Now About Sleep
It’s very common to have sleep problems in early recovery, and it is also very common for people with addiction to have had sleep problems all their lives. This has less to do with the past drug use than it does with brain functioning, so I’d like to explain a bit about that and how your doctor can help.
In general, there are two kinds of sleep troubles: trouble falling asleep and trouble staying asleep. Trouble staying asleep is most often a direct result of not having enough dopamine tone in the midbrain. Dopamine is the “I have enough” chemical. Low dopamine is the same signal your body uses to tell you you’re in a famine and in a famine you aren’t supposed to sleep soundly. Someone may come and take your food. So your ability to sleep soundly is a marker your doctor can use to know when the medication prescribed for you has returned your dopamine level to normal. If you take a sleep agent, you’ll mask that marker, and it will be harder for your doctor to know when you’ve reached a good dose of the medication.
Trouble falling asleep in addiction is generally not a night time problem; it’s a problem of the whole day. As we go through the day without vigorous recovery work, we accumulate little things here and there that play on our minds. As we’re busy and keeping ourselves distracted with day to day business, we don’t notice. When our head hits the pillow however, the distraction is gone and all that stuff comes rushing back. So the part of us that is keeping us awake can be thought of as the healthiest part that’s saying, “Hey, don’t go to sleep. We have recovery work left to do.” If you just lie there awake in bed, you’ll be practicing being awake in bed. Remember, you get more of whatever you practice. If you take a sleeping pill, you’re shutting up the healthiest part of you. Sounds like a lose/lose situation. Instead, if you can’t fall asleep in 20 minutes or so, get out of bed, sit in a chair, and read the Big Book, Alcoholics Anonymous. Don’t read in bed, don’t read a novel or a magazine. One of two things will happen. You’ll either get tired and go to sleep – you win. Or you’ll get good recovery work done – you win. You may stay up all night reading the Big Book. I’ve given this advice to hundreds of patients and not one (who didn’t nap the next day) has ever told me he didn’t sleep the next night.
Of course there are other causes of not sleeping besides addiction. Some are medical and associated with the brain and some are medical and not associated with the brain. Also, the normal human trauma response disrupts sleep and will generally pass in a few weeks if there are no reasons for it to become chronic. A chronic trauma response is pretty common in people with addiction so it’s a big one to keep in mind. In general, the key is that not sleeping is a symptom, and the principle is not to treat the symptom but find and resolve the underlying disorder.