People with REM sleep behavior disorder (RBD) act out their dreams and often suffer from poor sleep. The use of drugs or alcohol can make symptoms worse.

Sleep disorders usually have a negative impact on the quality of life of people who have them. In the case of REM sleep behavior disorder (RBD), people act out their dreams during REM (rapid eye movement) sleep. These individuals may talk, lash out suddenly or thrash around when having a stressful dream, which can be dangerous for the affected individual and their loved ones. This condition can be dangerous on its own but may present additional challenges when combined with drugs or alcohol.

Effects of Drug Use on REM Sleep Behavior Disorder Symptoms

People who already have RBD are likely to experience more severe sleep disturbances when they use ingest substances, especially alcohol, marijuana and stimulants. The way the brain regulates REM sleep is still not fully understood, and researchers continue to find that different drugs can trigger a wide range of sleep-related symptoms. For example, while benzodiazepines are often used to treat REM sleep behavior disorder, they may make symptoms worse in some individuals.

People with RBD sometimes experience initial symptom relief from drugs that suppress REM sleep. At other times, they may have an immediate, adverse reaction to these substances. In general, substance use degrades sleep quality and can cause insomnia or other sleep disorders.

Rapid Eye Movement Sleep Behavior Disorder and Alcohol

Sleep disruptions are a common side effect of alcohol use, even for people who only drink on rare occasions. Sleep problems can become chronic and pronounced for people who consume alcohol regularly, especially people who meet diagnostic criteria for alcohol dependence.

Alcohol affects different neurotransmitters and systems in the brain that regulate sleep. It can suppress REM sleep, causing people to wake up after a full night of sleep feeling like they hardly slept at all. It can also make people restless during sleep, more prone to vivid nightmares and symptoms of RBD. People often act out their dreams in ways that meet the criteria for REM sleep behavior disorder when they experience alcohol withdrawal.

REM Sleep Behavior Disorder and Marijuana

Like alcohol, many people use marijuana to relax and even to help them go to sleep. However, for people with sleep disorders, marijuana can cause sleep disruptions. Research shows that cannabis impacts REM sleep and reduces sleep quality in general. While reduced sleep quality can initially decrease episodes of acting out dreams, it often has a backlash effect that causes symptoms to re-emerge and become more severe over time.

Rapid Eye Movement Sleep Behavior Disorder and Stimulants

The sleep-suppressing effects of stimulant drugs are well-known. In addition to caffeine, the stimulants people use most often to suppress sleep include:

People with insomnia, RBD or other sleep disorders may resort to abusing stimulants to help them stay awake and alert the day after a poor night’s sleep. Unfortunately, this can quickly lead to a negative cycle in which the stimulants they take to counter the effects of poor sleep cause the quality of their sleep to worsen steadily.

Statistics on REM Sleep Behavior Disorder and Addiction

Not much research has been done yet on how exactly REM sleep behavior disorder relates to substance abuse. However, there is a correlation between this disorder and using addictive substances. For example, people with RBD are slightly more likely to have smoked tobacco than those without it.

Can REM Sleep Disorder Lead to Substance Abuse?

No one factor causes substance abuse. However, in some cases, people may turn to drugs and alcohol to temporarily improve their sleep, which may lead to addiction or dependence in the long term. Using and withdrawing from alcohol and certain substances can also cause symptoms of REM sleep behavior disorder to emerge.

Treating REM Sleep Behavior Disorder and Co-Occurring Substance Use Disorders

Unlike other DSM-5 disorders, REM sleep behavior disorder is primarily biological and does not require psychotherapy to treat. Coordinating its treatment with substance abuse treatment is as simple as making sure physicians communicate with clinicians providing addiction treatment to ensure that medications for RBD are not interfering with treatment goals.

However, integrated treatment can become more complicated when people with RBD and substance use disorders have other mental health conditions. Most antidepressants suppress REM sleep, especially in people with sleep disorders. This side effect can make it hard to control depressive symptoms without triggering worsened RBD symptoms or a recurrence of substance use. It is essential that people receiving treatment for REM sleep disorders and other mental health conditions work closely with clinicians to ensure that treatment for one condition does not make another worse.

The Recovery Village operates rehab facilities across the United States with qualified staff who understand the needs of people with co-occurring conditions. Contact a representative at the Recovery Village today to learn more about integrated treatment options that can meet your needs.

a woman is standing with her arms crossed.
Editor – Megan Hull
Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more
a woman with glasses is smiling for the camera.
Medically Reviewed By – Dr. Anna Pickering, PhD
Dr. Anna Pickering has a PhD in Cell and Molecular Biology. Anna works as a medical writer. She grew up in Oregon, where she developed a love for science, nature, and writing. Read more

Chen MC, Yu H, Huang ZL, Lu J. “Rapid eye movement sleep behavior disorder.” Current Opinions in Neurobiology, October 2013. Accessed May 10, 2019.

Bolla, Karen. “Sleep Disturbance in Heavy Marijuana Users.” Sleep, Jun 1, 2008. Accessed May 15, 2019.

Baig F, Lawton MA, Rolinski M, Ruffmann C, Klein JC, Nithi K, Okai  D, Ben-Shlomo Y, Hu MTM. “Personality and addictive behaviours in […]p behaviour disorder.” Parkinsonism and Related Disorders, April 2017. Accessed May 10, 2019.

Porter VR, Avidan AY. “Clinical Overview of REM Sleep Behavior Disorder.” Seminars in Neurology, August 1, 2017. Accessed May 10, 2019.

Aurora RN, Zak RS, Maganti RK, Auerbach SH, Casey KR, Chowdhuri S, Karippot A, Ramar K, Kristo DA, Morgenthaler TI. “Best Practice Guide for the Treatment of[…]avior Disorder (RBD).” Journal of Clinical Sleep Medicine, February 15, 2010. Accessed May 10, 2019.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.