Editing Insomnia (section)

=== Substance-induced ===

==== Alcohol-induced ====

{{Main|Alcohol use and sleep}}

Alcohol is often used as a form of self-treatment for insomnia to induce sleep. However, alcohol use to induce sleep can be a cause of insomnia. [[Long-term use of alcohol]] is associated with a decrease in [[NREM]] stage 3 and 4 sleep as well as suppression of [[REM sleep]] and REM sleep fragmentation. Frequent moving between sleep stages occurs with awakenings due to headaches, [[polyuria|the need to urinate]], [[dehydration]], and [[diaphoresis|excessive sweating]]. [[Glutamine]] rebound also plays a role when someone is drinking; alcohol inhibits glutamine, one of the body's natural stimulants. When the person stops drinking, the body tries to make up for lost time by producing more glutamine than it needs.

The increase in glutamine levels stimulates the brain while the drinker is trying to sleep, keeping them from reaching the deepest levels of sleep.<ref>{{cite web | vauthors = Perry L | date = 12 October 2004 | url = http://health.howstuffworks.com/hangover5.htm | work = HowStuffWorks | title = How Hangovers Work | archive-url = https://web.archive.org/web/20100315050850/http://health.howstuffworks.com/hangover5.htm | archive-date = 15 March 2010 | access-date = 20 November 2011 }}</ref> Stopping chronic alcohol use can also lead to severe insomnia with vivid dreams. During withdrawal, REM sleep is typically exaggerated as part of a [[rebound effect]].<ref name="sleep_medicine_a04">{{Cite book | vauthors = Lee-chiong T |title=Sleep Medicine: Essentials and Review |date=24 April 2008 |publisher=Oxford University Press|url=https://books.google.com/books?id=s1F_DEbRNMcC&pg=PT105 |isbn=978-0-19-530659-0 |page=105 }}</ref>

====Caffeine====

Some people experience sleep disruption or anxiety if they consume caffeine.<ref>{{cite journal | vauthors = O'Callaghan F, Muurlink O, Reid N | title = Effects of caffeine on sleep quality and daytime functioning | journal = Risk Management and Healthcare Policy | volume = 11 | pages = 263–271 | date = 7 December 2018 | pmid = 30573997 | pmc = 6292246 | doi = 10.2147/RMHP.S156404 | doi-access = free | title-link = doi }}</ref> Doses as low as 100&nbsp;mg/day, such as a {{cvt|6|oz|g}} cup of coffee or two to three {{cvt|12|oz|g}} servings of caffeinated soft-drink, may continue to cause sleep disruption, among other intolerances. Non-regular caffeine users have the least caffeine tolerance for sleep disruption.<ref name="Caffeinedependence JohnHopkins">{{cite web|url=http://www.caffeinedependence.org/caffeine_dependence.html|title=Information about caffeine dependence|date=9 July 2003|website=Caffeinedependence.org|publisher=Johns Hopkins Medicine|archive-url=https://web.archive.org/web/20120523135807/http://www.caffeinedependence.org/caffeine_dependence.html|archive-date=23 May 2012|url-status=usurped|access-date=25 May 2012}}</ref> Some coffee drinkers develop tolerance to its undesired sleep-disrupting effects, but others apparently do not.<ref name="Fredholm">{{cite journal | vauthors = Fredholm BB, Bättig K, Holmén J, Nehlig A, Zvartau EE | title = Actions of caffeine in the brain with special reference to factors that contribute to its widespread use | journal = Pharmacological Reviews | volume = 51 | issue = 1 | pages = 83–133 | date = March 1999 | doi = 10.1016/S0031-6997(24)01396-6 | pmid = 10049999 }}</ref>

==== Benzodiazepine-induced ====

Like alcohol, [[benzodiazepine]]s, such as [[alprazolam]], [[clonazepam]], [[lorazepam]], and [[diazepam]], are commonly used to treat insomnia in the short-term (both prescribed and self-medicated), but worsen sleep in the long-term. While benzodiazepines can put people to sleep (i.e., inhibit NREM stage 1 and 2 sleep), while asleep, the drugs disrupt [[sleep architecture]]: decreasing sleep time, delaying time to REM sleep, and decreasing deep [[slow-wave sleep]] (the most restorative part of sleep for both energy and mood).<ref>{{cite journal | vauthors = Ashton H | s2cid = 1709063 | title = The diagnosis and management of benzodiazepine dependence | journal = Current Opinion in Psychiatry | volume = 18 | issue = 3 | pages = 249–55 | date = May 2005 | pmid = 16639148 | doi = 10.1097/01.yco.0000165594.60434.84 }}</ref><ref>{{cite journal | vauthors = Morin CM, Bélanger L, Bastien C, Vallières A | title = Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse | journal = Behaviour Research and Therapy | volume = 43 | issue = 1 | pages = 1–14 | date = January 2005 | pmid = 15531349 | doi = 10.1016/j.brat.2003.12.002 }}</ref><ref>{{cite journal | vauthors = Poyares D, Guilleminault C, Ohayon MM, Tufik S | title = Chronic benzodiazepine usage and withdrawal in insomnia patients | journal = Journal of Psychiatric Research | volume = 38 | issue = 3 | pages = 327–34 | date = 1 June 2004 | pmid = 15003439 | doi = 10.1016/j.jpsychires.2003.10.003 }}</ref>

==== Opioid-induced ====
[[Opioid]] medications such as [[hydrocodone]], [[oxycodone]], and [[morphine]] are used for insomnia that is associated with [[pain]] due to their [[analgesic]] properties and [[hypnotic]] effects. Opioids can fragment sleep and decrease [[Rapid eye movement sleep|REM]] and [[Non-rapid eye movement sleep|stage 2]] sleep. By producing [[analgesia]] and [[sedation]], opioids may be appropriate in carefully selected patients with pain-associated insomnia.<ref name="Ramakrishnan-2007" /> However, dependence on opioids can lead to long-term sleep disturbances.<ref>{{Cite journal | vauthors = Asaad TA, Ghanem MH, Samee AM, El-Habiby MM |s2cid=76376646 |title=Sleep Profile in Patients with Chronic Opioid Abuse |doi=10.1097/ADT.0b013e3181fb2847 |journal=Addictive Disorders & Their Treatment |volume=10 |pages=21–28 |year=2011 }}</ref>