Recovering from a substance use disorder isn’t simply a matter of abstaining from drugs and alcohol. While that’s certainly a crucial element of recovery, a strong, sustainable recovery entails a change in lifestyle. That includes therapy, finding social support, and making healthy lifestyle changes such as eating better, exercising regularly, and getting plenty of quality sleep. The latter is especially important. Getting enough sleep makes recovery easier, while getting too little can make it much harder. Here’s why sleep is so important for anyone recovering from a substance use disorder.
First and foremost, good sleep is necessary for maintaining mental health. Mental health should be a primary concern for anyone recovering from addiction because substance use issues and mental health issues are often closely related. More than half of people with substance use disorders also have co-occurring mental health issues. These typically include major depression, anxiety disorders, PTSD, ADHD, personality disorders, autism spectrum disorders, and schizophrenia, among others. Insomnia and disturbed sleep are typical symptoms of many mental health issues and lack of sleep only compounds the problem. Any comprehensive treatment plan will include treatment and management of mental health issues too.
There is quite a bit of research linking poor sleep and poor mental health. One study followed more than 1000 adults between the ages of 21 and 30 for three years. The researchers found that participants who reported insomnia at the beginning of the study were four times more likely to develop major depression by the end of the three years. Another study of more than 1000 teenagers found that sleep problems preceded depression in about 69 percent of cases.
Lack of sleep also has a major effect on anxiety. It probably won’t surprise you that lack of sleep is strongly associated with anxiety but you might wonder which came first. After all, most of us have had the experience of lying awake at night worrying about some problem. Indeed, anxiety definitely impairs sleep but at least one study found that causation goes the other way too.
Researchers at UC Berkeley conducted a number of brain-imaging studies on volunteers after a full night’s sleep and then again after a night of sleep deprivation. They showed participants emotionally powerful videos while monitoring brain activity and found that after a night of sleep deprivation, an area of the brain called the medial prefrontal cortex–a part of the brain important for emotional regulation–had pretty much turned off, while other parts of the brain involved with emotion were overstimulated. In other words, one night without sleep obliterates your ability to control your anxiety.
Using questionnaires, the researchers determined that the participants’ anxiety levels had increased by about 30 percent following a night of sleep deprivation. Two follow-up studies confirmed these effects and found that next-day anxiety could be predicted from lack of sleep.
Given that anxiety disorders and depressive disorders together make up the most common co-occurring mental health issues with substance use disorders and given the importance of emotional regulation during recovery in general, it’s clear that getting enough restful sleep each night should be a priority for maintaining mental health.
Addiction has negative effects on most areas of your life and your health is no exception. For example, excessive drinking has been linked to many serious health problems including high blood pressure, heart disease, stroke, liver disease, obesity, type 2 diabetes, and cancers of the mouth, throat, esophagus, breast, stomach, liver, and colon. Cocaine is also linked to increased risk of stroke, inflammation of the heart muscle, inability of the heart muscle to contract, and aortic ruptures. Long-term opioid use has been shown to increase your risk of heart attack and heart failure as well as disrupting your endocrine system, which is responsible for hormone regulation, and impairing your body’s ability to fight infections.
If you’re recovering from a substance use disorder, you likely have an increased risk for some of the health issues mentioned above. It’s better not to compound your risk by running a chronic sleep deficit. Poor sleep has been linked to many of the same health issues, including cardiovascular disease and high blood pressure, obesity, diabetes, and poor immune function. Sleep, especially deep sleep, is when your body performs many crucial maintenance functions, including fighting infections, repairing injuries, getting rid of damaged cells, and flushing waste products from cellular metabolism out of the brain. When you don’t get enough sleep, you impair your body’s ability to take care of itself.
Also, the mental and physical benefits of quality sleep are not clearly separated. Increased anxiety from sleep deprivation, as discussed above, increases your level of stress throughout the day, which increases your levels of stress hormones like cortisol and adrenaline. These are helpful in the short term, but chronically high levels lead to health problems like cardiovascular disease and poor immune function. Similarly, hormonal disruption from lack of sleep affects many physiological processes but also negatively affects your mood and behavior. Getting enough quality sleep can help minimize the health effects of excessive substance use.
Although people often don’t think of it this way, addiction recovery is one long learning process. You have to learn new ways of thinking, new ways of processing your emotions, new ways of coping with stress, new ways of relating to other people, and new habits for living. You have to make a lot of changes in a relatively short time in order for recovery to last.
As it happens, sleep is also crucial for learning. Learning is a complex process. Unfortunately, we can’t just download information and skills into our brains like Neo learning kung fu. The first step in learning anything new has to do with attention. We don’t just absorb information; learning is an active process. You have to be able to focus on new information, separate the important bits from the trivial, and link it to what you already know. If you’re sleep deprived, this first step in the learning process is much more difficult.
After you have been initially exposed to new information or skills, and perhaps studied or practiced a bit, your brain has to integrate this new knowledge. This mostly happens during sleep. Studies have found that different kinds of information are consolidated during different phases of sleep. REM sleep, when dreaming mostly occurs, is important for several different kinds of learning, including both facts and skills. REM sleep is particularly important for learning information that is complex and emotionally charged.
This may be one reason relapse dreams are so common during recovery. A study by Massachusetts General Hospital found that about a third of all people in recovery remember having at least one relapse dream. The study also found that relapse dreams were more common among people who had sought some sort of help for addiction and they were more common among people who had entered recovery more recently. The researchers found that relapse dreams don’t seem to indicate a greater risk of relapse but instead speculate that dreaming about drug or alcohol use may be a normal part of the learning process the brain goes through during recovery.
So far, we’ve seen how a chronic sleep deficit can harm your mental and physical health and impede your progress in recovery. A good question might be: How much sleep do we actually need to avoid these negative outcomes? A quick Google search will tell you that most reliable sources recommend you get between seven and nine hours of sleep every night, which is quite a spread. Common sense will tell you that we’re all different and we need different amounts of sleep to function. However, the picture may be more complicated than either of these answers suggest.
A number of studies have tested the cognitive effects of various degrees of sleep restriction. One study divided participants up into groups that were allowed to sleep for three, five, seven, or nine hours a night for a week. At the end of the week, each group was then allowed to sleep for eight hours a night for three nights to recover. Each day, participants were given tests to measure various aspects of their cognitive ability.
As you might expect, the participants who only slept three hours a night declined steadily on their test performance throughout the week. The participants who slept either five or seven hours declined up to a point, and then seemed to level off at a new normal. The group that slept nine hours a night showed no change. During the recovery period, the group that slept three hours a night improved quickly on their cognitive performance, but their scores leveled off before reaching their fully rested baseline. The five and seven-hour groups improved slightly but never got back to their initial level of performance. The nine-hour group, as you might expect, showed no change.
This study is notable for two reasons. First, the participants in this study experienced cognitive impairment while sleeping seven hours a night, which is the bottom limit of the general recommendation of seven to nine hours. That indicates that the people who can function normally on seven hours of sleep may be a small percentage of the population. Second, it suggests that if you run a sleep deficit all week, you probably won’t be able to make up for it by sleeping more on the weekends.
As noted, there is some variation in how much sleep we actually need. When trying to figure out how much you need, there are several things to consider. First, you can’t necessarily go by how you feel. Studies have found that people who are running a chronic sleep deficit can’t accurately judge how impaired they are. It’s like being a poor judge of how drunk you are. The part of your brain that judges is offline. Second, you typically need more sleep when you are under stress. For example, someone who has had a hard workout, spent several hours studying, or is recovering from an illness will need more sleep. Generally speaking, it’s probably better to consider eight hours as the minimum amount of sleep you need and sleep more if you need extra recovery time.
Let’s say you’re convinced that sleep is crucial for recovery and that you want to get at least eight hours a night–but you can’t. Insomnia and disturbed sleep are common problems during detox and during the early months of recovery. What do you do if you can’t seem to get much quality sleep?
If you’re having trouble sleeping or if you seem to be sleeping enough but you’re still chronically tired, the first thing to do is talk to your doctor. There are somewhere around 80 sleep disorders–sleep apnea being the most well known–that can disrupt your sleep or prevent you from getting enough restorative deep sleep. Before you go any further, you want to eliminate medical causes of poor sleep. Be sure your doctor knows about your addiction history. Many sleep medications are basically just benzodiazepines and you don’t want to be taking addictive drugs to solve your sleep problem.
If your doctor finds no medical reason why you aren’t sleeping well, talk to your therapist. There are two reasons for this. One is that sleep problems are often a symptom of other mental health issues, including major depression, anxiety disorders, bipolar disorder, ADHD, and PTSD. If you get the proper treatment for these conditions, your sleep should begin to improve quickly.
Second, there is a specific cognitive behavioral therapy protocol for insomnia called CBT-I. It includes a number of different approaches to better sleep such as relaxation training, sleep restriction, stimulus control, biofeedback, and others that can help you sleep better. One way your therapist can help you is by examining the thoughts you have when trying to sleep. For example, you may be thinking something like, “Oh, insomnia again; I’m going to be a zombie tomorrow and I have so much to do,” and so on. These kinds of thoughts only make it harder to sleep and thinking differently about sleep can take the pressure off.
This is one of the methods included in CBT-I, which is called stimulus control. Sleep isn’t just a matter of flipping a switch and becoming unconscious; there are a lot of physiological processes that have to happen to fall asleep and stay asleep. It’s much easier for your body to coordinate all these processes if you go to bed at the same time every night and wake up at the same time every morning–even on weekends.
It’s also important to create a strong association between your bed and sleep. Just as Pavlov’s dogs salivated when they heard the bell, you want to feel sleepy as soon as you lie down in bed. If you do other things in bed–watch TV, read, look at your phone, eat, and so on–your weaken that association. Only use your bed for sleeping and sex. It’s also a good idea to have a regular bedtime routine to signal that it’s almost time to sleep.
Creating a good sleep environment makes it easier to fall asleep and stay asleep all night. The two primary factors are darkness and silence. Noise and light can wake you up fully or partially during the night, disturbing your quality of sleep. If you can’t get your room dark and quiet, consider sleeping with an eye mask and earplugs. Having your bedroom slightly cool also helps you sleep better. Experts typically recommend between 68 and 72 degrees fahrenheit.
Caffeine isn’t necessarily bad for you, assuming you get in the form of coffee or tea, and moderate amounts might even have slight health benefits. However, too much caffeine can also interfere with sleep. Most people know that coffee makes them alert but it also binds to adenosine receptors in the brain without activating them. This doesn’t make you alert but it does keep you from going to sleep. Caffeine has a half life of between four and six hours. If you have a cup of coffee in the morning, you might be down to one-sixteenth of that by the time you go to bed. However, if you have a cup of coffee in the afternoon, there might be as much as a quarter of the caffeine left–four times as much–plus whatever is left over from earlier, which can make it much harder to sleep. If insomnia has been a problem for you, cutting down on caffeine might help.
Finally, exercise is an excellent way to improve the quality of your sleep. Research shows that exercise can improve your sleep starting the very same night. We aren’t sure why this happens, but it’s likely related to the stress and anxiety-reducing qualities of exercise. The only caveat is that you don’t want to exercise too close to bedtime. Exercise gets your heart rate and body temperature up, which might make it harder to sleep.
Getting plenty of restful sleep is one of the best things you can do for your health and your recovery from addiction. It’s a foundational habit that will make your other recovery goals easier to achieve. One big advantage of inpatient treatment is that the regular schedule of daily life makes it easier to get in the habit of keeping a regular sleep schedule and our staff can help you resolve any sleep problems. At Steps Recovery Centers, we understand that a strong recovery requires a healthy body and mind. To learn more about our treatment options, explore our website or call us today at 385-236-0931.