Sequential studies of sleep disturbance and quality of life in abstaining alcoholics

Ecological momentary assessment and cue-elicited drug craving as primary endpoints: study protocol for a randomized, double-blind, placebo-controlled clinical trial testing the efficacy of a GLP-1 receptor agonist in opioid use disorder

BACKGROUND

Despite continuing advancements in treatments for opioid use disorder (OUD), continued high rates of relapse indicate the need for more effective approaches, including novel pharmacological interventions. Glucagon-like peptide 1 receptor agonists (GLP-1RA) provide a promising avenue as a non-opioid medication for the treatment of OUD. Whereas GLP-1RAs have shown promise as a treatment for alcohol and nicotine use disorders, to date, no controlled clinical trials have been conducted to determine if a GLP-1RA can reduce craving in individuals with OUD. The purpose of the current protocol was to evaluate the potential for a GLP-1RA, liraglutide, to safely and effectively reduce craving in an OUD population in residential treatment.

METHOD

This preliminary study was a randomized, double-blinded, placebo-controlled clinical trial designed to test the safety and efficacy of the GLP-1RA, liraglutide, in 40 participants in residential treatment for OUD. Along with taking a range of safety measures, efficacy for cue-induced craving was evaluated prior to (Day 1) and following (Day 19) treatment using a Visual Analogue Scale (VAS) in response to a cue reactivity task during functional near-infrared spectroscopy (fNIRS) and for craving. Efficacy of treatment for ambient craving was assessed using Ecological Momentary Assessment (EMA) prior to (Study Day 1), across (Study Days 2-19), and following (Study Days 20-21) residential treatment.

DISCUSSION

This manuscript describes a protocol to collect clinical data on the safety and efficacy of a GLP-1RA, liraglutide, during residential treatment of persons with OUD, laying the groundwork for further evaluation in a larger, outpatient OUD population. Improved understanding of innovative, non-opioid based treatments for OUD will have the potential to inform community-based interventions and health policy, assist physicians and health care professionals in the treatment of persons with OUD, and to support individuals with OUD in their effort to live a healthy life.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT04199728. Registered 16 December 2019, https://clinicaltrials.gov/study/NCT04199728?term=NCT04199728 .

PROTOCOL VERSION

10 May 2023.

Substance Abuse and Sleep Quality in University Students

Background

Substance abuse remains a challenging public health issue, especially among young people. It has been shown that poor sleep and substance abuse may have mutual intensifying effects. This study aimed to evaluate the rates of substance abuse, cigarette smoking, and alcohol consumption and their association with sleep disturbances among university students in 2021.

Methods

The participants were the students of the Faculty of Sciences, University of Guilan, Iran in 2021. Data were collected through a researcher-made demographic questionnaire, the first two questions of the translated version of the World Health Organization (WHO) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), and the Pittsburgh Sleep Quality Index (PSQI).

Findings

A total of 222 students entered the study from March to August 2021. The rates of substance abuse in the past three months and lifetime were 35.6% and 45.5%, respectively. The most common type of substance abuse was related to the 'other substances' category. Substance abuse was significantly higher in students living in dormitories and those with a family history of substance abuse. Poor sleep was found in 34.2% of the students, and substance abuse and alcohol consumption both in the past three months and lifetime were significantly associated with lower sleep quality.

Conclusion

This study showed that substance abuse was significantly associated with sleep disturbances. The study results also illustrated an upward trend of substance abuse in recent years among students in Rasht, which may be related to economic issues in the country and/or the effects of the COVID-19 pandemic. Considering the rising prevalence of substance abuse and its impacts on society, policymakers are highly recommended to pay special attention to its risk factors.

Influence of sleep quality on lapse to alcohol use during a quit attempt

AIMS

Sleep problems are common among individuals with alcohol use disorder (AUD) and is often associated with a heightened relapse risk. The present study examines the relationship between sleep and alcohol use among individuals with current AUD during a 6-day quit attempt as part of a medication study.

METHODS

The current study is a secondary analysis of a medication trial for individuals with AUD. Individuals with AUD (N = 53, 26 females) were randomized to active medication or matched placebo. Randomized participants completed a week-long medication titration (Days 1-7). Following the titration period, participants attended an in-person visit (Day 8) to begin a 6-day quit attempt. During the quit attempt, participants completed daily diary assessments to report on previous day alcohol consumption, sleep quality, and alcohol craving. In the present study, medication condition was controlled for in all models.

RESULTS

Baseline global sleep quality was not a significant predictor of drinks per drinking day (P = 0.72) or percent days abstinent (P = 0.16) during the 6-day practice quit attempt. Daily diary analyses found that greater sleep quality was associated with higher next-day drinks per drinking day (b = 0.198, P = 0.029). In contrast, participants reported worse sleep quality following nights of greater alcohol intake, albeit at a trend-level (b = -0.12, P = 0.053).

CONCLUSIONS

These results suggest that better sleep quality was a risk factor for drinking during the 6-day quit period, such that better sleep may be associated with increased craving for alcohol and alcohol use the next day. These findings are limited to the early abstinence period and should be considered in studies exploring longer periods of abstinence.

A Rare Case of Sleep Terror Disorder in an Adult With Chronic Alcohol Abuse: A Case Report and Literature Review

Sleep terror disorder and chronic alcohol abuse are severe conditions that can significantly impact an individual's quality of life. Sleep terror disorder is characterized by sudden and intense episodes of fear or terror, while chronic alcohol abuse can lead to physical and psychological problems that can negatively impact sleep quality. This patient had terminal insomnia with episodes of terror, screaming, and no memory of arousal. Treatment of sleep terror disorder in chronic alcohol abuse patients involves addressing any underlying medical or psychological issues, medication, and cognitive-behavioral therapy (CBT). CBT can help identify and dispute harmful thought patterns and teach coping mechanisms. We present a case of an adult male who had terminal insomnia with episodes of terror, screaming, and no memory of arousal.

Longitudinal determinants of insomnia among patients with alcohol use disorder

Insomnia is common among patients with AUD and can impair quality of life and cognitive functioning, as well as cause psycho-social problems and increased risk of relapse. Nonetheless, determinants of insomnia in patients with AUD have scarcely been studied. We aimed to examine prevalence and development of self-perceived insomnia among inpatients in treatment for AUD, and to examine factors in this group known to be associated with sleep disturbance in the general population. We examined self-reported information about sleep from 94 AUD inpatients in long-term treatment (up to 9 months) using a questionnaire identifying probable insomnia. Potential predictors identified in bivariate tests were used in binomial logistic regressions to examine the effect on sleep at baseline and at 6-week follow-up. Longitudinal multilevel analyses were used to examine factors affecting development of sleep quality during the treatment stay. At baseline, 54% of the patients reported sleep problems indicating insomnia. This was reduced to 35% at 6-week follow-up. In a cross-sectional analysis of sleep at baseline, we found that being male (OR 0.18, p = 0.042) and engaging in physical activity (OR 0.09, p < 0.001) were negatively associated with insomnia, while a high level of depressive symptoms (OR 1.10, p = 0.010) was positively associated after adjustment for age, history of trauma, and severity of dependence. Multilevel analyses of data over a 6-month period showed time interactions with physical activity, such that sleep improvement was greater in patients who initially had a low level of physical activity. This longitudinal study corroborates findings of high prevalence of insomnia among AUD patients and identifies factors in this group associated with insomnia, such as sex, depression, and physical activity. Future longitudinal studies are needed to examine the causal directions between sleep, depression, and physical activity and how these might be targeted in clinical settings.

Determinants of health-related quality of life in recently detoxified patients with severe alcohol use disorder

Background

Health-related quality of life (HRQoL) is an important clinical outcome in Alcohol Use Disorder (AUD) and is considered as a relevant indicator of treatment success. While a better understanding of the factors affecting HRQoL would enable to adjust patients’ care to favour treatment outcome, the determinants of HRQoL in AUD remain unclear. This study aims at describing HRQoL in AUD patients and at identifying its best predictors.

Methods

53 recently detoxified patients with severe AUD (sAUD) underwent a cognitive assessment and filled in a HRQoL questionnaire dedicated to AUD patients (Alcohol Quality of Life Scale; AQoLS), as well as questionnaires concerning socio-demographics, alcohol history, sleep quality, depression, anxiety and impulsivity. 38 healthy controls (HC) underwent the same assessment (except AQoLS) in order to identify the altered cognitive and clinical variables that could potentially be determinants of HRQoL in sAUD.

Results

sAUD patients reported that alcohol affects their HRQoL mainly in the “negative emotions”, “control”, “relationships”, and “sleep” domains. Compared to HC, they were impaired on episodic memory, working memory, executive functions, and processing speed tasks. They also reported lower sleep quality, higher depression, anxiety and impulsivity. No association was found between AQoLS total score and socio-demographics, cognitive performance, or sleep quality in patients. We found a significant correlation between HRQoL and depression/anxiety as well as impulsivity. Anxiety and impulsivity were indeed the only significant predictors of HRQoL, explaining 47.7% of the variance.

Conclusion

Anxiety and impulsivity are crucial determinants of HRQoL in recently detoxified sAUD patients. Since anxiety and impulsivity are frequent issues in addiction and especially in AUD, they should be particularly considered by clinicians to favour treatment outcomes.

Poor subjective sleep predicts compromised quality of life but not cognitive impairment in abstinent individuals with Alcohol Use Disorder

How disrupted sleep contributes to cognitive dysfunction over the dynamic course of Alcohol Use Disorder (AUD) is an emerging topic of investigation. Here, the Pittsburgh Sleep Quality Index (PSQI) was used to evaluate subjective sleep in 90 individuals with AUD sober for an average of 3 months and in 50 healthy controls. Relative to controls, AUD individuals had higher global PSQI scores (worse sleep), higher scores on the Beck Depression Inventory (BDI), worse Quality of Life (QoL) indicators, and poorer performance on cognitive composite tests (executive functioning, attention and working memory, visual and verbal learning or memory). Among AUD individuals, a higher PSQI score correlated with a higher BDI scores and worse QoL, but not with cognitive scales. Also noted in the AUD group were higher global PSQI scores in individuals also diagnosed with major depressive (MDD) or generalized anxiety (GAD) disorders. Together, the 4 variables explained 29.8% of the variance in AUD PSQI scores. In women with AUD, the 4 factors explained 39.3% of the variance in PSQI scores; in AUD men, the 4 measures explained 19.9% of the variance: MDD was salient in women, QoL in men with AUD suggesting differential factors associate with poor sleep in men and women with AUD even with sustained alcohol abstinence. Here, global PSQI scores were related to clinical diagnoses and life functioning but failed to predict cognitive performance in abstinent AUD individuals.

Emotional Dysregulation, Anxiety Symptoms and Insomnia in Individuals with Alcohol Use Disorder

Alcohol craving is associated with insomnia symptoms, and insomnia is often reported as a reason for alcohol relapse. The current study examined associations between emotional regulation, anxiety, and insomnia among a group of 338 patients with alcohol use disorder (AUD). Because insomnia most often develops after stressful experiences, it was expected that anxiety symptoms would mediate the association between emotional dysregulation and insomnia severity. It was also expected that an insomnia diagnosis would moderate the association between emotional dysregulation and anxiety symptoms, namely that higher anxiety levels would be found in individuals with insomnia than in those without insomnia. Insomnia severity was assessed with a total score based on the Athens Insomnia Scale (AIS). Additionally, an eight-point cut-off score on the AIS was used to classify participants as with (n = 107) or without (n = 231) an insomnia diagnosis. Moreover, participants completed the Emotion Regulation Scale (DERS; total score) and the Brief Symptoms Inventory (BSI; anxiety). Individuals with insomnia did not differ from those without insomnia in age (p = 0.86), duration of problematic alcohol use (p < 0.34), mean days of abstinence (p = 0.17), nor years of education (p = 0.41). Yet, individuals with insomnia endorsed higher anxiety (p < 0.001) and higher emotional dysregulation (p < 0.001). Anxiety symptoms fully mediated the association between emotional dysregulation and insomnia severity (p < 0.001). Furthermore, insomnia diagnosis positively moderated the association between emotional dysregulation and anxiety (p < 0.001). Our results suggest that emotional dysregulation can lead to insomnia via anxiety symptoms. Treating anxiety symptoms and emotional dysregulation could help to prevent or alleviate symptoms of insomnia in people with AUD. Moreover, treating insomnia in people with AUD may also have a positive effect on anxiety symptoms.

Sleep and substance use disorder treatment: A preliminary study of subjective and objective assessment of sleep during an intensive outpatient program

BACKGROUND AND OBJECTIVES

Characteristics of sleep concerns and their relationship to mental health in heterogeneous substance use disorder (SUD) treatment settings are not well understood. The purpose of this preliminary study was to assess sleep using subjective and objective measures at two time points during SUD treatment and compare sleep changes to changes in mental health measures.

METHODS

Treatment-seeking participants completed an assessment battery at the beginning of treatment (Time 1, N = 30) and again upon treatment completion (Time 2, approximately 4 weeks later, N = 22). The majority of participants were White (80%), male (63%), and presenting for alcohol use disorder (60.0%), though almost half reported polysubstance abuse (43%). Comorbidity was common (53%). Sleep and mental health questionnaires with 1 week of actigraphy and sleep diaries were completed at both time points.

RESULTS

Most participants met the criteria for a sleep disorder and mean scores on questionnaires showed poor sleep quality, insomnia symptoms, and frequent nightmares, with sleep quality and insomnia improving over time but remaining clinically significant. Nightmares did not improve. Actigraphy indicated poor sleep at both time points. Improvement in insomnia was related to improvement in measures of mental health while changes in actigraphy variables were not related to these measures.

DISCUSSION AND CONCLUSIONS

Multiple types of sleep disturbance are prevalent in this population, with nightmares persisting throughout treatment and insomnia symptoms showing a relationship with mental health symptoms.

SCIENTIFIC SIGNIFICANCE

This was the first study to longitudinally assess mental health with subjective and objective measures of sleep across multiple types of SUDs in a community SUD treatment setting.

Predicting alcohol use disorder remission: a longitudinal multimodal multi-featured machine learning approach

Predictive models for recovering from alcohol use disorder (AUD) and identifying related predisposition biomarkers can have a tremendous impact on addiction treatment outcomes and cost reduction. Our sample (N = 1376) included individuals of European (EA) and African (AA) ancestry from the Collaborative Study on the Genetics of Alcoholism (COGA) who were initially assessed as having AUD (DSM-5) and reassessed years later as either having AUD or in remission. To predict this difference in AUD recovery status, we analyzed the initial data using multimodal, multi-features machine learning applications including EEG source-level functional brain connectivity, Polygenic Risk Scores (PRS), medications, and demographic information. Sex and ancestry age-matched stratified analyses were performed with supervised linear Support Vector Machine application and were calculated twice, once when the ancestry was defined by self-report and once defined by genetic data. Multifeatured prediction models achieved higher accuracy scores than models based on a single domain and higher scores in male models when the ancestry was based on genetic data. The AA male group model with PRS, EEG functional connectivity, marital and employment status features achieved the highest accuracy of 86.04%. Several discriminative features were identified, including collections of PRS related to neuroticism, depression, aggression, years of education, and alcohol consumption phenotypes. Other discriminated features included being married, employed, medication, lower default mode network and fusiform connectivity, and higher insula connectivity. Results highlight the importance of increasing genetic homogeneity of analyzed groups, identifying sex, and ancestry-specific features to increase prediction scores revealing biomarkers related to AUD remission.

Contribution of sleep disturbances to the heterogeneity of cognitive and brain alterations in alcohol use disorder

Cognitive and brain alterations are common in alcohol use disorder and vary importantly from one patient to another. Sleep disturbances are also very frequent in these patients and remain largely neglected even though they can persist after drinking cessation. Sleep disturbances may be the consequence of specific brain alterations, resulting in cognitive impairments. But sleep disruption may also exacerbate alcohol-related brain abnormalities and cognitive deficits through common pathophysiological mechanisms. Besides, sleep disturbances seem a vulnerability factor for the development of alcohol use disorder. From a clinical perspective, sleep disturbances are known to affect treatment outcome and to increase the risk of relapse. In this article, we conducted a narrative review to provide a better understanding of the relationships between sleep disturbances, brain and cognition in alcohol use disorder. We suggest that the heterogeneity of brain and cognitive alterations observed in patients with alcohol use disorder could at least partially be explained by associated sleep disturbances. We also believe that sleep disruption could indirectly favor relapse by exacerbating neuropsychological impairments required in psychosocial treatment and for the maintenance of abstinence. Implications for clinical practice as well as perspectives for future research are proposed.

Addiction and Sleep Disorders

Shared neurophysiology of addiction and sleep disorders results in a bidirectional interplay. Diagnosing and treating primary sleep disorders, particularly in adolescents, can prevent the development of addiction in susceptible individuals. Addressing sleep issues in early recovery, and throughout maintenance, can prevent relapse. Cannabis use for insomnia shows mixed results; assisting with onset sleep latency in early use, this subsides with chronic use and holds addiction risk. Insomnia is a primary complaint of cannabis withdrawal syndrome and a primary cause of relapse in cannabis use disorder. An ideal sleep aid would prevent relapse and have low abuse potential. Pharmaceutical and behavioral options include suvorexant, mirtazapine, trazodone, and aerobic exercise, but clinical trials are lacking to demonstrate efficacy.

Non-pharmacological Approaches for Management of Insomnia

Insomnia is a prevalent sleep problem associated with a constellation of negative health-related outcomes and significant socioeconomic burden. It commonly co-occurs with psychiatric and medical conditions, which may further exacerbate these comorbid conditions and hinder treatment response. There is much empirical evidence to support the clinical efficacy of non-pharmacological treatment for insomnia, especially cognitive behavioral therapy for insomnia (CBT-I), in managing insomnia in a wide range of populations. This article reviews the research on the efficacy of CBT-I for primary insomnia and insomnia comorbid with other psychiatric and medical conditions, the empirical evidence regarding different CBT-I treatment modalities, the implementation of CBT-I across different age groups, and some initial evidence on the sequential combination of insomnia treatments. A brief overview of other non-pharmacological treatment with regard to complementary alternative medicine is also provided.

The impact of nationwide alcohol ban during the COVID-19 lockdown on alcohol use-related internet searches and behaviour in India: An infodemiology study

INTRODUCTION AND AIMS

To control the spread of COVID-19, India imposed a nationwide lockdown in phases including lockdown 1.0 (25 March-14 April) and 2.0 (15 April-3 May). Among other restrictions, it involved a complete ban of alcohol sales. We aimed to examine and interpret the changes in online search interest for keywords representing different alcohol-related themes during the lockdown period in India.

DESIGN AND METHODS

Data were extracted using the framework described for using Google Trends in health-related research. The list of alcohol-related search queries was prepared for four broad themes: types of alcoholic beverages consumed; means of accessing alcohol; problems experienced due to break in alcohol supply; and help-seeking for alcohol use disorders. The mean relative search volumes across three time periods (pre-lockdown; lockdown 1.0; lockdown 2.0) were compared using spss version 23.0.

RESULTS

A significant increase in online search interest for keywords related to the procurement of alcohol was observed in lockdown 1.0 but not during lockdown 2.0, compared with pre-lockdown. A significant increase in online search interest for alcohol withdrawal was observed during lockdown 1.0 compared to the pre-lockdown period. A significant increase in online search interest for keywords representing benzodiazepines was observed in lockdown 2.0.

DISCUSSION AND CONCLUSIONS

Indian internet users exhibited significantly increased online interest for alcohol-related searches during lockdown. It seems that the challenges associated with offering interventions for alcohol use-related problems are likely to continue once the lockdown is lifted and people have the option to access alcohol and treatment services freely.

Melatonin for Treatment-Seeking Alcohol Use Disorder patients with sleeping problems: A randomized clinical pilot trial

A high percentage of subjects diagnosed with alcohol use disorder (AUD) suffer from sleeping difficulties. Lack of sleep could lead AUD patients to relapse or, sometimes, to suicide. Most of the currently prescribed medications to treat this complex problem retain a high risk of side effects and/or dependence. Therefore, the aim of the current clinical trial is to investigate the possibility of the use of a safer treatment, such as the natural health product melatonin, to treat alcohol-related sleeping problems. Sixty treatment-seeking AUD subjects were assigned to melatonin (5 mg) or placebo for 4 weeks of treatment. Change in sleeping quality which is the primary outcome of the study was assessed using the Pittsburgh sleep quality index (PSQI) scale. Linear mixed models were used to statistically analyze the difference in scores before and after 4 weeks of treatment. There was a reduction in the global PSQI score in both groups with no significant drug effect between groups. In conclusion, the use of melatonin (5 mg)/day didn't differ from placebo in decreasing sleeping problems in a sample of AUD subjects after 4 weeks of treatment. However, higher doses are worth exploring in future research.

The prevalence of the sleep disturbances among the patients with substance use disorders

Background. There is evidence that sleep disorders may be significantly linked to the development of the substance use disorders (SUD). However, data about the prevalence of the sleep disturbances among patients with SUD in Russia are relatively limited.

Aim. To evaluate the frequency of the sleep disturbances among patients (n = 196) with alcohol (ÀD, n = 102), opioid (ÎD, n = 55) and polysubstance dependence (PD, n = 39) seeking addiction medical care.

Materials and methods. We conduct a cross-sectional study of sleep disturbances among patients in St. Petersburg in 2017–2018. The modified Insomnia Severity Index (ISI) was administered to assess sleep during different periods of time: lifetime, the past 12 months, and the past 30 days.

Results. All groups demonstrated relatively high presence of different sleep disorders (range: 49.0–76.5% among 196). The sleep disturbances over the past 30 days were more common in the AD group (60.8– 73.5% among 102) with the early morning awakening as the most frequent complaint. In the PD group the prevalence of lifetime sleep disturbances was high (94.9–100.0% among 39), whereas insomnia disorders were relatively rare over the past 30 days. However, it was sleep disturbances over the past 30 days that were statistically significantly more often (p < 0,05) observed in the group of patients who actively consume narcotic substances (40.2–87.2%), compared with the group of patients in remission (0–16.7%).

Conclusion. The results demonstrated the high prevalence of insomnia among patients with SUD and suggested that the remission have a positive effect on the symptoms of sleep disorders. Further studies of the association between sleep disturbances and SUD progression are needed. 

Sleep disturbances in early alcohol recovery: Prevalence and associations with clinical characteristics and severity of alcohol consumption

AIMS

We aimed to assess the prevalence of sleep disturbance in early alcohol recovery and its association with psychiatric comorbidity, cravings, propensity and severity of alcohol consumption.

DESIGN

The sample consisted of 18-80 year old patients (n = 303) receiving treatment for alcohol dependence. Sleep disturbance was measured using the Pittsburgh Sleep Quality Index (PSQI). Additional measures included PHQ-9, GAD-7 and Penn alcohol cravings scale (PACS), Inventory of Drug Taking Situations (IDTS) and alcohol consumption was measured utilizing the Time Line Follow Back (TLFB).Bivariate analyses evaluated the association between PSQI total score and other clinical characteristics. A multivariable model was computed for sleep disturbance with predictors entered into the model using automated stepwise selection.

FINDINGS

The sample was majority male (66%), White (93%) with a mean age of 42.2 ± 11.6 years. Baseline PSQI score was 10.2 ± 4.13 and most subjects (88%) reported sleep disturbance at baseline. Baseline sleep disturbance was associated with depressive symptoms (p < .0001), anxiety symptoms (p < .0001), craving (p < .0001), propensity to drink when experiencing unpleasant emotions (p < .0001), physical discomfort (p < .0001), loss of personal control (p = 0.03), conflict (p = 0.002), number of drinks consumed (p = 0.004), drinking days (p = 0.004) and hazardous drinking days (p = 0.03) in bivariate analyses. However, in the multivariable model, only PHQ-9 total score and IDTS physical discomfort subscale were associated with sleep disturbance.

CONCLUSION

Sleep disruption is common in early alcohol recovery. Future studies should examine the prognostic and clinical implications of its association with current depressive symptoms and a propensity to drink while experiencing physical discomfort.

Prospective associations between insomnia symptoms and alcohol use problems among former and current military service personnel

BACKGROUND

Despite evidence that insomnia symptoms exacerbate alcohol use disorder symptoms, there is a dearth of prospective research testing bidirectional associations between these variables. Furthermore, no studies have prospectively examined these associations among military personnel, a vulnerable population for sleep- and alcohol-related problems. Thus, the current study examined whether insomnia symptoms prospectively predicted increased alcohol use disorder symptoms among a sample of military service members and veterans over a 6-month follow-up period, as well as whether alcohol use disorder symptoms led to increases in insomnia.

METHOD

Hypotheses were tested among a sample of 274 current and past military service members who participated in a baseline and 6-month assessment using self-report measures.

RESULTS

Path analyses revealed that insomnia symptoms significantly prospectively predicted increased month-6 heavy drinking and alcohol-related problems, but not days drinking or being bothered by drinking. None of the alcohol variables significantly predicted insomnia.

CONCLUSION

Results support a model in which insomnia symptoms exacerbate alcohol use disorder symptoms, specifically heavy drinking and alcohol-related problems. Future research should seek to examine these findings in diverse populations and test potential mechanisms and clinical implications of these results.

Poor Sleep and Its Relation to Impulsivity in Patients with Antisocial or Borderline Personality Disorders

Studies investigating sleep and personality disorders consistently demonstrate a relation between personality disorders characterized by behavioral disinhibition and/or emotional dysregulation (traditionally termed cluster B personality disorders) and poor sleep. This finding is in line with previous studies associating insomnia with impulsive behavior, since this is a core characteristic of both antisocial and borderline personality disorder. The current study investigates a group (n = 112) of forensic psychiatric inpatients with antisocial or borderline personality disorder or traits thereof. Subjective sleep characteristics and impulsivity were assessed with the Pittsburgh Sleep Quality Index, the Sleep Diagnosis List, and the Barratt Impulsiveness Scale, respectively. More than half of the patients (53.6%) report poor sleep quality and 22.3% appears to suffer from severe chronic insomnia. Both poor sleep quality and chronic insomnia are significantly associated with self-reported impulsivity, in particular with attentional impulsiveness. This association was not significantly influenced by comorbid disorders. Actively treating sleep problems in these patients may not only improve sleep quality, mental health, and physical well-being, but may also have impact on impulsivity-related health risks by increasing self-control.

Alcohol Dependence and Its Relationship With Insomnia and Other Sleep Disorders

Sleep-related complaints are widely prevalent in those with alcohol dependence (AD). AD is associated not only with insomnia, but also with multiple sleep-related disorders as a growing body of literature has demonstrated. This article will review the various aspects of insomnia associated with AD. In addition, the association of AD with other sleep-related disorders will be briefly reviewed. The association of AD with insomnia is bidirectional in nature. The etiopathogenesis of insomnia has demonstrated multiple associations and is an active focus of research. Treatment with cognitive behavioral therapy for insomnia is showing promise as an optimal intervention. In addition, AD may be associated with circadian abnormalities, short sleep duration, obstructive sleep apnea, and sleep-related movement disorder. The burgeoning knowledge on insomnia associated with moderate-to-severe alcohol use disorder has expanded our understanding of its underlying neurobiology, clinical features, and treatment options.

Comorbid insomnia and cognitive behavior therapy

Insomnia most commonly presents comorbidly in association with medical and psychiatric disorders. Comorbid insomnia, however, remains under treated in the majority of patients. Concerns about drug interactions, adverse events, and dependence as well as the assumption that treating the insomnia as a secondary presentation that will resolve when the primary condition improves are all factors that contribute to the under treatment of comorbid insomnia. This article presents the growing research evidence that highlights the benefits and importance of targeting the insomnia that presents comorbidly with medical and psychiatric conditions utilizing the nonpharmacological and effective treatment of cognitive behavior therapy.

Insomnia in alcohol dependent subjects is associated with greater psychosocial problem severity

INTRODUCTION

Although psychosocial problems are commonly associated with both alcohol misuse and insomnia, very little is known about the combined effects of insomnia and current alcohol dependence on the severity of psychosocial problems. The present study evaluates whether the co-occurrence of insomnia and alcohol dependence is associated with greater psychosocial problem severity.

METHODS

Alcohol dependent individuals (N = 123) were evaluated prior to participation in a placebo-controlled medication trial. The Short Index of Problems (SIP), Addiction Severity Index (ASI), Insomnia Severity Index (ISI), and Time Line Follow Back (TLFB), were used to assess psychosocial, employment, and legal problems; insomnia symptoms; and alcohol consumption, respectively. Bivariate and multivariate analyses were used to evaluate the relations between insomnia and psychosocial problems.

RESULTS

Subjects' mean age was 44 years (SD = 10.3), 83% were male, and their SIP sub-scale scores approximated the median for normative data. A quarter of subjects reported no insomnia; 29% reported mild insomnia; and 45% reported moderate-severe insomnia. The insomnia groups did not differ on alcohol consumption measures. The ISI total score was associated with the SIP total scale score (β = 0.23, p = 0.008). Subjects with moderate-severe insomnia had significantly higher scores on the SIP total score, and on the social and impulse control sub-scales, and more ASI employment problems and conflicts with their spouses than others on the ASI.

CONCLUSION

In treatment-seeking alcohol dependent subjects, insomnia may increase alcohol-related adverse psychosocial consequences. Longitudinal studies are needed to clarify the relations between insomnia and psychosocial problems in these subjects.

Risky drug use and effects on sleep quality and daytime sleepiness

OBJECTIVE

Sleep problems are commonly reported following alcohol and cannabis abuse, but our understanding of sleep in non-clinical drug using populations is limited. The present study examined the sleep characteristics of alcohol and cannabis users recruited from the wider community.

METHODS

Two hundred forty-eight self-identified alcohol and/or cannabis users (131 women and 117 men) with a mean age of 26.41 years completed an online study that was advertised via online forums, print media and flyers. As part of the study, participants completed validated sleep scales assessing sleep quality (Pittsburgh Sleep Quality Index) and excessive daytime sleepiness (Epworth Sleepiness Scale) in addition to validated drug scales assessing alcohol (Alcohol Use Disorders Identification Test) and cannabis (Marijuana Screening Inventory) use.

RESULTS

Problems with sleep quality were more commonly reported than were complaints of excessive daytime sleepiness. Clinically significant poor sleep quality was associated with comorbid problem alcohol and cannabis use. Women reporting problem alcohol and cannabis use had poorer sleep outcomes than men.

CONCLUSIONS

Social drug users who report risky alcohol and cannabis use also report poor sleep. Poor sleep quality likely exacerbates any drug-associated problems in non-clinical populations.

Assessment and treatment of insomnia in adult patients with alcohol use disorders

Insomnia in patients with alcohol dependence has increasingly become a target of treatment due to its prevalence, persistence, and associations with relapse and suicidal thoughts, as well as randomized controlled studies demonstrating efficacy with behavior therapies and non-addictive medications. This article focuses on assessing and treating insomnia that persists despite 4 or more weeks of sobriety in alcohol-dependent adults. Selecting among the various options for treatment follows a comprehensive assessment of insomnia and its multifactorial causes. In addition to chronic, heavy alcohol consumption and its effects on sleep regulatory systems, contributing factors include premorbid insomnia; co-occurring medical, psychiatric, and other sleep disorders; use of other substances and medications; stress; environmental factors; and inadequate sleep hygiene. The assessment makes use of history, rating scales, and sleep diaries as well as physical, mental status, and laboratory examinations to rule out these factors. Polysomnography is indicated when another sleep disorder is suspected, such as sleep apnea or periodic limb movement disorder, or when insomnia is resistant to treatment. Sobriety remains a necessary, first-line treatment for insomnia, and most patients will have some improvement. If insomnia-specific treatment is needed, then brief behavioral therapies are the treatment of choice, because they have shown long-lasting benefit without worsening of drinking outcomes. Medications work faster, but they generally work only as long as they are taken. Melatonin agonists; sedating antidepressants, anticonvulsants, and antipsychotics; and benzodiazepine receptor agonists each have their benefits and risks, which must be weighed and monitored to optimize outcomes. Some relapse prevention medications may also have sleep-promoting activity. Although it is assumed that treatment for insomnia will help prevent relapse, this has not been firmly established. Therefore, insomnia and alcohol dependence might be best thought of as co-occurring disorders, each of which requires its own treatment.

The Association of Alcohol Severity and Sleep Quality in Problem Drinkers

AIMS

The association between alcohol use and sleep problems is well established and clinically meaningful, particularly as predictors of relapse. This study aims to elucidate the relationship between sleep disturbances and alcohol problems in a non-treatment-seeking community sample using an alcoholism problem severity factor.

METHODS

Participants were problem drinkers (N = 295) from the Los Angeles community who had a breath alcohol content (BrAC) of 0.00 g/dl when they completed an in-person assessment battery comprised of measures of sleep quality, anxiety and depression, cigarette smoking, as well as multiple assessments of alcohol use and alcohol use problems.

RESULTS

A series of hierarchical regressions showed that alcohol problem severity explained a significant amount of variance in sleep disturbance beyond demographic, mood and smoking variables. Alcohol problem severity was predictive of the PSQI global score (B = 1.11, P < 0.001), perceived sleep quality factor (B = 0.18, P < 0.001) and daily disturbance factor (B = 0.28, P < 0.001). However, contrary to study hypothesis, alcohol problem severity was predictive of improved sleep efficiency (B = -0.14, P < 0.05).

CONCLUSIONS

In sum, alcohol problem severity may be predictive of sleep disturbances. Given the complex nature of these relationships, further work is needed to develop adequate treatment for sleep disturbance during alcohol recovery. Nonetheless, this study suggests that as alcohol problem severity increases so do sleep problems. Thus, attending to sleep problems at early stages of alcohol problems may be warranted.

Treatment of co-occurring anxiety disorders and substance use disorders

Anxiety disorders commonly co-occur with substance use disorders both in the general population and in treatment-seeking samples. This co-occurrence is associated with greater symptom severity, higher levels of disability, and poorer course of illness relative to either disorder alone. Little research has been conducted, however, on the treatment of these co-occurring disorders. This gap may not only leave anxiety untreated or undertreated but also increase the risk for relapse and poor substance use outcomes. The aim of this article is to review the current state of the literature on treating co-occurring anxiety and substance use disorders. In addition to presenting a brief overview of the epidemiology of this co-occurrence, the article discusses the challenges in assessing anxiety in the context of a substance use disorder, the evidence for various treatment approaches, and recent advances and future directions in this understudied area. Also highlighted is the need for future research to identify optimal behavioral and pharmacologic treatments for co-occurring anxiety and substance use disorders.

The prevalence of sleep disturbance in alcoholics admitted for treatment: a target for chronic disease management

Prolonged and heavy use of alcohol is associated with persistent sleep disturbances. Objective and subjective measures of sleep quantity and quality were collected on 164 individuals undergoing detoxification. A high prevalence of sleep disturbance was found in this sample. Sleep quality improved by week 4 but continued to be altered, signaling a target area for recovery management. This study supports the high prevalence of sleep disturbance in individuals undergoing alcohol treatment. Health promotion strategies in an addiction recovery model should address quality-of-life enhancements for individuals and their families including optimizing sleep quality and duration through sustained recovery.

Sleep and substance use disorders: an update

Substance use disorders (SUD) are common and individuals who suffer from them are prone to relapse. One of the most common consequences of the use of and withdrawal from substances of abuse is sleep disturbance. Substances of abuse affect sleep physiology, including the neurotransmitter systems that regulate the sleep-wake system. Emerging research now highlights an interactive effect between sleep disorders and substance use. New findings in alcohol and sleep research have utilized sophisticated research designs and expanded the scope of EEG and circadian rhythm analyses. Research on marijuana and sleep has progressed with findings on the effects of marijuana withdrawal on objective and subjective measures of sleep. Treatment studies have focused primarily on sleep in alcohol use disorders. Therapies for insomnia in cannabis disorders are needed. Future research is poised to further address mechanisms of sleep disturbance in alcoholics and the effect of medical marijuana on sleep and daytime functioning.

A longitudinal study of insomnia and other sleep complaints in adolescents with and without alcohol use disorders

BACKGROUND

Sleep disturbances are both common and well-characterized in adults with alcohol use disorders (AUDs), but have received little study in adolescents with AUDs. Furthermore, a handful of studies suggest that sleep complaints are a risk factor for AUDs. However, no published studies have yet examined the longitudinal course of sleep complaints in adolescents with AUDs; in particular, it remains unclear how persistent AUD-associated sleep complaints are in this age group, and what types of sleep complaints are most relevant to alcohol-use symptoms. We investigated these questions in a 5-year longitudinal study of adolescents with and without AUDs at baseline.

METHODS

Participants were 696 adolescents (age 12 to 19) from a longitudinal study at the Pittsburgh Adolescent Alcohol Research Center. At baseline, 347 participants had a current AUD (AUD+), while 349 had no current or past AUD (AUD-). We examined sleep and alcohol involvement at baseline as well as 1-, 3-, and 5-year follow-up visits. Sleep variables included self-reported insomnia and hypersomnia, as well as variability in weekday-weekend sleep duration, all at baseline. Covariates included sex, age, current alcohol symptoms, and depression severity.

RESULTS

The AUD+ group reported more overall sleep disturbance at baseline, including greater insomnia and hypersomnia complaints, and greater variability in weekday-weekend sleep duration. Group differences in insomnia and hypersomnia complaints persisted to the 5- and 3-year follow-ups, respectively. In the AUD- group, greater insomnia complaints at baseline predicted an increase in alcohol symptoms at the 1-year follow-up, while greater variability in sleep duration at baseline predicted an increase in alcohol symptoms at the 3- and 5-year follow-ups.

CONCLUSIONS

These results complement previous findings in other samples, indicating that insomnia and other sleep problems are a chronic predicament for adolescents with AUDs. The findings also suggest that sleep disturbances may place adolescents without AUDs at an elevated risk of developing alcohol problems.

Cognitive and behavioural therapy for insomnia (CBT-I) in psychiatric populations: a systematic review

Insomnia is highly co-morbid with psychiatric disorders, making it a frequent issue in treatment planning in psychiatric clinics. Research has also shown that although insomnia may originally precede or be a consequence of a psychiatric disorder, insomnia likely becomes semi-independent, and may exacerbate those disorders if it is not addressed, leading to reduced treatment response. Cognitive behavioural therapy for insomnia (CBT-I) is now recommended as the first line of treatment of primary insomnia. The research reviewed below indicates that CBT-I in patients with co-morbid depression, anxiety, post-traumatic stress disorder (PTSD), and substance abuse disorders is generally effective for insomnia and sometimes the co-morbid disorder as well. Although more research is needed before definitive recommendations can be made, it appears as though CBT-I is a viable approach to treating the patient with co-morbid insomnia and psychiatric disorders.

Neurochemical mechanisms of alcohol withdrawal

Alcohol dependence encompasses a serious medical and societal problem that constitutes a major public health concern. A serious consequence of dependence is the emergence of symptoms associated with the alcohol withdrawal syndrome when drinking is abruptly terminated or substantially reduced. Clinical features of alcohol withdrawal include signs of central nervous system hyperexcitability, heightened autonomic nervous system activation, and a constellation of symptoms contributing to psychologic discomfort and negative affect. The development of alcohol dependence is a complex and dynamic process that ultimately reflects a maladaptive neurophysiologic state. Perturbations in a wide range of neurochemical systems, including glutamate, γ-aminobutyric acid, monoamines, a host of neuropeptide systems, and various ion channels produced by the chronic presence of alcohol ultimately compromise the functional integrity of the brain. These neuroadaptations not only underlie the emergence and expression of many alcohol withdrawal symptoms, but also contribute to enhanced relapse vulnerability as well as perpetuation of uncontrolled excessive drinking. This chapter highlights the hallmark features of the alcohol withdrawal syndrome, and describes neuroadaptations in a wide array of neurotransmitter and neuromodulator systems (amino acid and monoamine neurotransmitter, neuropeptide systems, and various ion channels) as they relate to the expression of various signs and symptoms of alcohol withdrawal, as well as their relationship to the significant clinical problem of relapse and uncontrolled dangerous drinking.

A longitudinal study of drinking and depression as predictors of insomnia in alcohol-dependent individuals

Insomnia and depressive symptoms are common symptoms among alcohol-dependent (AD) patients. AD individuals (N = 364) were assessed during 2004-2009 in the Midwestern United States at baseline and 6-month intervals with the Sleep Problems Questionnaire, Time-Line Follow-Back interview, and the depression subscale of the Brief Symptom Inventory. Hierarchical Linear Modeling was used to analyze the data in this longitudinal study. When modeled separately, both quantity of drinking (p < .01) and depression (p < .001) predicted insomnia severity, controlling for time, age, and gender. Drinking also predicted depressive symptoms (p < .001), and its effect on insomnia was mediated by depression severity (p < .001).

Excessive sleepiness prevalence in public transportation drivers of a developing country

OBJECTIVE

To determine the prevalence of excessive sleepiness (ES) in bus and auto-rickshaw drivers from Lima, Peru.

METHODS

We conducted a cross-sectional study of Lima's bus and auto-rickshaw drivers to estimate ES prevalence in this population. Survey sites were private transportation companies, systematically selected with a snowball approach. ES was assessed with the Spanish-validated version of the Epworth sleep questionnaire (ESQ) with a cutoff score >10. We obtained relevant demographic information.

RESULTS

Four hundred and thirty-four bus and auto-rickshaw drivers were eligible for analysis. The overall ES prevalence was 32.7 percent (95% confidence interval [CI]: 28-37.2). ES prevalence was higher in bus drivers than in auto-rickshaw drivers, 38 percent (95% CI: 31.7-44.2) and 26.9 percent (95% CI: 20.6-33.1), respectively (P = .01). We used data from all subjects to obtain regression equations for ESQ score with several predictors. Being a bus driver, working additional nighttime hours per week, having depression or anxiety, and alcohol abuse had small but significant associations with ESQ scores.

CONCLUSION

ES prevalence in Lima's public transportation drivers is in a medium range as suggested by previous regional studies.

The influence of emerging low mood symptoms on sleep in children: a pilot study

PURPOSE

Sleep disturbances can lead to the onset and relapse of psychiatric disorders. However, the age at which this relationship begins and the role of sleep disturbances in the trajectory to the onset of a psychiatric disorder are still not fully understood. The purpose of this study was to explore, based on self- and parental-reports of mood symptoms, subjective and objective sleep in young children who are at risk of developing a psychiatric disorder but who have not yet met diagnostic criteria.

PATIENTS AND METHODS

Twenty-one children (eleven girls) between the ages of 8 and 11 (mean age = 9.7 years, standard deviation = 1.1 years) were dichotomized into low mood (LM) and not low mood (NLM) groups based on scoring below or above the median threshold score on at least two of the following questionnaires: the Child Depressive Rating Scale (CDRS), Weinberg Screening Affective Scale (WSAS), and Quick Inventory of Depressive Symptomatology (QIDS). The children completed sleep diaries and underwent two nights (for adaptation and baseline) of polysomnography. Sleep stages and sleep microarchitecture (alpha, sigma, beta, and delta) in the first half of the night, were analyzed.

RESULTS

Self-reported sleep disturbance accounted for 72% of the variance (F[3, 20] = 15, P < 0.005) of the Weinberg Screening Affective Scale in LM children. LM children had fewer arousals at night, but awakened earlier than NLM children. Regardless of mood, girls had more sleep disturbance, as well as lower alpha, beta, and delta power in the first half of the night, compared to boys. Girls with LM had shorter sleep times and a lower percentage of rapid eye movement sleep.

CONCLUSIONS

Girls with and without LM, and without a clinical diagnosis of depression, showed more sleep disturbances than boys of the same age. Sleep disturbances evident early in life and in LM girls may reflect greater risk for future sleep or psychiatric disorders.

A multinational study of sleep disorders during female mid-life

BACKGROUND

Although sleep disturbances are common during female mid-life, few studies have described in detail the prevalence of this problem and related risk factors.

OBJECTIVE

To determine the prevalence of sleep disturbances in mid-aged women using validated tools. Assessment of determinants capable of influencing the prevalence of insomnia and poor sleep quality was also performed.

METHODS

A total of 6079 women aged 40-59 of 11 Latin American countries were invited to fill out the Athens Insomnia Scale (AIS), the Pittsburgh Sleep Quality Index (PSQI), the Goldberg Anxiety and Depression Scale, the Menopause Rating Scale (MRS), the Brief Scale of Abnormal Drinking and a general socio-demographic questionnaire.

RESULTS

Overall, 56.6% of surveyed women suffered of either insomnia, poor sleep quality, or both. Specifically, 43.6% and 46.2% presented insomnia and poor sleep quality in accordance to the AIS and the PSQI respectively. The prevalence of insomnia increased with female age (from 39.7% in those aged 40-44 to 45.2% in those aged 55-59, p<0.0001) and menopausal stage (from 39.5% in premenopausal aged 40-44 to 46.3% in late postmenopausal ones, p<0.0001). "Awakening during the night" (AIS: Item 2) was the most highly rated of all items and contributing in a higher degree (mean 16%) to the total score of the scale in all menopausal phases. Sleep quality also worsened with age and menopausal status, impairment particularly affecting sleep efficiency and latency and the increased use of hypnotics. Vasomotor symptoms (VMS), depressive mood and anxiety were associated to sleep disturbances. Women presenting sleep disturbances displayed a 2-fold increase in the severity of menopausal symptoms (higher total MRS scores) which was translated into a 6-8 times higher risk of impaired quality of life. Logistic regression analysis determined that female age, the presence of chronic disease, troublesome drinking, anxiety, depression, VMS, drug use (hypnotics and hormone therapy) were significant risk factors related to the presence of sleep disturbances. Higher educational level related to less insomnia and better sleep quality.

CONCLUSION

Insomnia and poor sleep quality were highly prevalent in this mid-aged female sample in which the influence of age and the menopause was only modest and rather linked to menopausal symptoms already occurring since the premenopause.

Poor sleep at baseline predicts worse mood outcomes in patients with co-occurring bipolar disorder and substance dependence

BACKGROUND

Sleep problems are common in patients with bipolar disorder and have been shown to predict subsequent mood symptoms. Sleep problems have also been shown to lead to worse substance use outcomes in individuals with substance use disorder. However, the relationship between sleep and clinical outcomes in a population with co-occurring bipolar disorder and substance use disorder is unclear.

METHOD

This secondary analysis included 60 outpatients (mean age = 38.1 years; recruited via advertisements, fliers, clinician referrals, and hospital treatment programs) who met DSM-IV criteria for both bipolar disorder and substance use disorder (assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders) and who participated in a randomized clinical trial comparing integrated group therapy for bipolar disorder and substance use disorder to group drug counseling for substance use disorder alone. A 12-week treatment period preceded a 24-week follow-up. Poor sleep was assessed with the Pittsburgh Sleep Quality Index, which provides 7 component subscores and an overall sleep score. Data were collected from August 2003 through April 2007.

RESULTS

When analyses were controlled for baseline mood, substance use, and treatment condition, baseline sleep score predicted mood over the course of the 12-week treatment (β = 0.28; P < .05) and 24-week follow-up (β = 0.46; P < .01): worse sleep was associated with worse mood outcomes. Sleep was not associated with substance use outcomes.

CONCLUSIONS

Impaired sleep is a prognostic factor for mood outcomes in patients with co-occurring bipolar and substance use disorders. Further investigation is warranted into the long-term clinical outcomes of poor sleep in this population with co-occurring bipolar disorder and substance use disorder so that appropriate interventions can be developed.

Prevalence and correlates of insomnia in a polish sample of alcohol-dependent patients

BACKGROUND

Insomnia is an important symptom in alcohol-dependent patients because it may persist despite abstinence and predispose to relapse to drinking. The goal of the present study was to evaluate the prevalence and clinical correlates of insomnia in a sample of 302 alcohol-dependent patients admitted to treatment programs in Poland.

METHODS

Participants were mostly men (73.8%) with a mean (SD) age of 43.5 (9.7) years. Insomnia in the past 1 month was assessed using a total score of 6 or higher on the Athens Insomnia Scale.

RESULTS

Insomnia affected 62.9% of patients, and delayed sleep induction was the most common subtype. Insomnia was associated in bivariate analyses with less education, inadequate finances, problem drinking at an earlier age of onset, drinking frequency and quantity, drinking-related consequences, severity of alcohol and nicotine dependence, psychiatric and physical severity, and a childhood history of sexual or physical abuse (p < 0.05). Logistic regression analysis showed that mental and physical health status, severity of alcohol dependence, number of drinking days in the past 3 months, and childhood abuse were independent predictors of insomnia, explaining approximately 30 to 40% of the variance.

CONCLUSIONS

More than 60% of alcohol-dependent patients in a Polish sample screened positive for insomnia using a validated scale, a rate similar to those assessed with other scales in other countries. The study also showed that insomnia in alcohol-dependent patients is associated with poor physical health and childhood abuse, similar to the general population. The multifactorial nature of insomnia in alcohol-dependent patients has treatment implications.

PER3 polymorphism and insomnia severity in alcohol dependence

STUDY OBJECTIVES

Insomnia is common, persistent, and associated with relapse in alcohol-dependent (AD) patients. Although the underlying mechanisms are mostly unstudied, AD patients have impaired circadian rhythms and sleep drive, which may be genetically influenced. A polymorphism in the PER3 gene (PER3(4/4), PER3(4/5), PER3(5/5)) has previously been associated with circadian preference and sleep homeostasis, and the PER3(4/4)genotype has been characterized by evening preference and decreased sleep drive. The purpose of this study was to examine the influence of this polymorphism on insomnia severity in AD patients. We hypothesized that the PER3 polymorphism would be an independent predictor of insomnia severity with greatest severity observed in those with the PER3(4/4)genotype.

DESIGN

Cross-sectional association of patient characteristics, genotype, and insomnia severity. Significant (P < 0.05) bivariate correlates were further analyzed by hierarchical, forced entry multiple linear regression.

SETTING

Alcohol treatment programs in Warsaw, Poland.

PATIENTS

Diagnosed with alcohol dependence (n = 285), according to the Diagnostic and Statistical Manual of Mental Disorders, 4(th) edition.

MEASUREMENTS AND RESULTS

Drinking frequency, mental and physical health status, childhood abuse, and PER3 genotype were independent predictors of insomnia severity, as measured by a 7-item subscale of the Sleep Disorders Questionnaire, explaining 28.9% of the variance. Addition of the genotype in the final step significantly increased the amount of variance explained by 1.1% (P = 0.027). Those with the PER3(4/4)genotype had the greatest severity of insomnia symptoms.

CONCLUSIONS

PER3 genotype contributed unique variance in predicting insomnia severity in AD patients. These results are consistent with genetically influenced impairment in sleep regulation mechanisms in AD patients with insomnia.

The association between insomnia and suicidal thoughts in adults treated for alcohol dependence in Poland

BACKGROUND

Suicidal ideation is elevated for individuals with alcohol use disorders. Sleep problems are associated with suicide risk and alcohol use, and sleep problems may be associated with suicide risk in those with alcohol use disorders. For the present study, we hypothesized that self-reported sleep problems are associated with suicidal thoughts in a sample of adults seeking treatment for alcohol dependence in Poland.

METHODS

The sample included 304 patients in addiction treatment programs in Warsaw, Poland who met criteria for alcohol dependence. Measures included demographic characteristics, frequency of alcohol use, psychiatric symptoms, suicidal ideation and two measures of insomnia, which differed by time frame: the Athens Insomnia Scale (AIS, past 1 month) and the Sleep Disorders Questionnaire (SDQ-7, past 6 months). Multivariable logistic regression models tested the association between insomnia and suicidal thoughts.

RESULTS

In models that controlled for age, gender, and days of recent drinking, both measures of sleep problems were associated with suicidal ideation: AOR=2.01 (95% CI: 1.50-2.70) [AIS] and 1.73 (95% CI: 1.29-2.31) [SDQ-7]. The association of sleep problems, as measured by the AIS, with suicide remained significant after adjusting for psychiatric symptoms, although the estimated effect size was smaller (AOR=1.47; 95% CI: 1.05-2.06).

CONCLUSIONS

Among Polish adults with alcohol dependence, insomnia severity was associated with suicidal ideation. This finding highlights the need to assess for sleep problems, in addition to suicidal thoughts, in alcohol treatment settings and to further examine the potential consequences of poor sleep in this population.

Sleep homeostasis in alcohol-dependent, depressed and healthy control men

Visually scored and power spectral analyses (PSA) of polysomnography (PSG) recordings reveal abnormalities in alcohol dependence (AD) and major depressive disorder (MDD), including deficiencies in slow wave activity (SWA) during non-rapid eye movement (NREM) sleep. SWA parameters reflect the integrity of the homeostatic sleep drive, which have not been compared in those with AD or MDD. Ten men with AD were compared with 10 men with MDD and 10 healthy controls (HCs), all aged 20-40 years. They maintained an 11 pm to 6 am sleep schedule for 5-7 days, followed by 3 consecutive nights of PSG in the laboratory: night 1 for adaptation/screening; night 2 for baseline recordings; and night 3 as the challenge night, delaying sleep until 2 am. SWA was quantified with PSA across 4 NREM periods. Men with AD generated the least SWA at baseline. In response to sleep delay, HC men showed the expected SWA enhancement and a sharper exponential decline across NREM periods. Both the MDD and the AD groups showed a significantly blunted SWA response to sleep delay. Men with MDD had the least SWA in the first NREM period (impaired accumulation of sleep drive), whereas men with AD had the slowest SWA decay rate (impaired dissipation of sleep drive). These results suggest that both SWA generation and its homeostatic regulation are impaired in men with either AD or MDD. Finding interventions that selectively improve these different components of sleep homeostasis should be a goal of treatment for AD and MDD.

Persistent insomnia, abstinence, and moderate drinking in alcohol-dependent individuals

Insomnia is common, persistent, and increases the risk for relapse in alcohol-dependent (AD) patients. Abstinence has long been considered the best strategy for allowing sleep to normalize, although how many and which patients respond to abstinence is unknown. The aims of this study were to investigate the prevalence and correlates of both baseline and persistent insomnia in AD patients. The course of sleep problems in response to abstinence, moderate drinking, or relapse following treatment was also examined. A naturalistic longitudinal outcomes study interviewed 267 patients (69% male; mean age of 44 years) with DSM-IV alcohol dependence at baseline and 6 months later (84% follow-up rate) . The Sleep Problems Questionnaire, Time-Line Follow-Back Interview, and Brief Symptom Inventory measured insomnia, drinking, and psychiatric symptoms, respectively. Simple correlations, logistic regression, and repeated measures analysis of variance were used to analyze the data. At baseline, 47% of patients were classified with insomnia, which was independently predicted by female gender and psychiatric severity. Both abstinence and moderate drinking outcomes significantly predicted a reduction of insomnia symptoms after controlling for gender and psychiatric severity. Among patients with baseline insomnia, however, insomnia persisted in over 60% of cases, which was predicted by baseline insomnia severity. Moreover, insomnia persisted in one-quarter of patients despite abstinence. Treatment aimed at preventing relapse to heavy drinking provides good first-line therapy for insomnia in AD patients, but some may require insomnia-specific evaluation and treatment in addition to substance-focused treatment and psychiatric care. 

Pharmacological treatment of insomnia in alcohol recovery: a systematic review

AIMS

To conduct a systematic review of pharmacological agents used to treat sleep problems in alcohol recovery.

METHODS

In accordance with the Quorum statement, we searched PubMed, EMBASE, Psych Info and Medline databases using the terms alcohol, insomnia/sleep and treatment/management with no year/language restrictions.

RESULTS

The search revealed 1239 articles and 20 met inclusion criteria. Trazodone was compared against placebo and found to be superior in two trials. Trazodone and gabapentin improved sleep measures with gabapentin performing significantly better in an open-label study. The data regarding gabapentin are equivocal with few studies showing a clear benefit. In one randomized trial, topiramate resulted in improved subjective sleep measures and a reduction in the percentage of heavy drinking days. Two randomized control trials of carbamazepine revealed improvement in subjective sleep measures. A randomized study showed lormetazepam was better than zopiclone on some measures. In a small placebo-controlled trial, acamprosate was found to result in improvements on some sleep measures. In single, small, mostly open-label studies, quetiapine, triazolam, ritanserin, bright light and magnesium have shown efficacy, while chlormethiazole, scopolamine and melperone showed no difference or worsening.

CONCLUSION

Trazodone has the most data suggesting efficacy. This finding is tempered by a study suggesting its association with a return to heavy drinking in some patients. Data regarding the efficacy of gabapentin are unclear at this point.