RESOLVING THE LEDGER
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Good sleep is crucial to healthy functioning . If we don’t get enough sleep or if it’s of insufficient quality, we often have problems the next day. We may have a harder time concentrating or may feel irritable and sluggish. If sleep problems persist, as they do for up to one in three adults , those individuals are at risk for a range of serious physical and mental health difficulties, including problems with heart and circulatory systems, issues with thinking and memory, as well as respiratory and immune disorders.
A substantial number of Americans turn to cannabis and alcohol to help them fall asleep. Indeed, there are estimates that nearly one in 10 Americans regularly use cannabis for sleep, and many adults report using alcohol in this way. Sadly, these rates are higher for young adults .
While cannabis and alcohol may seem to assist in sleep, these substances offer a cheap trick. While they can initially make a person feel sleepy, they don’t produce the kind of restorative sleep humans need to function well. In fact, researchers warn that regular use not only weakens healthy sleep but increases the risk of dependence.
Philip Gehrman is a psychologist and professor who directs the Sleep Neurobiology and Psychopathology lab at the University of Pennsylvania. I asked him what he thought of the use of these substances for sleep. “As alcohol is metabolized, it is broken down into compounds that disrupt sleep and lead to more wakefulness in the night. So, any benefit at the beginning of the night is not worth the price you pay the rest of the night,” he said. “There is much less research on cannabis, but it has a similar pattern to alcohol. Plus, if you use either alcohol or cannabis as a coping strategy to improve sleep, it increases the chances of becoming dependent on them.”
I also reached out to Lisa Fucito , a professor of psychiatry at Yale and the director of the Tobacco Treatment Service at Smilow Cancer Hospital.“Alcohol, cannabis, and other psychoactive substances do not address the behavioral and cognitive processes that perpetuate insomnia,” she said. “While these substances may provide short-term sedation, their sleep effects tend to diminish with tolerance in as little as a few days and can worsen sleep continuity and quality.” Tolerance can develop within days, and is often followed by rebound sleep disruption in the second half of the night.
As a psychologist, I venture that most people who use substances to sleep are trying to help, not harm, themselves. They are likely not informed about the potential damaging effects of these substances or their ineffectiveness.
The research evidence overwhelmingly supports that cognitive behavioral therapy is a safer, more effective long-term solution for many sleep difficulties, even if it lacks the appeal of a quick fix. This can help address the root cause of behaviors such as spending excessive time in bed awake, maintaining irregular sleep schedules, and conditioned arousal such as worrying about sleep.
Noelle Smith is a psychologist and vice-president of clinical care at Moona Health , which specializes in cognitive behavioral therapy for insomnia via telehealth. “The good news is that insomnia is highly treatable,” she said. Cognitive behavioral therapy teaches skills like establishing a consistent sleep schedule, strengthening the connection between bed and sleep, and changing the unhelpful worries that keep people awake. “The results are more durable than medication and other substances with fewer side effects,” Smith added, “so people see lasting improvement in their ability to fall and stay asleep.”
It’s possible that some of us who are struggling with sleep-related issues may not have the time or money to seek formal services. Fortunately, the U.S. Department of Veterans Affairs National Center for PTSD and the Department of Defense’s National Center for Telehealth and Technology developed free evidence-informed mobile apps that anyone can use alone or in conjunction with their health care provider. These apps can assist in learning effective ways to increase healthy sleep.
To be sure, there are a wide range of sleep complaints and disorders including, but not limited to, insomnia, breathing, and movement disorders. The American Academy of Sleep Medicine launched the Sleep is Good Medicine campaign to increase public education about the importance of sleep and its connection to health. They offer a wealth of resources such as a podcast called Talking Sleep and tips on talking to one’s doctor about sleep.
Given that sleep-related difficulties are so widespread, please know that you are not alone. Effective strategies exist, and using alcohol or cannabis to sleep is counterproductive.
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