Sleep and Substance Use

“Sleep is the single most effective thing we can do to reset our brain and body health each day — Mother Nature’s best effort yet at contra-death.”

― Matthew Walker, author of “Why We Sleep: Unlocking the Power of Sleep and Dreams”.

Why is Sufficient Sleep Necessary to our Functioning :

Sleep is a physiological necessity, so much so, that we spend nearly one third of our lives sleeping. Getting sufficient, quality sleep, is as important to our survival as food and water. Research has shown that chronic lack of sleep, or poor quality sleep, increases the risk of health problems including high blood pressure, cardiovascular disease, insulin resistance, Type 2 diabetes, obesity, depression and other mental health disorders. Poor sleep quality reduces productivity and increases irritability. Without sufficient sleep you are unable to form or maintain the pathways in your brain which are responsible for learning and the creation of new memories, thus making it harder to concentrate and respond to situations effectively. Lethargy, dullness of mind, forgetfulness, feelings of not being able to cope, or even grumpiness are all signs of insufficient, poor quality sleep.

Substance Use and Sleep :

Sleep and substance use is frequently bidirectional in nature- substance use causes problems with sleep and sleeping; but insomnia and insufficient sleep may also be a factor in substance use and addiction. Different substances affect sleep in different ways, for example, alcohol increases slow wave sleep and suppresses rapid eye movement (REM) sleep. During periods of acute withdrawal, sleep latency (the time taken to fall asleep) is increased and the total time spent asleep is decreased. Similarly, opiates, despite being sedatives, interrupt sleep by increasing wakefulness and decreasing total sleep time, slow wave sleep, and REM sleep. Furthermore, opioids and opiates are known to affect the brain mechanism that controls breathing. This can potentially create sleep apnoea events where individuals experience pauses in their breathing, resulting in snoring or gasping, a dry mouth and even a headache in the morning. In terms of cannabis, chronic users develop a tolerance towards its’ sleep-enhancing effects. During withdrawal and periods of abstinence from cannabis, unusual dreams and poor sleep quality is common. This poor quality sleep together with insomnia has been shown to be predictive of a relapse amongst users of cannabis, with over 40 % of participants in one study reporting prolonged periods of insomnia and 10 % of those who relapsed, cited insomnia as a factor in their relapse. Insomnia experienced during withdrawal from substances, frequently fuels craving.

Sleep as a Predictive Factor in Relapse :

Poor quality sleep is a predictive factor in relapse. Studies have shown that sleep disturbances are reported by individuals for some drugs, long after they have quit taking them and after other withdrawal symptoms have subsided. For example, disruptions in REM sleep can sometimes persist for 1 to 3 years amongst alcoholics who have achieved sobriety. The REM stage of sleep is believed to be associated with mood regulation and the consolidation of memories. Disturbed sleep appears to be a significant predictor of relapse in alcoholics even after controlling other factors, such as depression. Further, because sleep is important in memory consolidation, sleep dysfunction may interfere with the learning of new associations and skills needed for successful recovery from alcoholism.

Although this is a relatively new area of study and much of the research that has been done in this field has been done on small groups, there can be no doubt that in order to successfully recover from addiction, we need to be mindful of practising good sleep hygiene.

Practising Good Sleep Hygiene :

Here are some tips that may assist you in practising good sleep hygiene.

1. Get sufficient exposure to daylight : light, especially sunlight, is one of the key drivers of circadian rhythms (internal processes that regulates the sleep-wake cycle, repeating roughly every 24 hours) that can encourage quality sleep.
2. Avoid caffeine and nicotine and other chemicals that interfere with sleep.
3. Exercise early : exercise stimulates the body to secrete the stress hormone cortisol, which causes the brain to become alert, so although exercise can help you fall asleep faster and sleep more soundly, it needs to be done at the correct time. Ideally, exercising should be completed at least three hours before your intended bed time. It is best to exercise earlier in the day.
4. Unplug from electronics: maintain a 30-60 minute pre-bed time that is free of all devices such as mobile phones, tablets, laptops and televisions. Not only do these devices cause our brains to be stimulated, they also generate blue light that may decrease melatonin (the hormone associated with sleep produced by the pineal gland. It helps you fall asleep by calming the body before bed ).
5. Follow a consistent routine at bedtime: follow the same steps each night, including things like putting on your pyjamas and brushing your teeth. Your brain picks up on the little cues that are telling it – it is time for sleep.
6. Budget 30 minutes for winding down prior to sleep: use calming aids such as soft music, light stretching, reading, meditation or prayer. Try not to make falling asleep your goal, instead focus on relaxation. Meditation, mindfulness, breathing exercises and other relaxation techniques may put you in the correct mindset for bed.
7. Don’t Toss and Turn: try to maintain a healthy mental connection between being in bed and actually being asleep. If after 20 minutes you haven’t managed to fall asleep, get up and stretch, read, or do something else calming in low light before attempting to fall asleep again.
8. Don’t Dine Late: Eating dinner late, especially if it’s a big, heavy, or spicy meal, can mean you’re still digesting when it’s time for bed. If you need to snack before bedtime, the snack should be a light one.

If you are a recovering addict or alcoholic and you are experiencing persistent problems with sleep, do not ignore them. Keep a sleep journal, speak to your sponsor or counsellor and seek assistance in improving your quality of sleep.

RESOURCES :

Sleep Hygiene :

https://www.sleepfoundation.org/articles/sleep-hygiene

Differential Effects of Addictive Drugs on Sleep and Sleep Stages :

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688758/

Sleep Disorders in Substance Abusers- How Common Are They? :

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2766287/

Connections between Sleep and Substance Use Disorders :

https://www.drugabuse.gov/about-nida/noras-blog/2020/03/connections-between-sleep-substance-use-disorders

Drugs, sleep, and the addicted brain :

https://www.nature.com/articles/s41386-019-0465-x

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