Saturday, January 12, 2008

Managing Sleep Without Addictive Medication

When people in recovery complain of sleep problems, how to help without the use of addictive substances, or substances cross tolerant with alcohol? The latter may remind the brain of alcohol and elicit or intensify craving.

1) Sleep Hygiene

No naps. If one will fall to the ground, from being so sleepy, one cannot stand up anymore, one may have a 15 minute nap. This is the most important remedy of sleep hygiene.

Exercise for as much as possible in the afternoon. If one cannot even move, start with a few minutes of low impact activity, walking.

No caffeine after lunch. Try to limit the total to 2 or 3 drinks a day. A drink is 6 oz. coffee, or 8 oz of iced tea or caffeinated soda.

No stressful, agitating activities past 8 PM or 2 hours before sleep.

2) Check for Sleep Problems if Sleep Hygiene Does Not Help


Jerky movements of legs and other body parts. These do not have to fully wake up the person.

Stopping breathing, gasping, or choking.

These require a sleep evaluation and referral to a sleep specialty clinic. Jerky movements respond to Restless Legs Syndrome medication from one's general practitioner. Some increase impulsivity and addictive behavior. The GP should be informed of the history of addiction, and watch for the onset of new addictive behavior.

3) Sleep Hygiene Ineffective; No Formal Sleep Disorder

Melatonin is a hormone, available over the counter. One could try 3 mg, one or two tablets, especially, sublingually. It has a more powerful cousing, ramelteon, about 8 times as potent, used in higher doses.

In females increasing doses of trazodone or mirtazepine may help. Trazodone costs $4 for 30 pills at Walmart. Males may have mirtazapine, but not trazodone without a discussion of priapism risk. Mirtazepine increases appetite, good if someone is too thin, not so good otherwise. Both being anti-depressants, and despite their sedative effects, if the patient feels more agitated (3% of patients will), these should not be used again.

Clonidine, an adult blood pressure medicine, has many uses in addiction. It may help people sleep. Naturally, if one has normal or low blood pressure, a blood pressure pill may cause falls from too low blood pressure.

Quetiapine has sedation as a side effect. It may also quiet racing thoughts at night. Doctors often use it to support sobriety as well.

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