Insomnia treatment in the context of alcohol use disorder: A systematic review and meta-analysis

Abstract

Purpose To determine the efficacy of behavioral and pharmacological interventions for insomnia among individuals with alcohol use disorder (AUD). Procedures Comprehensive literature searches of psychological, medical, and educational databases were conducted through October 2016. Eligible studies evaluated the efficacy of an insomnia intervention, included a comparison condition, sampled individuals with AUD and either insomnia disorder or complaints of insomnia, assessed sleep-related outcomes, and provided relevant statistics to calculate between-group effect sizes. Effect sizes were estimated for sleep quality, days of alcohol abstinence, and symptoms of depression. Type of intervention (behavioral versus pharmacological) was tested as a moderator of intervention efficacy. Main Findings Nine studies met eligibility criteria and were included in the final review and meta-analysis. Random-effects models indicated that intervention participants reported greater improvements in sleep quality (d+ =0.62, 95%CI= 0.28, 0.97) and symptoms of depression (d+ =0.52, 95%CI= 0.06, 0.98) than control participants. Participants reported significantly greater improvements in sleep quality in response to behavioral (d+ =1.20, 95%CI= 0.70, 1.70) as opposed to pharmacological (d+ =0.43, 95%CI= 0.19, 0.67) interventions. Behavioral (d+ =0.74, 95%CI= 0.31, 1.18) and pharmacological (d+ =0.08, 95%CI= −0.64, 0.78) interventions did not have significantly different effects on depressive symptoms. Neither behavioral nor pharmacological interventions improved rates of alcohol abstinence. Conclusions Insomnia interventions improve sleep quality and reduce symptoms of depression among individuals with comorbid AUD. Given the methodological weaknesses of studies reviewed, additional research is needed to determine the efficacy of insomnia treatment in improving rates of alcohol relapse within this population.

Effect of suvorexant on event-related oscillations and EEG sleep in rats exposed to chronic intermittent ethanol vapor and protracted withdrawal

“…Despite the abundance of data on the importance of alcoholinduced sleep disturbance to the clinical course of alcoholism [97], there have been few studies that have specifically evaluated therapeutic agents for comorbid insomnia disorder in animal models of protracted alcohol withdrawal [15,22,24]. In a recent review [15], the current pharmacological and behavioral treatment for insomnia associated with alcohol dependence is listed, and some encouraging results were reported for gabapentin [98,99], quetiapine [100,101], and cognitive behavioral therapy for insomnia (CBT-I) [102,103]. We have demonstrated previously, in animal models, that gabapentin can ameliorate some of the sleep pathology that is seen following chronic ethanol vapor exposure by reducing sleep fragmentation [104,105].…”

Rhythms of life: circadian disruption and brain disorders across the lifespan

“…Further investigations in humans and animals are necessary to determine how circadian misalignment and/or disruption, along with sleep deprivation, independently and together, may affect the development of reward and cognitive neural systems and whether interventions that target these systems are clinically beneficial. A recent meta-analysis performed on nine studies investigated the impact of insomnia treatment on alcohol use disorder 181 . Behavioural (but not pharmacological) interventions for insomnia improved sleep quality and reduced symptoms of depression; however, there was no evidence that these interventions improved rates of alcohol abstinence, suggesting that improving sleep quality alone is not sufficient to prevent relapse.…”

Sleep Regularity Index in Patients with Alcohol Dependence: Daytime Napping and Mood Disorders as Correlates of Interest

“…The SRI may be an appropriate way to capture the effects of changes in sleep timing and duration, like those experienced by patients transitioning into and out of a structured inpatient treatment program. Episodes of relapse are often accompanied by sleep disturbance [11][12][13][14][15] making it difficult to describe sleep patterns with current measures that rely on defining one "major rest interval", such as variation in the mid-sleep time point. The SRI assesses multiple rest intervals throughout the day, which may be important when considering variations in alcohol craving and ultimately relapse.…”