How to deal with insomnia during withdrawal
A lot of people don’t understand the difference between detox (or acute withdrawal), the period of time it takes for a substance to be eliminated from your system, and withdrawal (or post-acute withdrawal), a time period marked by uncomfortable symptoms related to the body adjusting to living without that substance. Post-acute withdrawal can last anywhere from weeks to months after detox/acute withdrawal is over.
One of the most common symptoms of post-acute withdrawal from almost any substance is insomnia. On top of making post-acute withdrawal more intolerable, insomnia can also cause exhaustion, a suppressed immune system, a higher propensity for becoming ill, and higher stress levels.
The danger here is that the stress of post-acute withdrawal —exacerbated by insomnia— can cause people in early stages of recovery to lapse back into regular use.
Because of this, we have compiled a list of ways to combat insomnia so you can get the sleep you need to recover.
What causes insomnia during post-acute withdrawal?
During the process of developing a substance use disorder, the stage is being set for insomnia in post-acute withdrawal. When you use and abuse substances, your brain slows its production of dopamine because your regular substance use is providing more than enough dopamine to make up for what your brain would normally supply.
Dopamine not only causes you to feel high, but it regulates your mood. When you’re going through post-acute withdrawal, your brain hasn’t had enough time (usually 4-6 weeks) to produce enough dopamine again. This causes increased stress levels, which raises the body to a panicked “fight-or-flight” level that continues until dopamine levels can be regulated. Four to six weeks of this level of stress only perpetuates more stress and at higher levels.
According to the National Sleep Foundation, insomnia can be caused by:
- Feelings of overwhelm.
- Worrying about the past or the future.
All of these triggers for insomnia can be easily caused by post-acute withdrawal.
Insomnia and withdrawal by drug
Withdrawal from most substances can cause insomnia, including:
- Alcohol– Withdrawal symptoms usually start within eight hours of the last drink, peak within 24-72 hours, and may continue for weeks.
- Amphetamines– Post-acute withdrawal begins within 3-5 days after the last use. Users generally sleep excessively at first and then develop symptoms of insomnia.
- Benzodiazepines– Post-acute withdrawal begins within 1-4 days of continuation and insomnia is one of the first symptoms. Full-blown withdrawal can last 10-14 days, and after that, anxiety (which can lead to further insomnia) can occur until treatment begins.
- Cocaine– Insomnia can begin in a few hours or several days after stopping use and can last up to 10 weeks.
- Marijuana– Though withdrawal symptoms are milder in recovering marijuana users, insomnia is a common symptom in heavy users. Studies have shown that 40% of teens in recovery from marijuana experienced withdrawal when they stopped using.
- Opioids and opiates– Insomnia is usually present in the early part of withdrawal, which can start within 12-30 hours of the last use.
Withdrawal from all of these drugs is considered chronic —as opposed to transient or short-term— because it affects people with substance use disorders in post-acute withdrawal at least three nights a week for a month or longer.
How can you treat insomnia medicinally?
There are some substance-specific treatments available for those experiencing insomnia.
Benzodiazepines and Ambien can be helpful, though some patients with alcohol use disorders are at increased risk for benzodiazepine abuse. Anticonvulsants like carbamazepine and gabapentin may also be helpful. Tricyclic antidepressants like amitriptyline and doxepin have also been used for insomnia, but alcohol-induced changes in liver metabolism make it hard to judge the proper dosage. Quetiapine, an atypical antipsychotic, has also been used for this purpose.
There are also some medications that are recommended for insomnia regardless of substance:
- Benzodiazepines such as flurazepam, clonazepam, quazepam, lorazepam, and alprazolam were once the most commonly prescribed sedating hypnotics and can be used for withdrawal during post-acute withdrawal. Benzodiazepines come with a risk of tolerance and dependence.
- Non-benzodiazepine hypnotics like zolpidem, zaleplon, eszopiclone, and ramelteon are the preferred treatment for insomnia. These medications do come with side effects that include drowsiness, dizziness, fatigue, headache, and diarrhea.
- Over-the-counter antihistamines such as diphenhydramine, doxylamine, chlorpheniramine, and hydroxyzine can make you drowsy and help induce sleep, but they can also cause daytime sleepiness, cognitive impairment, dizziness, and dry mouth.
- Trazadone, an antidepressant, is often prescribed for insomnia. Studies have found that Trazadone improves sleep at night, but does not affect sleepiness during the day, your overall thinking, or your brain function.
Consult a doctor before beginning any medication regimen for insomnia.
How can you treat insomnia with vitamins or supplements?
There are many vitamins and dietary supplements that are commonly used to help treat insomnia. While the American Academy of Sleep Medicine (AASM) has stated there is limited scientific proof that vitamins and supplements work to treat insomnia, most of these treatments are not harmful, and may work for you.
- 5-L-5-hydroxytryptophan (HTP) is a byproduct of tryptophan, an amino acid that helps form serotonin, which is associated with health sleep. However, there is not much evidence to show that it improves insomnia.
- Kava is used to reduce anxiety and improve sleep, but some do not consider it safe because of reports of reports of liver failure and dangerous interactions with alprazolam, sleep medications, alcohol, and antidepressants.
- Melatonin reduces the time that it takes to fall asleep at a dose of just 0.3mg.
- Valerian root is a sedating herb, and some studies have shown that it improves your quality of sleep.
Just because these vitamins and supplements are available without a prescription doesn’t mean that you should start taking them without speaking to your doctor as there could be interactions with other medications or with personal medical conditions.
What are some other ways to treat insomnia?
The National Sleep Foundation states that non-medical approaches are key to helping with insomnia, even in conjunction with medication, vitamins, or supplements. Some methods include:
- Avoid naps if you possibly can as they can throw off your sleep schedule. Avoid alcohol, caffeine, and nicotine late in the day. Alcohol can help you fall asleep, but will often cause you to wake up in the middle of the night. Caffeine and nicotine are both stimulants and will keep you awake longer.
- Breathing or relaxation exercises can help. Many are readily available on YouTube or via other free online resources.
- Exercise before dinner or about four to six hours before bed. A lull in energy occurs a few hours after exercise, which should coincide with bedtime.
- If you lay awake for more than twenty minutes, get up and do something relaxing in another room, like reading or listening to music or a podcast. Lying awake in bed for too long can create a link in your brain between your bedroom and wakefulness.
- Keep your bedroom cool and well-ventilated.
- Make sure your bedroom is dark and use a fan or white noise machine or app to reduce distractions.
- Not using electronic devices thirty minutes before bed or in bed, as blue light can make the brain more wakeful.
- Take a hot bath 1.5-2 hours before bed.
- Try to go to bed and wake up at the same time every day, regardless of how much or how little sleep you’ve gotten the night before. This will help to create a pattern that your body can become accustomed to.
- Turning down the lights in your home about an hour before bed and taking half an hour to wind down before you decide to go to sleep.
- Use your bed only for sleep and sex. This ensures that you don’t associate the bed with other, more wakeful activities.
Many drugs can cause insomnia during post-acute withdrawal, but luckily there are many available ways to treat it. Medications, vitamins, supplements, and behaviors can all help you get the sleep you need so you can make your way through withdrawal more smoothly.
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