A Dream Deferred: How Substance Abuse Affects Sleep
Substance abuse is associated with many physical and mental health problems, including sleep disturbances. The relationship between sleep disruptions and substance abuse work in two directions:
- Substances can cause sleep disturbances
- Sleep difficulties can result in addiction (or relapse) due to substance use for relief.
How Our Bodies Regulate Sleep: Circadian Rhythms
Circadian rhythms are the changes people experience that result from a daily cycle. The way we respond to daylight and darkness is one example. Sleeping at night and being awake during the day is a light-related circadian rhythm.
Our biological clocks produce circadian rhythms and regulate their timing by using proteins that communicate throughout the cells in the body. Signals from the outside environment, such as light and darkness, cue our circadian rhythms. Irregular rhythms have known links to many chronic health conditions, such as sleep disorders (i.e. insomnia), depression, and bipolar disorder.
Substance Abuse and Insomnia
One in five people suffer from chronic insomnia, and this puts them at risk for substance abuse. Researchers have found that people who have sleep and circadian disorders can develop or see a progression of central nervous system (CNS) disorders like substance abuse. People who can’t sleep well may seek relief by taking drugs or alcohol, and long-term use becomes an addiction.
Alcohol and Sleep Disturbances
When people with alcohol use problems drink, they typically have problems falling asleep and sleep for less time. Also, researchers found that people with alcohol abuse problems are more likely to suffer from other sleep disorders, such as sleep apnea.
Conversely, sleeping problems may influence some individuals to develop alcohol problems when they frequently drink to induce sleep. In addition, sleep problems may raise the risk of relapse among people who are abstinent after having alcohol abuse issues.
The Role of Sleep in Addiction Treatment
The regulation of the sleep-wake cycle can play an important role in treating addictive behaviors. Sleep and circadian-based interventions are critical parts in the prevention and treatment of substance use disorders.
Cognitive behavioral therapy (CBT) as a sleep intervention, can help regulate sleep at night, improve sleep quality, and enhance daylight functioning. Treatment using CBT, which uses behavioral and cognitive strategies, focuses on the factors that cause long-term insomnia due to behaviors that disrupt the circadian system.
CBT addresses these behaviors, including, using alcohol or drugs to sleep, napping during the day, using large amounts of caffeine to stay awake during the day, and reducing the stress that surrounds the inability to sleep. CBT can also address unrealistic sleep expectations in order to promote better sleep.
Circadian-based interventions are used to control environmental cues. Chronic insomnia can be triggered by the environment where a person sleeps. If the bed and bedroom become associated with wakefulness and with activities and behaviors that are not conducive to sleep, insomnia can result. Examples include watching television, reading, or worrying about insomnia.
These cues associated with wakefulness are modified to make the sleep environment more conducive to a good night’s rest. Stimulus control therapy is used to make environment stimuli more compatible with sleeping and to stabilize the sleep/wake clock.