Insomnia is a “prevalent and persistent” problem for patients in the early phases of recovery from the disease of addiction — and may lead to an increased risk of relapse.
“Treating sleep disturbance in early recovery may have considerable impact on maintenance of sobriety and quality of life,” said Nicholas Rosenlicht, M.D., of the University of San Francisco.
In a report in the Journal of Addiction Medicine, the researchers cite evidence suggesting that the incidence of insomnia in early recovery may be five times higher than the general population. And it may persist for months to years.
Insomnia may be linked with a higher risk of alcohol-related problems and relapse, the researchers noted. The association may run in the other direction as well — other studies have found that people with sleep disturbances are more likely to be at risk of developing addiction.
Compounding the problem, some people addicted to alcohol drink in the evening as a way to address sleep problems, the researchers reported. But it has the opposite effect: Alcohol is a well-documented cause of sleep disruption with toxic effects on several neurobiological systems, and may contribute to lasting sleep problems even during abstinence, according to the researchers.
So if insomnia contributes to relapse, can treating insomnia reduce that risk?
The evidence is mixed, according to the researchers. They note that some studies have shown that using medication for insomnia during recovery (mainly from addiction with alcohol) can lower the relapse rate.
But medical professionals should be cautious when prescribing medications to address insomnia in the recovering patient, according to the researchers. These patients may be at an increased risk for misuse, abuse, or addiction to sleep medications, or prone to “rebound insomnia” after medications are discontinued, they note.
Most addiction specialists said they’d be reluctant to prescribe any medication to patients with sleep problems, according to one survey.
This belief has made behavioral approaches more widely used to treat patients with insomnia during recovery, according to the researchers. In particular, evidence supports the use of cognitive-behavioral therapy (CBT), they reported.
This approach includes daily sleep diaries and questionnaires to gather information on the patient’s insomnia and progress during treatment, as well as education on sleep and the effects of substances, including “sleep hygiene” practices to promote good sleep, the researchers said.
CBT intervenes by targeting processes that perpetuate insomnia, the researchers explained. Behavioral interventions include sleep restriction, limiting time in bed to the actual amount of time slept, and stimulus control, seeking to strengthen the association between being in bed and sleeping.
Patients also receive cognitive interventions, challenging negative, or catastrophic thoughts about the consequences of insomnia.
“Treatment of insomnia after abstinence represents an important treatment target and an integral part of any recovery plan,” Rosenlicht concluded.
Source: Wolters Kluwer Health