Insomnia Due to Drug or Substance Abuse and Dependence

Chronic use and cessation of use of most reported substances are associated with significant sleep disturbance. Studies on tobacco and marijuana smokers, cocaine and opiate addiction, and recovering alcoholics all find sleep problems during use and withdrawal. The diagnosis of substance use related insomnia requires that the sleep difficulty be etiologically associated with substance use, but clinically distinct from the acute effects of the substance or symptoms of withdrawal. Indeed, changes in sleep patterns often persist beyond the immediate withdrawal symptoms, suggesting that chronic drug exposure and the development of addiction may interfere with mechanisms involved in sleep regulation. While there is increasing awareness of the protracted sleep difficulty during abstinence, there is scant understanding of the underlying neurophysiology, and treatment options are limited.