Sleep Issues and Addiction

Getting a good night's sleep matters, especially for adolescents and young adults. Insomnia and other sleep disorders are linked to increased risk of chronic health conditions such as diabetes and heart disease. Sleep deprivation also affects mental health and can lead to depression and even addiction. In fact, sleep problems may play a role in a young person's susceptibility to using alcohol and drugs in the first place.

Experts at the Hazelden Betty Ford Foundation specialize in the prevention, assessment, and treatment of addiction and co-occurring disorders among adolescents and young adults ages 12-25. Sleep psychologist Mark Rosenblum, PsyD, LP, CBSM, helps adolescent and young adult patients in addiction treatment also recover the sleep they need. Here he discusses the connection between sleep disorders and substance abuse—and the most effective solutions.

Needing More, Getting Less

Teens typically need more sleep than adults do in order to feel alert and refreshed. But too many teens don't get the sleep they need. Estimates of childhood insomnia range from 10 to 30 percent of the population. More specifically, the 2006 Sleep in America poll shows that 30 percent of high school students report having difficulty falling asleep on a regular basis and 20 percent report having difficulty remaining asleep. The inability to get a good night's sleep can be a risk factor for substance abuse, says Rosenblum. "We know that some individuals self-medicate their insomnia with alcohol or other drugs." Sleep disorders and daytime sleepiness are considered by many in the addiction treatment field to be signs of possible substance abuse among teens.

Energizing the Risks

Efforts to offset daytime fatigue—one of the most common consequences of sleep disorders—can lead to misuse of caffeine and other stimulants. Energy drink consumption has skyrocketed in popularity among adolescents and young adults, as have the dangerous consequences associated with use of such stimulants. According to the Drug Abuse Warning Network, the number of emergency department visits involving energy drinks doubled from 2007 to 2011. Among college students, energy drink consumption is linked to increased use, misuse, or abuse of marijuana, alcohol, and prescription drugs. "Further study is needed, but there is a troubling trend. We are seeing that teens who consume energy drinks may also be developing substance abuse issues," notes Rosenblum.

Is it Insomnia?

Effective treatment for a sleep disorder begins with an accurate diagnosis, says Rosenblum. For example, circadian rhythm sleep disorders and other conditions can mimic insomnia symptoms in adolescents. "We have known for some time that teens are at risk for becoming 'night owls' or having what we refer to as circadian rhythm sleep disorders. In these conditions, the internal clock becomes misaligned with the environmental clock," explains Rosenblum. He emphasizes the importance of consulting with an experienced, qualified sleep specialist to ensure an accurate diagnosis and effective treatment.

Sleep Meds—a Last Resort

Given the connection between sleep disorders and substance abuse, Rosenblum recommends behavioral approaches, such as cognitive behavioral therapy for insomnia (CBT-I), as the first line of treatment for insomnia rather than sleep medications, even over-the-counter remedies. Melatonin, often billed as a natural remedy, is one popular over-the-counter sleep aid. Melatonin is a hormone, however, and its effects on the physiological processes of puberty remain largely unknown. Prescription sleep medications are associated with a number of known health risks, including physical side effects, dependency, and increased tolerance. What's more, teens who have been prescribed sleep medications are at greater risk for later misusing the drug to get high or engage in sensation-seeking experiences. As Rosenblum explains, prescription sleep medications are not more effective than CBT-I. "Behavioral treatments are shown to be just as effective and in some cases more effective than sleep medications, without all of the attendant risks."