Substance/Medication-Induced Sleep Disorder

Substance/medication-induced sleep disorders can manifest in various ways, reflecting the specific type and extent of sleep disruption caused by a specific substance. Below are some key signs and symptoms to identify and understand the condition. 

Insomnia-related symptoms

People experiencing symptoms similar to insomnia due to substance use might experience the following symptoms: 

• Difficulty falling asleep, despite being tired
• Waking up frequently throughout the night
• Difficulty getting back to sleep after waking up
• Waking up too early in the morning
• Increased errors or accidents due to fatigue
• A sense of not being refreshed after a night’s sleep, which can lead to fatigue and irritability during the day

Hypersomnia-related symptoms

People experiencing symptoms similar to hypersomnia due to substance use might experience the following symptoms: 

• Prolonged sleep at night
• Difficulty waking up in the morning, even if alarms are used
• An increased desire for naps during the daytime, sometimes at inappropriate times like at work or during meals
• Grogginess or experiencing “brain fog” during waking hours 
• Decreased energy and motivation, sometimes described as lethargy 

Parasomnia-related symptoms

People experiencing symptoms similar to parasomnia due to substance use might experience the following symptoms: 

• Nightmares or night terrors causing distress or fear upon waking
• Sleepwalking or engaging in other activities (like eating or talking) while asleep
• Sleep paralysis or the sense of being unable to move upon waking up
• Waking up in an extremely confused state
• Acting out dreams while asleep, which can lead to injuries

Sleep-related movement disorder symptoms

Individuals experiencing symptoms similar to sleep-related movement disorder due to substance use might experience the following symptoms: 

• Restless leg syndrome or the irresistible urge to move the legs, which is often accompanied by unpleasant sensations
• Periodic limb movement disorder, which can cause involuntary leg or arm twitches during sleep
• Bruxism or the grinding/clenching of teeth while asleep
• Sleep-related rhythmic movement disorder, which can include repetitive movements (like head banging or rocking) before falling asleep or during sleep

General symptoms

General symptoms that may accompany this condition include the following: 

• Mood disturbances, including depression or irritability
• Difficulty concentrating or memory problems
• Decreased performance at work or school
• Physical symptoms like headaches or stomach issues due to disrupted sleep
• Increased susceptibility to illness, potentially due to reduced immune function

Understanding substance/medication-induced sleep disorder symptoms can be crucial to pinpoint these conditions and distinguish them from other sleep disturbances. However, some signs may overlap with other conditions’ symptoms, so consultation with a health professional can be crucial.

The onset and progression of substance/medication-induced sleep disorders can be attributed to specific causes and influenced by various risk factors.¹ Common causes may include the following: 

• Alcohol: While initially inducing drowsiness, regular or heavy consumption can interfere with the REM sleep cycle, leading to disturbed or less restorative sleep.
• Stimulants: Substances like caffeine, nicotine, and certain recreational drugs can result in insomnia or frequent nighttime awakenings.
• Prescription medications: Drugs like beta-blockers, certain antidepressants, and others may affect sleep patterns.
• Recreational drugs: The use of substances like cocaine, amphetamines, and MDMA can lead to sleep disturbances.
• Sedatives: Withdrawal from or prolonged use of benzodiazepines and other sleep medications can lead to “rebound insomnia” or other sleep issues.
• Opioids: Chronic opioid use can cause a pattern of disrupted sleep.  

Risk factors

Risk factors for the development of a substance-induced sleep disorder may include the following: 

• Duration of use: Prolonged and consistent use of a substance or medication increases the likelihood of disturbed sleep.
• Age: Older adults may have an altered metabolism that can influence how substances affect them, making them more susceptible to sleep disruptions.
• Coexisting mental health disorders: Individuals with anxiety, depression, or other psychiatric conditions may be at higher risk due to the combined effects of their conditions and substance or medication use.
• Genetics: Genetic factors can make some individuals more susceptible to the sleep-disrupting effects of certain substances.
• Prior sleep disorders: Individuals with pre-existing sleep disorders may be more vulnerable to further disturbances from substance or medication use.
• Multiple medications: Taking multiple medications can increase the risk due to potential drug interactions affecting sleep.

Treating substance/medication-induced sleep disorders often involves addressing the disturbance's underlying cause and the sleep disorder itself. Often, the primary goal is to restore healthy sleep patterns while ensuring the individual’s overall health and well-being. 

Medication

In some cases, medications may be used to support individuals experiencing sleep difficulties due to substance use. Below are a few potential options: 

• Adjusting or changing medications: If a prescribed medication or substance  is the cause of a sleep disorder, a healthcare provider might recommend stopping, adjusting the dosage or switching to a different medication.
• Sleep aids: Sleep aids may be used temporarily but are often not a long-term solution. Sleep medications can have dangerous or challenging side effects and be habit-forming. 
• Antidepressants: In cases where depression or anxiety exacerbates sleep disturbances, certain antidepressants may improve sleep.

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.

Other treatment options

Other treatment options for substance/medication-induced sleep disorders include the following: 

• Bright light therapy: Exposure to bright lights at specific times may reset the body’s internal clock, especially for those with circadian rhythm disorders.
• Sleep hygiene education: Learning about positive sleep habits may improve sleep quality overall. These practices might include keeping a consistent sleep schedule, creating a comfortable sleep environment, or limiting screens before going to bed. 
• Biofeedback: This technique can train individuals to control physiological functions to improve relaxation and sleep. Electronic monitoring allows individuals to gain awareness of and control over certain bodily functions to induce relaxation and sleep.

Self-care

Below are a few self-care practices that may be helpful: 

• Establish a routine: Going to bed and waking up at the same time every day, even on weekends, may regulate the body’s internal clock.
• Limit stimulants: Avoiding caffeine, nicotine, and certain medications close to bedtime may improve sleep.
• Improve your sleep environment: Creating a relaxed, dark, and quiet environment can enhance sleep quality. 
• Avoid alcohol: Even if it causes drowsiness initially, alcohol can disrupt the sleep cycle later that night.
• Stay active: Regular physical activity may regulate sleep patterns.

Combining these treatments and self-care techniques may significantly improve sleep quality in those affected by substance/medication-induced sleep disorders. However, consulting healthcare professionals to tailor the right approach to individual needs can be valuable.

Therapy can be an excellent resource for those experiencing substance/medication-induced sleep disorders because it provides tools and strategies to reduce sleep disturbances. Online counseling services like BetterHelp can connect individuals with licensed therapists suited to their specific needs, making professional support more convenient for some clients. Other potential resources include:

• American Academy of Sleep Medicine (AASM) Sleep Education: This organization promotes awareness of sleep and sleep disorders, offering practical and educational resources to help individuals navigate sleep-related challenges.
• The Sleep Foundation: This organization is dedicated to improving health and well-being through sleep education and advocacy, offering articles, tools, and recommendations for individuals with sleep disorders.
• The National Institute of Neurological Disorders and Stroke (NINDS): This resource offers a wealth of information on how sleep affects the brain while providing comprehensive insights into sleep disturbances and current research in sleep. 

Seeking out these resources can offer guidance, support, and knowledge, making it easier for individuals to understand and manage sleep disturbances effectively.

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

While limited research specifically addresses substance/medication-induced sleep disorder treatments, insights from general sleep disorder treatments may be applicable in some cases. 

A study published in Sleep Medicine Reviews involving 40 controlled investigations found that adjusting light exposure can significantly improve sleep patterns, especially for those with psychiatric conditions that may cause such imbalances. Notably, avoiding light in the evening led to longer sleep durations. While these light interventions show promising results for improving sleep in cases of circadian disturbances, they might be even more effective when tailored to specific sleep issues and combined with other behavioral strategies.

A separate study in the International Journal of Environmental Research and Public Health examined cognitive-behavioral therapy for shift workers struggling with insomnia. When comparing online and face-to-face therapies, both showed about a 7% increase in sleep efficiency, with results suggesting that online CBT-I is effective for shift workers' sleep challenges. Though promising, more comprehensive research, considering factors like gender and insomnia severity, is needed to confirm these findings, especially for those with substance/medication-induced sleep disorders.

Below are several key statistics on sleep disorders and substance-induced sleep disorders: 

• A study published in Frontiers of Psychiatry says, “Insomnia is [experienced] by between 30% and 85% of SUD (substance use disorder) patients, depending on the primary substance of [misuse] and other methodological factors.”
• According to a research review on cannabis and sleep published in Current Psychiatry Reports, “Disturbed sleep is commonly reported with 67% to 73% of adults and 33% to 43% of adolescents reporting disturbed sleep during a quit attempt.”
• The Pain Medicine journal says, “The majority of patients with CNCP [chronic noncancer pain] report difficulties with some type of sleep disturbance, with a prevalence of sleep disorders estimated as greater than 50% in this patient population.”
• A review in BMC Primary Care comparing the effectiveness of cognitive-behavioral therapy for insomnia concluded, “CBT-I is at least as effective for treating insomnia when compared with sleep medications, and its effects may be more durable than medications.”