Clinical review
Insomnia, alcoholism and relapse

https://doi.org/10.1016/S1087-0792(03)90005-0Get rights and content

Abstract

Insomnia and alcoholism are significantly associated in community surveys and patient samples. Insomnia occurs in 36–72% of alcoholic patients and may last for weeks to months after initiating abstinence from alcohol. Some correlates of insomnia in alcoholic patients are identical to those observed in non-alcoholic insomniacs, including anxiety and depression, tobacco smoking, and the use of alcohol to aid sleep. Other studies suggest that as the severity of alcoholism increases, so does the likelihood of insomnia in alcoholic patients. In the sleep laboratory, alcoholic patients who complain of insomnia have disrupted sleep continuity when compared to alcoholic patients without insomnia complaints. Recently sober alcoholics are also more likely than non-alcoholics to have sleep-disordered breathing and increased periodic leg movements, which might contribute to insomnia in some alcoholic patients. The co-occurrence of insomnia and alcoholism is clinically significant because alcoholism can exacerbate the adverse consequences of insomnia (e.g. mood changes and performance decrements) and because insomnia among patients entering treatment for alcoholism has been significantly associated with subsequent alcoholic relapse. Baseline polysomnographic correlates of subsequent relapse include prolonged sleep latency, decreased sleep efficiency and total sleep time, increased rapid eye movement sleep pressure, and decreased slow wave sleep. Whether treatment of insomnia in alcoholic patients reduces relapse rates is unknown, but preliminary treatment guidelines that accommodate the special characteristics of alcoholic patients are provided, with a goal to reduce daytime impairment and psychological distress.

References (77)

  • F. Placidi et al.

    Effect of antiepileptic drugs on sleep

    Clinical Neurophysiology

    (2000)
  • R. Malcolm et al.

    Update on anticonvulsants for the treatment of alcohol withdrawal

    Am J Addict

    (2001)
  • K.J. Brower

    Alcohol's effects on sleep in alcoholics

    Alcohol Res Health

    (2001)
  • American Psychiatric Association
  • E.O. Bixler et al.

    Prevalence of sleep disorders in the Los Angeles metropolitan area

    Am J Psychiatry

    (1979)
  • D.E. Ford et al.

    Epidemiologic study of sleep disturbance and psychiatric disorders

    JAMA

    (1989)
  • K.J. Brower et al.

    Epidemiology of insomnia and alcoholism in the general population

    Alcohol Clin Exp Res

    (2002)
  • S. Braz et al.

    Alcohol consumption and sleep complaints in the city of São Paulo: an epidemiological survey

    Sleep Res

    (1991)
  • C. Janson et al.

    Insomnia in men — a 10-year prospective population based study

    Sleep

    (2001)
  • K.J. Brower et al.

    Alcohol and other drug-related problems

  • M.K. Stoller

    Economic effects of insomnia

    Clin Therapeutics

    (1994)
  • M.K. Hohagen et al.

    Prevalence and treatment of insomnia in general practice

    Eur Arch Psychiatry Clin Neurosci

    (1993)
  • K.J. Brower et al.

    Insomnia, self-medication, and relapse to alcoholism

    Am J Psychiatry

    (2001)
  • J.H. Foster et al.

    Application of a quality of life measure, the Life Situation Survey (LSS), to alcohol-dependent subjects in relapse and remission

    Alcohol Clin Exp Res

    (2000)
  • F. Baekeland et al.

    Clinical correlates of reported sleep disturbance in alcoholics

    Q J Stud Alcohol

    (1974)
  • D.B. Clark et al.

    Health problems in adolescents with alcohol use disorders: self-report, liver injury, and physical examination findings and correlates

    Alcohol Clin Exp Res

    (2001)
  • H.J. Aubin et al.

    Effects of tetrabamate and of diazepam on sleep polygraphy during subacute withdrawal in alcohol-dependent patients

    Human Psychopharmacology

    (1994)
  • T. Shinba et al.

    Alcohol consumption and insomnia in a sample of Japanese alcoholics

    Addiction

    (1994)
  • J.H. Foster et al.

    Impaired sleep in alcohol misusers and dependent alcoholics and the impact upon outcome

    Alcohol Clin Exp Res

    (1999)
  • E.A.R. Robinson et al.

    Explaining unexpected gender differences in hostility among persons seeking treatment for substance use disorders

    J Stud Alcohol

    (2001)
  • V. Zarcone

    Alcoholism and sleep

    Adv Biosci

    (1978)
  • M.V. Vitiello

    Sleep, alcohol, and alcohol abuse

    Addiction Biology

    (1997)
  • O. Le Bon et al.

    Sleep in detoxified alcoholics: impairment of most standard sleep parameters and increased risk for sleep apnea, but not myoclonias - a controlled study

    J Stud Alcohol

    (1997)
  • J.C. Gillin et al.

    Increased pressure for rapid eye movement sleep at time of hospital admission predicts relapse in nondepressed patients with primary alcoholism at 3-month follow-up

    Arch Gen Psychiatry

    (1994)
  • K.J. Brower et al.

    Polysomnographic and subjective sleep predictors of alcoholic relapse

    Alcohol Clin Exp Res

    (1998)
  • M.S. Aldrich et al.

    Sleep-disordered breathing in alcoholics

    Alcohol Clin Exp Res

    (1999)
  • T.E. Skoloda et al.

    Sleep quality reported by drinking and non-drinking alcoholics

  • J.H. Foster et al.

    Predictors of relapse to heavy drinking in alcohol dependent subjects following alcohol detoxification: The role of quality of life measures, ethnicity, social class, cigarette and drug use

    Addiction Biology

    (1998)
  • Cited by (296)

    • Insomnia: clinical presentation, diagnostic characterization, and etiological considerations

      2023, Encyclopedia of Sleep and Circadian Rhythms: Volume 1-6, Second Edition
    View all citing articles on Scopus
    View full text