Chronic insomnia and other sleep problems may be a pathway by which problematic substance use develops in individuals predisposed to addiction.
Drugs of all kinds are abused by people with addictive tendencies—from NyQuil to benzodiazepines, to alcohol, to opiates. Those with insomnia and other sleep disturbances may use drugs and alcohol to self-medicate, but tolerance to the sedating effects of these substances develops quickly and, as a result, people suffering from insomnia (and now alcoholism) must consume larger quantities with greater frequency to achieve sleep. The danger in this is that the risk for dependence increases exponentially.
Alcohol-dependent individuals with difficulty falling asleep may have irregular circadian rhythms, as suggested by delayed onset of nocturnal melatonin secretion. They also may have low homeostatic sleep drive, another factor required to achieve slumber.
Nicotine-dependent individuals often experience difficulty falling asleep, sleep fragmentation, and less restful sleep compared with nonsmokers. Those who use marijuana have short-term difficulty falling asleep and decreased slow-wave sleep percentage during withdrawal. Funnily enough, medical marijuana is distributed as a sleep-aid among many of its users.
In people addicted to cocaine, there is a prolonged sleep latency, decreased sleep efficiency, and decreased REM sleep with intranasal self-administration, followed by hypersomnia during withdrawal.
With other stimulants, such as methamphetamines and methylphenidate, sleep complaints are similar to those reported with cocaine use. Typical of the side effects of opiate abuse, users experience decreased slow-wave sleep, increased stage-2 sleep with minimal impact on sleep continuity, vivid dreams and nightmares, and central sleep apnea.
There are a number of things we can do to address and hopefully overcome insomnia. Abstaining from using drugs or alcohol can greatly decrease insomnia; using the bedroom for nothing else but sleep will forge an association between our beds with falling asleep; aside from sexual activity, do not use the bed for anything but sleep—do not read in bed, watch TV in bed, eat in bed, or worry in bed; and avoid taking naps during the day so you are good and tired by the time bedtime rolls around.
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