Sleep Problems in Recovering Alcoholics

Sleep Disruption in Alcohol Withdrawal and Through Recovery

Sad Woman
Alcohol Affects Sleep Paterns. © PhotoXpress.com

Many people with alcohol use disorders also have sleep problems. They may fall to sleep easily, but excessive alcohol use disrupts their sleep during the latter part of the night.

If you drink to excess, even occasionally, you have probably experienced sleep problems. What you may not know is if you quit drinking and remain sober you can have significant sleep problems long after you stop drinking.

Most heavy drinkers who quit drinking find it difficult to sleep during the early days of sobriety; it is one of the most common alcohol withdrawal symptoms and one that causes many to relapse.

Typical Recovery Sleep Problems

Research shows that sleep disruption can last long after alcohol withdrawal symptoms cease. Studies have found that:

  • Sleep problems can last for many months after quitting drinking.
  • Recovering alcoholics typically have more problems with sleep onset than with sleep maintenance.
  • Many recovering alcoholics had sleep problems that predate their alcohol dependence.

Poor Sleep Quality, Less Deep Sleep

"Three or more drinks will cause the average person to fall asleep sooner than usual," said Shawn R. Currie, of the University of Calgary. "However, falling asleep faster is the only real benefit of alcohol for sleep. The more prevalent, disruptive effects include more frequent awakenings, worse sleep quality; reduction of deep sleep, and earlier-than-usual waking times, leading people to feel they did not get enough sleep."

He notes that when an alcoholic is actively drinking, they have these types of sleep disruptions. But they may also continue to occur in the two to six months of abstinence following withdrawal. He notes that recovery and abstinence are more challenging if you aren't able to get enough good-quality sleep.

Sleep Not Restorative

People in alcohol recovery take a long time to fall asleep, have problems sleeping through the night, and feel that their sleep is not restorative. Lab studies show reductions in deep sleep and abnormalities in REM sleep in persons with more than a year of sobriety.

"Sleep has a reputation among the recovering community of being one of the last things that fall back into place for an individual," said David Hodgins, professor of psychology at the University of Calgary. "It's also recognized as a potential precipitant of relapse. In the 12-step community, there's a little saying that describes the risk factors for relapse; it's called HALT. People who are Hungry, Angry, Lonely or Tired are at an increased risk of relapse. Certainly, one way a person can be tired is through sleep disruptions."

Sleep Problems Can Last for Months

Researchers found that alcoholics with both short- and long-term abstinence had similarly disturbed sleep after they quit drinking. In general, problems with sleep onset were worse than with sleep maintenance, according to Currie's studies. "Most insomniacs have a combination of problems getting to sleep and problems staying asleep," said Currie.

"Our results indicate that most recovering alcoholics have both types of insomnia but the onset problem is generally worse."

Sleep Problems Predated Alcoholism

Many people experiencing insomnia in recovery also had insomnia before they became dependent on alcohol. Currie notes that chronic insomnia affects 10 to 15 percent of the general adult population, but half of his study participants had insomnia before became alcohol dependent. "Although we cannot infer any causal connection between insomnia and alcoholism from this data, it is hard to ignore such a high rate of pre-existing sleep problems in the sample," he says.

Treatment for Insomnia

The first treatment for insomnia in recovery is sobriety, and many patients will see improvement. For specific treatment of insomnia, behavioral therapies are the preferred treatment rather than medications, as they have been shown to be effective and they won't interfere with sobriety. Health care providers have to weigh the risks and benefits of prescribing medications for insomnia for those in recovery, although some relapse prevention medications can help promote sleep.

Developing Good Sleep Habits

To prevent or help reduce insomnia, develop good sleep habits, such as keeping a regular rising time, avoiding napping, and refraining from stimulants like caffeine in the evening.

Sources:

Brower KJ. Assessment and treatment of insomnia in adult patients with alcohol use disorders. Alcohol. 2015;49(4):417-427. doi:10.1016/j.alcohol.2014.12.003. ​​

Geiger-Brown JM, Rogers VE, Liu W, Ludeman EM, Downton KD, Diaz-Abad M. Cognitive behavioral therapy in persons with comorbid insomnia: A meta-analysis. ​Sleep Medicine Reviews. 2015;23:54-67. doi:10.1016/j.smrv.2014.11.007. ​​​

 

Roehrs T, Roth T. Sleep and sleep disorders. In: Verster JC, Brady K, Galanter, Conrod P, editors. Drug Abuse and Addiction in Medical Illness. New York NY: Springer; 2012. pp. 375–385.

Continue Reading