Persistent Insomnia, Abstinence, and Moderate Drinking in Alcohol-Dependent Individuals

Abstract

Introduction Insomnia is common, persistent, and increases the risk for relapse in alcohol-dependent (AD) patients. Abstinence has long been considered the best strategy for allowing sleep to normalize, although how many and which patients respond to abstinence is unknown. The aims of this study were to investigate the prevalence and correlates of both baseline and persistent insomnia in AD patients. The course of sleep problems in response to abstinence, moderate drinking, or relapse following treatment was also examined. Methods A naturalistic longitudinal outcomes study interviewed 267 patients (69% male; mean age 44 yr) with DSM-IV alcohol dependence at baseline and 6 months later (84% follow-up rate). The Sleep Problems Questionnaire, Time-Line Follow-Back Interview, and Brief Symptom Inventory measured insomnia, drinking, and psychiatric symptoms, respectively. Simple correlations, logistic regression, and repeated-measures analysis of variance were used to analyze the data. Results At baseline, 47% of patients were classified with insomnia, which was independently predicted by female gender and psychiatric severity. Both abstinence and moderate drinking outcomes significantly predicted a reduction of insomnia symptoms after controlling for gender and psychiatric severity. Among patients with baseline insomnia, however, insomnia persisted in over 60% of cases, which was also predicted by psychiatric severity. Moreover, insomnia persisted in one-quarter of patients despite abstinence. Conclusions Treatment aimed at preventing relapse to heavy drinking provides good first-line therapy for insomnia in AD patients, but some may require insomnia-specific evaluation and treatment in addition to substance-focused treatment and psychiatric care.

The association between sleep disturbances and alcohol relapse: A 12-month observational cohort study

“…16 Given that insomnia can persist despite abstinence from alcohol, patients who report using alcohol to help them fall asleep represent a subset that appears to be particularly vulnerable to relapse. 17 Over 57% of our cohort of patients with alcohol dependence was using hypnotic medication at the time of admission. This is significantly greater than the rates of hypnotic use in the general population with a recent survey reporting a 3% use in community dwelling adults.…”

Measuring Sleep Disturbances in Patients With Alcohol Use Disorders

“…Thus, a validated sleep screening tool that is fast and simple to administer in patients with alcohol use disorders is needed for clinical practice (Brower et al, 2011;Morin et al, 2011). When an abnormal score is observed using a screening test, the sleep diary is probably the most used next step to further evaluate sleep complaints (Carney et al, 2012).…”

“…Conversely, the PSQI contains a wide range of items, including the use of sleep medication, and remains a useful tool, particularly for research and drug development. Although additional screening tests have been developed (Brower et al, 2011;Morin et al, 2011;Yu et al, 2011), the SSI is a subset of items of the most widely used and best characterized instruments to measure anxiety and depression, the Hamilton Anxiety and Depression Rating Scales. These scales are frequently used in different fields of research (including alcohol use disorders), and among alcoholic patients with anxiety and depression symptoms.…”

“…This self-report measure has been widely used in previous studies of alcohol-dependent subjects with sleep disturbance (Foster and Peters, 1999;Cohn et al, 2003;Friedmann et al, 2008;Mason et al, 2014). Other screening tools have been reported, such as the Sleep Problems Questionnaire (Brower et al, 2011), which consists of 4 items and represents a shorter alternative to the PSQI, and the Insomnia Severity Index, which is a 7-item self-report questionnaire to detect cases of insomnia in the population and is sensitive to treatment response (Morin et al, 2011).…”

Insomnia: psychological and neurobiological aspects and non-pharmacological treatments

“…On the other hand, sleep problems may predispose to developing alcohol problems. Sleep difficulties may enhance the risk of relapse among abstinent alcoholics 49,50 . Clinicians should take interest and care in investigating the use of alcohol with patients who complain about insomnia.…”