sleeping, you may take something to help you at night. You may “self-medicate” with illegal drugs, alcohol, or medication. But substance misuse or withdrawal from drugs can cause sleep problems or make them worse. And if you have a problem using or abusing drugs, issues with your rest can raise your chances for relapse.

You can get help for your substance misuse and your sleep issues. You may need to treat other problems at the same time, like anxiety or another health condition.

To find the care you need, talk to your doctor or find a substance abuse treatment center.

There are a lot of substances that can disrupt your sleep. You may have problems getting ZZZs even when you take a prescription or over-the-counter (OTC) drug the right way. Tell your doctor if this happens to you. They may want to change your medicine or lower the dose.

But you may not get a good night’s rest if you abuse:

Prescription, nonprescription, and OTC medicines that can cause sleep problems include:

If you have a substance use disorder (SUD), it’s common to have insomnia. That’s when you have trouble falling or staying asleep. Experts think there may be a brain connection between the two. That’s because a lack of sleep puts you in a state of “hyperarousal.” And like other kinds of stress, this can raise the chances you’ll abuse drugs.

Some substances change how you go through your sleep stages. You may not get the right amount of non-rapid eye movement (NREM). That’s when you get your deep sleep. Drugs can also mess with your rapid eye movement (REM) sleep, where you do your dreaming and move around more.

Substance abuse can lead to:

  • Nighttime wakefulness
  • Less “good” sleep
  • Lower overall sleep time
  • Strong daytime sleepiness (hypersomnia)

You may get into a cycle of use when you take drugs like cocaine, caffeine, and nicotine. They’re stimulants that make you feel alert. That means you may not get good sleep if you use them a lot. And if you’re tired in the morning, you may keep using these drugs to keep you from feeling drowsy.

Liquor, beer, and wine can make you sleepy. That’s because alcohol is a depressant. But if you drink a lot, these drowsy effects get weaker. You build up what’s called a tolerance. That means you have to use more alcohol to get the effect. In that case, it's more likely that you'll get an alcohol use disorder (AUD).

But alcohol can affect the quality of your sleep even if you don’t have an AUD. That’s partly because you’re likely to wake up as the drug wears off. Alcohol also relaxes your muscles, including the ones in your throat. That can make breathing harder, which would also wake you.

Your REM and slow-wave sleep (SWS) also take a hit when you drink too much. SWS is important because it plays a part in learning, memory, and other kinds of mental tasks.

When you quit taking drugs, you may get insomnia or other sleep problems, including broken sleep, strange dreams, or restless legs syndrome. All of these can take a toll on your mental and physical health. That can make your recovery harder.

You may have sleep problems when you withdraw from:

  • Alcohol
  • Marijuana
  • Opioids
  • Cocaine
  • Stimulants
  • Prescription or nonprescription drugs

This can be even harder if you’ve been addicted to drugs or alcohol and you’re trying to stop.

A quarter to three-quarters of people in treatment for alcohol abuse report insomnia, sleep apnea, and other problems, and it is a common complaint in people trying to quit opioids. And poor sleep quality is typical in withdrawal from cocaine. One study found people in recovery from drug or alcohol abuse were 5 times more likely to have insomnia.

These disturbances may end after your physical withdrawal or continue for months or years into your recovery.

Even quitting regular marijuana use can cause sleep problems. This typically lasts several days but may continue for several weeks.

There are therapies and nonaddictive medications (see Treatment section below) that may help with sleep in recovery. Talk to your doctor about the best approach for you.

In addition, there are a number of things you can do on your own to help improve your sleep. These include:

  • Get up at the same time each day.
  • Expose yourself to the sun as soon as you can each morning to help set your sleep, or “circadian,” rhythms.
  • Exercise regularly (but not too close to bedtime).
  • Don’t eat too much late at night.
  • Stop eating or drinking anything with caffeine several hours before you go to sleep. (This includes several OTC medications.)
  • Keep your naps short, and don’t nap in the late afternoon.
  • Sleep in a dark, quiet room that isn’t too hot or too cold.
  • Start a regular “wind-down” routine before bed. Try a bath, light reading, or relaxation exercises.

Your doctor might prescribe you medicine to help with your insomnia. When used the right way, it can help you sleep. But it’s possible to abuse these meds. For example, if you use them to:

  • Cope with stress
  • Get a high feeling

Insomnia drugs are best used for short-term help with sleep. That usually means only at certain times or for less than 4 weeks. If you use them more often or longer, you may become dependent. You could also have withdrawal symptoms when you stop taking them. Some are mild while others are more serious.

You could still have insomnia. You may also have:

It can be hard to quit using drugs on your own. You may get better through a substance abuse program. The Substance Abuse and Mental Health Services Administration (SAMHSA) can help you can find a treatment center in your area. Call 800-662-4357 anytime of day, year-round. Find more information at samhsa.gov.

If you have physical or mental problems that affect your sleep, talk to your doctor. They’ll ask you questions about your sleep habits. And make sure to tell them about any illegal drugs, alcohol, or medication you’re taking.

There are non-addictive prescription drugs that can help, like:

Some solutions for insomnia or other sleep problems aren't drugs at all. Ask your doctor about: