Sleep Problems and Substance Use: When Insomnia Drives Substance Use, and Substance Use Makes Sleep Worse

Written by the medical team at Day One Rehabilitation Center, Nakhon Nayok, Thailand · Medically reviewed by Dr. Pichayut Kasemphakdeephong (Psychiatrist)

Insomnia, restless sleep, waking up in the middle of the night, nightmares, sleeping through the day but staying awake at night, or needing alcohol, cannabis, or medication to fall asleep are common problems in people who use substances — and are sometimes one of the main reasons someone isn’t ready to stop using.

Some people start by drinking alcohol before bed because it seems to make falling asleep easier. Some use cannabis to quiet their thoughts. Some use sleeping pills or anti-anxiety medication continuously because they’re afraid they won’t be able to sleep, while people who use yaba or crystal meth may go without sleep for long stretches while using, then sleep excessively once the drug wears off.

As this repeats, the person may start to believe that “without the substance, I can’t sleep,” and the fear of not being able to sleep itself becomes a reason to use again.

Sleep problems shouldn’t be treated as a minor issue in addiction treatment, because insufficient sleep affects mood, concentration, decision-making, and self-control. At the same time, insomnia after stopping a substance can become a major trigger for relapse. Treatment therefore needs to look at sleep, the type of substance, withdrawal, and any underlying mental health problem all together.

What Kinds of Sleep Problems Are Seen Alongside Substance Use?

Sleep problems aren’t limited to insomnia. Each person who uses substances may show a different pattern, depending on the type of substance, when it’s used, and any co-occurring psychiatric conditions.

Signs a family may notice include:

Taking a long time to fall asleep
Waking frequently during the night and struggling to fall back asleep
Waking earlier than usual despite not having had enough sleep
Sleeping so much during the day that they can’t sleep at night
Bedtime and wake time constantly shifting
Going without sleep for one or several nights while using
Sleeping abnormally long after stopping a stimulant
Nightmares or waking up feeling anxious
Needing to drink or use before bed to feel able to fall asleep
Increasing the amount of alcohol, medication, or substance used to help sleep
Waking up feeling unrested even after apparently sleeping for many hours
Irritability, poor concentration, or mood changes after insufficient sleep

Having a sleep problem doesn’t always mean it’s caused by the substance. Stress, depression, anxiety disorder, PTSD, bipolar disorder, ADHD, and certain physical conditions can also disrupt sleep.

The important thing is to determine whether the symptoms began before or after substance use, and how sleep changes while the substance is active, once it wears off, and after stopping altogether.

How Do Yaba, Crystal Meth, Alcohol, Cannabis, and Other Substances Affect Sleep?

Each substance affects sleep differently, and “using it makes me fall asleep” doesn’t mean that substance is properly solving a sleep problem.

Yaba and Crystal Meth

Yaba and crystal meth are stimulants. People who use them may feel alert, energetic, and not sleepy, allowing them to go without sleep for far longer than usual.

With continued use, this sleep deprivation can worsen concentration, decision-making, and emotional control. Some people become irritable, anxious, or paranoid. Heavy use combined with prolonged sleep deprivation can lead to hallucinations or other psychotic symptoms.

After stopping a stimulant, some people instead sleep a great deal, feel exhausted, have no energy, and experience low mood in the initial period. After that, sleep patterns may still not return to normal right away.

Families shouldn’t expect sleep to return to normal in just one night after stopping yaba or crystal meth. Recovery takes time and other symptoms should be monitored as well.

Alcohol

Many people feel that alcohol makes them drowsy and helps them fall asleep quickly, so they start using it as a “sleep aid.” But drowsiness from alcohol isn’t the same as quality sleep.

With regular use, the body can become accustomed to alcohol’s effects, requiring larger amounts to get the same feeling. Sleep can become fragmented, with waking during the night, or the person may feel unrested the next day.

The key concern is that if continued drinking leads to dependence, cutting down or stopping suddenly can cause insomnia, anxiety, tremors, sweating, and restlessness — and in severe cases, complications that require medical care.

So someone who drinks heavily on a regular basis and says “I can’t sleep without drinking” should be evaluated for dependence and withdrawal risk. This shouldn’t be solved by stopping alone without a safety assessment.

Cannabis

Some people use cannabis because it makes them feel relaxed or drowsy. But with continued use, the relationship between cannabis and sleep can become more complicated.

Someone who uses regularly and then stops may experience insomnia, vivid dreams, irritability, restlessness, or a craving to use cannabis again. They may then interpret this as “cannabis treats my insomnia,” when in fact some of these symptoms may simply reflect the body readjusting after stopping cannabis.

If someone needs to use cannabis every single night to feel able to sleep, they should be evaluated for possible dependence — not just judged by how many hours of sleep they’re getting.

Certain Sleeping Pills and Anti-Anxiety Medications

Some medications have real medical benefit when used as clinically indicated and under a doctor’s care. But certain sleeping pills or anti-anxiety medications can lead to dependence if used continuously or inappropriately.

Once the body becomes accustomed to the medication, the person may feel they need it in order to sleep at all, and some increase the dose on their own once it stops feeling as effective as before.

Stopping certain medications suddenly after continuous use can carry risk, so doses shouldn’t be adjusted or reduced without a doctor’s guidance.

Why Does Insomnia Make Relapse So Easy?

For someone trying to quit, insomnia can be one of the most discouraging symptoms. Even with a genuine intention to stop, going several nights without sleep can lead to thinking, “If I just use once, at least I’ll get to sleep tonight.”

For some people, the substance has long been part of a bedtime routine — coming home, showering, drinking, then sleeping, or using cannabis every night before bed. When the substance stops, it isn’t just the drug’s effect that disappears — the entire routine disappears with it.

Another group of people doesn’t use the substance directly for sleep, but has an underlying problem that prevents sleep — anxiety, racing thoughts, nightmares from trauma, depression, or work stress. Until these problems are treated, the person may go back to the substance because it feels like the fastest way to fall asleep or quiet their mind.

A pattern can develop where stress and insomnia lead to using a substance to help sleep. With continued use, natural sleep becomes disrupted, so trying to stop makes falling asleep even harder at first, and the misery of insomnia becomes a reason to use again.

Relapse prevention therefore needs a plan for coping with sleepless nights specifically — not just cravings that occur during the day.

Is Insomnia From the Substance, or Is There a Co-Occurring Psychiatric Condition? How Can You Tell?

Sleep problems appear in many kinds of psychiatric conditions, so assessment needs to consider other symptoms as well.

Someone with depression may have insomnia, wake too early, or in some cases sleep more than usual, along with low mood, losing interest in things they used to enjoy, low energy, and feelings of hopelessness.

Someone with an anxiety disorder may struggle to fall asleep because of racing thoughts or worry about various things, while someone with PTSD may fear sleep itself because of nightmares, waking up startled, or feeling unsafe at night.

Another condition that must be carefully distinguished is bipolar disorder — especially if someone clearly needs much less sleep but doesn’t feel tired, has a lot of energy, talks fast, has racing thoughts, feels unusually confident, spends money excessively, or engages in risky behavior. This kind of reduced sleep is different from wanting to sleep but being unable to, and should be evaluated by a psychiatrist.

Yaba, crystal meth, and other stimulants can cause similar-looking symptoms, so it’s important to determine whether the change started before or after substance use.

If the sleep problem was present before substance use began, there may be an underlying sleep disorder or pre-existing mental health condition. If it began after use, or became clearer during withdrawal, the effects of the substance also need to be assessed. In some people, both problems occur together.

How Is a Sleep Problem Treated When It Co-Occurs With Addiction?

Appropriate treatment doesn’t mean giving everyone a sleeping pill. It first requires finding out what’s disrupting sleep and what role the substance is playing.

Assessing the Type of Substance and the Risk of Withdrawal

It’s necessary to know which substance is being used, how often, when it was last used, and whether multiple substances are being used together.

Especially for someone who drinks alcohol or uses certain depressants continuously, insomnia after stopping may be part of withdrawal, with other symptoms potentially following, so a medical evaluation is needed.

This shouldn’t be solved by drinking more, taking more medication, or buying medication to self-treat, as this can lead to dependence or the risks of combining multiple substances.

Restoring a Regular Sleep Schedule

After long-term substance use, sleep and wake times can become disordered. Recovery therefore requires consistently building a new routine.

This means trying to wake up at roughly the same time every day, reducing overly long daytime naps, getting light exposure and staying active during the day, cutting back on caffeine close to bedtime, and building a bedtime routine that doesn’t involve any substance.

These changes may not improve sleep on the very first night, but consistency helps the body gradually relearn its natural sleep rhythm.

Addressing the Thoughts and Behaviors That Keep Insomnia Going

Some people, fearing they won’t be able to sleep, try even harder to force themselves to fall asleep. When it doesn’t work, they start worrying, “I definitely won’t be able to work tomorrow” or “Tonight is going to be terrible again,” which only makes the body more alert.

Therapy can help adjust both the thoughts and behaviors that keep insomnia going — such as spending long periods in bed doing other activities, sleeping to “make up” for lost sleep at irregular times, or relying on a substance every time the person thinks they won’t be able to sleep.

For someone with an addiction, sleep treatment must be connected to relapse prevention, because sleepless nights can be exactly when cravings to use again spike.

Treating the Mental Health Condition That’s Preventing Sleep

If insomnia comes from depression, an anxiety disorder, PTSD, bipolar disorder, or psychotic symptoms, treating sleep alone may not be enough.

A psychiatrist needs to assess the underlying condition and consider medication as clinically indicated. Especially for someone with a history of addiction, medication choices should also account for the risk of dependence and misuse.

The goal, then, isn’t simply to make someone “sleep because of medication,” but to treat the underlying cause of the insomnia so the person can sleep again without relying on a substance as their main solution.

How Should Families Help When the Person Says They Can’t Sleep Without the Substance?

The statement “I can’t sleep if I don’t use” shouldn’t be dismissed as just an excuse, because in someone who has used continuously, insomnia after cutting down or stopping is a genuine phenomenon.

That said, acknowledging that they genuinely can’t sleep doesn’t mean the family should help find them the substance or medication to keep using.

A family might respond, “I understand you can’t sleep right now and that it’s miserable, but if you need to use every single night just to fall asleep, I want us to find a safer way to treat this and figure out why you can’t sleep.”

Families can help by noting useful information — what time the person goes to sleep and wakes up, whether they nap during the day, when they use the substance, and how mood changes after using or stopping.

Families shouldn’t buy sleeping pills or anti-anxiety medication to give them, and shouldn’t share medication belonging to another family member, as this can interact with the substances they’re already using or increase the risk of dependence.

If the person hasn’t slept for several nights and shows paranoia, hallucinations, confusion, abnormal behavior, or unusually high energy without feeling tired, they should be evaluated urgently.

If there is severe withdrawal, seizures, severe confusion, severe psychotic symptoms, or thoughts or behaviors of harming oneself or others, urgent medical evaluation is needed.

When Sleep Problems Co-Occur With Substance Use, Where Should You Start Seeking Help?

If the main problem is insomnia, nightmares, or an irregular sleep schedule, and alcohol, cannabis, or other substances are only used occasionally without a clear pattern of addiction — or if the person isn’t ready for treatment yet and the family wants guidance first — a good place to start is a consultation at Piti Clinic, our outpatient mental-health clinic in Bangkok (Pradiphat Road, Saphan Khwai), to assess the sleep problem, mental health, and the relationship between symptoms and substance use, and to help the family plan how to talk with the person and encourage them into appropriate treatment.

But if the person needs to drink or use almost every night just to sleep, is using in increasing amounts or frequency, can’t control their use, has tried to stop and relapsed repeatedly, has withdrawal symptoms, or if use is affecting mood, work, finances, and relationships, this is likely no longer just a sleep issue — it should be seriously evaluated and treated as an addiction.

Especially when insomnia has become the main reason for every relapse, residential treatment can help someone get through the early period of stopping under supervision, while restoring sleep and assessing any co-occurring psychiatric conditions.

Restoring Sleep and Treating Addiction at Day One Rehabilitation Center

For those with addiction alongside disrupted sleep, Day One Rehabilitation Center focuses on assessing whether the sleep problem existed before substance use, was caused by the substance, occurred during withdrawal, or has another co-occurring psychiatric condition as a contributing cause.

Residential treatment reduces access to substances and allows sleep, wake, meal, and daily activity routines to become more consistent, while monitoring symptoms in the period after stopping use.

A psychiatrist can assess withdrawal risk, sleep problems, and co-occurring psychiatric conditions — such as depression, anxiety disorder, PTSD, bipolar disorder, or psychotic symptoms — and consider medication as appropriate.

Individual therapy helps identify what the insomnia is connected to — stress, racing thoughts, loneliness, nightmares, or fear of not being able to sleep — and helps build ways of coping that don’t involve going back to the substance.

At the same time, relapse prevention needs to prepare for situations where sleep may worsen again after returning home, because having an occasional bad night of sleep doesn’t mean recovery has failed, and doesn’t mean the person needs to immediately go back to the substance to fix it.

Patients should know what to do if they start having ongoing sleep trouble again, who to contact, and what signs mean they should see a doctor — especially if they start sleeping very little alongside a clear change in mood or behavior.

The goal, then, isn’t just to help someone sleep while they’re at the center — it’s to help sleep become a stable part of everyday life again, and to stop it from being a reason to go back to depending on a substance.

Frequently Asked Questions About Sleep Problems and Substance Use

Can alcohol help with sleep?

Alcohol may make someone drowsy and help them fall asleep faster at first, but it can disrupt sleep quality and continuity. If someone needs to drink regularly to sleep, both the sleep problem and their drinking pattern should be assessed.

Can cannabis treat insomnia?

Cannabis shouldn’t be used to self-treat insomnia, especially if it starts being needed every night or in increasing amounts. Someone who uses regularly and then stops may experience insomnia or vivid dreams for a period, so it’s worth assessing whether dependence is also present.

Why does someone sleep so much after quitting yaba?

After stopping a stimulant, some people feel very exhausted, have no energy, experience low mood, and sleep more than usual at first, because the body is adjusting after a period of stimulation and possible accumulated sleep debt. If symptoms are severe, or if there are thoughts or behaviors of self-harm, an evaluation is needed.

Why does insomnia get worse after quitting a substance?

Certain substances cause the body to adapt, so stopping them can cause temporary insomnia. In addition, problems the substance had been masking — such as anxiety or nightmares — may become clearer again. Insomnia after stopping a substance should therefore be managed with care, not used as a reason to go back to using.

After several sleepless nights, when should you be concerned?

If continued sleeplessness is accompanied by confusion, paranoia, hallucinations, dramatic behavior changes, or unusually high energy without feeling tired, an urgent evaluation is needed — especially with a history of stimulant use or a psychiatric condition.

If insomnia follows stopping alcohol, is it okay to drink a little to help sleep?

Alcohol shouldn’t be used to self-treat withdrawal. If someone who drinks heavily or continuously experiences insomnia, tremors, sweating, anxiety, or restlessness after cutting down or stopping, they should be evaluated for withdrawal risk by medical staff.

Is it okay to buy sleeping pills to self-medicate after quitting drugs?

Medications shouldn’t be bought and taken without guidance, or borrowed from someone else. Certain sleeping pills and anti-anxiety medications carry a risk of dependence and can be dangerous when combined with alcohol or other substances. Medication choices should go through a doctor’s evaluation.

Can insomnia lead to relapse?

Yes, sleep problems can be a major trigger for relapse, especially for someone who used to rely on the substance to help them sleep. Managing sleep is therefore part of relapse prevention.

Which should be treated first — insomnia or the addiction?

They should be treated together. If there is intoxication or withdrawal risk, safety must be addressed first. After that, restoring sleep should happen alongside treating the addiction and assessing any psychiatric condition that may be causing the insomnia.

Do sleep problems combined with substance use always require going to a treatment center?

Not for everyone. If the sleep problem is the main issue and substance use is only occasional without a clear pattern of addiction, a mental health and sleep evaluation can be a starting point. But if the person needs to rely on the substance regularly to sleep, can’t control their use, keeps increasing the amount, stops and relapses repeatedly, or has withdrawal symptoms, residential addiction treatment at Day One Rehabilitation Center should be seriously considered.

Better Sleep Is Part of Recovery From Addiction

Insomnia can be both a starting point and a consequence of substance use. Some people start using because they want to sleep, but with continued use, they end up depending on the substance more and more, and when they try to stop, sleep gets worse at first — leaving them feeling as if they have no way to sleep without it.

This feeling can change. Restoring sleep may take time, especially after long-term continuous use. What matters is not trying to solve the problem by increasing the substance or switching to self-medicating with another drug.

If depression, an anxiety disorder, PTSD, bipolar disorder, or another mental health condition is present underneath, that cause must be treated as well. And if insomnia has become a trigger for relapse, sleep should be explicitly built into the relapse-prevention plan.

The goal of treatment, then, isn’t just helping someone sleep tonight — it’s helping the body and mind gradually regain a stable sleep rhythm, get through a bad night’s sleep without going back to the substance, and use quality sleep as part of long-term life recovery.