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Drugs of Abuse, Sleep, and Quality of Life

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Sleep and Quality of Life in Clinical Medicine

Summary

Attempting to treat patients who are actively using addictive drugs is unlikely to be helpful and is potentially harmful. Actively using patients should be referred for detoxification before treatment for insomnia is implemented. All drugs of abuse cause insomnia. Although insomnia is most severe during withdrawal, it may be a long-lasting complication of addiction. Cocaine has been shown to provoke “occult” insomnia: degraded sleep accompanied by deteriorated cognitive functioning without the sensation of lack of sleep. This is thought to be caused by a decreased drive for sleep. Insomnia during methadone maintenance is the rule. Because of methadone-provoked central sleep apnea and because of the common lethality of benzodiazepines added to methadone, benzodiazepines are contraindicated during methadone maintenance. Physicians should be sure to include non-medication approaches for insomnia such as sleep hygiene, and if available, acupuncture. If medications are indicated for insomnia, trazodone, low-dose mirtazapine, quetiapine, clonidine, and valproic acid are good choices. Drug dreams are probably provoked by the same mechanism as drug craving: up-regulation of the ventral tegmental dopaminergic seeking system. Attention to drug-seeking during dreams may facilitate recovery.

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Authors
  1. Brian Johnson
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Editors and Affiliations

  1. Section Psychopharmacology Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3508TB, PoBox 80082, Utrecht, The Netherlands

    Joris C. Verster

  2. Divison of Clinical Pharmacology and Experimental Therapeutics Department of Medicine, College of Physicians and Surgeons of Columbia University, 630 West 168th Street - Rm # BB813, New York, NY 10032, USA

    S. R. Pandi-Perumal

  3. Department of Psychiatry, Kunin-Lunenfeld Applied Research Unit (KLARU), 3560 Bathurst St., Toronto, M6A 2E1, Canada

    David L. Streiner

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Johnson, B. (2008). Drugs of Abuse, Sleep, and Quality of Life. In: Verster, J.C., Pandi-Perumal, S.R., Streiner, D.L. (eds) Sleep and Quality of Life in Clinical Medicine. Humana Press. https://doi.org/10.1007/978-1-60327-343-5_35

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  • DOI: https://doi.org/10.1007/978-1-60327-343-5_35

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-60327-340-4

  • Online ISBN: 978-1-60327-343-5

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