Eye-opening link between insomnia and substance abuse

Here’s one seriously dysfunctional relationship. Addiction can cause insomnia, and insomnia can prolong addiction. 

Greg Sahlem, M.D., an instructor in the Department of Psychiatry and Behavioral Sciences, talked about that vicious cycle at the annual Update on Psychiatry conference at the Medical University of South Carolina. 

“If you look at the general population data, insomnia is very common. Some studies have said as much as 20 percent of the general population suffers from it,” Sahlem said in a talk called “Sleep Disruption in Substance Use Disorders.”

“[Insomnia] can increase the incidence of major depressive order. It can also make existing depressive disorders worse, make alcohol use disorders worse and have profound effects on depression and suicidality. Poor sleep is not something to gloss over.”

People with an alcohol problem are especially susceptible to insomnia, he said. “Ninety percent of the people in one study being treated for alcohol use had substantial sleep disruption. They found that 30 days later, half the cohort still had disruption. It wasn’t mild sleep disruption. It was significant.”

Sleep disruption is a strong predictor of relapse, Sahlem said.

He drew a distinction between acute insomnia, which means a person has trouble falling asleep more than three nights a week for less than a month, and chronic insomnia, which can go on for much longer. 

Treatments include cognitive behavioral therapy, which Sahlem said is very effective but takes several weeks to work and lacks enough therapists trained in it. 

Some doctors also prescribe benzodiazepines such as Ativan, Xanax and Klonopin to treat insomnia. Sahlem said they’re a quick fix but have serious drawbacks, especially for people with alcohol issues who may misuse them. “They’re really good for a few days, but once you go longer they quit being effective and people are stuck on them because there are withdrawal symptoms.”

Sahlem also talked about Z-drugs. “Those are Ambien and Sonata and others. They’re better than benzos but not much better. They don’t tend to work well in the long run.”

Sahlem said non-invasive brain stimulation may help some people by interacting with sleep wake circuits in the brain either before or during sleep, “like a sleep pacemaker.”  

If it seems surprising that insomnia treatments are at a relatively early stage, Sahlem said keep in mind that this is a young field when viewed in the context of scientific research as a whole. “REM sleep was just discovered in the ‘50s. If you look at the science of sleep, there’s really only been any data since then.”