Poor sleep is a common struggle of many of my patients. Chronic insomnia seems to be the bane of the initial weeks of recovery. Many patients ask me questions such as “When will I be sleeping like normal?” and “Can I get meds to help me?” Part of the difficulty with insomnia is that it often creates a vulnerable period for those already fighting to avoid a drink or getting high. It leads to irritability, poor work and relationship performance, and discouragement.
Before answering the above frequently asked questions regarding sleep, we have to understand some basic sleep-science. Typical sleep involves stages including slow-wave sleep (very restful) and REM (dreamland). Most drugs of abuse influence those stages. For instance, alcohol suppresses REM. It also tends to shorten the time needed to fall asleep (sleep ‘latency’) and leads to more early-morning waking. When a person stops drinking, they often have a rebound of those stages: it’s harder to fall asleep and REM (dreamland) is more vivid and expansive.
It is very important for patients to learn effective sleep habits (commonly referred to as ‘sleep hygiene’). This includes avoiding nightly caffeine, keeping the bedroom dark and quiet, avoiding televisions and distracting clocks in the bedroom, and using the bed for only 2 things….
When medications are used to treat insomnia, I avoid any that could be abused or cause strong side effects. The primary goal of early recovery continues to be sobriety, and helping a patient with sleeping improves the ability to cope with this initially trying period of change. We treat insomnia now but trust that the stages of sleep will gradually improve over time as the brain heals.
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