I have been wondering about the lack of sleep we get and the increased chance of abusing a substance.  So I did some googling and found a few articles on this.  Thought I might share one with you.



Sleepy (Photo credit: Wikipedia)

Sleep Disorders in Substance Abusers

Youssef Mahfoud, MD, Farid Talih, MD, David Streem, MD, and Kumar Budur, MD

Youssef Mahfoud, Dr. Mahfoud is an Addiction Psychiatry Fellow from the Department of Psychiatry, University Hospitals, Cleveland, Ohio;

Contributor Information.

ADDRESS CORRESPONDENCE TO: Youssef Mahfoud, MD, University Hospitals, WO Walker Center, 10254 Euclid Ave., Suite 3200, Cleveland, OH 44106; E-mail: youssef.mahfoud@uhhospitals.org

This article has been cited by other articles in PMC.

There are some interesting things in this article.  I will post a few things and then talk about it a bit.  If you would like to see the full article please see the link above.


Substance abuse is a major public health problem with high morbidity and mortality. Comorbid disorders are suspected to cause a high relapse rate. Subjects with sleep disorders tend to self medicate with alcohol and tranquilizers to promote sleep or abuse stimulants to stay awake during the day. Substance abuse can, in turn, cause sleep disturbances, which can result in relapse. No studies have systematically studied the prevalence of various sleep disorders in these subjects.

Methods: This is a cross-sectional study conducted at the Alcohol and Drug Recovery Center (ADRC) at Cleveland Clinic, Cleveland, Ohio. Subjects with active substance abuse and the ability to consent were recruited to complete a comprehensive sleep disorder questionnaire, including a general medical, psychiatric, and substance abuse history as well as validated scales (e.g., Insomnia Severity Index, Pittsburgh Sleep Quality Index (PSQI), Berlin Questionnaire for sleep apnea and restless legs).

Results: Thirty patients completed the survey so far. The most commonly abused substance was alcohol (80%) followed by narcotics (40%); about 66 percent were polysubstance users. Forty-six percent of the patients reported using substance to self-medicate sleep problems. The prevalence of various sleep disorders in this population along with the prevalence in general population in parenthesis are as follows: Sleep impairment (PSQI>5) was noted in 96 percent (15%) of the subjects, and 56 percent (10–15%) had insomnia of moderate-to-severe degree. Symptoms suggestive of sleep apnea were reported in 53 percent (4–6%) of the subjects and restless leg syndrome symptoms in 33 percent (10%).

Conclusion: Substance abuse is on the rise and affects every aspect of society. Our study has, for the first time, systematically evaluated various sleep disorders in these subjects who seem 5 to 10 times more likely to have sleep disorders. Diagnosing and treating sleep disorders will have a huge impact in inducing remission. However, this study has significant limitations, including a small number of subjects, subjective data collected via questionnaires, and no long-term follow-up, which makes it difficult to draw conclusions.


sleepy fairy

sleepy fairy (Photo credit: Wikipedia)

I had a feeling that there would be a link here.  I know on many nights my hubby would say that he could not get to sleep unless he had a bit to drink.  Well that “bit” kept getting bigger and bigger.  It’s the self medication that some times can make the issue at hand worse and if we are being treated by a Dr for the condition, taking the RX meds and still self mediating we could be causes the medication from the Dr to not work, or making even work in a negative way.  We might just be over all making the situation worse.

The sleep aids is a big grey area with me.  I take some over the counter ones once in a while if I can not sleep.  Most of the time it is either stress related or migraine induced.  I play a game on my lappytop or read a book to help unwind my brain, but if my head is pounding the book is not going to do me any good.  I try not to take them very often and sometimes I wait till it’s too late to take them.  I have to be able to drive to work the next day.


The relationship between substance abuse and sleep is emerging as an area of great interest for researchers. According to the 2007 National Survey on Drug Use and Health, 7.6 percent of Americans older than 12 years met the criteria for alcohol abuse or dependence, and the prevalence of illicit drug use in the same year was as high as 14.5 percent.1 Similarly, sleep disorders are also very common. The National Sleep Foundation’s Sleep in America Poll, 2008, showed that about two-thirds (65%) of working adults reported experiencing sleep problems at least a few nights a week within the past month, and 44 percent reported this occurring every night or almost every night.2

I am part of that group that has an issue getting to sleep more that a few nights a week. 

Several studies have reported sleep problems associated with the use of several illicit drugs, and the vast majority of alcoholic patients entering treatment reported insomnia-related symptoms, such as difficulty falling and maintaining sleep.3,4 For example, the prevalence of insomnia ranged from 36 to 72 percent in patients admitted for alcoholism treatment, depending on sample characteristics and instruments used to measure insomnia.46 The polysomnographic features after drinking alcohol, during withdrawal, and during abstinence are well defined. Alcohol intake increases slow wave sleep and suppresses rapid eye movement (REM) sleep. During periods of acute withdrawal, sleep latency (time taken to fall asleep) is increased, total sleep time is decreased, slow wave sleep returns to baseline while REM sleep either rebounds or returns to baseline. Sleep fragmentation and REM sleep disruptions can sometimes persist for 1 to 3 years after achieving sobriety.7 Similarly, opiates, despite their sedating effect, interrupt sleep by increasing wakefulness and decreasing total sleep time, slow wave sleep, and REM sleep.8 Some researchers debate the cause and effect relationship between sleep and substance abuse disorders. Sleep problems might predispose an individual to alcoholism.9 Sleep problems can sometimes be severe enough to reverse alcohol or drug treatment success and precipitate a relapse to addiction or dependence.10 Disturbed sleep is a significant predictor of relapse even after controlling other factors, like depression, and the severity of alcohol dependence and relapse was greater in individuals with alcoholism who had insomnia versus those with alcoholism without insomnia at baseline.11 However, paucity of information is noted regarding the prevalence of sleep disorders in subjects who abuse other drugs, and very little information is available on the prevalence of other sleep disorders even in subjects who abuse alcohol. It is in this context that a cross-sectional study was conducted to determine the prevalence of various sleep disorders in subjects who were admitted to the ADRC at Cleveland Clinic, a tertiary referral center.

I remember that when my hubby was detoxing he said that he hardly slept.  He went to bed very late and was up very early.  Now that is a much different story.  Mind you we are both in the 28-34 age group and yet we are ready for bed at like 9pm at night and more than willing to sleep in, till 7am.  Yes, 7am is sleeping in for us when we are used to getting up at 5am during the week.

Hubby has said a few times lately that he remembers being about to stay up sooo late when he was drinking or right when he got sober.  I remember having to stay up till 1 or 2 am and having to drive home from a friend’s house or my Brothers.  I would still get up at 6am most Saturdays to go out with my mom and then come home, take a quick nap and then start it all over again.  Sundays I would be so dead that I could not do anything.  Most of the time from the lack of sleep I would have such a bad migraine that I would stay in bed all day.

I've had a migraine/headache for 6 days straig...

I've had a migraine/headache for 6 days straight. Today was so bad I couldn't concentrate on what I was saying. I'm not even sure I knew WHAT I was saying because of the pain. I even mixed up two people's names and felt really dumb afterwards. Anyone got a migraine cure? 🙂 (Photo credit: Wikipedia)


The results from our study show a very high prevalence of sleep disturbances among subjects with substance abuse or dependence, with almost all of the subjects reporting impaired sleep quality. Also, more than half of the subjects had moderate-to-severe insomnia. This is much higher than what is found in the general population (17–30%) or in a general medical sample (16%, severe insomnia; 34%, mild insomnia over the prior 4 weeks).18,19 More than half of the subjects had a high pre-test probability for sleep apnea, which is again higher than in the general population (4–6%).20 Of note, the prevalence of symptoms suggestive of restless legs syndrome was also very high (33%) compared to the general population (10%).21 Almost half of the subjects admitted to abusing a substance to promote sleep, and this is consistent with the findings in the previous studies wherein subjects reported consuming alcohol to help them with insomnia.

This study has several limitations, including a small sample size, collection of data from self-administered questionnaires, and lack of objective sleep metrics, which reduce the ability to apply the findings in clinical practice. A follow-up study with a larger sample size and with objective sleep metrics, such as Actigraphy, Polysomnography and Multiple Sleep Latency Test (MSLT), is warranted to further elucidate the findings of this study.

Well that is all that I will post from that article, if you would like to read more of it please check it out. I know that with my migraines having a sleep schedule that really don’t change is what I need to make sure that I am giving myself the best chance to avoid a migraine for that day.  It seems that might be a clue towards substance abuse as well.  It seems that when I was told that a lack of sleep messes with your whole system, they were telling the truth.  So if it be migraines or substance abuse, we need to try to get to bed the same time every night and get sleep.

I know easier said than done.  Most nights I spend a long time looking at the fan in the bed room.  I found that having the TV on low helps me, if it is too quiet in the room the ringing in my ears is too much for me to handle.  If the room is too warm I will not be able to stay asleep at all.  If I have clothes on that are too tight or restrictive in any way then I can not get any rest.  I hope this might shred some light on what might be keeping you awake at night.

One day we will know the serenity of falling asleep shortly after laying down at night.  God bless you my friends.

If no one has told you they love you today, I love you and God does too!