How Insomnia Happens With Recovering Alcoholics

Tired woman taking a nap in a cafe
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Many people with alcohol use disorders also have sleep problems. They may fall asleep easily, but excessive alcohol use disrupts their sleep during the latter part of the night.

If you drink to excess, even occasionally, you have probably experienced sleep problems. "Three or more drinks will cause the average person to fall asleep sooner than usual," says Shawn R. Currie, of the University of Calgary. "However, falling asleep faster is the only real benefit of alcohol for sleep."

What you may not know is if you quit drinking and remain sober you can have significant sleep problems long after you stop drinking.

Most heavy drinkers who quit drinking find it difficult to sleep during the early days of sobriety; it is one of the most common alcohol withdrawal symptoms and one that causes many to relapse.

Typical Recovery Sleep Problems

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 25% to 72% of people with alcohol use disorders report sleep troubles. The more prevalent, disruptive effects include more frequent awakenings, worse sleep quality, reduction of deep sleep, and earlier-than-usual waking times, leading people to feel they did not get enough sleep."

Studies have found that:

  • Sleep problems can last for many months after quitting drinking.
  • Recovering alcoholics typically have more problems with sleep onset than with sleep maintenance.
  • Many recovering alcoholics had sleep problems that predate their alcohol dependence.

Research also shows that sleep disruption can last long after alcohol withdrawal symptoms cease. They may continue to occur in the two to six months of abstinence following withdrawal. Currie notes that recovery and abstinence are more challenging if you aren't able to get enough good-quality sleep.

Non-Restorative Sleep

People in alcohol recovery take a long time to fall asleep, have problems sleeping through the night, and feel that their sleep is not restorative.

Lab studies show reductions in deep sleep and abnormalities in REM sleep in persons with more than a year of sobriety.

"Sleep has a reputation among the recovering community of being one of the last things that fall back into place for an individual," says David Hodgins, professor of psychology at the University of Calgary. "It's also recognized as a potential precipitant of relapse.

Within the 12-step community, there's a little saying that describes the risk factors for relapse; it's called HALT. People who are Hungry, Angry, Lonely or Tired are at an increased risk of relapse. Certainly, one way a person can be tired is through sleep disruptions."

Insomnia

Researchers found that alcoholics with both short- and long-term abstinence had similarly disturbed sleep after they quit drinking. In general, problems with sleep onset were worse than with sleep maintenance, according to Currie.

"Most insomniacs have a combination of problems getting to sleep and problems staying asleep," he says. "Our results indicate that most recovering alcoholics have both types of insomnia but the onset problem is generally worse."

Types of Insomnia

  • Acute insomnia: Brief period of trouble sleeping, often caused by a stressful life event or experience
  • Chronic insomnia: problems falling or staying sleeping at least three nights per week for three months or longer
  • Comorbid insomnia: occurs with another condition, like depression or anxiety, that also interferes with sleep
  • Onset insomnia: trouble falling asleep
  • Maintenance Insomnia: inability to sleep through the night (wake up and can't fall back to sleep)

Many people experiencing insomnia in recovery also had insomnia before they became dependent on alcohol. Currie notes that chronic insomnia affects 10% to 15% of the general adult population, but half of his study participants had insomnia before became alcohol dependent. "Although we cannot infer any causal connection between insomnia and alcoholism from this data, it is hard to ignore such a high rate of pre-existing sleep problems in the sample," he says.

Treatment for Insomnia

The first treatment for insomnia in recovery is sobriety, and many patients will see improvement. For the specific treatment of insomnia, behavioral therapies are the preferred treatment rather than medications, as they have been shown to be effective and they won't interfere with sobriety.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

The goal of cognitive behavioral therapy for insomnia (CBT-I) is to change sleep habits as well as any misconceptions about sleep and insomnia that may perpetuate sleep difficulties. CBT-I often entails regular, weekly meetings, during which your therapist will give you sleep assessments, work with you to alter problematic sleep behaviors, and ask you to complete a sleep diary at home.

Sleep Restriction

This type of behavioral therapy works to improve your sleep efficiency, or the time you spend asleep divided by the time you spend in bed. The idea behind sleep restriction is that by limiting the amount of time you allow yourself to sleep and stay in bed, you'll increase your desire to sleep (called sleep drive) and sleep less fitfully and more efficiently.

Medication

There are many medications used to treat insomnia, including benzodiazepine and nonbenzodiazepine medications. If you're in recovery, your healthcare provider will need to weigh the risks and benefits of prescribing these medications for insomnia.There are also some relapse prevention medications that can help promote sleep.

Complementary Therapy

Numerous complementary therapies have been used to treat insomnia in people in recovery, including:

Sleep Hygiene

Taking time to fix your sleep hygiene is another way to help prevent or reduce insomnia. This can include the following:

  • Develop a relaxing bedtime routine. Whether you write in a journal, download a meditation app, or wind down with a warm bath, doing something calming prior to lights out will help set the tone for solid slumber.
  • Keep your room dark, cool, and comfortable. Avoid the use of television, cell phones, computers, or e-readers in your bedroom. The blue light from these electronic devices can suppress the body's sleep-inducing hormone melatonin and interfere with your internal body clock. The NSF recommends keeping your room temperatures above 75 degrees Fahrenheit and below 54 degrees Fahrenheit and using light-blocking curtains, shades, or blinds to keep your bedroom dark.
  • Keep a regular sleep/wake schedule. This will enable your body to get used to a certain time schedule and then be ready to sleep when it is time.
  • Avoid napping. Naps decrease your overall amount of sleep debt, making it more difficult to fall asleep again at night at the proper time. 
  • Refrain from stimulants in the evening. Stimulants that disrupt sleep include caffeine (coffee, tea, soft drinks, chocolate) and nicotine. According to a study published in Psychology, Health & Medicine, the average person loses more than one minute of sleep for every cigarette they smoke.
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