Treatment Options for Sleep Disturbances During Alcohol Recovery

Abstract

Sleep disturbances are extremely common in the early stages of recovery from alcohol dependence and may persist for several months despite continued abstinence. Studies indicate that sleep disturbances independently increase the risk for relapse to alcohol, suggesting that targeting these problems during recovery may support continued abstinence. However, there is limited information in the addiction literature about available and effective treatments for sleep disturbances in recovering alcoholic patients. The primary goals of this article are to describe the phenomenology of sleep disturbances during recovery from alcohol dependence, to outline the evidence linking sleep problems with alcohol relapse, and to describe available pharmacological and nonpharmacological treatment options, including the evidence regarding their efficacy in recovering alcoholic patients. Recommendations for future research are provided along with special considerations for treating insomnia in this population, including avoiding cross-dependent sedatives, such as benzodiazepines and benzodiazepine receptor agonists (BzRAs). alcohol; alcoholism; sleep; insomnia; treatment; pharmacological; nonpharmacological; cognitivebehavioral treatment Insomnia is a complaint of difficulties falling asleep, frequent and/or prolonged awakenings, and/or consistently unrefreshing sleep that occurs despite adequate sleep opportunity. Insomnia is exceedingly common: as many as 1/3 of adults report experiencing persistent insomnia symptoms during the year. [1][2][3][4] Insomnia symptoms persisting for more than one month that are associated with daytime impairment and/or psychological distress define an insomnia disorder, which occurs in one in ten individuals. Persistent insomnia is associated with wide ranging adverse consequences, including decreased quality of life, increased risk for psychiatric disturbances, increased work absenteeism, and poor interpersonal functioning. 1,2,5,6 Among patients in recovery from alcohol dependence, insomnia complaints are especially frequent and may persist for weeks to months post-abstinence. [7][8][9][10][11][12][13][14] Of particular importance, untreated insomnia may interfere with recovery from the primary alcohol addiction and contribute to relapse within the first several months of recovery. 12,15,16 Thus, treating insomnia in recovering alcoholic patients may aid in their recovery and support continued abstinence. Keywords NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptDespite the putative importance of sleep in the recovery process, there is limited information in the addiction literature about appropriate treatment options for insomnia during recovery. This may exist for a variety of reasons: clinicians assume that co-morbid sleep problems will remit with treatment of the primary alcohol condition; sleep problems are de-emphasized as relatively less important in the early stages of treatment for alcohol dependence; or physicians may be reluctant to address sleep problem...

Dose–response study of chronic alcohol induced changes in sleep patterns in rats

“…It could be related to the decrement in performance that accompanies poor sleep contributes to psychological and/or social pressures to begin drinking again, or that recovered alcoholics with insomnia actually return to drinking as a form of selfmedication (Brower, 2003), but scant support exists for either of these hypotheses. A number of investigators have begun to incorporate strategies for improving sleep in abstinent alcoholics with the hope that this will decrease relapse drinking (Allen et al, 1977;Arnedt et al, 2007;Gann et al, 2004;Hornyak et al, 2004;Karam-Hage and Brower, 2000;Staner et al, 2006;Zarcone and Hoddes, 1975). Obviously, improvements in this potential therapeutic intervention could be made if a better understanding of alcohol induced sleep pathologies was available.…”

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

“…Unlike many other medications such as some antidepressants, acamprosate does not appear to adversely affect sleep. Other drugs such as gabapentin and quetiapine have been shown to have potential in improving sleep in abstinence (see Arnedt et al, 2007 for review) (IV).…”

Sleep disorders in alcoholism

“…Риск развития инсомнии при алкогольной бо-лезни выше у женщин, пациентов с семейным анам-незом злоупотребления алкоголем, у больных, кото-рые начали злоупотреблять алкоголем в более позд-нем возрасте (старше 27 лет), с длительным анамне-зом злоупотребления (больше 7 лет), с сопутствую-щей психической патологией (эндогенная депрес-сия, тревожные расстройства) [21,22]. Описанные особенности, по мнению авторов соответствующих работ, являются свидетельством развития именно физической зависимости от алкоголя, поскольку похожие изменения можно наблюдать при зависи-мости от других лекарственных препаратов (барби-тураты, опиаты, психостимуляторы).…”

“…В период ремиссии алкогольной болезни такие характеристи-ки сна, как повышение давления ФБС (снижение латентности, высокая доля, плотность быстрых дви-жений глаз), снижение представленности 3-4-й стадий медленного сна могут быть предикторами рецидива заболевания в ближайшие 5-6 мес [27]. Наличие и выраженность нарушений сна в период острой абстиненции также имеет значимую поло-жительную связь с риском рецидива [21].…”

“…Таким образом, возникает своеобразный «порочный круг», для раз-рушения которого необходимо приложить большие усилия как со стороны пациента, так и со стороны врача, поскольку подбор лекарственной терапии у таких пациентов осложняется более высоким ри-ском развития лекарственной зависимости. Так, агонисты бензодиазепиновых рецепторов, обладаю-щие высоким риском развития привыкания и зави-симости, влияющие на структуру сна и вызывающие «рикошетную» инсомнию при отмене, не рекомен-дованы для купирования инсомнии в абстинентном периоде, за исключением случаев алкогольного де-лирия [21]. Дополнительный риск приема бензодиа-зепинов связан с возможностью их передозировки при одновременном употреблении с алкоголем.…”