How does sleep play a protective role before, during and after MDMA use?

Ecstasy is widely used in nightlife. After alcohol and tobacco, it is the most commonly used drug at the dance events where we provided information.

Because MDMA is the active ingredient in ecstasy, we will talk about MDMA in the rest of the article.

MDMA initially releases a lot of serotonin in the brain, followed by two phases of serotonin depletion. In addition, several studies show that MDMA causes increased cortisol levels.

Both the serotonin peak and the increased cortisol level influence the circadian system (the 24-hour rhythm, or the biological clock). For that reason, MDMA is often associated with sleeping problems.

Heavy MDMA users can even suffer from long-term abnormal cortisol levels, which can lead to long-term or even chronic sleep problems.

The few studies that have been done on the use of MDMA in combination with sleep deprivation have shown a correlation between sleep deprivation and negative side effects of MDMA. Poor sleep was associated with more negative effects.

MDMA by day vs MDMA by night

Research shows that MDMA is associated with stronger impulse control when taken during the day. However, this impulse control is not found when MDMA is taken at night and sleep deprivation comes into play. This means that MDMA as a drug in principle causes less impulsive behavior, but when there is also sleep deprivation, people still become more impulsive. The same study also looked at psychomotor functioning and the results are comparable.

When MDMA is used during the day and there is no sleep deprivation yet, MDMA has a stimulating effect on psychomotor functioning (movement). This means that MDMA ensures that we can control our body better and more specifically. However, when MDMA is used at night, psychomotor functioning deteriorates enormously and controlling our body suddenly becomes more difficult.

Attention also deteriorates if MDMA is used at night and sleep deprivation plays a role. This means that when going out it is not so much the MDMA, but the lack of sleep that is the cause of attention problems. These findings indicate an interaction effect between sleep deprivation and MDMA; the effect of MDMA on impulse control, psychomotor functioning and attention depends on the degree of sleep deprivation.

Sleep deprivation and drug-related complaints

As mentioned earlier, sleep deprivation contributes to the development of drug-related complaints such as visual snow, HPPD, depersonalization and derealization disorders and difficult psychedelic experiences. HPPD stands for hallucinogen persisting perception disorder, in which people suffer from disturbed perceptions such as visual snow (eye noise) and palinopsia (afterimages).

Depersonalization disorder is characterized by the constant or recurring feeling that everything you are experiencing feels unreal. We are then talking about your own body, feelings or movements. Derealization disorder is characterized by the constant or recurring feeling of unreality about the environment. See also the information about these disorders on

In the case of both disorders, the person continues to realize that in reality this feeling is not right. Sleep deprivation reduces resilience and is often seen in people who suffer from these long-term complaints.

Despite the fact that these complaints are often reported after the use of psychedelics such as truffles and LSD, MDMA appears to be the biggest trigger of visual snow, HPPD and depersonalization and derealization disorders.

It is good to be aware that these are possible side effects of MDMA, but also that a good night’s sleep can reduce the risk of these types of complaints.

Unity Tip: Make sure you are well rested before using MDMA. For example, take a nap before going to a night party.

Sleep is a protective factor

Although research on this topic is scarce, the above findings are a good example of the influence that sleep deprivation has. Certain behaviors, such as impulsivity and decreased focus, are often blamed on drug use, when these behaviors may also be due to sleep deprivation. This also means that sleep can prevent certain behaviors and that sleep can serve as a protective factor. In addition, sleep deprivation increases the risk of complaints such as visual snow, HPPD and depersonalization and derealization disorders, which can be triggered by MDMA.

With the collaboration of: Gerard Alderliefste, Layla Deibert, Raoul Koning, Sarsani Schenk and Teun van der Velden


  • Alderliefste, G. J. (2016). DPS en HPPD: signalering, diagnostiek en behandeling van persistente waarnemingsstoornissen na partydrugs. Verslaving, 12(3), 172–184.
  • Butler, G., & Montgomery, A. (2004). Impulsivity, risk taking and recreational ‘ecstasy’ (MDMA) use. Drug and Alcohol Dependence, 76(1), 55-62.
  • Croes, E., Vreeker, A., De Ruiter, N., & Alderliefste, G. (2017). Langdurige klachten na ecstasygebruik. Geraadpleegd van
  • Kuypers, K. P. C., Wingen, M., Samyn, N., Limbert, N., & Ramaekers, J. G. (2007). Acute effects of nocturnal doses of MDMA on measures of impulsivity and psychomotor performance throughout the night. Psychopharmacology, 192(1), 111–119.
  • Schierenbeck, T., Riemann, D., Berger, M., & Hornyak, M. (2008). Effect of illicit recreational drugs upon sleep: Cocaine, ecstasy and marijuana. Sleep Medicine Reviews, 12(5), 381–389.