What Is Substance/Medication-Induced Sleep Disorder?

When Alcohol, Drugs, or Medications Interfere with Sleep

Insomnia
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Substance or medication-induced sleep disorder is the official diagnostic name for insomnia and other sleep problems which are caused by use of alcohol, drugs, or taking certain medications. Roughly translated, that means that one of the effects of drinking alcohol, using a drug, or taking a medication, is having a problem with getting to sleep at the time you want to sleep, staying asleep at the time you want to sleep, excessive sleepiness during the day, or unusual behaviors when you do sleep.

Substance or medication-induced sleep disorder is different from the occasional difficulty with getting to sleep or staying asleep that is actually quite normal. It is also different from the temporary insomnia or exhaustion that often affects people straight after alcohol or drug use, which is a normal response to the substance, or the activities of people who use alcohol or drugs, such as staying up later than your usual bedtime or participating in tiring activities during the time that alcohol or drugs are used (such as dancing). In contrast to these normal responses to alcohol or drugs, substance/medication-induced sleep disorder interferes with sleep more significantly, and the negative effects last for much longer.

Which Drugs Cause Substance/Medication-Induced Sleep Disorder?

A wide variety of psychoactive substances can cause substance induced sleep disorder, including:

  • Cannabis
  • Opioids
  • Sedatives
  • Hypnotics
  • Anxiolytics
  • Amphetamines
  • Cocaine
  • Tobacco
  • Other substances or stimulants

Medications known to cause substance/medication induced sleep disorders include:

  • Adrenergic agonist or antagonists
  • Dopamine agonist or antagonists
  • Cholinergic agonist or antagonists
  • Serotonergic agonist or antagonists

The Chronic Cycle of Substance Use and Sleep Problems

Many people find that alcohol and some other drugs have a relaxing effect, and, at least in the beginning, that a drink, joint, or dose of a tranquilizer or opiate can help them sleep. Others find caffeine or other stimulant drugs can help them stay awake for long periods, when they need to stay alert but would otherwise be sleepy.

For some people who regularly drink alcohol or take recreational drugs or medications, a chronic cycle can develop, of drinking or taking a drug or medication to attempt to relax and unwind, or to get to sleep or stay asleep, or the opposite, to stay awake during long shifts or all-night parties. The drug interferes with the body’s natural processes of activation and relaxation, making it harder to fall asleep. The person is then more likely to use a substance again, to help with sleep, possibly needing more of the drug to take effect as tolerance develops.

However, this doesn’t work for long. While alcohol and other relaxing drugs may help you get to sleep initially, the sleep is not restorative or restful, and you may be surprised to also experience wakefulness during the night.

This is typically followed by periods of sleeplessness, fatigue, exhaustion, and uncontrollable feelings of tiredness and sleepiness during waking hours. Frustrated, many people who experience these issues often turn to caffeine and other stimulants to combat daytime fatigue, which in turn makes it harder to fall asleep at bedtime.

Types of Substance/Medication-Induced Sleep Disorder

There are four main types of substance-induced sleep disorder:

  • Insomnia type: With the insomnia type of sleep disorder, you may have difficulty falling sleep or staying asleep, wake up a lot during the night, or not feel rested from sleep.
  • Daytime sleepiness type: With the daytime sleepiness type of sleep disorder, the person feels excessively sleepy or tired during the daytime, or, less often, sleeps for a very long time, perhaps longer than they wanted or intended to.
  • Parasomnia type: With the parasomnia type of sleep disorder, you can experience abnormal behaviors during sleep, a time when most of us remain fairly still and quiet while asleep in bed (except for possible snoring).
  • Mixed type: With the mixed type of sleep disorder, the person affected has several different sleep symptoms, but no particular symptom predominates. They may have periods of insomnia at night, coupled with sleepiness during the day, for example.

How Soon After Taking the Drug Can a Sleep Disorder Be Induced?

In some cases, a sleep disorder can be induced almost immediately after taking a drug or medication. According to diagnostic guidelines for physicians and other healthcare professionals who assess sleep disorders, there is even a category "with onset during intoxication," which means that the sleep disturbance actually begins when the individual was under the influence of alcohol, a recreational drug, or medication.

It can also occur during withdrawal. Sleep problems are a very common withdrawal symptom, and, like other withdrawal symptoms, will often resolve themselves within days or weeks of discontinuing alcohol, drugs, or medications. So time is needed to determine whether sleep problems are simply a symptom of withdrawal, which becomes clear if the person's sleep improves within a few days or weeks of ceasing to take the drug.

In contrast, with substance-induced sleep disorder, problems with sleep can start during withdrawal, and continue or get worse as the person moves through the detox process, and into the post-withdrawal phase of recovery. Sometimes, sleep problems are part of a larger cluster of longer term withdrawal symptoms, known as post-acute withdrawal syndrome (PAWS).

What If You Had Sleep Problems Before Using Alcohol, Drugs, or Medications?

When physicians or other healthcare professional give a diagnosis of substance/medication-induced sleep disorder, they check to make sure that the sleep problem wasn't there before the use of alcohol, drugs, or medications thought to be responsible. This is because there are different types of sleep problems, and if the symptoms were there before the substance use, it isn't the substance or medication-induced type of sleep disorder.

Generally, the diagnosis of substance/medication-induced sleep disorder isn't given to people who have a history of sleep problems without substance use, or if the symptoms continue for more than a month after the person becomes abstinent from the alcohol, drugs or medication. This does not mean that their sleep problems are not real or serious; it simply means that they are not considered to have been caused by substance use. As noted earlier, there are many different causes of sleep disorders, and most can be improved by lifestyle changes in addition to reducing or eliminated alcohol, drugs, or medications with side effects that interfere with normal sleep patterns.

Distress or Impact on Life

Finally, for the diagnosis of substance/medication-induced sleep disorder to be given, there has to be some sort of significant impact that the sleep problem is having on the person's life, either by causing a great deal of distress, or by impairing some aspect of their life. This can include anything from their social life to their employment situation, or another part of their life that is important to them.

Becoming Aware of Your Sleep Problem

It can take months or even years to become aware of a substance- or medication-induced sleep disorder. As drugs tend to affect feelings of alertness and relaxation, people expect their sleep to be affected to some extent, and anticipate a rebound effect afterwards. Then, it can seem like just a series of bad nights, rather than a disorder that is not going away on its own.

The irony of substance-induced sleep disorder is that many people affected by it drink, take drugs, or use medications to try and get to sleep, yet those same drugs actually interfere with getting a good night's sleep afterwards. For this reason, people often don't realize that it is alcohol, drugs or medications that are causing the sleep problems, because they associate those substances with inducing sleep.

Sleep problems can have many different causes, ranging from stress to the normal effects of aging. Therefore, physicians might not realize the true nature of the problem, because many people are not open with their physician about alcohol or drug use, due to stigma and fear of being judged. They may also lie about how much of a prescription medication or over the counter medication they are using, for fear of being cut off from their supply of medication. People who do admit to alcohol and drug use will also often underestimate or under-report the amount of alcohol or drugs they are using. All of these factors make it quite common for people to not get the right diagnosis of substance/medication-induced sleep disorder.

A Word From Verywell

Once you become aware of your sleep problem and what is causing it, it is important to get professional help to manage the transition back to healthy sleep patterns. Talk to your doctor about being referred to an addiction medicine or sleep specialist. If you are using alcohol, opioids, meth, or benzodiazepines, it is important to get proper medical support during the withdrawal process. Not only will this make it more comfortable, with fewer symptoms, but these substances can lead to severe withdrawal symptoms like seizures or psychosis that can be life-threatening without medical supervision.

Once you have discontinued the drug that caused your sleep problems, your sleep patterns will take time to return to normal. Be patient. The best ways to support this process are:

  • Setting and sticking to regular sleep and waking up times
  • Engaging in regular exercise during the day
  • Getting outside in the morning, which helps to re-set your "body clock"
  • Avoiding stress
  • Good nutrition, without going to bed overly hungry or full

Source

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, fifth edition, DSM-5. American Psychiatric Association, 2013.

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