Sleep, Recovery, and You

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Many people in recovery from addiction share a common problem: sleep.

Or, we should say, lack thereof.

Granted, some people in recovery find they sleep too much. For whatever reason, that’s how their body responds to the absence of alcohol and drugs. This article is not really for those people. It’s for the large majority of those in recovery for whom falling asleep and getting a good night’s rest feels nearly impossible, especially when they first enter treatment or try to quit.

Getting good sleep during recovery can be difficult for at least three reasons. Research on the relationship between sleep and alcohol/substance use performed over the past several decades shows:

  1. Alcohol and drug use can disturb sleep
  2. Abstinence after prolonged alcohol or drug use can further disturb sleep
  3. Disturbed sleep, lack of sleep, and insomnia are primary indicators and risk factors for relapse for alcohol and substance use disorders

There’s a reason why lack of sleep, sleep deprivation, and insomnia can lead to relapse: they lead to high levels of circulating cortisol in the bloodstream. Cortisol – among other things – is the chemical known as the stress hormone. We’ll explain why chronic exposure to high levels of cortisol can cause problems for people in recovery, but first, we need to back up and discuss the importance of sleep, in general.

Sleep: What Happens When You Don’t Get Enough

Perhaps the best way to understand why we need sleep is to have a look at what happens when we don’t sleep as much as we should. Remember: experts say most adults need about seven and a half hours of sleep per night. This varies from person to person, of course, but it’s a good general rule, and it’s backed up by research. And you probably know from personal experience that when you go consecutive days without getting at least seven hours of sleep, things tend to go downhill.

Things go wrong in two categories: mental and physical. Here’s a simple breakdown of the problems we face when we go without sleep:

Mental Effects of Sleep Deprivation

  • Decreased concentration
  • Impaired decision making
  • Difficulty with emotional coping and management
  • Increased stress reactivity (emotional)
  • Sluggish thoughts
  • Impaired speech
  • Increased impulsivity

Physical Effects of Sleep Deprivation

  • Slow response times
  • Impaired balance
  • Impaired coordination
  • Impaired Immunity
  • Increased stress reactivity (physical)
  • Hypertension
  • Digestive problems
  • Cardiovascular problems

When we consider all the things that go wrong when we’re sleep deprived, we’re faced with recognizing the fact that without sleep, it’s safe to say everything goes wrong. That’s why sleep deprivation is used to torture people – it drives us insane and destroys our bodies. All of this information can be summed up and tied in a bow with this fact: researchers at Harvard University found that people who sleep five hours or less a night have an increased mortality risk – from all causes – of around 15 percent.

Sleep deprivation is bad: that’s clear. Now, let’s examine how chronic stress – often a result of sleep deprivation – can affect your physical, mental, and emotional well-being.

Chronic Stress: Consequences

As mentioned above, sleep deprivation can lead to an elevation in circulating levels of cortisol, the human stress hormone. Our natural stress response system, which most of us know as our fight-or-flight reflex, evolved over millennia to help us survive the myriad external stressors humans faced in the distant past. Modern stress triggers the same mechanism, even though the stimuli we experience these days typically aren’t life-threatening.

We want to clarify something about stress: your body does not really know the difference between immediate, life-threatening survival stress and the stress that we experience on a day-to-day basis in the modern world. The chemical cascade inside your body is the same. Further, we want to point out that you may have become so accustomed to minor stresses that you may not realize your body is over-exposed to stress hormones – especially if you’re in recovery from an alcohol or substance use disorder.

That’s why it’s important to understand that chronic stress can lead to the following problems:

  • Anxiety
  • Depression
  • Decreased immunity
  • Headaches
  • Weight gain
  • Memory problems
  • Difficulty concentrating

In addition, research shows that stress can overwhelm the part of your brain called the executive function network. This network controls how you process, prioritize, and make decisions based on the input and information your brain receives throughout the course of a day. When you’re engaged in a complex task, your executive function network keeps you focused. It suppresses information from the environment that distracts you and facilitate the information that helps you complete your task.

The executive network is powerful: it can ignore information from the environment that’s attached to rewarding experiences, such as food, and – the part that’s important to this article – things like alcohol or drugs.

Sleep, Stress, and Relapse: What You Can Do

When stress overwhelms your executive function network, it becomes less efficient at ignoring reward cues – which can lead to relapse.

The stress in your life may not be caused by a lack of sleep. But if it is, there are several steps you can take to give yourself a better chance at getting good sleep. You may have heard the phrase before: it’s called sleep hygiene.

Here are some things you can do to improve your sleep hygiene:

General Tips

  • Change how you think of your bedroom: think of it as a place to sleep, and that’s it.
  • Do things like reading, watching TV, working, or playing games in other rooms.
  • Avoid reading, writing, working, watching TV, surfing the web on your laptop or tablet, playing games, or scrolling through your phone while in your bedroom.
  • Keep your bedroom quiet and cool. Turn down the thermostat. Keep extra blankets nearby in case you get chilly during the night.
  • Keep your bedroom dark as possible. This stimulates the release of melatonin, which tells your body it’s time to go to sleep. Use blackout shades to keep out ambient light from outdoors.
  • Make your bed comfortable. You don’t have to break the bank, but consider a weighted blanket, softer sheets, and pillows you like. If you sleep with a partner and this causes space problems, consider investing in a larger bed, or sleeping in separate beds.
  • Exercise regularly. Avoid intense workouts 4-6 hours before bedtime.

Daily Tips

  • Set your alarm for the same time every day. Even weekends and holidays. A consistent, regular schedule will help normalize your sleep patterns and help keep your hormones balanced.
  • Avoid naps after 3 pm.
  • No caffeine after lunch.
  • Avoid anything containing nicotine before bedtime.

Evening Tips

  • Begin your bedtime routine early. Mirror the transition from light to dark as closely as you can to the natural cycle of sunrise and sunset. If you have electric lights on past midnight, you trick your brain into thinking it’s still daytime, and it won’t want to go to sleep naturally.
  • Power down electronic devices about half an hour before you go to bed. This includes television, smartphones, laptops, tablets, and video games. This gives your mind time to transition from the electronic stimulation it receives virtually all day long.
  • Find your evening ritual. This can be anything that works for you: take a bath, go for a walk, have a light snack, do some yoga or stretching, meditate, or read – but not in the bedroom.
  • If you aren’t tired and sleepy, don’t go to bed. Do something to relax and wait until your body and mind to be ready.
  • Don’t go to bed hungry, but don’t a huge meal too close to bedtime. Try light snack that includes a few grams of protein.
  • Try to avoid sleeping pills. If you use them, or feel the need to use them on a regular basis, consult with a medical professional – especially if you’re in recovery.
  • Do your best to go to bed with a clear mind. Worry and anxiety can keep you up. Consider using a journal to write things down before you turn in, or make a to-do list for the morning – that way you know you’ve done everything you can for the day, and have a plan for addressing outstanding items in the morning.
  • If you have loud roommates, family members, or live in a large city, consider earplugs.
  • If you don’t fall asleep within twenty minutes of getting in bed, get up and do something until you feel relaxed enough to try again. Tossing and turning in the dark tends to add to stress, and you end up being stressed about the fact you’re not getting to sleep.

Lack of sleep may or may not be a problem for you during recovery. If it is, the tips above are proven effective in helping establish good sleep habits. And good sleep habits mean good sleep, which means less stress – and less stress is a good thing.

Start Simple, Build on What Works

Sleep is tricky, because everyone has a different relationship with sleep. Some people can fall asleep anywhere, anytime. In the car, in their favorite chair, or at their desk at work – it doesn’t seem to matter. For others, however, falling asleep is a problem. No matter how hard they try, it’s elusive. Difficulty falling asleep may even be the reason they turned to alcohol and drugs in the first place: they wanted something to calm their mind and quiet their thoughts so they could get much needed rest.

Sleep is also tricky because adequate sleep is essential for overall health and wellness. Sleep deprivation causes a host of physical, psychological, and emotional problems. For people in recovery, the primary danger of sleep deprivation is increased stress, which dramatically increases likelihood or relapse.

That’s why finding what works for you is more important than following the rules laid out above to the letter: if they don’t work, ignore them – but you should try them all to see if they help. Start with the easy things you know you can do. Create an evening ritual. Start winding down early. Turn off electronics, close the blinds, have a cup of tea, do some journaling. Make your bedroom cool, dark, and quiet, and see if all that helps.

On the other hand, if curling up in bed with a good book or watching on some mindless Netflix does the trick and puts you out like a light without fail – do that.

What’s important is finding what works for you, making it repeatable, and re-establishing the healthy sleep routines that may have been disrupted by alcohol or drug use.