Can’t Sleep? Non-Pharmaceutical Options for Treating Insomnia During Recovery

You’re in recovery and feeling good that you have made it through detox and the first few weeks of a treatment program. You look forward to feeling better and returning to a stable routine. But you find yourself getting anxious because you haven’t been sleeping as well as you’d like. You may be having a hard time getting to sleep, or you may wake up during the night and find yourself unable to fall back to sleep. So you certainly don’t feel refreshed when the morning alarm goes off.

What is going on?

According to a study by the National Institutes of Health (NIH), almost 75 percent of recovering alcoholics reported sleep problems immediately following detox. Often, the insomnia symptoms lasted about five weeks. But for some, insomnia was still a problem after six months of abstinence. Unfortunately, insomnia is often a predictor of relapse. Alcoholics with insomnia were two times more likely to relapse than those without insomnia. So it is vital for people in recovery to address their sleep disturbances.

Circadian Rhythm Cycle Disturbance and Insomnia

Circadian rhythm cycles are built-in “biological clocks” that regulate many of the body’s metabolic processes, including the typical 24-hour sleep/wake cycle. Alcohol and cocaine are known to disrupt certain neurotransmitters in the brain that control or regulate sleep. While small amounts of alcohol can cause the initial onset of sleepiness, during the latter part of the sleep cycle alcohol drastically interrupts sleep. Alcohol decreases the amount of rapid eye movement (REM) sleep time during the first half of the night, but REM then “rebounds” and increases later in the sleep cycle. This causes frequent awaking during the night, because REM is a lighter, less restorative sleep.

The Substance Abuse/Insomnia Cycle

Stimulants (cocaine, amphetamines, MDMA etc.) disrupt sleep by producing a feeling of wakefulness and increased energy levels. But sooner or later your body cries out for rest. However, if you have an altered circadian cycle, normal sleep is not likely to be forthcoming. A vicious cycle can result when one attempts to deal with stimulant drug-related insomnia by using depressant-type drugs or alcohol. Studies show that up to 28 percent of adults experiencing frequent insomnia use alcohol to help them fall asleep. Unfortunately, once a substance abuse/insomnia cycle becomes established, it is very difficult to break.

Sleep Disturbance and Relapse

A NIH study on “Treatment Options for Sleep Disturbance During Alcohol Recovery,” published in the Journal of Addictive Diseases, 2007, reported that after five months of abstinence, people in treatment for alcohol use disorders who were still reporting disturbed sleep were approximately twice as likely to have relapsed than those whose sleep had normalized.

People in recovery also face other health issues when they are sleep deprived. According to WebMD.com, sleep deprivation can place one at an increased risk for heart disease, high blood pressure, stroke and diabetes. Sleep deprivation has also been linked to depression, impaired cognitive abilities (decreases in memory, concentration), and faster aging (due to a lack of growth hormone that is produced during sleep).

So obviously, treating insomnia during recovery is of major importance. There are both prescription drugs and over-the-counter sleep aid drugs available, but these are risky for people in recovery, as they, too, can become addictive. The dietary supplement melatonin is considered to be a safe alternative. WebMD.com reports that as little as 0.2mg. or as much as 20.0mg. of melatonin are safe dosages for most adults. But you should consult your physician before taking melatonin to determine the safety for your individual case.

Below are some other non-pharmaceutical options that may help you get a better night’s sleep.

Non-Pharmaceutical Options for Treating Insomnia

• Create a sleep schedule. Since disruption of normal circadian rhythms is indicated as a contributing factor in insomnia, re-establishing a normal sleep/wake pattern is important. Your sleep cycle may take some time to readjust, but if you are strict with your bedtime and wake-up schedule, this may help normalize your circadian rhythms. Avoid napping during the day while you are attempting to re-adjust your sleep cycle.
• Practice good “sleep hygiene.” This means taking control of all habits related to sleep. For instance, if you find it difficult to go to sleep, rather than tossing and turning in bed, get up and do something else, such as reading a book. You want your mind to associate your time in bed with sleep rather than insomnia-related stress. Control other environmental cues related to sleep time as well, such as resisting the urge to watch TV or work on your computer while in bed.
• Monitor your food and drink intake. Avoid eating a large meal just before bedtime. If you are uncomfortably full, it will be harder to fall asleep. However, some people find that a small amount of warm milk or a small amount of protein food, such as turkey, helps them fall asleep faster. Avoid caffeine drinks near bedtime as well; you may need to reduce or eliminate caffeine by late afternoon.
• Use relaxation techniques to de-stress and calm yourself shortly before you retire. There are many relaxing guided imagery CDs available that help you turn down the chatter in your mind and re-focus on something soothing instead. You can listen to soft music or use a “white noise” machine to block out noises. Gentle exercise such as Tai Chi or Qi Gong, and the use of progressive muscle relaxation are other options you can try.
• Don’t take your worries to bed. Many people who wake up during the night immediately begin to go over in their minds any problems or issues they may be currently experiencing. This habit is counter-productive to your goal of returning to sleep. Instead of reflecting on and mentally processing problems during the night, write them down and plan to address them in the morning. Keep a pad and pencil near your bed so you can quickly write down a few notes that will help you bring the memory back to mind in the morning. By “tabling” the issue for later, you will help your mind let go of the worry and relax back into sleep.

Restful sleep is essential for success in recovery.

Be diligent and persistent, but gentle with yourself, as you try to re-establish good sleep habits.