Connection Between Sleep and Substance Misuse

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.

Which Drugs Affect Sleep?

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:

  • Alcohol
  • Marijuana 
  • Illegal drugs (cocaine, heroin, amphetamines, methamphetamines)

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

  • Blood pressure medicine
  • Some antidepressants
  • Pseudoephedrine (Sudafed)
  • Nicotine (like in cigarettes)
  • Medicines with caffeine (like Excedrin or No-Doz)
  • Some cough medicines
  • Allergy or asthma medicine

How Do Drugs Affect Sleep?

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)

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Alcohol and Sleep

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.

Drug Withdrawal and Sleep

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

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.

Abuse of Insomnia Drugs

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:

  • Anxiety
  • Irritability
  • Confusion
  • Speech problems
  • Seizures

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Treatment

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:

  • Doxepin (Silenor)
  • Ramelteon (Rozerem)

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

  • Cognitive behavior therapy (CBT)
  • Mindfulness meditation
  • Muscle relaxation therapy
  • Biofeedback
  • Exercise
  • Melatonin supplements
WebMD Medical Reference Reviewed by Brunilda Nazario, MD on March 17, 2020

Sources

SOURCES:

Addiction Science & Clinical Practice: “Sleep abnormalities associated with alcohol, cannabis, cocaine, and opiate use: a comprehensive review.”

Substance Abuse and Mental Health Services Administration: “Treating Sleep Problems of People in Recovery From Substance Use Disorders.”

Cleveland Clinic: “Drug-and Alcohol-Related Sleep Disorders.”

National Sleep Foundation: “How Medications Can Affect Sleep,” “How Alcohol Affects the Quality — and Quantity — of Sleep,” “Safe Use of Sleep Aids.”   

Psychiatric Clinics of North America: “Sleep Disturbance in Substance Use Disorders.”

Psychiatry: “Sleep Disorders in Substance Abusers: How Common Are They?”

Journal of Substance Abuse Treatment: “Prevalence of restless legs syndrome during detoxification from alcohol and opioids.”

FDA: “Taking Z-drugs for Insomnia? Know the Risks.”

The British Journal of Psychiatry: “Misuse of benzodiazepines and Z-drugs in the UK.”

Peer J: “Potentially inappropriate use of benzodiazepines and z-drugs in the older population — analysis of associations between long-term use and patient-related factors.”

International Journal of Neuropsychopharmacology: “An Insight into Z-Drug Abuse and Dependence: An Examination of Reports to the European Medicines Agency Database of Suspected Adverse Drug Reactions.” 

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