A common expectation in early recovery is that sleep will improve the moment the drinking or drug use stops. For many people, the first weeks bring the opposite: trouble falling asleep, waking through the night, and feeling tired all day.
This article explains why that happens, how long it tends to last, why it matters for recovery, and which treatments have the strongest evidence.
Sleep and substance use affect each other
NIDA describes the relationship as running in both directions. Drug use can lead to sleep problems, and those sleep problems can in turn increase the risk of withdrawal, craving, and relapse. Most substances also alter the body's sleep-wake cycle (NIDA).
NIAAA reports the same pattern with alcohol. Sleep disorders can contribute to the development of alcohol use disorder, and alcohol use disorder can cause sleep disorders. Among people with alcohol use disorder, the prevalence of sleep disorders ranges from 36 to 91 percent (NIAAA).
Alcohol can feel like it helps sleep. NIAAA notes that even moderate doses change the physiology of sleep, for example by reducing rapid eye movement (REM) sleep. Alcohol may also worsen sleep-disordered breathing and limb movements during sleep, which lowers sleep quality (NIAAA).
What the first weeks usually look like
A 2024 review of insomnia in alcohol and opioid use lays out a typical timeline. Insomnia is usually reported in the acute withdrawal phase, about one to two weeks, and in the early recovery phase, about two to eight weeks after detox. In some people it continues into longer-term recovery (Akinnusi et al.).
The same review describes what early-recovery sleep often looks like for people with alcohol use disorder: more broken-up sleep, more frequent shifts between sleep stages, and more awakenings, especially in the second half of the night. Falling asleep may take longer, and less of the time in bed is spent asleep (Akinnusi et al.).
NIAAA notes that these changes may be subacute or chronic, recovering only after 30 or more days of abstinence (NIAAA).
Sleep problems are also common with opioids. The review reports that sleep complaints can persist for months or longer after starting medication for opioid use disorder, and that about three-quarters of patients on buprenorphine, extended-release naltrexone, or methadone experience insomnia (Akinnusi et al.).
Why it matters for recovery
Poor sleep is not only uncomfortable. The 2024 review describes insomnia in early recovery as a risk factor for relapse, and links it with higher risk of depression and suicide (Akinnusi et al.).
That is why sleep belongs in the treatment plan, not as an afterthought. NIAAA notes that an integrated plan might include cognitive behavioral therapy for alcohol use disorder alongside CBT for a co-occurring condition, including sleep disorders (NIAAA).
The treatment with the strongest evidence: CBT-I
Cognitive behavioral therapy for insomnia, or CBT-I, is a structured, talk-based treatment focused on sleep.
The 2024 review summarizes five randomized trials of CBT-I in people with alcohol use disorder and insomnia. Across them, CBT-I improved how quickly people fell asleep, how efficiently they slept, how often they woke, and daytime symptoms such as fatigue. Gains were maintained at three- and six-month follow-ups in the trials that checked. Effects on drinking itself were mixed. The authors note the trials were small and varied, but results consistently favored CBT-I for sleep (Akinnusi et al.).
One of those trials was published in JAMA Psychiatry in 2023. It included 67 veterans in treatment for alcohol use disorder. Those who received five weekly CBT-I sessions had greater reductions in insomnia severity than those who received a single session on sleep hygiene. They also reported fewer alcohol-related problems at follow-up. There was no difference in abstinence or heavy-drinking frequency. The authors concluded that CBT-I should be considered a first-line treatment for insomnia, regardless of abstinence (Miller et al.).
In plain terms, you do not have to wait for a long stretch of sobriety before treating sleep.
A caution about sleep medications
When sleep is poor, it is natural to want a pill. The evidence calls for care here.
NIAAA advises clinicians to avoid as-needed prescriptions of medications with misuse or overdose potential for people with alcohol use disorder. That includes benzodiazepines for sleep, and Z-drugs such as zolpidem (NIAAA). The 2024 review adds that these drugs carry risks of misuse, tolerance, and overdose, and that combining them with opioids can slow breathing (Akinnusi et al.).
This does not mean medication is never used. The review notes it may be considered when daytime problems or distress continue about four weeks after stopping alcohol, with the choice based on safety, other conditions, and relapse risk (Akinnusi et al.). That is a decision for a prescriber who knows your full history.
Other causes worth checking
Not every sleep problem is insomnia. The review notes that conditions such as obstructive sleep apnea and restless legs syndrome are often overlooked in people with substance use disorders. It also cites a meta-analysis that found alcohol use raised the risk of sleep apnea by 25 percent (Akinnusi et al.). Loud snoring, gasping at night, or heavy daytime sleepiness are worth mentioning to your care team.
Questions worth asking your care team
- Is my sleep problem likely to be part of withdrawal or early recovery?
- Do you offer CBT-I, or can you refer me to someone who does?
- Should I be checked for sleep apnea or another sleep disorder?
- Are any of my current medications affecting my sleep?
- If you suggest a sleep medication, what are the risks for someone in recovery?
The short version
Sleep problems are common in early recovery and may take a month or more to settle, sometimes longer. Poor sleep is linked with craving and relapse risk, so it deserves treatment. CBT-I has the strongest evidence and can start early, without waiting for long-term sobriety. Sleep medications with misuse potential call for caution and a prescriber's judgment.