If you have trouble sleeping, the first thing to ask yourself is whether it could be caused by a substance or medication. The most common culprits are caffeine and alcohol; they probably cause more sleepless nights than all other causes combined.
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Caffeine, amphetamines and cocaine increase alertness and delay sleep, while withdrawal from these substances leads to hypersomnia. Alcohol, sedatives and opioids initially have a calming effect, but ultimately lead to a fragmented and spoiled night’s sleep.
Over-the-counter cold pills, diet pills and sleep aids often go unrecognized as causes of insomnia, and antihistamines can put you to sleep at the wheel.
Antidepressants can also often influence sleep in both directions (insomnia or hypersomnia) depending on the type of medication and individual differences in the way one responds to it. For example, the SSRIs (Prozac, Zoloft and Fevarin) are usually stimulant so you would expect them to cause insomnia, and yet some people respond to them with drowsiness and hypersomnia. Most illegal drugs disrupt normal sleep patterns, often in significant ways.
Sometimes it is difficult to determine which came first, the sleeping problem or the associated sleeping pill use. In a common scenario, it starts with you taking a sleep aid or nightcap for insomnia. However, after a while you become physiologically dependent on the aid and your insomnia becomes worse and more persistent than ever before.
Diagnosis according to DSM IV According to the diagnostic manual, you have a substance-related sleep disorder if the following occurs:
- You have trouble falling asleep or staying asleep, sleep too much, or feel sleepy during the day.
- Your sleep problem is due to alcohol intake, excessive use of a substance (such as caffeine, cocaphne or amphetamines), abstinence from a substance you have used for a long time (such as sleeping tablets) or the side effects of a medication you are taking.
- Your sleep problem is serious enough to interfere with your normal daily functioning.
