The Tricky Relationship Between Sleep and Recovery
Alcohol is a frenemy of sleep. At first glance a seeming ally, it ultimately undermines the good things that sleep has to offer.
When people with substance use disorders (SUDs) think back to the pre-recovery days, they often recall turning to alcohol for help with falling asleep. Even though having a drink before bedtime initially has a pleasantly mellowing effect, it can result in a lower-quality slumber. The insidious power of alcohol derives from the ease of falling asleep. For the first half of the night, things tend to work out: “The sleep alcohol induces is associated with intense slow-wave brain activity, which is considered to be the deepest, most restorative kind of sleep,” according to Timothy Roehrs, director of sleep disorders research at Henry Ford Hospital in Detroit.
Drifting off into sleep fast feels great. In fact, some people say that they became dependent on alcohol in the first place because they used it as a sleeping aid. But over the whole night and in the long run, alcohol disrupts normal sleep patterns. Since the body metabolizes alcohol fast, once it’s done doing it—often in the middle of the night—the brain finds itself in the phase of so-called shallow sleep. The shallow, or light, sleep is less refreshing and more wakeful than rapid eye movement (REM) state of sleep and the deeply restful slow wave sleep (SWS). Depending on how much alcohol one drinks before bedtime, arousals produced by alcohol can bring on sweats, headaches, and fitful dreaming. Depending on a person, three to a few drinks can do it.
How about sobriety and sleep, then? Are they on better terms than alcohol and sleep? Recently, scientists have been looking at the relationship between recovery and sleep. And it does appear that the reverse of alcohol having a negative effect on sleep is true: people in recovery seem to be helped by restful slumber. The rub is, they need to work at it extra hard.
The relationship between sleep and recover can be complicated, especially in the earlier stages of recovery.
Sleep disturbance is a feature of the withdrawal process and common in the early phase of recovery. In general, developing and stabilizing new patterns of sleep may take several weeks or months.
The use of over-the-counter and prescription sleep aids can work for a while, but it poses a number of problems in the mid- and longer term. The risks include increased tolerance and dependency.
According to a 2014 study published in the Journal of Addiction Medicine, people in recovery are at a five times higher risk for insomnia. Sleep troubles often indirectly lead to substance abuse, and they can take a long time to return to normal during sobriety—in some cases, they never do.
Higher levels of REM sleep (the state less restful than SWS) in patients admitted to one-month alcoholism treatment program predicted relapse within three months after discharge in 80 percent of patients.
Tiredness is one of the risk factors for relapse. Per acronym HALT: if you are Hungry, Angry, Lonely, or Tired, the temptation is greater to fall off the wagon. “Certainly, one way a person can be tired is through sleep disruptions,” says David Hodgings, professor of psychology at the University of Calgary.
How can people in recovery from drugs and alcohol overcome these obstacles and get to a place a deeper rest, which can help their overall health and strengthen their recovery?
Second, talk to your physician, who will most likely not prescribe any drugs that risk addiction.
Third, consider the power of mindfulness. Look for a therapist who practices mindfulness-based therapy and use mindfulness meditation to fall asleep—and to stay sober.
Agnes Green is a researcher for the sleep science hub Tuck.com. She holds two masters degrees in the social sciences from the University of Chicago and Northwestern University. She sleeps most soundly after a kettlebell workout in Portland, Oregon.