Sleep, Addiction, and Mental Health

February 13th, 2023

By P. Casey Arrillaga, LCSW, LCDC

It will come as no surprise that addiction and other mental
health disorders can have a pretty bad effect on sleep, but what about the
other way around? Do the pattern and quality of your sleep impact addiction and
mental health? In short, yes. In fact, sleep, addiction, and mental health all
influence each other in multiple ways, some of which are pretty straightforward
and others that are more complex.

To start, let’s look at the importance of sleep. In his book
“Why We Sleep”, sleep researcher Matthew Walker, PhD lays out a case for how
vital the time we spend sleeping is for our mental health, memory, and overall
wellbeing. He notes that the idea of “making up for lost sleep” is a myth, that
we ask adolescents to be awake and in school at all the wrong times, and that
most people in our society are not taking sleep as seriously as they should,
often treating it as a nuisance rather than a life-giving and mind-refreshing
time.

If this applies for the average person, how much worse is it
for someone who is suffering from addiction or any other mental health
condition? As is turns out, it’s much worse. Studies show that even low doses
of alcohol have a strong negative effect on sleep quality. For instance, the
people drinking even light amounts of alcohol spend less time in REM sleep,
which turns out to be vital for memory, and sleep more lightly, meaning their
sleep is more likely to be interrupted by any disturbance in their environment.
It’s not only their sleep that suffers, however. The same research shows that
such people are then significantly sleepier during the next day, which can be
life-threatening if they are in a safety-sensitive job or even just get behind
the wheel of a car. Unsurprisingly, all these effects are made worse when
people drink heavily, which is to be expected for anyone with an addiction, and
all too often the case for those who suffer from any other mental health
condition.

Other drugs of abuse don’t fare much better. While low doses
of THC may be used to help with sleep apnea, most addicted people use in much
higher doses, which have been shown to disrupt sleep patterns in unhealthy
ways. Opiates similarly disrupt healthy sleep and tend to leave people feeling
like they haven’t gotten enough rest. As you might imagine, stimulants such as
cocaine and especially methamphetamine are well-known for destroying sleep
patterns, with methamphetamine users often staying up for days without any
sleep at all, something known to create or exacerbate any number of mental
health issues.

To make things worse, researchers have found the drug use
and sleep issues feed one another. For instance, opiate users suffer from
insomnia as a result of the routine withdrawal effects of the drug, and then
are more likely to relapse because they are tired. This puts them into a cycle
of using the drug, going into withdrawal, not getting enough sleep as a result,
and then being more likely to use again because the lack of sleep lowers their
mental defenses that might otherwise help them make a decision to resist
relapse. Users of other drugs may find themselves in a similar bind.

While people with mental health issues are more likely to
abuse alcohol and other drugs, even without such use, they are vulnerable to
having sleep issues that put them into a similar downward spiral.  Depression and anxiety are both strongly
associated with sleep issues. As with example of opiate use detailed above, feeling
anxious tends to lead to insomnia, and then the lack of sleep makes the person
more vulnerable to anxiety. Depression can lead to similar results even though
it is sometimes associated with getting too much sleep. As anyone with
depression might already know, even getting a lot of sleep does not usually
lead to them feeling refreshed. People with more acute mental health issues
like schizophrenia or PTSD typically suffer from sleep issues of all kinds. For
people with schizophrenia, these sleep issues often show up before any of the
other typical symptoms. For this reason, the sleep disturbances don’t seem to
be solely the result of the potent medications used to treat schizophrenia,
although these certainly don’t help.

Given all of this, what can be done? For anyone abusing
alcohol and other drugs, whether they have other mental health issues or not,
stopping the drug use is the first priority. Without this, not much else is
going to happen. Depending on the severity of use and what types of drugs are
involved, medically supervised detox and residential treatment may be required.
During the first stage of this process, the sleep issues will probably get
worse before they get better, but then sleep typically improves. While the
worsening sleep may tempt the person to return to drug use, it is supremely
important to avoid this, which is why a medically-supervised setting is usually
the best way to go.

Once this is done, or if it is not an issue at all, then
positive steps to improve sleep are the next priority. Seeking help with
addiction recovery and/or mental health can also be much better than trying to
go it alone. Support groups such as Alcoholics Anonymous, SMART Recovery, and
the National Alliance on Mental Illness [NAMI] all offer meetings to help
alleviate addiction and other mental health issues. Individual and group
psychotherapy have been shown to help significantly with sleep issues. Studies
show that even for people with severe mental health issues, exercise is of
significant benefit for improving sleep, as is keeping a regular sleep
schedule. While there is some disagreement about whether sleep medications are
a good idea, many people turn to them to help overcome the insomnia that so
typically accompanies quitting alcohol and other drug use.

Exploring these options and finding the right combination
for you can get you off the downward spiral of addiction, mental health issues,
and sleep disturbance, and onto an upward spiral of sobriety, better mental
health, and a good night’s sleep.

About The Author

P. Casey Arrillaga is the Team Leader for Education at
Windmill Wellness Ranch, and he is the author of books including “Realistic
Hope: The Family Survival Guide for Facing Alcoholism and Other Addictions”.
His books, podcast, videos, etc. can be found at CaseyAuthor.com