Personalized Pharmacotherapy for Treatment Approaches Focused at Primary Insomnia

Treatment of insomnia associated with alcohol and opioid use: a narrative review

Substance use disorders (SUDs) are associated with profound sleep disturbances, including insomnia, sleep fragmentation, and circadian rhythm dysfunction resulting in serious mental and physical consequences. This minireview presents an overview of the neurocircuitry underlying sleep disturbances in SUDs and elaborates on treatment options with emphasis on alcohol use disorder (AUD) and opioid use disorder (OUD). A PubMed, Embase, CINAHL Plus, Cochrane, and Scopus search were conducted using sleep- and AUD/OUD related keywords from January 1st, 2000, to January 31st, 2023, with preferences for recent publications and randomized-controlled trials. A bidirectional relationship exists between insomnia and addiction with the status of each condition impacting the other in dictating clinical outcome. Existing evidence points to a resurgence of insomnia during detoxification, and unless treated satisfactorily, insomnia may lead to relapse. The discussion summarizes the strengths and limitations of cognitive behavioral therapy and pharmacological treatment for insomnia in SUDs covering evidence from both animal and clinical studies. The assumption of reestablishing normal sleep patterns by attaining and maintaining sobriety is misguided. Comorbid insomnia in patients with SUDs should be approached as an independent condition that requires its own treatment. Future clinical trials are needed with the aim of providing a resource for guiding clinical management of the many patients with insomnia and SUD.

What Sways People's Judgment of Sleep Quality? A Quantitative Choice-Making Study With Good and Poor Sleepers

Study objectives:

We conceptualized sleep quality judgment as a decision-making process and examined the relative importance of 17 parameters of sleep quality using a choice-based conjoint analysis.

Methods:

One hundred participants (50 good sleepers; 50 poor sleepers) were asked to choose between 2 written scenarios to answer 1 of 2 questions: “Which describes a better (or worse) night of sleep?”. Each scenario described a self-reported experience of sleep, stringing together 17 possible determinants of sleep quality that occur at different times of the day (day before, pre-sleep, during sleep, upon waking, day after). Each participant answered 48 questions. Logistic regression models were fit to their choice data.

Results:

Eleven of the 17 sleep quality parameters had a significant impact on the participants’ choices. The top 3 determinants of sleep quality were: Total sleep time, feeling refreshed (upon waking), and mood (day after). Sleep quality judgments were most influenced by factors that occur during sleep, followed by feelings and activities upon waking and the day after. There was a significant interaction between wake after sleep onset and feeling refreshed (upon waking) and between feeling refreshed (upon waking) and question type (better or worse night of sleep). Type of sleeper (good vs poor sleepers) did not significantly influence the judgments.

Conclusions:

Sleep quality judgments appear to be determined by not only what happened during sleep, but also what happened after the sleep period. Interventions that improve mood and functioning during the day may inadvertently also improve people’s self-reported evaluation of sleep quality.