Alcohol Detox and Sleep
As anyone who’s been through alcohol detox can attest, sleep problems are one of the largest obstacles to recovery. Not helping matters is the fact that detoxing from alcohol isn’t an overnight process. It takes time for your body to adjust to living without alcohol, and you’ll experience sleep problems during that time.
By the end of this guide, you’ll understand how alcohol disrupts sleep, what causes sleep problems during detox, and coping tips so you can sleep better during this tough time, and stick it through to the end.
How alcohol disrupts sleep
Alcohol is a depressant, so it does make you drowsy. However, that drowsiness doesn’t mean you sleep well. When you fall asleep after a night of drinking, you’re more prone to nightmares, enuresis (urination during sleep), and night sweats. Alcohol also causes your throat muscles to relax and collapse into your airways, causing snoring and its more serious cousin, sleep apnea.
Alcohol further interrupts your sleep cycle by wreaking havoc on your core body temperature. Thermoregulation plays a critical role in helping you sleep. Your body temperature falls in the evening, kicking off melatonin production. It reaches its lowest point in the middle of the night before rising again in the morning to greet the day.
Part of the reason why alcohol makes you drowsy is that because it causes your core body temperature to drop. However, as you sleep, the alcohol makes it way through your system, and your body responds by raising your core body temperature. As a result, you wake up earlier than ideal and before you’ve sufficiently had enough sleep.
Worse, the sleep experienced by chronic alcohol consumption isn’t high-quality. Chronic alcohol abuse changes your sleep architecture and the way your nervous system functions. Specifically, it affects your GABA receptors and reduces your melatonin levels. Brain scans of alcoholics show that they have more alpha and delta brain waves than non-alcoholic, healthy sleepers, and that they spend less time in REM sleep, the stage of sleep critical for memory consolidation.
These problems with sleep efficiency and architecture persist throughout recovery.
Detox timeline and symptoms
Alcohol is a depressant. It slows down the way your brain functions. In alcoholics, your brain and nervous system learn to adjust to the chronic presence of alcohol, working harder to keep your brain awake (instead of depressed) and keeping your neurotransmitters firing as they should be. During withdrawal, your brain remains in this state but without the alcohol it became used to relying on. This causes the uncomfortable symptoms associated with withdrawal.
In addition to sleep problems, common symptoms of detox include: headache, nausea and vomiting, shakes or tremors, fever, depression and/or anxiety, worsened mood, and irritability.
While symptoms and severity vary by individual, detox generally follows this timeline:
- Detox symptoms begin 8 hours after the last drink.
- Symptoms peak 1 to 3 days later.
- Between 5 days to a week later, symptoms decrease in severity and some may go away entirely.
- In the following weeks to months, symptoms continue to decrease in severity.
In the medical community, detox is split into two main time periods: acute withdrawal describes the first week or so (the first three bullet points above), while post-acute withdrawal describes the final bullet.
One disturbing symptom of acute alcohol withdrawal is delirium tremens (DTs). DTs take place in the 2 to 3 days after your last drink, and include fever, hallucinations, heavy sweats, increased blood pressure and heart rate. It affects about 5% of those in withdrawal.
Sleep problems are experienced throughout both acute and post-acute withdrawal, but insomnia is one of the more challenging symptoms of the post-acute withdrawal period. Post-acute withdrawal syndrome (PAWS) can last up to a year. Individuals have trouble sleeping and experience prolonged effects of sleep deprivation, such as difficulty focusing, increased irritability, and weakened reflexes.
Sleep problems during alcohol detox
Unfortunately, some of the sleep problems experienced during detox are more acutely uncomfortable because you have one less coping mechanism: drinking alcohol.
In fact, many people with alcohol addiction originally turned to alcohol as a way to help them fall asleep. Some estimates put the number as high as 60 percent. Over time, they become so dependent on alcohol that they can’t sleep without it. You can imagine how this affect is only compounded during the detox period.
Their reliance on alcohol isn’t limited to sleep. Alcoholics become used to living with alcohol, and relying on it for mood regulation, pain tolerance, and more. Their lives are run by their addiction. During detox, they’re suddenly left having to figure out how to get by without it. This is especially tough given the physical symptoms of alcohol detox.
Substance abuse like alcohol addiction interferes with your brain’s normal production of dopamine, the happy neurotransmitter that helps your brain regulate your mood and tolerance for pain. It takes weeks for your dopamine levels to return to normal during detox. In the meantime, your brain feels more stressed, more pained, and less happy during detox.
It’s no wonder detox is associated with a host of self-defeating thoughts, anxieties and worries that make it difficult to stay motivated to stick to a recovery plan. Unfortunately, anxiety alone can be a trigger for insomnia – the largest sleep problem affecting those in recovery.
Alcohol detox and insomnia
Alcoholics in recovery are 5 times likelier to experience insomnia than the general population, with three-quarters experiencing it during detox. Sleep-onset insomnia is particularly common, although it’s typical for those in detox to regularly experience both forms of insomnia.
Sleep-onset insomnia describes a difficulty staying asleep, while sleep-maintenance insomnia refers to trouble staying asleep, frequent awakenings during the night, and/or difficulty returning back to sleep.
Insomnia compounds the unique challenges of detox. Without enough sleep, we have a tough time regulating our mood. We feel worse, physically, mentally, and emotionally. We have a difficult time focusing during the day. The sleep deprivation caused by insomnia also negatively impacts our judgment and decision-making, which can lead some to mistakenly believe they were better off with their addiction. Recovering alcoholics with insomnia are twice as likely to relapse as those who are sleeping well.
Insomnia is one of the biggest predictors of relapse. That’s why it’s part of the HALT acronym popularized by the Alcoholics Anonymous community (Hungry, Angry, Lonely, or Tired are all conditions that increase one’s risk for relapse).
Other common sleep problems during detox include:
- Hypersomnia (oversleeping without feeling restored)
- Frequent nightmares or especially disturbing dreams
- Daytime fatigue
During detox, many recovering alcoholics experience less nREM sleep, including deep sleep, the stage of sleep critical for muscle and tissue repair and recovery. This explains why so many recovering alcoholics report waking up feeling unrefreshed.
Depending on the individual, sleep problems can last up to years during detox. There is some good news, though – once the sleep problems go away, it’s a sign you’ve fully detoxed.
How to get better sleep during alcohol detox
Sleeping better is critical to a successful recovery. Experts recommend including sleep as part of the treatment plan, as better sleep makes the other aspects of detox easier to manage. For example, one study showed that successful treatment of insomnia both improved sleep and symptoms of depression in those with comorbid alcoholism.
However, given the individual’s tendency for addiction, clinicians may advise to avoid sedatives or other medication. In that case, the following behavioral tips can improve sleep during detox.
- Set and follow a consistent sleep schedule. Go to bed and wake up at the same time every day. You want to train your mind to associate those times of day as times to sleep or wake, respectively.
- Establish a bedtime routine that relaxes you, mind, body, and soul. Like with your sleep schedule, the key is to follow the same set of activities each night, so your brain learns to recognize this routine as the precursor to sleep. Options include brushing your teeth, turning off electronics, practicing aromatherapy or meditation, reading a book, or performing deep breathing or muscle relaxation exercises. Progressive muscle relaxation therapy in particular has shown to be helpful for recovering alcoholics.
- Turn off all electronics in the hour before bed. Your eyes are especially sensitive to the blue light in these devices, so using them tricks your brain into thinking it’s daytime, keeping you alert when you want to fall asleep.
- Eat well. A healthy diet makes you feel better overall, but it also improves sleep. Heavy meals late at night, especially ones made of overly fatty or sugary foods, can upset your stomach so it’s more difficult to sleep. Stay hydrated with lots of water. Avoid caffeine (from coffee, tea, or other food and drink), especially after the early afternoon.
- Exercise regularly. Exercise helps tire the body so sleep comes easier at night. Just be sure to exercise during the daytime – ideally in the morning, but no later than the late afternoon. Otherwise, you’ll feel so energized your body will have a tough time falling asleep at night.
- Use a diary. Troublesome thoughts are barriers to sleep and recovery. Instead of letting them spin you into a downward spiral as you lie awake at night, get them out of your head and into a journal. Writing down your worries will help you feel more in control.
- Consider cognitive behavioral therapy for insomnia (CBT-I). CBT-I is the most effective treatment for insomnia. Therapists work with patients over a short period, usually 6 sessions or so. Sessions focus on helping the patient recognize the problematic thoughts and behaviors that contribute to their insomnia, such as the anxieties common to detox. Once the patient understands how they’re blocking themselves from sleep, they can stop those thoughts and behaviors in their tracks and replace them with healthier reactions that promote rather than inhibit sleep.
- Bright light therapy is another option. Individuals sit in front of an artificial light device that mimics that brightness of natural sunlight. Light therapy practiced in the early morning helps reset the sleep-wake cycle. In one study, it reduced sleep onset and improved overall sleep quality for those in acute alcohol withdrawal.
- Lean on friends, family, and peers for support. Having a support system of people who love and care about you will help you stay motivated in times when it gets tough – and it will. Being around loved ones lifts mood. Spend time with them and ask them to call and check in on you. Ask others for help sticking to your recovery plan and sleep schedule.
- The SAMHSA National Helpline is a 24/7 free and confidential helpline that refers individuals and their loved ones to local treatment centers and support groups. Individuals can call (800) 662-4357 for help in English or Spanish. The website also includes helpful resources about what to expect during detox.
- Additional options for locating treatment facilities and support groups include the SAMHSA online directory, the NIAAA Alcohol Treatment Navigator, Recovery.org, Addiction Resource, and Alcoholics Anonymous.
- Connect with others going through what you’re going through, or who have successfully overcome their addiction, on online forums such as the Recovery.org forums, Alcoholism and StopDrinking subreddits, DrugAbuse.com Detox and Withdrawal forums, Patient.info Alcohol Consumption forum, and SoberRecovery.com.