Alcohol and Insomnia as a Co-occurring Disorder
Alcohol and Insomnia Problems
Drug or alcohol abuse, as well as sleep disorders such as insomnia, are commonly related. Alcohol abuse and other drug addiction, especially cocaine and crystal meth, may cause insomnia disorder in most people. Attempts to treat insomnia with addictive sleep aids such as Ambien or sedating substances such as alcohol or benzodiazepines have contributed to sleeping disorders among the elderly.
The average adult sleeps 7.5 to 8 hours every night. Although the function of sleep is still not entirely understood, much evidence shows that lack of sleep can have profound effects, including impaired breathing, increased risk of depressive disorders, and heart disease. In addition, extreme daytime sleepiness resulting from sleep disruption is linked with memory deficits, impaired occupational and social function, and car accidents.
Considering that alcohol is a depressant, it may seem surprising that alcohol is known to interfere with fundamental aspects of sleep quality. Alcohol consumption can induce sleep disorders by disrupting the duration and sequence of sleep states and altering total sleep time and the time required to fall asleep (i.e., sleep latency). This article explores the health effects, which include the effects of alcohol consumption on sleep patterns, the possible health effects of alcohol consumption combined with disturbed sleep, and the risk for relapse in those with alcoholism who fail to recover standard sleep patterns.
Between 35 and 70% of individuals who use alcohol have insomnia. One reason for poor sleep after drinking alcohol is that the production of adenosine (a chemical in the brain that acts as a sleep-inducer) increases while drinking, allowing you to go to sleep quickly. However, this chemical quickly subsides, making you more likely to wake up throughout the night. Drinking alcohol before bed is also connected with more slow-wave sleep patterns called delta activity. However, alpha activity, which indicates wakefulness with eyes closed and often precedes sleep, is turned on simultaneously. Experiencing these two brain wave activities is thought to inhibit quality rest. Also, alcohol inhibits REM sleep, which is often considered the most mentally restorative sleep phase.
Causes of Insomnia
Insomnia is a common sleep disorder that can make it hard to fall asleep, hard to stay asleep, or cause you to wake up too early and not be able to get back to sleep. As a result, you may still feel tired when you wake up. Insomnia can drain your energy level, mood, health, work performance, and quality of life.
Many adults experience short-term (acute) insomnia, which lasts for days or weeks. It’s usually the result of stress or a traumatic event. But some people have long-term (chronic) insomnia that lasts for a month or more. Insomnia may be the primary problem, or it may be associated with other medical conditions or medications.
Chronic insomnia is usually a result of stress, life events, or habits that disrupt sleep. Treating the underlying cause can resolve insomnia, but sometimes it can last for years.
Common causes of chronic insomnia include:
- Concerns about work, school, health, finances, or family can keep your mind active at night, making it difficult to sleep. In addition, stressful life events or trauma — such as the death or illness of a loved one, divorce, or a job loss — also may lead to insomnia.
Travel or work schedule
- Your circadian rhythms act as an internal clock, guiding such things as your sleep-wake cycle, metabolism, and body temperature. Disrupting your body’s circadian rhythms can lead to insomnia. Causes include jet lag from traveling across multiple time zones, working a late or early shift, or frequently changing shifts.
Caffeine, nicotine, and alcohol
- Coffee, tea, cola, and other caffeinated drinks are stimulants. Drinking them late afternoon or evening can keep you from falling asleep at night. Nicotine in tobacco products is another stimulant that can interfere with sleep. Alcohol may help you fall asleep, but it prevents deeper stages of sleep and often causes awakening in the middle of the night.
Poor sleep habits
- Poor sleep habits include an irregular bedtime schedule, naps, stimulating activities before bed, an uncomfortable sleep environment, and using your bed for work, eating, or watching TV. In addition, computers, TVs, video games, smartphones, or other screens just before bed can interfere with your sleep cycle.
Overeating late in the evening
- Having a light snack before bedtime is OK, but overeating may cause you to feel physically uncomfortable while lying down. Many people also experience heartburn, a backflow of acid and food from the stomach into the esophagus after eating, which may keep you awake.
Chronic insomnia may also be associated with medical conditions or the use of certain drugs. Treating the medical condition may help improve sleep, but insomnia may persist after the medical condition improves.
Mental health disorders
- Anxiety disorders, such as post-traumatic stress disorder, may disrupt your sleep. Awakening too early can be a sign of depression. Insomnia often occurs with other mental health disorders as well.
- Examples of conditions linked with insomnia include chronic pain, cancer, diabetes, heart disease, asthma, gastroesophageal reflux disease (GERD), overactive thyroid, Parkinson’s disease, and Alzheimer’s disease.
- Many prescription drugs can interfere with sleep, such as certain antidepressants and medications for asthma or blood pressure. In addition, many over-the-counter medications — such as some pain medications, allergy and cold medications, and weight-loss products — contain caffeine and other stimulants that can disrupt sleep.
- Sleep apnea causes you to stop breathing periodically throughout the night, interrupting your sleep. Restless legs syndrome causes unpleasant sensations in your legs and an almost irresistible desire to move them, which may prevent you from falling asleep. Alcohol and insomnia can increase the risks of sleep apnea.
How Alcohol Affects People With Insomnia
When people notice they’ve developed a sleep disorder, their first reaction is usually to have a drink. As a result, 20% of adults in the United States will use some form of alcohol to help them fall asleep. Alcohol may help many fall asleep occasionally. However, the consumption of alcohol, even a single serving, will make it more difficult for an individual to reach deep sleep. Also known as REM sleep. Without deep sleep, our body and mind are unable to do what’s necessary to prepare for the next day.
Clearly, alcohol and insomnia can feed off each other. Awareness and a smart approach to sleeping well can be the key to better sleep habits. The major issue is that people may not feel the negative effects of the use of alcohol and insomnia that follows at first. They can try it a few times and think their sleeping problems are cured. Eventually, however, they notice that they are tired when they wake up. The solution seems simple; they have another beer, another glass of wine, another shot. But, the more they take, the more they feel they need, and soon, they’ve built a dependency on alcohol in order to feel relaxed.
Alcohol and Sleep Deprivation
Drinking alcohol can worsen certain sleep disorders, notably insomnia and obstructive sleep apnea.
Alcohol and Insomnia
Insomnia may include the following symptoms: difficulty falling asleep, waking frequently during the night, difficulty falling asleep again after waking, waking too early, and daytime sleepiness. People with insomnia sometimes use alcohol to self-medicate. Studies have found that approximately 30% of people with ongoing insomnia have used alcohol within the past year as a sleep aid. Alcohol and insomnia problems are strongly linked; estimates of insomnia in people with alcohol dependency range from 36% to 67%.
Because alcohol consumption can result in frequent waking, changes to the sleep stages, and a reduction in the amount of REM sleep, it is likely that alcohol exacerbates insomnia and its use as a sleep aid is not recommended.
Obstructive Sleep Apnea
Obstructive sleep apnea is a sleep disorder characterized by frequent pauses in breathing during sleep. These pauses, or apneas, usually last 10 to 30 seconds and may occur several times during the night. Often, nighttime obstruction occurs when the soft tissue at the back of the throat collapses and closes the airway. Relaxed throat muscles, a narrow respiratory tract, a large tongue, or excess fatty tissue in the throat can also block the airway.
Alcohol disrupts breathing during sleep by relaxing the throat muscles. Alcohol can also reduce the brain’s ability to wake and detect a lack of oxygen in the body, and this can lead to longer and more frequent breathing pauses. As such, it is recommended that people with sleep apnea either avoid drinking alcohol altogether or at least cut back on their drinking.
Alcohol Is Not a Sleep Aid
Anyone who has drunk alcohol can tell you that it puts you in a relaxed mood, promoting sleepiness. While this works for initiating sleep, several studies have found that alcohol does not improve sleep quality.
There are several stages of sleep, the most important of which is the rapid eye movement (REM) stage. As the name suggests, your eyes are seen to rapidly dart back and forth under your eyelids during this stage, and sleep studies have concluded that the REM stage is where the body restores itself and recovers from the stressors of the prior day. This is also the stage of sleep where dreaming occurs.
The stages of sleep
There are several stages of sleep that occur once we close our eyes. We progress from stage 1 to REM, and then the sleep cycle begins again. The stages are as follows:
- Stage 1: Light sleep where we are awakened easily. Our eyes move slowly and muscle activity slows. Alpha waves are seen when observing brain activity.
- Stage 2: Our eye movements stop and our brain waves become slower with occasional rapid bursts. Heart rate slows down and body temperature begins to drop. This stage is meant to prepare us for deep sleep. Rhythmic brain-wave activities known as theta waves and sleep spindles are seen.
- Stages 3 and 4: Known as slow-wave sleep. Blood pressure falls, breathing slows, and the body becomes immobile. It is most difficult to be awakened during this part of the sleep cycle; most people feel groggy and disoriented when they wake up during these stages. Delta waves are seen when observing brain activity.
- REM stage: This stage dominates the later portions of sleep and increases in duration as the night progresses. The brain is seen to be most active during this time, behaving very similarly to when we are awake. Low amplitude mixed-frequency brain waves consisting of theta, alpha, and beta waves are seen.
Consuming alcohol robs us of REM sleep. While it may help induce sleep at first, later during the night it is disruptive. Decreased time spent in REM can impact concentration, motor skills, and even memory. Alcohol also results in more frequent awakenings throughout the night and increases alpha wave sleep, which makes us feel less refreshed in the morning and causes poor daytime functioning.
Alcohol and Insomnia as a Co-occurring Disorder
The majority of common mental illnesses, including depression, anxiety, and PTSD, are related to insomnia disorder, and alcohol and drug abuse disorders are not left out. However, the correlation may be complicated and bidirectional: alcohol and drug use can lead to insomnia, but sleep problems can also increase the risk of substance abuse and addiction. This relationship between alcohol and insomnia is sometimes diagnosed as a co-occurring disorder or a dual diagnosis.
Addiction experts are paying more attention to subjects surrounding sleep and considering ways to deal with sleep disruption in opioid use in turn insomnia disorder prevention and treatment as they understand the significance of this once-overlooked aspect. Most types of substance abuse severely disrupt the brain’s sleep-regulating systems, affecting latency, sleep duration, and quality of sleep.
During withdrawal, drug users often experience insomnia, whereby drug cravings are fueled, and relapse is possible. Furthermore, the importance of sleep in consolidating new memories cannot be overstated, poor sleep quality may make it more difficult to learn new coping and self-control skills that are needed for recovery.
Treatment for Alcohol and Insomnia Problems
Alcohol is the most abused addictive substance in America, as more than 17 million people in the United States are considered to suffer from addiction to alcohol. The Substance Abuse and Mental Health Service Administration (SAMHSA), publishes that over 1.5 million American adults were considered to be currently abusing a prescription drug.
Mixing prescription insomnia medication such as Ambien and alcohol magnifies the side effects of both and may promote more use of both. A wide variety of options are available to help the person stop taking Ambien and alcohol and avoid serious side effects from polysubstance abuse. Many Ambien users respond well to residential rehab programs.
If you are struggling with alcohol and insomnia, it’s crucial to first get an accurate assessment of all the symptoms. When the symptoms have been evaluated by a mental health professional, it may be determined that another form of mental condition is present and needs a particular type of treatment. Very often, some combination of psychotherapy, medication, and/or lifestyle changes are effective for coping with functional.
Detox is often considered the first stage of treatment. It will help you navigate the complicated process of alcohol withdrawal, but it doesn’t address patterns of thought and behavior that contribute to drug use. Various treatment approaches and settings can help provide the ongoing support necessary to maintain long-term sobriety after you complete detox.
Cravings are very common during detox and can be challenging to overcome. This often leads to relapse. Constant medical care provided during inpatient treatment helps prevent relapse. Clinicians can provide necessary medication and medical expertise to lessen cravings and the effects of withdrawals.
Several different modalities of psychotherapy have been used in the treatment of mental health disorders along with addiction, including:
- Cognitive Behavioral Therapy (CBT) – is an effective treatment that involves making changes in both the patterns of negative thoughts and the behavioral routines which are affecting the daily life of the depressed person for various forms of depression.
- Dialectical Behavioral Therapy – is a comprehensive mental health and substance abuse treatment program whose ultimate goal is to aid patients in their efforts to build a life worth living. The main goal of DBT is to help a person develop what is referred to as a “clear mind.”
- Person-Centered Therapy – is a strategy that allows and encourages clients to understand and resolve their concerns in a safe, supportive environment.
- Solution Focused Therapy – is an approach interested in solutions that can be quickly implemented with a simple first step leading to further positive consequences.
Dual Diagnosis Treatment
Drug abuse and mental health disorders often co-occur. In many cases, traumatic experiences can result in a mental health disorder and substance abuse. Dual diagnosis rehabilitation treats both of these issues together. The best approach for the treatment of dual diagnosis is an integrated system. In this strategy, both the substance abuse problem and the mental disorder are treated simultaneously. Regardless of which diagnosis (mental health or substance abuse problem) came first, long-term recovery will depend largely on the treatment for both disorders done by the same team or provider.
Medication-Assisted Treatments (MAT) for substance use disorders and mental health disorders are commonly used in conjunction with one another. This includes the use of medications and other medical procedures. During your rehab, the staff from your treatment facility will help you identify what caused your addiction and teach you skills that will help you change your behavior patterns and challenge the negative thoughts that led to your addiction. Sometimes, the pressures and problems in your life lead you to rely on substances to help you forget about them momentarily.
If you or a loved one are struggling with long-term drug abuse and a co-occurring mental health condition such as depression, contact one of our helpful treatment specialists today. We Level Up can provide information on dual diagnosis and detox programs that may fit your specific needs.