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Alcohol use disorders and sleep disruption
Poor sleep can affect multiple aspects of quality of life, and is associated with conditions like heart disease, hypertension, diabetes and depression. This month we are addressing the bidirectional relationship that exists between sleep disruption and alcohol. Among patients with alcohol use disorder, sleep disturbances are common during phases of active drinking, withdrawal, and abstinence, with more than of half of alcohol-dependent patients suffering from symptomatic insomnia. Co-occurrence of alcohol dependence and insomnia is associated with greater psychosocial problem severity, impacting personal and professional relationships.
As Professor Timothy Roehrs explains in his video presentations, alcohol can disrupt circadian rhythms and circadian disruption can promote alcohol intake. The causal mechanisms of how they interact as risk factors for one another remain unclear. This reciprocal interaction can result in a vicious circle of alcohol intake causing poor sleep and self-administration of alcohol for sleep problems. Disruptions in circadian rhythms can persist during abstinence for several weeks to months and increase the risk for relapse. Physicians should address alcohol with patients who present in general practice with sleep problems. In our article section you will find practical information for assessment of sleep problems and an overview of treatments.
Puja K. Parekh, Angela R. Ozburn, Colleen A. McClung
Alcohol 2015, Volume 49, pages 341-349
Decades of research supports the notion that there exists a bidirectional relationship between alcohol abuse and circadian rhythm disruptions. In their review of a number of recent studies providing strong evidence that circadian genes regulate several aspects of dopaminergic transmission, the authors discuss how neurotransmitter systems and reward circuitry are under circadian control and are modulated by drug and alcohol experience, as well as how specific circadian genes regulate drug and alcohol responses. Further studies of the interactions between alcohol, circadian rhythms, and circadian genes are warranted. Together with findings from recent investigations these could help to uncover new therapeutic targets and optimize timing of administration of existing therapies.
Sleep and use of alcohol and drug in adolescence. A large population-based study of Norwegian adolescents aged 16 to 19 years
Børge Sivertsen, Jens Christoffer Skogen, Reidar Jakobsen, Mari Hysing
Drug and Alcohol Dependence 2015, Volume 149, pages 180-186
The authors report on a large population-based study from Norway conducted in 2012 in which 9328 adolescents aged 16–19 years (54% girls) were surveyed. The main objective of the current study was to examine the association between a range of sleep problems and sleep behaviors, and use and misuse of alcohol and illicit drugs. The main findings from this study are that short sleep duration, sleep deficit, large bedtime differences and insomnia were significantly associated with higher odds of all measures of alcohol and drug use/misuse. The associations were in a dose–response manner, and were only partly attenuated by co-existing symptoms of depression, ADHD, and sociodemographic factors. Adolescent sleep problems have been linked to both higher rates of depressive symptoms, increased risk for school non-attendance and poor academic performance. Assessment of sleep could be included in assessment and interventions for alcohol and drug use, and an even broader perspective including mental health problems could be warranted when adolescents present with these behaviors.
Kirk J. Brower
Alcohol 2015, Volume 49, pages 417-427
This article focuses on assessing and treating insomnia that persists despite 4 or more weeks of sobriety in alcohol-dependent adults. Approximately one-quarter of alcohol-dependent patients will have persistent insomnia despite abstinence from alcohol. Poor sleep is associated with relapse, but the mechanism involved is unknown. The article includes practical information like questions which can help in determining the nature, severity, and potential causes of the symptoms; sleep hygiene guidelines; educational approaches; and an overview of behavioral therapies and pharmacotherapies.
Ninad S. Chaudhary, Kyle M. Kampman, Henry R. Kranzler, Michael A. Grandner, Swarnalata Debbarma, Subhajit Chakravorty
Addictive Behaviors 2015, Volume 50, pages 165-172
The authors investigated the association between insomnia and psychosocial problems from a qualitative and a quantitative perspective in a treatment-seeking sample of alcohol dependent subjects. Seventy-five percent of the participating subjects reported insomnia, and 61% of these subjects had insomnia that was moderate–severe in intensity (clinically significant insomnia). Subjects with moderate–severe insomnia were found to have significantly higher scores on the Short Index of Problems total score and on the social and impulse control sub-scales, as well as higher scores on the Addiction Severity Index for employment problems and conflicts with their spouses than others. The authors conclude that in actively drinking alcohol dependent subjects, the presence of insomnia was associated with recent psychosocial problems. Knowledge gained from these associations may help us to identify individuals at higher risk of recidivism and thus may aid in the development of a comprehensive treatment plan.
Part 1 of lecture series Alcohol dependence and sleep disruption
Part 2 of lecture series Alcohol dependence and sleep disruption
Part 4 of lecture series Alcohol dependence and sleep disruption