Substance Abuse and Sleep Disorders

Read Time: 25 minutes

Written by: Takeesha Roland, MS Psych and MS Neurology

The concept of substance abuse describes the excessive use of drugs or alcohol that leads to significant clinical impairments and the loss of ability to function academically, professionally, and socially.[1]

Individuals who were otherwise healthy prior to abusing substances typically begin to experience a number of health issues, including sleep problems such as:[2]

  • Insomnia.
  • Sleep apnea.
  • Restless leg syndrome.

Some people may even continue to suffer from insomnia after they have overcome a period of substance abuse and have remained abstinent for an extended period.[3] To prevent these, and many other health consequences from arising, it can be important to avoid developing a substance abuse disorder in the first place, or to seek substance abuse treatment as early as possible.

Average Nightly Sleep Duration

 

Treatment for chronic sleep disorders is notoriously difficult. The treatment for these sleep disorders becomes even more challenging when it is discovered that substance abuse may be the precipitating factor leading to the sleep disturbances, especially when a doctor has to consider prescribing sleep medications.

Detection of substance abuse as a factor in sleep disorders should, above all, prompt treatment or referral for treatment for the drug or alcohol problem in question. Without some form of effective treatment, substance abuse may cause complications that can become life-threatening—dwarfing the importance of any troublesome sleep disturbances that a patient may present with.

Still, the fact that sleep patterns can be disrupted secondary to drug and alcohol use remains a concern. The purpose of this guide will be to explore the ways that various forms of substance abuse can negatively impact sleep patterns and eventually lead to sleep disorders.

Health Problems Arising from Sleep Deprivation

When sleep deprivation becomes persistent, it can lead to a number of serious health problems, including:

  • A loss of mental function: Sleep deprivation impairs:[4]
    • Alertness.
    • Attention.
    • Reasoning.
    • Problem solving.
    • Concentration.
  • Memory problems: Memories are consolidated during the night when an individual gets a good night’s rest. Sleep deprivation can interfere with this process.4
  • An increased risk of developing diabetes or cardiovascular disease, such as:[5]
    • Congestive heart failure.
    • Myocardial infarction (heart attack).
    • Arrhythmias (irregular heartbeat).
    • Hypertension (high blood pressure).
    • Stroke.
  • Depressive symptoms: Sleep disorders – insomnia in particular – commonly lead to the development of depression.[6] Conversely, insomnia also tends to be one of the first signs of depression.
  • Premature aging: Sleep disorders cause the body to release larger amounts of the stress hormone cortisol.5 Over time, excessive amounts of cortisol can break down collagen in the skin and reduce the skin’s elasticity and smoothness. A lack of sleep also hinders growth hormone release—a hormone that boosts tissue repair.

Sleep disorders can also lead to overeating, which may lead to:

  • Obesity.
  • Decreased insulin sensitivity.
  • Diabetes.

Sleep problems have been shown to cause additional endocrine hormone disruption, prompting a decrease in leptin along with the simultaneous increase in ghrelin. Leptin release typically leads to feelings of satiety, while ghrelin increases hunger and appetite. As a result, food intake, especially foods with high carbohydrate and fat contents, can dramatically increase secondary to sleep problems.5 This marked caloric increase, naturally, can lead to obesity.

Furthermore, sleep deprivation is associated with impaired carbohydrate metabolism and glucose intolerance, which increases the risk of developing diabetes.

Relationship Between Lack of Sleep & Body Mass Index

 

Untreated sleep disorders have also been shown to double the risk of death, especially in people who frequently get less than 5 hours of sleep a night.2

The Relationship Between Sleep Disorders and Substance Abuse

The incidence of sleep disorders is about 5-10 times higher for people who have substance abuse disorders in comparison to otherwise healthy adults.[7] The prevalence of sleep disorders in those with substance abuse issues is a concern, as serious sleep problems can disrupt substance abuse treatment and increase the likelihood of relapse.

Sleep problems are common amongst people with substance use disorders. In fact, an estimated 70% of people admitted into detoxification programs report sleep problems at admission.8 80% of people with sleep problems report that their sleep problems are related to substance use.8

The relationship between substance abuse and sleep disorders is bidirectional—meaning that sleep problems increase an individual’s risk for developing a substance use disorder and substance use leads to problems with sleep.[8]

Unfortunately, some people’s sleep problems – such as insomnia – can actually increase their risk for developing certain disorders, including substance abuse disorders. This is especially true if their sleep problems are not properly treated in a timely manner.5 Persistent insomnia has been associated with:6

  • Alcohol use.
  • Marijuana (cannabis) and other drug use.
  • Depression.
  • Suicidal ideation.
  • Suicide attempts.

Relationship between Sleep Disorders and Substance Abuse

There appears to be bidirectional interplay between substance abuse and sleep disorders. As mentioned, long-standing sleep disturbances can potentially elicit a substance abuse problem. On the other hand, substance abuse itself can directly lead to the onset of sleep disorders such as insomnia and sleep apnea.2

One of the main reasons that substance abuse causes the development of or exacerbates sleeping disorders is because substance use directly impacts various central nervous system processes. Even withdrawal symptoms are often associated with the onset of sleep disorders.2,3

Sleep Disorders Resulting from Substance Abuse

Many sleep disorders may arise from a background of substance abuse, the most commonly known being insomnia. Insomnia isn’t the only issue to arise, however. Below are a few other sleep disorders commonly seen in a substance abusing population.2

Parasomnias

Parasomnias are undesirable and unexpected experiences that occur around the time an individual tries to go to sleep,2 in particular:

  • Sleep terrors.
  • Sleepwalking.
  • Sleep eating.
  • Sleep sex.
  • Sleep paralysis.

Although a person may appear to an outside observer to be actively and purposefully engaging in these types of behaviors, an individual who suffers from parasomnias does not retain any memory of the experiences.

REM Behavior Disorder

Rapid eye movement (REM) sleep behavior can manifest in another form of sleep disorder, called REM Behavior Disorder (RBD), in which people act out their dreams. The experience is similar to that of the parasomnias.

This sleep disorder can be very dangerous to the individual who is suffering from it as well as any who are around them, as the resultant behaviors can include:

  • Kicking.
  • Falling out of bed.
  • Running.
  • Bumping into furniture.
  • Reaching.
  • Punching.

These types of behaviors can lead to injuries that may be as minor as a bruise or cut, or much more serious such as broken bones or a fractured skull.

 Sleep Paralysis

Sleep paralysis is a temporary paralysis that occurs when an individual is transitioning from a state of being asleep to waking up. It tends to occur during REM sleep and is therefore, believed to be the result of REM sleep disturbances, which can be associated with substance abuse.2

What typically happens is that as an individual begins to wake up and open their eyes, it is discovered that the body is paralyzed. The paralysis is often accompanied by auditory and visual hallucinations, breathlessness, terror, and even a sense of a menacing presence in the room.

Sleep paralysis can be very frightening, but it typically does not result in any physical harm to those who experience it. The cause of sleep paralysis is not always known, but in some cases it can be precipitated by another health issue, such as an underlying anxiety disorder. Additionally, the phenomenon may arise in conjunction with a second sleep disorder known as narcolepsy.

Narcolepsy

Narcolepsy is a neurological condition that develops due to an inability to properly regulate the alternating states of wakefulness and sleep.2 There are 4 common narcolepsy symptoms:

  • Sleep paralysis.
  • Excessive daytime sleepiness and fatigue.
  • Hypnagogic hallucinations (vivid hallucinations that begin during the onset of sleep).
  • Cataplexy (sudden loss of muscle tone)—a symptom that can be triggered by strong emotions.

Alcohol Abuse and Sleep Patterns

Alcohol abuse is associated with insomnia and sleep disturbances

 that can persist long after the last drinking episode, and even in those who have maintained sobriety for a long time.3 The bidirectionality that we alluded to earlier holds true here too, as some individuals will develop alcohol abuse issues in association with their insomnia while others will experience insomnia as a result of alcohol abuse.

General Effects Of Alcohol Use on Sleep

For instance, some people who struggle with insomnia begin to use alcohol as a sleep aid.6 As their body begins to adapt to consuming small amounts of alcohol, larger amounts may become necessary to help them sleep. If this type of pattern continues, a substance abuse disorder may develop in which an individual begins to feel as if they can no longer fall asleep without the assistance of alcohol.

Similarly, alcohol abuse can lead to insomnia because ethanol’s direct influence on the brain can suppress REM sleep and increase slow wave sleep. Also troublesome is the fact that during periods of acute alcohol withdrawal, the time it takes to fall asleep (sleep latency) increases, people wake up frequently, and total sleep time decreases as the body attempts to restore its normal REM pattern and slow wave sleep pattern.2

Over time, this form of sleep disturbance may result in profound insomnia. Unfortunately, this type of REM sleep disruption may persist for 1-3 years after sobriety has been achieved.3

Sleep Apnea

Alcohol abuse has also been shown to cause sleep apnea or make this condition worse.2 Sleep apnea is a disorder in which the upper respiratory tract (e.g., pharynx) becomes narrow or completely closes when a person is asleep.[9]

An episode of apnea causes a person to stop breathing; this intermittently awakens the individual, who then has to resume breathing before returning to sleep. This can occur hundreds of times a night and necessitates the administration of positive airway pressure (via a BiPAP or CPAP device) in order to sleep properly.

Percent of People in Rehabs with Sleep Apnea

Uncontrolled sleep apnea causes shortened sleep times and resultant daytime sleepiness. Individuals who abuse alcohol have an increased risk of developing this disorder, especially those who snore.[10]

This is because consuming moderate to high amounts of alcohol in the evening can cause relaxation of both tongue and airway musculature, allowing the air passage to become narrow. This can lead to episodes of apnea in people who did not previously have the disorder and subsequently worsens episodes in persons who do.[11][12]

In patients who have severe sleep apnea, consuming 2 or more drinks per day are 5 times more likely to have a fatigue-related car accident in comparison with sleep apnea patients who consume little to no alcohol per day.[13]

Moreover, the combination of sleep apnea, snoring, and alcohol increases an individual’s risk of:[14]

  • Hypertension.
  • Irregular heartbeat.
  • Heart attack.
  • Stroke.
  • Sudden death.

Frequent apneic episodes result in reduced systemic blood flow as well as efficient oxygen transport throughout the body. This compromises oxygen delivery to vital organs such as the heart and brain.

Restless Leg Syndrome

Another serious problem that may occur due to alcohol abuse is the onset of a phenomenon known as restless leg syndrome—a neurological condition that causes sensorimotor problems in the legs.2

An analogous condition can also occur in the upper body, with symptoms developing in the arms as well. Typical symptoms include unpleasant sensations such as:

  • Cramping.
  • Tingling.
  • Numbness.
  • Burning.
  • Tugging.
  • Aching.
  • Itchiness in the legs, feet, calves, or thighs.

The unpleasant sensations generally decrease upon movement of the limbs. However, this means that the person has to keep moving the limb to experience relief and this reduces the ability to maintain restful sleep.

Restless Leg Syndrome

The symptoms of restless leg syndrome usually occur at night when an individual is lying down, but the condition has been shown to additionally disrupt daily activities while at rest.[15]

Some restless leg sufferers also develop another form of sleep disorder called periodic limb movement disorder in which an individual’s limbs begin to move involuntarily during sleep.15 The movements are jerky, awaken the person who has the condition, and can occur as frequently as every 15 seconds in severe cases.

Nutritional Deficiencies

People who abuse alcohol often have poor diets, which can lead to vitamin and other nutritional deficiencies. Certain deficiencies (e.g., iron-deficiency anemia) can result in cumulative peripheral nerve damage leading to:[16]

  • Neuropathic pain.
  • Peripheral neuropathy.
  • Restless leg syndrome (if damage is in the nerves of the limbs).

By reducing the intake of alcohol or achieving sobriety, some individuals improve their nutritional status, which can dramatically decrease the symptoms of restless leg syndrome.[17]

 Type 2 Diabetes

As previously mentioned, sleep disorders can lead to overeating. Persistently overeating can raise an individual’s risk of developing diabetes. Alcohol abuse has also been associated with obesity as well as type 2 diabetes.[18]

Prevalence of Diabetes in the U.S.

The previously mentioned alteration in leptin and ghrelin hormone signaling can result in overeating. As a result, macronutrients such as fats and carbohydrates may be consumed faster than the body can efficiently process. This can overwhelm the body’s metabolic machinery, so to speak, and lead to high levels of circulating glucose (sugar) in the blood.

The liver, while preoccupied with its detoxification tasks of breaking down ingested alcohol, is unable to efficiently process the concomitant surge in circulating blood sugar. As a result, obesity in combination with uncontrolled sugar levels can eventually also predispose one to develop type 2 diabetes.18

To summarize, alcohol abuse can lead to sleep disorders, which can in turn alter normal eating patterns. Similarly, alcohol abuse can lead to dangerous fluctuations in weight that may eventually cause irreversible organ damage (e.g., liver) and disorders such as diabetes.

Once an individual has been diagnosed with diabetes, they must manage a troubling and chronic condition—often a burden that persists throughout the rest of their lives. Similarly, late stage liver disease that develops due to alcohol abuse is irreversible, although refraining from drinking alcohol can markedly slow the course of progression of the disease.

Clearly, the dangerous combination of alcohol and sleep disorders can lead to an unhealthy pattern of eating that, in turn, can elicit disastrous health problems if both are not effectively treated.

Smoking Effects on Sleep Patterns

Compared to the general population, the rates of cigarette smoking are much higher in alcohol and substance abusers.[19]

Rates of Cigarette Usage

Smokers who are fairly healthy have been shown to be 4 times more likely than non-smokers to report feeling daytime fatigue even after a night’s sleep.[20] Furthermore, smoking leads to less time spent in deep sleep and more time sleeping lightly.

It is proposed that the stimulating effects of nicotine cause people to experience nicotine withdrawal on a nightly basis, which may contribute to sleep disturbances that prompt individuals to get up to smoke.20 The nicotine withdrawal also appears to result in faster brain activity while an individual tries to sleep, resulting in a sleep pattern more consistent with that of a light sleeper than a deep sleeper.

Furthermore, the sleep pattern disturbance is mostly observed during the onset of sleep, which was also found to be feasible because blood nicotine levels of smokers tend to be the highest at night. Accordingly, nicotine stimulates the release of the following neurotransmitters associated with wakefulness:20

Moreover, it takes the body about 2 hours to break down half of the nicotine that is absorbed from smoking and minor withdrawal appears to have sufficient influence to disrupt sleep after this period of nicotine processing concludes. This process may explain why smokers tend to suffer from symptoms of insomnia such as trouble falling asleep and staying asleep.20

Smoking is also harmful in general because it:[21]

  • Reduces blood circulation throughout the entire body.
  • Increases the risk of heart disease.
  • Speeds up the progression of heart disease.

Overall, the combination of substance abuse and smoking exacerbates the symptoms of sleep disorders. Therefore, refraining from smoking altogether or quitting is essential toward restoring and maintaining good health.

Effects of Drugs on Sleep

One of the negative effects of substance abuse is the disruption of the circadian rhythm.4 The circadian rhythm is an internal clock in the body that determines when it is time to sleep and when it is time to wake up. When this rhythm is disturbed, sleep patterns become dramatically altered and sleep disorders such as insomnia can develop.

For instance, by introducing the body to depressants (e.g., alcohol and/or sedatives) regularly, the internal clock begins to change. Similarly, taking stimulants (e.g., cocaine and prescription amphetamines such as Adderall) to stay awake, for example, may also begin to disrupt the body’s ability to sleep at night by altering the internal clock. In addition, drug-seeking behavior tends to increase at night,7 making it even harder to sleep.

Drugs of Abuse

There are 3 broad classes of commonly consumed substances which may eventually lead to drug abuse. These include stimulants, depressants, and hallucinogens with the categories encompassing alcohol, misused prescription medication and illicit substances.

Stimulants

Stimulants are substances that ramp up processes in the body such as blood pressure and heart rate, but also have the ability to increase body temperature. Some examples of illicit stimulants include:

  • Methamphetamine (e.g., speed or crystal meth).
  • Ecstasy (MDMA).
  • Cocaine.

Stimulant abuse also occurs in the form of misused prescription medication. Some examples of potentially abusable prescription stimulants include:

  • Adderall
  • Ritalin
  • Vyvanse

Stimulant Use in the U.S.

Individuals who struggle with sleep disorders may take stimulants during the day to stay awake. Untreated sleep disorders can perpetuate the need for stimulant activity in order to function during waking hours, but such a pattern of taking this type of drug consistently can easily lead to drug abuse.2

As mentioned, now-abstinent, prior long-term alcohol abusers tend to suffer from chronic sleep problems such as increased wakefulness at night, decreased amounts of slow wave sleep, and daytime fatigue.2 As a result, some individuals begin taking stimulants just to get through the day. Over time, such a use of stimulants can lead to:[22]

  • Insomnia.
  • Anxiety.
  • Confusion.
  • Agitation.

Ecstasy (MDMA)

Ecstasy is a popular recreational drug of abuse and a neurotoxin to serotonergic neural activity in the brain.[23] More specifically, ecstasy users have been found to have reduced serotonin transporters.[24]

Ecstasy (MDMA) Use Among People Aged 12 or Older

Furthermore, disruption of serotonin regulation in the brain has been associated with sleep apnea. Recreational ecstasy users who have been abstinent for at least 2 years still display higher rates of sleep apnea and hypopnea (periods of abnormally low respiration rates or restricted breathing) than non-users.23

The association between past ecstasy use and the incidence of sleep apnea indicates that this drug augments brain serotonin dysfunction and potentially worsens symptoms of sleep apnea.

This particular drug is usually purchased on the street, meaning that the actual contents of the drug are unknown. In other words, it is hard to know whether the drug contains just ecstasy or additional harmful substances that may further contribute to its extremely damaging effects.

Individuals who take ecstasy often think that it is safer than other drugs such as crystal meth or speed,23 but it contains many of the same, or similar chemical components as other stimulants.

Some MDMA effects can be especially dangerous for people who are already suffering from sleep disorders, including:

  • Emotional problems such as anxiety, paranoia, or depression.
  • Memory and sleep problems.
  • The breakdown of muscle tissue (myolysis) which leads to the release of muscle enzymes into the bloodstream that may cause kidney damage or kidney failure.
  • A rapid decrease of sodium (salt) in the blood, which can disrupt a number of functions in throughout the brain and body.
  • An irregular, rapid, or slow heartbeat, which can be fatal.

Dizziness, nausea, and vomiting may also develop shortly after taking stimulants such as ecstasy which can further disrupt sleep patterns, especially if the stimulant is taken in the evening.

Stimulants, in general, cause various changes in the body, and the emotional as well as physical side effects that ecstasy causes can put individuals at an increased risk of suffering from fatal complications.

Cocaine

Cocaine is a highly addictive sympathetic nervous system stimulant

 with a wide variety of effects, including vasoconstriction. As blood vessels constrict, systemic blood pressure increases. This and other side effects of the sympathomimetic drugs – including cocaine – can increase the risk of heart attacks and strokes in otherwise healthy individuals, as well as in those who are already predisposed to health problems.

Cocaine Use Among People Aged 12 or Older

Cocaine use can also cause changes in the brain that may lead to:

  • Circadian rhythm problems.
  • Sleep disturbances.
  • Appetite suppression.

More precisely, cocaine abuse causes changes to a structure in the brain called the nucleus accumbens—an area that regulates reward and pleasure-motivated behavior.[25] The chemical influence on this brain center can cause individuals to prioritize drug-seeking above all other life-preserving activity.

The decreased ability to control drug-seeking behavior due to cocaine abuse eventually leads to increased vigilance or wakefulness, and cocaine abusers manifest suppressed REM sleep even when they are able to fall asleep.25

Sleep-related cognitive processes such as memory consolidation are also affected due to these sleep disturbances. The process of cocaine withdrawal further complicates the symptoms of sleep disorders.

Cocaine abusers reportedly lack awareness of their sleep problems and may be less likely to ask their doctor for treatment to improve their sleep. This can be risky, as studies show that poor sleeping can trigger relapse among those in recovery.[26]

Methamphetamine

Methamphetamine abuse can lead to significantly abnormal dopamine transport. Dopamine is a neurotransmitter involved with the regulation of pleasure, reward, and some forms of movement. Subsequently, methamphetamine abusers tend to have impaired motor and cognitive function.

Long-term methamphetamine users are also more susceptible to developing Parkinson’s disease, as this condition is associated with depleted dopamine.[27]

Methamphetamine use can also lead to:

  • A loss of appetite.
  • Memory loss.
  • Depression.

Meth Use in the U.S.

Some individuals who have sleep disorders take this drug to increase wakefulness while at work, but tolerance to this drug develops quickly.[28] The rapid tolerance means that an individual would have to keep increasing the dose in order to experience the same effect.

Long-term methamphetamine users may experience insomnia and have difficulty falling asleep. Given that the high from methamphetamine starts and fades away quickly, it is common for people to take repeated doses—cycling through a binge and crash period. During a binge, an individual may forget to eat or sleep for hours or even days. Because of extreme sleep deprivation, users may experience a number of psychotic symptoms, such as delusions and paranoia.[29]

Methamphetamine abuse is associated with decreased:28

  • Non-rapid eye movement sleep.
  • Sleep efficiency.
  • Total sleep time.

As a result, methamphetamine can disrupt sleep patterns—one more detrimental effect to add to the myriad of associated dependency and cognitive problems.

Depressants

Depressants refer to substances that slow down normal processes in the body and physical activity by altering the manner in which the brain sends and receives signals. Examples include:

  • Alcohol.
  • Marijuana (cannabis).
  • Benzodiazepines (BZD).
  • Opioids such as methadone, codeine, morphine and heroin.

Opioid Painkiller Use in the U.S.

In some cases, people who have sleep disorders use depressants (tranquilizers) as a sleep aid instead of alcohol. However, some individuals may combine the two in order to sleep; both forms of self-medicating can be very dangerous.2

Doctors are even reluctant to prescribe sleep aids such as benzodiazepines for individuals with sleep disorders who have a history of substance abuse for more than a few weeks, if ever, due to concerns about patients beginning to abuse such drugs.3 This is because although sleep medication is typically deemed both safe and effective for most patients suffering from sleep problems, they are prone to abuse in patients who have substance abuse disorders or a history of substance abuse.[30]

Benzodiazepines, in particular, when used in doses and for lengths of time beyond the short course that is prescribed can quickly lead to dependency, and the accompanying withdrawal syndrome is not only difficult to manage, but can be quite dangerous.

A less severe side effect of note in some individuals is the development of restless leg syndrome when they are withdrawing from benzodiazepines or opioids.17 In most cases, this condition resolves on its own after the withdrawal phase is over.

Alternatives to the habit forming sleep aids exist. The following have very low abuse potential, and may be indicated for use in cases of insomnia in those individuals with known substance use issues. Some examples include:30

  • Ramelteon.
  • Trazodone (an antidepressant).
  • Gabapentin (an anti-seizure drug).

Newer drugs that are less likely to cause substance abuse are being developed as well, and can help in the pharmaceutical treatment of sleep disorder in situations where the increased likelihood of benzodiazepine or non-benzodiazepine sedative (e.g. Ambien, Lunesta) abuse is a factor.

Marijuana

Marijuana, most frequently used as a recreational drug, is one of the most commonly used substances in an adolescent population.25 Most people who take marijuana would agree that it is, in general, less harmful than heroin or cocaine, but the effects that marijuana has on mental processes can lead to serious problems such as:

  • Increased hunger (typically referred to as having the munchies): This may result in overeating that, in turn, leads to obesity and high blood sugar levels (hyperglycemia).
  • Short-term memory problems, which may negatively alter behavior.
  • Impaired concentration, cognition, and hand-eye coordination.
  • Depressive symptoms and an altered state of mind.
  • Serious damage to different organs such as the kidneys and heart (if combined with alcohol).

Number of people with marijuana use disorder

Frequent marijuana use can also cause slow and irregular breathing, which can reduce blood oxygen levels to dangerously low amounts.25 This side effect can lead to the onset or exacerbation of sleep apnea symptoms. In other words, although some people take this drug for recreational purposes, long-term use can result in some serious health problems.

Marijuana Use Among 8th, 10th, and 12th Graders

Heroin

Heroin is a widely abused opiate street drug, with dangerous depressant effects. Similar to other depressants, it can alter breathing patterns resulting in irregular or even prolonged apneic intervals (interrupted breathing)25—a common side effect that can worsen sleep apnea.

People with a Heroin Use Disorder

Additional harmful effects include:

  • A brief sense of euphoria followed by a state of drowsiness and confusion.
  • Slowed breathing, which may lead to anoxic brain injury and death.
  • Liver, brain, and lung damage.
  • Blood vessel damage, bruising, and poor circulation.
  • Infection at site of injection, if used intravenously.

In general, people who struggle with opioid abuse often report having trouble falling asleep and staying asleep.25 This can be secondary to any number of effects, but most likely results from a decrease in delta brain wave activity and REM sleep patterns, as well as the significant breathing problems that regular opioid use can cause.

Hallucinogens

Hallucinogens, as the name sounds, are substances that may cause hallucinations by affecting the mind and the senses. If hallucinations occur, an individual may see objects that are distorted or not really there. This phenomena may elicit:

  • Paranoia.
  • Abnormal behavior.
  • Panic attacks.

Hallucinogen Use in the U.S.

PCP, LSD, ketamine, mescaline and magic mushrooms are all classified as hallucinogens. Ecstasy and large amounts of marijuana may also elicit effects similar to the hallucinogens.

Hallucinogens are also associated with insomnia as they cause wakefulness and restlessness.[31] This type of drug may also cause:

  • Increased blood pressure.
  • Tingling sensations.
  • Trembling.
  • Cold sweats.
  • Paranoia.

Symptoms such as these can further disrupt sleep patterns.

Ketamine

Ketamine Timeline

Ketamine is a dissociative drug, with some hallucinogenic properties, that is often used for medical purposes as a general anesthetic. It prevents sensory information such as pain signals from being sent and received by the brain.

The effects that ketamine can have on a person depends of different factors such as weight, height, and health status. For most people, it causes distorted hearing, vision, thinking, and emotional changes.

When taken in large amounts or on a regular basis, however, ketamine also causes:[32]

  • Confusion
  • Concentration problems.
  • Memory loss.
  • Hallucinations.
  • Delirium.
  • Amnesia.

Additional side effects that may occur after taking ketamine include:

  • Panic and anxiety attacks, paranoia, dangerous and abnormal behavior.
  • Increased heart rate, blood pressure, and breathing.
  • Sweating, drowsiness, nausea, and vomiting.

All of the side effects that have been described in regard to ketamine use, especially regular use, can lead to sleep problems or worsen the symptoms of sleep disorders.

Treatment for Substance Abuse

For individuals with substance abuse problems, who are also suffering from sleep disorders, prescribing the appropriate type of medication that will prevent continued substance abuse or a relapse can be quite difficult.

As a result, alternative forms of treatment may become necessary for such individuals. One such alternative is cognitive behavioral therapy (CBT), which has been shown to improve the ability to fall asleep as well as sleep time.[33]

Cognitive Behavioral Therapy (CBT)

CBT entails teaching individuals how to limit use of their bedroom environment for the purposes of sleep only. For some, this might seem in stark contrast to how many of us have grown accustomed to using our bedroom spaces—such as for viewing television or using the phone. Even lying in bed worrying about not being able to sleep is an activity that is discouraged, instead urging people to take such worries outside of the bedroom, and to return when sleep beckons.

[EMBED CBT VIDEO: https://recoverybrands.wistia.com/medias/d5gobfuuq7]

Patients undergoing this therapy are also advised against caffeine or nicotine use as well as evening exercise—any behaviors or activities that can diminish the chance of quick sleep before actually going to bed.

Cognitive behavioral therapy, in particular, is used to gain an impression of factors that contribute to patients’ anxiety regarding their sleep problems. Once they are uncovered, steps are taken to help them overcome their apprehensions in order to promote healthy sleep patterns.

However, this form of therapy also focuses techniques shown to positively influence behavior and emotions, such as:[34]

  • Enhancing emotion regulation.
  • Impulse control.
  • Assertiveness and distress tolerance.

Furthermore, CBT involves skills training sessions in which emotional expression and recognition, problem-solving, and relaxation techniques are fostered. In addition, there are sessions in which stressful scenarios are narrated and patients are provided with psycho-education that helps them work through the real-life scenarios.

Research has consistently shown that the multi-faceted components of CBT enable this approach to be especially effective at reducing stress and anxiety;34 factors that can influence the onset and progression of sleep disorders.

For individuals who have a substance abuse disorder or a history of substance abuse, limiting the use of potentially habit forming prescription sleep aids or avoiding them altogether is in their best interest. Fortunately, CBT provides an effective option for those who are suffering from sleep disorders.

Importance of Substance Abuse Recovery 

Substance abuse is among the leading preventable causes of death and emergency room visits even though a number of effective treatments have been established. This discrepancy appears to be due to people failing to seek treatment for at least 10 years after the first signs of substance abuse began.[35] As a result, undetected and untreated substance abuse currently remain major health concerns.

We’ve shown that sleep disturbances often arise due to substance abuse. Over time, sleep deprivation can lead to serious health problems such as:5

  • Reduced mental function.
  • Depression.
  • Premature aging.
  • Heart disease.
  • High blood pressure.
  • Stroke.
  • Obesity.
  • Diabetes.

The risk of suffering from health problems such as these should urge people who are struggling with substance abuse to seek professional treatment.

Substance abuse is a complex issue and it is made even more complicated alongside debilitating conditions such as sleep disorders. As described, the combination of both can lead to serious complications and death.

Avoiding drug use altogether or seeking treatment at the first sign of substance abuse is the best way to stay healthy. Management of sleep disorders and substance abuse can be aided by seeking the help of qualified professionals—anyone struggling with both is strongly urged to do so.

Inpatient vs Outpatient Treatment

References

[1]

 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. 4th ed. Washington DC: Author; 2000.

[2] Mahfoud Y, Talih F, Streem D, Budur K. Sleep disorders in substance abusers: how common are they? Psychiatry (Edgmont). 2009; 6(9):38-42.

[3] Brower KJ. Alcohol’s effects on sleep in alcoholicsAlcohol Res Health. 2001; 25(2):110-25.

[4] Brick J. Handbook of the medical consequences of alcohol and drug abuse. New York, NY: The Haworth Press; 2004.

[5] Copinschi G. Metabolic and endocrine effects of sleep deprivationEssent Psycho-pharmacol. 2005; 6(6):341-7.

[6] Roane BM, Taylor DJ. Adolescent insomnia as a risk factor for early adult depression and substance abuseSleep. 2008; 31(10):1351-6.

[7] Morse SA, MacMaster SA, Kodad V, Robledo K. The impact of a sleep hygiene intervention on residents of a private residential facility for individuals with co-occurring mental health and substance use disorders: results of a pilot studyJ Addict Nurs. 2014; 25(4):204-8 .

[8] Angarita, G. A., Emadi, N., Hodges, S., & Morgan, P. T. (2016). Sleep abnormalities associated with alcohol, cannabis, cocaine, and opiate use: a comprehensive review. Addiction science & clinical practice11(1), 9.

[9] Strollo, PJ, Rogers, RM. Obstructive sleep apneaN Engl J Med. 1996;  334(2):99-104 .

[10] Aldrich, MS, et al. Sleep-disordered breathing in alcoholics: Association with ageAlcohol Clin Exp Res. 1993; 17(6):1179-1183 .

[11] Mitler, MM, et al. Bedtime ethanol increases resistance of upper airways and produces sleep apneas in asymptomatic snorersAlcohol Clin Exp Res. 1988; 12(6):801-805 .

[12] Dawson, A., et al. Effect of bedtime ethanol on total inspiratory resistance and respiratory drive in normal nonsnoring menAlcohol Clin Exp Res. 1993;  17(2):256-262 .

[13] Aldrich, MS, Chervin, RD. Alcohol use, obstructive sleep apnea, and sleep-related motor vehicle accidents. Sleep Res. 1997; 26:308.

[14] Bassetti, C, Aldrich, MS. Alcohol consumption and sleep apnea in patients with TIA and ischemic stroke. Sleep Res. 1996; 25:400.

[15] Natarajan R. Review of periodic limb movement and restless leg syndrome. J Postgrad Med. 2010; 56(2):157-62 .

[16] Mehmood T, Auerbach M, Earley CJ, Allen RP. Response to intravenous iron in patients with iron deficiency anemia (IDA) and restless leg syndrome (Willis-Ekbom disease)Sleep Med. 2014; 15(12):1473-6 .

[17] Phillips B, Young T, Finn L, Asher K, Hening WA, Purvis C. Epidemiology of restless legs symptoms in adultsArch Intern Med. 2000; 160(14):2137-41 .

[18] Moreno-Indias I, Cardona F, Tinahones FJ, Queipo-Ortuño MI. Impact of the gut microbiota on the development of obesity and type 2 diabetes mellitus. Front Microbiol. 2014; 5:190 .

[19] Shankar A, Klein R, Klein BE. The association among smoking, heavy drinking, and chronic kidney diseaseAm J Epidemiol. 2006; 164(3):263-71 .

[20] Zhang L, Samet J, Caffo B, Bankman I, Punjabi NM. Power spectral analysis of EEG activity during sleep in cigarette smokersChest. 2008; 133(2):427-32 .

[21] Otsuka R, Watanabe H, Hirata K, Tokai K, Muro T, Yoshiyama M, Takeuchi K, Yoshikawa J. Acute effects of passive smoking on the coronary circulation in healthy young adults. JAMA. 2001; 286(4):436-41 .

[22] Orr K, Taylor D. Psychostimulants in the treatment of depression. A review of the evidenceCNS Drugs. 2007; 21:239-57 .

[23] McCann UD, Sgambati FP, Schwartz AR, Ricaurte GA. Sleep apnea in young abstinent recreational MDMA (“ecstasy”) consumersNeurology. 2009; 73(23):2011-7 .

[24] McCann UD, Szabo Z, Seckin E, Rosenblatt P, Mathews WB, Ravert HT, Dannals RF, Ricaurte GA. Quantitative PET studies of the serotonin transporter in MDMA users and controls using [11C]McN5652 and [11C]DASBNeuropsychopharmacology. 2005;  30(9):1741-50 .

[25] Schierenbeck T, Riemann D, Berger M, Hornyak M. Effect of illicit recreational drugs upon sleep: cocaine, ecstasy and marijuanaSleep Med Rev. 2008; 12(5):381-9 .

[26] National Institute on Drug Abuse. (2008). Chronic Cocaine Abusers Have Occult Insomnia in Early Abstinence.

 

[27] Guilarte TR. Is methamphetamine abuse a risk in parkinsonism? Neurotoxicology. 2001; 22:725-31 .

[28] Comer SD, Hart CL, Ward AS, et al. Effects of repeated oral methamphetamine administration in humans. Psychopharmacology (Berl). 2001;155:397-404 .

[29] Rawson, R. A., & Condon, T. P. (2007). Why do we need an Addiction supplement focused on methamphetamine?. Addiction102(s1), 1-4.

[30] Howland RH. Gabapentin for Substance Use Disorders: Is it Safe and Appropriate? J Psychosoc Nurs Ment Health Serv. 2014;  6:1-4 .

[31] Jalali F, Afshari R, Babaei A. Smoking crushed hyoscine/scopolamine tablets as drug abuse. Subst Use Misuse. 2014; 49(7):793-7 .

[32] Kapur S, Seeman P. NMDA receptor antagonists ketamine and PCP have direct effects on dopamine D2 and serotonin 5-HT2 receptors – Implications for models of schizophrenia. Molecular Psychiatry. 2002;7:837-844 .

[33] Geiger-Brown JM, Rogers VE, Liu W, Ludeman EM, Downton KD, Diaz-Abad M. Cognitive behavioral therapy in persons with comorbid insomnia: A meta-analysisSleep Med Rev. 2014; 23C:54-67 .

[34] Durham, R.C., Chambers, J.A., Power, K.G., Sharp, D.M., Macdonald, R.R., Major, K.A., Dow, M.G., Gumley, A.I. (2005). Long-term outcome of cognitive behaviour therapy clinical trials in central ScotlandHealth Technol Assess. 2005; 9(42):1-174 .

[35] Charlson FJ, Baxter AJ, Dua T, Degenhardt L, Whiteford HA, Vos T. Excess mortality from mental, neurological and substance use disorders in the Global Burden of Disease Study 2010Epidemiol Psychiatr Sci. 2014; 15:1-20 .

National Institute on Drug Abuse. (2017). The Concerning Link Between Inadequate Sleep and Adolescent Substance Use.

Centers for Disease Control and Prevention. (2016). Prevalence of Healthy Sleep Duration among Adults — United States, 2014.

Mahfoud, Y., Talih, F., Streem, D., & Budur, K. (2009). Sleep Disorders in Substance Abusers: How Common Are They? Psychiatry (Edgmont)6(9), 38–42.

Mahfoud, Y., Talih, F., Streem, D., & Budur, K. (2009). Sleep Disorders in Substance Abusers: How Common Are TheyPsychiatry (Edgmont)6(9), 38–42.

Centers for Disease Control and Prevention. (2017). Tobacco Use Among Adults with Mental Illness and Substance Use Disorders.

Substance Abuse and Mental Health Services Administration. (2016). Results from the 2015 National Survey on Drug Use and Health: Detailed Tables.

LINK TO: http://www.recovery.org/topics/cocaine-facts/

Substance Abuse and Mental Health Services Administration. (2016). Results from the 2015 National Survey on Drug Use and Health: Detailed Tables.

Substance Abuse and Mental Health Services Administration. (2016). Results from the 2015 National Survey on Drug Use and Health: Detailed Tables.

Substance Abuse and Mental Health Services Administration. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health.

Substance Abuse and Mental Health Services Administration. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health.

Substance Abuse and Mental Health Services Administration. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health.

Substance Abuse and Mental Health Services Administration. (2016). Results from the 2015 National Survey on Drug Use and Health: Detailed Tables.

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Last updated on November 6, 2018
2018-11-06T11:58:42+00:00