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| Bill (William) Yates, M.D. Brain Post |
Sleep problems complicate the treatment and recovery in alcoholism.
Heavy alcohol consumption modifies the nature of sleep architecture.
A high blood alcohol concentration at bedtime may promote sleep early in the sleep cycle.
However, as alcohol levels decline, sleep is often interrupted with limiting rapid eye movement (REM) sleep duration.
Shortened total sleep time with alcohol can produce a lack of feeling well rested on awakening.
For those with alcoholism or alcohol dependence, successful treatment and alcohol abstinence can restore a normal sleep pattern. However, the clinical picture appears more complicated.
Kirk Brower and colleagues at the University of Michigan published an important summary of the effects of alcoholism treatment on sleep.
In their study, 267 subject with alcoholism in treatment were assessed for sleep problems at baseline and again six months later.
The key findings from their study included:
- 47% of subjects had insomnia at baseline
- 60% of all subjects with insomnia at baseline had persistent insomnia six months later
- Women and those with greater psychiatric severity had higher rates of insomnia persistence
- Subjects who reduced drinking quantities had improvement in sleep
- However, a quarter of subjects who maintained abstinence reported persistent insomnia
A significant high level of insomnia persistence despite abstinence is important. This group of persistent insomniacs need formal sleep assessment and many might benefit from an overnight sleep lab study known as polysomnography.
The current study did not assess specifically for sleep apnea but they note sleep apnea may contribute to sleep problems in many recovered alcoholics.
Successful restoration of normal sleep in abstinence may promote higher rates of alcoholism recovery.
Readers with more interest in this study can access the free full-text manuscript by clicking on the PMID link in the citation below.
Photo of street scene from Galway, Ireland is from the author's files.
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Brower KJ, Krentzman A, & Robinson EA (2011). Persistent insomnia, abstinence, and moderate drinking in alcohol-dependent individuals. The American journal on addictions / American Academy of Psychiatrists in Alcoholism and Addictions, 20 (5), 435-40 PMID: 21838842.
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The problem is often confounded by sufferers being a) multi-morbid and b) multi-dependent, e.g. also heavy smokers. Any drug that metabolizes at a rate that its blood plasma levels sink below the "zone of comfort" during sleep, e.g., say, within two to six hours, will disrupt sleep patterns, just like a busy road would that "awakes" at five in the morning if you would need to continue sleeping until, say, seven, to have your full eight hours' rest. Since "social" drinking is also concentrated temporally in the late hours, this is often a vicious circle that patients can only escape if they are hospitalized for a truly lengthy period ... and someone has to finance that then ...
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