Melissa Killeen
Sleep has a potent effect on the addicted brain
There are many tools available to a recovery coach. Information on the importance of sleep is one of them. Sleep is a necessity for everyone, including those in recovery from addiction. In fact, successful recovery and practicing healthy sleep habits are inseparable. Sleep has a potent effect on the addicted brain, proving to be one of the most influential factors in successful recovery.
Dr Ralph Carson, author of The Brain Fix, describes why proper sleep is crucial while recovering from addiction. He explains that for addicts in an inpatient treatment program, it’s paramount that individuals be prepared to accept new concepts, embrace a different lifestyle, and apply their creativity to this recovery challenge. The effectiveness of treatment is compromised if people aren’t getting quality sleep and thus don’t wake up feeling refreshed, responsive, positive, and committed to the hard work of recovery.
Of special interest to those in recovery, sleep impacts the pre-frontal cortex of the brain. Sleep removes neural toxins from the brain, which provides the brain the opportunity to re-organize the information that it has learned. Addiction negatively affects the pre-frontal cortex of the brain, leading to many problems, including compulsivity, impulsivity and most of all, impaired judgment. Strengthening this part of the brain is an essential part of the recovery process and strengthening the pre-frontal cortex involves getting enough sleep to clear out the neural toxins accumulated during the day.
Psychologist Jack Edinger, Ph.D., of the VA Medical Center in Durham, North Carolina, and Professor of Psychiatry and Behavioral Sciences at Duke University, cautions that treating depression usually doesn’t resolve sleep difficulties. From his clinical experience, he has found that most patients with depression should be checked for insomnia and should be examined for specific behaviors and thoughts that may perpetuate the sleep problems. When people develop insomnia, they try to self-regulate or compensate by engaging in activities to help them get more sleep. Maybe they sleep later in the mornings or spend excessive times in bed or nap. These efforts usually appear as depression and are not helpful in resolving insomnia.
According to sleep researchers, a night’s sleep is divided into five continually shifting stages, defined by the types of brain waves that reflect either lighter or deeper sleep. Toward morning, there is an increase in rapid eye movement, or REM sleep, when the muscles are relaxed and dreaming occurs, and recent memories may be consolidated in the brain. Experts say that hitting a snooze alarm over and over again to wake up is not the best way to feel rested. “The restorative value of rest is diminished, especially when the increments are short,” says psychologist Edward Stepanski, Ph.D. who has studied sleep fragmentation at the Rush University Medical Center in Chicago. This on-and-off-again effect of dozing and waking causes shifts in the brain-wave patterns. Sleep-deprived snooze-button addicts are likely to shorten their quota of REM sleep, impairing their mental functioning during the day.
Cognitive behavioral therapy and sleeping
From his clinical Cognitive Behavioral Therapy (CBT) work and research on sleep, psychologist Charles M. Morin, Ph.D., a Professor in the Psychology Department and Director of the Sleep Disorders Center at University Laval in Quebec, Canada, says that ten percent of adults suffer from chronic insomnia. In a National Sleep Foundation study released in the recent issue of the Sleep Medicine Alert, Morin outlines how CBT helps people overcome insomnia. Clinicians use sleep diaries to get an accurate picture of someone’s sleep patterns. Bedtime, waking time, time to fall asleep, number and durations of awakening, actual sleep time and quality of sleep are documented by the person suffering from insomnia.
A person can develop poor sleep habits like using their smart phone, tablet or laptop in bed, watching Jimmy Fallon in order to go to sleep or eating too much before bedtime. Many times they may compensate by sleeping late the day after a bout of insomnia, or taking a long nap during the day to compensate for the lost sleep. Some develop a fear of not sleeping and a pattern of worrying about the consequences of not sleeping, which perpetuates the insomnia and can result in a dependence on sleep aids. Cognitive behavioral therapies are essential for patients attempting to alter the conditions that perpetuate insomnia.
CBT attempts to change a person’s dysfunctional beliefs and attitudes about sleep such as letting go of thoughts like, “I’ve got to sleep eight hours tonight” or “I’ve got to take medication to sleep” or “I just can’t function if I don’t sleep.” These thoughts focus too much on sleep, which can be similar to performance anxiety. Sleep has a way of creeping up on you when you are not actively seeking it. Banishing negative thoughts will allow sleep to arrive at your bedroom door.
According to a study published in the October 2004 issue of The Archives of Internal Medicine, cognitive behavior therapy is more effective and lasts longer than the sleeping pill, Ambien. The study involved 63 healthy people with insomnia who were randomly assigned to receive Ambien, cognitive behavior therapy, both or using a placebo. The patients in the therapy group received five 30-minute sessions over six weeks. They were given daily exercises to “recognize, challenge and change stress-inducing thoughts” and were taught techniques like delaying bedtime or getting up to read if they were unable to fall asleep after 20 minutes. The patients taking Ambien were on a full dose for a month and then were weaned off the drug. At three weeks, 44 percent of the patients receiving the therapy and those receiving the combination therapy and pills fell asleep faster compared to 29 percent of the patients taking only the sleeping pills. Two weeks after all the treatment was over, the patients receiving the therapy fell asleep in half the time it took prior to the study, and only 17 percent of the patients taking the sleeping pills fell asleep in half the time.
What works in many cases, is to give a person more control over their sleep. A person can keep a sleep diary for a couple of weeks so a clinician can monitor the amount of time spent in bed to the actual amount of time sleeping. Then the clinician can instruct the patient to either go to bed later or get up earlier or vice versa. A person can also establish more stimulus control over his or her bedroom environment, such as going to bed only when sleepy, getting out of bed when unable to sleep, removal of electronic devices from the bedroom and not smoking or drinking before bedtimes. The same wake-up times every morning (including weekends) and avoiding daytime naps are also good regimes to adopt in thwarting insomnia.
Finally, a person can incorporate relaxation techniques as part of his or her treatment. For example, a person can give herself or himself an extra hour before bed to relax and unwind and time to write down gratitude lists, meditate or use tapping (Emotional Freedom Techniques).
In CBT, said Morin, breaking the thought process and anxiety over sleep is the goal. “After identifying the dysfunctional thought patterns, a clinician can offer alternative interpretations of what is getting the person anxious so a person can think about his or her insomnia in a different way.” Morin offers some techniques to restructure a person’s cognitions. “Keep realistic expectations, don’t blame insomnia for all daytime impairments, do not feel that losing a night’s sleep will bring horrible consequences, do not give too much importance to sleep and finally develop some tolerance to the effects of lost sleep.”
How can I get more sleep?
According to leading sleep researchers, here are some techniques to get more sleep:
• Start a sleep diary to chart your progress
• Keep a regular sleep/wake schedule and develop a regular bedtime (go to bed at the same time on weekends as on weeknights)
• Try and wake up without an alarm clock—get rid of the snooze alarm
• Attempt to go to bed earlier every night for a certain period of time; this will ensure that you’re getting enough sleep
• Give yourself a 60-minute relaxation period before you sleep, meditate, chant, write a gratitude list, complete an eleventh step
• Don’t drink or eat caffeine four to six hours before bed and minimize daytime use
• Don’t smoke, especially near bedtime or if you awake in the night
• Avoid alcohol and heavy meals before sleep, curb night eating
• Get regular exercise
• Minimize noise, light and excessive hot and cold temperatures where you sleep
• Avoid daytime naps, especially after 3pm
• Reading is okay, however make it a non-stimulating choice, romance, murder mysteries and sci-fi thrillers are very stimulating and can inhibit the relaxation portion of your pre-sleep ritual
• Consider taking a hot shower at bedtime, instead of in the morning. Use aromatic soaps that promote sleep such as chamomile and lavender
Dr Ralph Carson writes about the additional impacts of having a pre-frontal cortex that is “shut down” due to poor sleep. He explains: “This can cause you to overreact to negative experiences. Instead of facing your problems like a well-reasoned adult, you’ll be more apt to act moody, inpatient, or irritable.” For those in recovery, these negative mood states can be extremely triggering, increasing the likelihood of relapse.
As previously stated, sleep deprivation inhibits the pre-frontal cortex’s ability to work efficiently, making it more difficult to focus on “what your big goals are.” Addicts who increase the duration of their sleep experience an improved ability to “resist relapse.” Increased sleep makes their brains cleaner and better fueled, helping them remember their goals to remain sober.
If you choose to try a few of these suggestions, please first speak to a medical professional about your lack of sleep or insomnia.
Resources using in compiling this blog:
National Sleep Foundation
http://www.sleepfoundation.org/
American Academy of Sleep Medicine
http://www.aasmnet.org/
American Insomnia Association
http://www.americaninsomniaassociation.org/
Sleep Research Society
http://www.sleepresearchsociety.org/
NIH National Center for Sleep Disorders Research
http://www.nhlbi.nih.gov/sleep
The MayoClinic.com Sleep Center
MayoClinic.com
Ralph Carson (2012) The Brain Fix, Health Communications, Deerfield Beach, Florida, p 214
http://ralphcarson.com/
National Institute of Health (2013) How Sleep Clears the Brain,
http://www.nih.gov/researchmatters/october2013/10282013clear.htm
National Institute of Health (2013), New Brain Cleaning System Discovered:
http://www.nih.gov/researchmatters/september2012/09172012brain.htm
Martica Heaner (2004), Snooze Alarm Takes Its Toll on a Nation, Health Section, New York Times.com, http://www.nytimes.com/2004/10/12/health/12snoo.html
American Psychological Association (2014 ) Why Sleep is so important and what happens when you don’t get enough, http://www.apa.org/topics/sleep/why.aspx
John O’Neil (October 5, 2004) Treatment: Think before You Sleep, New York Times.com, Vital Signs Section, http://www.nytimes.com/2004/10/05/health/05trea.html
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