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Insomnia During Recovery From Substance Abuse

Reviewed by: HU Medical Review Board | Last reviewed: June 2020

Recovering from alcohol or drug abuse is tough work. Unfortunately, sleep problems like insomnia are a common and troublesome side effect to the body adjusting to its new normal.

Studies show that insomnia is common in the early stages of recovery from alcohol dependence and may last for several months. To complicate matters, untreated sleep problems increase the chances of relapse.1

Relationship between insomnia and alcohol

Insomnia and alcohol have a complicated relationship. Doctors know that people with insomnia have an increased risk of developing alcohol abuse. They also know that 1 in 10 people with insomnia uses alcohol to self-medicate. In fact, more than 50 percent of problem drinkers report that their insomnia began before their drinking.1-2

Insomnia during withdrawal

Studies report that 6 to 8 out of 10 people report sleep problems during their withdrawal period. This insomnia can last up to 12 weeks or longer. The type of sleep problems reported included:1

  • Waking up frequently
  • Movement during sleep
  • Changes in sleep stages

Certain groups are more likely to experience insomnia during their recovery period, including:1

  • Those over age 55
  • African Americans
  • Those with depression

After 6 months of no alcohol, sleep patterns tended to return to whatever was normal for that person. However, this may not mean good quality sleep if the person experienced insomnia before the alcohol abuse began.1

Treatments for abstinence insomnia

Untreated insomnia can lead to relapse so treatment aids recovery and supports long-term abstinence. However, treatment understandably needs to avoid any potentially addictive drugs.

The best choices for treating insomnia, whether someone is in recovery or not, include:1

Cognitive behavioral therapy for insomnia

Cognitive behavioral therapy for insomnia may be thought of as “sleep coaching.” CBT-I has been shown to be as effective or better at treating insomnia than drugs. An example of CBT-I for insomnia might include:

  • Avoiding daytime naps and improving sleep habits (sleep hygiene)
  • Decreasing worry about lack of sleep
  • Correcting unrealistic sleep expectations

Encouraging good sleep habits involves making sure the bedroom is quiet, dark, and comfortable. Reducing caffeine and avoiding electronic devices close to bedtime can also help improve sleep.

Drugs that treat insomnia during recovery

Trazodone, certain antidepressants, and antihistamines are the drugs most often prescribed to treat insomnia in people in recovery. However, there is little evidence that these treatments work, and some antidepressants make insomnia worse.

Melatonin, an over-the-counter supplement that encourages sleep, may be suggested.

Sometimes alcohol withdrawal symptoms are treated with benzodiazepines. These can help with insomnia but are not usually used long-term due to the risk of abuse. There are other prescription sleeping pills that might be helpful when used under careful doctor supervision.

Some studies show that anticonvulsants, especially gabapentin, may be helpful in treating insomnia in people recovering from alcohol abuse. There is also a cooling headband that has been FDA-approved for insomnia. It is available by prescription, but non-prescription versions are available too. This is a non-drug way of treating insomnia that might be helpful for some people. Costs begin at $200.3

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