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Sleep-Wake Disorders & Substance Abuse

Sleep-wake disorders can increase stress and cause sleep deprivation. This may lead to self-medicating in order to get rest or stay awake.

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Drug abuse degrades sleep quality, making sleep problems worse.

The Link Between Sleep-Wake Disorders & Substance Abuse

Sleep-wake disorders are a group of conditions that lead the body’s circadian rhythm to be out of sync with one’s surroundings or community. This can lead to physical and mental problems.

Abusing drugs and alcohol can influence when you fall asleep and wake up too. This is not just because of the drug’s immediate effects on the body, but also due to long-term changes in the brain that may cause chronic illness.

Specifics of Sleep-Wake Disorders

Sleep-wake disorders are sleep problems that occur when the body’s natural circadian rhythm does not line up with the sleeping and waking cycles of most people or does not match up to daytime and nighttime hours.

Having a circadian rhythm that is out of sync with one’s surroundings or loved ones can be stressful in the short term. In the long term, sleep-wake disorders influence eating patterns and body weight, hormonal cycles, and body temperature.

If you have a sleep-wake disorder, you may have trouble falling asleep and waking up at times that are considered normal in your society. This could be temporary, such as problems that are due to travel or a change in work schedule.

It could also be a permanent condition. This can cause immense stress because your natural sleep cycle does not match up with your work schedule or when your friends and family are awake.

A sleep-wake disorder can be a very isolating condition. People who suffer from them often feel lonely and depressed.

Types of Sleep-Wake Disorders

Diagnosing a sleep-wake disorder may involve a sleep test.

Primary care reports find that between 10 and 20 percent of people complain about significant sleep problems. About a third of adults report insomnia, with about 6 to 10 percent meeting the criteria for an insomnia disorder. This could be caused by an underlying sleep-wake disorder.

Types of sleep-wake disorders include:

  • Jet lag disorder. This is the most common sleep-wake disorder that is typically temporary. This can affect anyone traveling quickly across multiple time zones.

    It results from significant changes in the rhythm of the sunrise and sunset compared to what a person’s circadian rhythm is used to. This can lead to temporary insomnia. For people who travel often, chronic insomnia can become a problem due to lack of regular daylight cycles.

    Typically, it takes a day to recover from jet lag, but many people take substances in an effort to combat it. Abusing sedatives or alcohol can exacerbate the problem due to the resulting poor quality sleep.

  • Shift work sleep disorder. Like jet lag, shift work sleep disorder is a temporary sleep problem, although it can take longer to recover from. The disorder involves a change in work schedule so drastic that you need to sleep during a very different time of day, so you can be awake for an evening, overnight, or early morning shift.

    Lack of access to natural daylight can make this condition much worse. Using blackout blinds to sleep during the day and waking up with a UV light can help to ease the transition or smooth out dramatic changes in work schedule that will not last.

  • Delayed sleep-wake phase disorder. This is a circadian rhythm disorder in which your body’s natural sleep pattern is delayed at least two hours, compared to the natural cycles of those around you. Typically, you will fall asleep later in the night or even in the early morning hours, causing you to struggle to wake up in the morning.

    Delayed sleep-wake phase disorder can make your work and social life tough. Symptoms of the condition can look like insomnia, especially if you attempt to get up at a “normal” morning time to get to a daytime work shift.

  • Advanced sleep-wake phase disorder. Similar to delayed sleep-wake phase disorder, advanced sleep-wake phase disorder means that your body is out of sync with others’ natural rhythms. Instead of falling asleep later, you tend to get sleepy in the late afternoon or early evening, and you get up very early in the morning, often before dawn.

    Trying to stay awake later at night and resist the urge to get up in the morning can lead to sleep deprivation. This condition can impact social activities with friends or family, but many people with advanced sleep-wake phase disorder find satisfaction in early morning shift work.

  • Non-24-hour sleep-wake rhythm disorder. Typically, people with this condition fall asleep a little later every night and get up a little later every day. Non-24-hour sleep-wake rhythm disorders are more common in people who are blind because they cannot process natural daylight to keep them in a more regular circadian rhythm.
  • Irregular sleep-wake rhythm disorder. People struggling with this condition have no clear sleeping and waking pattern. They may become tired very late one night and very early another night.

    Many people with irregular sleep-wake rhythm disorder take several naps over a 24-hour period, with a sleeping pattern more like that of an infant than an adult who sleeps for eight hours, on average. Risk factors include dementia, brain damage, and mental disabilities.

Some conditions may require adherence to sleep hygiene and quitting use of most drugs and alcohol. In other cases, you may need specific medications to keep you awake at certain hours and to help you sleep at others. Exposure to ultraviolet (UV) light and taking melatonin supplements work for most moderate sleep-wake disorders.

Using Substances to Self-Medicate Sleep Issues

Sleep abnormalities like insomnia caused by sleep-wake disorders are associated with substance abuse. People who have sleep-wake disorders may begin abusing sedative medications or alcohol to force themselves to sleep, while those who abuse stimulant drugs may develop sleep disorders because they stay awake for days at a time.

About 70 percent of people admitted to addiction treatment programs reported a sleep problem prior to their admission. Roughly 80 percent of that group reported that the sleep problem was directly associated with substance abuse.

The relationship between these two conditions appears to be bidirectional, with one leading to the other. Each condition exacerbates the other. 

Drugs & Alcohol Make Sleep-Wake Disorders Worse

Chronic sleep-wake disorders cause sleep loss, feelings of inadequacy, and work or social struggles. For most people, using light exposure therapy, taking melatonin supplements, or using sleep hygiene to manage a regular sleep schedule can greatly help.

Sleep deprivation that is caused by forcing the circadian rhythm into an unnatural or unfamiliar rhythm can seem like insomnia, which can add to stress. That can then trigger substance abuse.

At the same time, there are some drugs that can trigger these sleep-wake disorders or make them worse. Drugs that are associated with chronic sleep problems include:

  • This common substance is often used to relax at the end of the day. Some people even drink to promote sleep.

    Alcohol binds to the gamma-aminobutyric acid (GABA) receptor cells in the brain, which leads to relaxation and sleepiness. Chronic use of alcohol leads to tolerance, so the substance has a less hypnotic effect. This may cause you to escalate your drinking, and it can change how the brain manages the GABA neurotransmitter when you are not drinking.

    Insomnia is closely associated with regular heavy drinking. About 35 to 70 percent of people who struggle with problem drinking self-report insomnia. The prevalence is affected by how much they drink.

    Alcohol decreases sleep latency, so people usually fall asleep faster after drinking. But it prevents deep sleep, which allows for rapid eye movement (REM) cycles at night. This means the quality of the sleep is poorer despite falling asleep more quickly. Poor-quality sleep means stress and anxiety, and this often leads to drinking more as a method of self-medication.

    People who have a sleep-wake disorder where they feel tired all the time or have trouble falling asleep at night may self-medicate with alcohol; however, this will make their sleep condition worse.

  • As medical and recreational cannabis become more common, more people use these drugs and believe they are safe. In fact, medical cannabis dispensaries may recommend strains that are higher in cannabidiol (CBD) and lower in tetrahydrocannabidiol (THC) to ease sleep problems like insomnia.

    Long-term use of cannabis has been associated with increased insomnia, problems with sleep cycles, and poor-quality sleep. While the drug reduces sleep latency at first, making it easier for you to fall asleep, using it regularly builds up your body’s tolerance and changes how your brain falls asleep.

    Sleep-wake disorders might get worse while you use this drug. When you try to quit, withdrawal symptoms often manifest as anxiety and insomnia.

  • This is a potent stimulant drug. Many people who abuse cocaine go on cocaine binges, trying to keep their mood and energy up so they can avoid a depressive crash when the drug wears off. This can cause you to stay awake for several days, which can dramatically harm circadian rhythms.

    Being unable to sleep for more than a day or two at a time can change your body’s sleep pattern so much that you develop a sleep-wake disorder. When you quit abusing cocaine, you may suffer from insomnia, hypersomnia, or both.

  • These central nervous system (CNS) depressants are prescribed to manage chronic or severe pain, and one of their common side effects is daytime drowsiness. Tolerance to the analgesic and euphoric effects can occur rapidly, but the sedative effects continue.

    People who abuse heroin, without pre-existing chronic sleep disorders, report lower quality sleep, according to the Pittsburgh Sleep Quality Index (PSQI), and daytime sleepiness issues, according to the Epworth Sleepiness Scale (ESS). People who begin methadone maintenance treatment to overcome opioid abuse report trouble falling and staying asleep, mimicking some sleep-wake cycle disorders.

Treating Both Conditions Together Improves Rehabilitation

Whether a person abuses substances and develops sleep problems, or has sleep difficulty and self-medicates to manage it, both sleep-wake disorders and substance abuse feed into each other. Drugs and alcohol lower the quality and amount of sleep, changing when you fall asleep and wake up, and being unable to fall asleep or get up at a normal time makes self-medicating behaviors worse.

This makes recovery harder. You may feel like you need a stimulant to stay awake or a sedative to fall asleep.

People who have specific circadian rhythm disorders that are not temporary can get treatment from a sleep specialist. For most people, however, taking sedatives and stimulants is not an appropriate medical solution. Instead, managing circadian rhythms with UV light therapy, melatonin supplements, and a regular sleep schedule is the best approach to treatment.

Because sleep disorders are so closely associated with substance abuse, more detox and rehabilitation programs are screening for these conditions so they can be treated concurrently. Co-occurring disorders should be fully addressed in addiction treatment, including during detox, since insomnia and hypersomnia are both associated with withdrawal symptoms.

With comprehensive treatment, those who struggle with substance abuse and sleep-wake disorders can effectively achieve recovery. By addressing both conditions, the chances of relapse are reduced.

References

Sleep-Wake Disorders. (December 2016). Journal of the American Medical Association (JAMA).

What Are Sleep Disorders? (July 2017). American Psychiatric Association (APA).

Jet Lag Disorder. (September 2018). Mayo Clinic.

Shift Work Disorder Symptoms. National Sleep Foundation.

Delayed Sleep-Wake Phase – Overview & Facts. American Academy of Sleep Medicine (AASM).

Advanced Sleep-Wake Phase – Overview & Facts. American Academy of Sleep Medicine (AASM).

Non-24-Hour Sleep-Wake Rhythm – Overview & Risk Factors. American Academy of Sleep Medicine (AASM).

Irregular Sleep-Wake Rhythm – Overview & Symptoms. American Academy of Sleep Medicine (AASM).

Sleep Abnormalities Associated with Alcohol, Cannabis, Cocaine, and Opiate Use: A Comprehensive Review. (April 2016). Addiction Science & Clinical Practice.

Insomnia and Alcohol and Substance Abuse. Office of Alcoholism and Substance Abuse Services, New York State.

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