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Yeh YH, Zheng MH, Tegge AN, Athamneh LN, Freitas-Lemos R, Dwyer CL, Bickel WK. The phenotype of recovery XI: associations of sleep quality and perceived stress with discounting and quality of life in substance use recovery. Qual Life Res 2024; 33:1621-1632. [PMID: 38504067 PMCID: PMC11116204 DOI: 10.1007/s11136-024-03625-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE Sleep and stress show an interdependent relationship in physiology, and both are known risk factors for relapse in substance use disorder (SUD) recovery. However, sleep and stress are often investigated independently in addiction research. In this exploratory study, the associations of sleep quality and perceived stress with delay discounting (DD), effort discounting (ED), and quality of life (QOL) were examined concomitantly to determine their role in addiction recovery. DD has been proposed as a prognostic indicator of SUD treatment response, ED is hypothesized to be relevant to the effort to overcome addiction, and QOL is an important component in addiction recovery. METHOD An online sample of 118 individuals recovering from SUDs was collected through the International Quit and Recovery Registry. Exhaustive model selection, using the Bayesian Information Criterion to determine the optimal multiple linear model, was conducted to identify variables (i.e., sleep quality, perceived stress, and demographics) contributing to the total variance in DD, ED, and QOL. RESULTS After model selection, sleep was found to be significantly associated with DD. Stress was found to be significantly associated with psychological health, social relationships, and environment QOL. Both sleep and stress were found to be significantly associated with physical health QOL. Neither sleep nor stress was supported as an explanatory variable of ED. CONCLUSION Together, these findings suggest sleep and stress contribute uniquely to the process of addiction recovery. Considering both factors when designing interventions and planning for future research is recommended.
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Affiliation(s)
| | - Michelle H Zheng
- Civil and Environmental Engineering Department, University of California, Los Angeles, CA, USA
| | - Allison N Tegge
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA
- Department of Statistics, Virginia Tech, Blacksburg, VA, USA
| | - Liqa N Athamneh
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA
| | | | - Candice L Dwyer
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA
- Department of Psychology, Virginia Tech, Blacksburg, VA, USA
| | - Warren K Bickel
- Fralin Biomedical Research Institute at VTC, Roanoke, VA, USA.
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Baskerville WA, Grodin EN, Ray LA. Influence of sleep quality on lapse to alcohol use during a quit attempt. Alcohol Alcohol 2024; 59:agae009. [PMID: 38366914 PMCID: PMC10873907 DOI: 10.1093/alcalc/agae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/27/2023] [Accepted: 12/16/2023] [Indexed: 02/19/2024] Open
Abstract
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.
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Affiliation(s)
- Wave-Ananda Baskerville
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 51563, Los Angeles, CA 90095-1563, United States
| | - Erica N Grodin
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 51563, Los Angeles, CA 90095-1563, United States
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 757 Westwood Plaza #4, Los Angeles, CA 90095, United States
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 51563, Los Angeles, CA 90095-1563, United States
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 757 Westwood Plaza #4, Los Angeles, CA 90095, United States
- Brain Research Institute, University of California, Los Angeles, 695 Charles E Young Dr. S, Los Angeles, CA 90095, United States
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Bedard ML, Lord JS, Perez PJ, Bravo IM, Teklezghi AT, Tarantino LM, Diering GH, McElligott ZA. Probing different paradigms of morphine withdrawal on sleep behavior in male and female C57BL/6J mice. Behav Brain Res 2023; 448:114441. [PMID: 37075956 PMCID: PMC10278096 DOI: 10.1016/j.bbr.2023.114441] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/29/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023]
Abstract
Opioid misuse has dramatically increased over the last few decades resulting in many people suffering from opioid use disorder (OUD). The prevalence of opioid overdose has been driven by the development of new synthetic opioids, increased availability of prescription opioids, and more recently, the COVID-19 pandemic. Coinciding with increases in exposure to opioids, the United States has also observed increases in multiple Narcan (naloxone) administrations as a life-saving measures for respiratory depression, and, thus, consequently, naloxone-precipitated withdrawal. Sleep dysregulation is a main symptom of OUD and opioid withdrawal syndrome, and therefore, should be a key facet of animal models of OUD. Here we examine the effect of precipitated and spontaneous morphine withdrawal on sleep behaviors in C57BL/6 J mice. We find that morphine administration and withdrawal dysregulate sleep, but not equally across morphine exposure paradigms. Furthermore, many environmental triggers promote relapse to drug-seeking/taking behavior, and the stress of disrupted sleep may fall into that category. We find that sleep deprivation dysregulates sleep in mice that had previous opioid withdrawal experience. Our data suggest that the 3-day precipitated withdrawal paradigm has the most profound effects on opioid-induced sleep dysregulation and further validates the construct of this model for opioid dependence and OUD.
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Affiliation(s)
- Madigan L Bedard
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Pharmacology, University North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Julia Sparks Lord
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; UNC Neuroscience Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Patric J Perez
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Isabel M Bravo
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adonay T Teklezghi
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa M Tarantino
- Department of Genetics, School of Medicine, University of North Carolina, Chapel Hill, NC, USA; Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Graham H Diering
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; UNC Neuroscience Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Zoe A McElligott
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Pharmacology, University North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Gendy MNS, Frey BN, Van Ameringen M, Kuhathasan N, MacKillop J. Cannabidiol as a candidate pharmacotherapy for sleep disturbance in alcohol use disorder. Alcohol Alcohol 2023:7150867. [PMID: 37139966 DOI: 10.1093/alcalc/agad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 05/05/2023] Open
Abstract
Among individuals with alcohol use disorder (AUD), it is estimated that the majority suffer from persistent sleep disturbances for which few candidate medications are available. Our aim wass to critically review the potential for cannabidiol (CBD) as a treatment for AUD-induced sleep disturbance. As context, notable side effects and abuse liability for existing medications for AUD-induced sleep disturbance reduce their clinical utility. CBD modulation of the endocannabinoid system and favorable safety profile have generated substantial interest in its potential therapeutic use for various medical conditions. A number of preclinical and clinical studies suggest promise for CBD in restoring the normal sleep-wake cycle and in enhancing sleep quality in patients diagnosed with AUD. Based on its pharmacology and the existing literature, albeit primarily preclinical and indirect, CBD is a credible candidate to address alcohol-induced sleep disturbance. Well-designed RCTs will be necessary to test its potential in managing this challenging feature of AUD.
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Affiliation(s)
- Marie N S Gendy
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON L8P 3R2, Canada
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
- Women's Health Concerns Clinic at St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
| | - Nirushi Kuhathasan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON L8S 4K1, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON L8P 3R2, Canada
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada
- Women's Health Concerns Clinic at St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON L8N 3K7, Canada
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, ON L8S 4K1, Canada
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Bedard ML, Lord JS, Perez PJ, Bravo IM, Teklezghi AT, Tarantino L, Diering G, McElligott ZA. Probing different paradigms of morphine withdrawal on sleep behavior in male and female C57BL/6J mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2022.04.06.487380. [PMID: 36415467 PMCID: PMC9681041 DOI: 10.1101/2022.04.06.487380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Opioid misuse has dramatically increased over the last few decades resulting in many people suffering from opioid use disorder (OUD). The prevalence of opioid overdose has been driven by the development of new synthetic opioids, increased availability of prescription opioids, and more recently, the COVID-19 pandemic. Coinciding with increases in exposure to opioids, the United States has also observed increases in multiple Narcan (naloxone) administrations as life-saving measures for respiratory depression, and, thus, consequently, naloxone-precipitated withdrawal. Sleep dysregulation is a main symptom of OUD and opioid withdrawal syndrome, and therefore, should be a key facet of animal models of OUD. Here we examine the effect of precipitated and spontaneous morphine withdrawal on sleep behaviors in C57BL/6J mice. We find that morphine administration and withdrawal dysregulate sleep, but not equally across morphine exposure paradigms. Furthermore, many environmental triggers promote relapse to drug-seeking/taking behavior, and the stress of disrupted sleep may fall into that category. We find that sleep deprivation dysregulates sleep in mice that had previous opioid withdrawal experience. Our data suggest that the 3-day precipitated withdrawal paradigm has the most profound effects on opioid-induced sleep dysregulation and further validates the construct of this model for opioid dependence and OUD. Highlights Morphine withdrawal differentially dysregulates the sleep of male and female mice3-day precipitated withdrawal results in larger changes than spontaneous withdrawalOpioid withdrawal affects responses to future sleep deprivation differently between sexes.
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Stone KC. Postpartum Behavioral Sleep Intervention for Smoking Relapse Prevention: A Pilot Trial. Matern Child Health J 2023; 27:272-285. [PMID: 36625953 PMCID: PMC10039394 DOI: 10.1007/s10995-022-03575-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Rates of postpartum smoking relapse are high (70-90%) but standard relapse prevention interventions are not effective postpartum. This pilot study evaluated effects of a combined relapse prevention and sleep intervention on sleep and relapse to smoking. METHODS Twenty-eight postpartum mothers were assigned to the intervention group-combined relapse prevention and behavioral sleep intervention-or to the comparison group-relapse prevention alone. Questionnaires and actigraphy were completed at baseline (1-week postpartum), post-treatment (8-weeks postpartum), and follow-up (12-weeks postpartum). Sleep diaries were completed weekly for the first 8 weeks postpartum and once at 12 weeks postpartum. To corroborate abstinence, CO levels in expired air were measured weekly for the first 8 weeks postpartum and at follow-up. Timeline Followback (TLFB) and salivary cotinine analysis were conducted at baseline, post-treatment, and follow-up to assess for nicotine and other substance use (TLFB) and to further corroborate abstinence (salivary cotinine analysis). RESULTS The sleep intervention lengthened maternal nighttime actigraphic sleep by an average of 48 minutes nightly; lengthened the longest bout of consolidated actigraphic sleep by an average of 42 minutes nightly; increased actigraphic sleep efficiency into the healthy range (> 85%); and lowered subjective ratings of sleep disturbance (ps < .05). Findings were inconclusive regarding whether better sleep was associated with abstinence. Post Hoc analyses identified the presence of an additional support person in the home as well as social and emotional support as being positively correlated with smoking abstinence (p < .05; p < .01). CONCLUSIONS FOR PRACTICE (1) Postpartum sleep can be improved with behavioral interventions in women with a history of smoking. (2) Social-emotional postpartum support is an important factor in preventing smoking relapse for these women.
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Affiliation(s)
- Kristen C Stone
- Warren Alpert Medical School of Brown University, Box G-A1, Providence, RI, 02912, USA.
- Brown Center for the Study of Children at Risk, Women & Infants Hospital, 101 Dudley St, Providence, RI, 02905, USA.
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Effects of Socio-Familial Behavior on Sleep Quality Predictive Risk Factors in Individuals under Social Isolation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063702. [PMID: 35329386 PMCID: PMC8950965 DOI: 10.3390/ijerph19063702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 02/01/2023]
Abstract
Social confinement involves a series of temporary changes in the habits and lifestyles of individuals, severely affecting their regular activities and schedules and substantially modifying socio-familial behavior (SFB) and sleep quality (SQ). There is no literature reporting the effects of SFB changes on SQ during social confinement due to the COVID-19 outbreak. An observational transversal research design, with group comparison and correlation methods, was used to perform the present study. The results were analyzed as follows: (1) An exploratory factor analysis (EFA); (2) A description of the sample was determined by proportions comparisons of sleep habits between the different variables of interest; and (3) A linear regression model was analyzed to explore the predictive association of the negative effects of social isolation during the COVID-19 pandemic on SFB and SQ. In addition to the global SFB score, two SFB factors were identified as predictors affecting the SQ, SF-Habits, and SF-Emotional scores, suggesting a close balance between daily life activities and sleep health during critical social changes. Furthermore, two main risk factors resulted from the regression analysis: economic concerns and increased alcohol consumption. Therefore, the predictive capacity of economic concerns showed statistical significance in anticipating negative sleep quality scores. Overall, this suggests that sleep quality, economic concerns, schedules, and substance use were associated with the self-perception of coping skills, elucidating the importance of fostering habits related to schedules within the home and ensuring that all family members participate.
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8
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Sharma R, Parikh M, Mishra V, Zuniga A, Sahota P, Thakkar M. Sleep, sleep homeostasis and arousal disturbances in alcoholism. Brain Res Bull 2022; 182:30-43. [PMID: 35122900 DOI: 10.1016/j.brainresbull.2022.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/12/2022] [Accepted: 01/29/2022] [Indexed: 12/11/2022]
Abstract
The effects of alcohol on human sleep were first described almost 70 years ago. Since then, accumulating evidences suggest that alcohol intake at bed time immediately induces sleep [reduces the time to fall asleep (sleep onset latency), and consolidates and enhances the quality (delta power) and the quantity of sleep]. Such potent sleep promoting activity makes alcohol as one of the most commonly used "over the counter" sleep aid. However, the somnogenic effects, after alcohol intake, slowly wane off and often followed by sleep disruptions during the rest of the night. Repeated use of alcohol leads to the development of rapid tolerance resulting into an alcohol abuse. Moreover, chronic and excessive alcohol intake leads to the development of alcohol use disorder (AUD). Alcoholics, both during drinking periods and during abstinences, suffer from a multitude of sleep disruptions manifested by profound insomnia, excessive daytime sleepiness, and altered sleep architecture. Furthermore, subjective and objective indicators of sleep disturbances are predictors of relapse. Finally, within the USA, it is estimated that societal costs of alcohol-related sleep disorders exceed $18 billion. Thus, although alcohol associated sleep problems have significant economic and clinical consequences, very little is known about how and where alcohol acts to affect sleep. In this review, a conceptual framework and clinical research focused on understanding the relationship between alcohol and sleep is first described. In the next section, our new and exciting preclinical studies, to understand the cellular and molecular mechanism of how acute and chronic alcohol affects sleep, are described. In the end, based on observations from our recent findings and related literature, opportunities for the development of innovative strategies to prevent and treat AUD are proposed.
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Affiliation(s)
- Rishi Sharma
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri, Columbia MO 65201
| | - Meet Parikh
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri, Columbia MO 65201
| | - Vaibhav Mishra
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri, Columbia MO 65201
| | - Abigail Zuniga
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri, Columbia MO 65201
| | - Pradeep Sahota
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri, Columbia MO 65201
| | - Mahesh Thakkar
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri, Columbia MO 65201.
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Sharma R, Sahota P, Thakkar MM. Rats exposed to chronic alcohol display protracted insomnia and daytime sleepiness-like behavior during alcohol withdrawal ✰. Physiol Behav 2021; 228:113200. [PMID: 33038349 DOI: 10.1016/j.physbeh.2020.113200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Alcohol use disorder (AUD), a chronic brain disorder, is characterized by a multitude of symptoms, including insomnia, during withdrawal. Previously, we have shown that rats exposed to chronic alcohol displayed insomnia-like symptoms during acute withdrawal. Since insomnia lasts for several years and is a major risk factor of relapse to alcoholism, the present study is designed to investigate the long-term effects of alcohol withdrawal on sleep-wakefulness. METHODS Adult male Sprague-Dawley rats, instrumented with sleep recording electrodes, were divided into two groups: Alcohol and Control. Rats were either administered alcohol (35% v/v), mixed with infant formula (Alcohol group) or control mixture containing water and infant formula (Controls; 10 mL/kg) every 8 h for 4 days using Majchrowicz's chronic binge drinking protocol. Electrographic recordings of sleep-wakefulness were performed until withdrawal day 7, however, the data was analyzed for withdrawal days 3, 5 and 7 in both Control and Alcohol groups. RESULTS As compared to the controls, alcohol-exposed rats displayed insomnia-like symptoms as revealed by a) significant reduction in the quantity and quality of sleep during the light (inactive) period and b) a significant increase in NREM sleep with a concomitant reduction in the amount of time spent in the wakefulness during the dark (active) period of alcohol withdrawal. CONCLUSION Our results suggest that the chronic binge model of alcohol dependence mimics clinical symptoms of AUD especially protracted insomnia and is suitable for understanding the mechanisms associated with alcohol withdrawal-induced behaviors.
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Affiliation(s)
- Rishi Sharma
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri, Columbia MO 65201
| | - Pradeep Sahota
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri, Columbia MO 65201
| | - Mahesh M Thakkar
- Harry S. Truman Memorial Veterans Hospital and Department of Neurology, University of Missouri, Columbia MO 65201.
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Alcohol. Alcohol 2021. [DOI: 10.1016/b978-0-12-816793-9.00001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Chronic alcohol exposure reduces acetylated histones in the sleep-wake regulatory brain regions to cause insomnia during withdrawal. Neuropharmacology 2020; 180:108332. [PMID: 32961200 DOI: 10.1016/j.neuropharm.2020.108332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Alcohol use disorder (AUD) develops after chronic and heavy use of alcohol. Insomnia, a hallmark of AUD, plays a crucial role in the development of AUD. However, the causal mechanisms are unknown. Since chronic alcohol reduces acetylated histones and disrupts the epigenome, we hypothesized that chronic alcohol exposure will reduce acetylated histones in wake-promoting regions of the brain to cause insomnia during alcohol withdrawal. METHODS Adult male C57BL/6J mice, surgically instrumented for electrophysiological monitoring of sleep-wakefulness, were exposed to chronic alcohol (6.8%) consumption using Lieber-DeCarli liquid diet. Three experiments were performed. First, the effect of chronic alcohol consumption was examined on sleep-wakefulness during 7 days of withdrawal. Second, the expression of acetylated histones, H3 lysine 14 (AcH3K14), was examined in two major sleep-wake regulatory brain regions: basal forebrain (BF) and lateral hypothalamus (LH) of the brain by using western blotting. Next, blockade of histone deacetylase, via systemic administration of TSA was examined on alcohol-induced changes in sleep-wakefulness. RESULTS Alcoholic mice displayed a significant reduction in the quality and quantity of NREM sleep coupled with a significant increase in wakefulness that lasted for several days during alcohol withdrawal. In addition, alcoholic mice displayed a significant reduction in the expression of AcH3K14 in both BF and LH. Systemic administration of TSA significantly attenuated insomnia and improved the quality and quantity of sleep during alcohol withdrawal. CONCLUSIONS Based on our results, we suggest that a causal relationship exists between reduced histone acetylation and insomnia during alcohol withdrawal.
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Roehrs TA, Auciello J, Tseng J, Whiteside G. Current and potential pharmacological treatment options for insomnia in patients with alcohol use disorder in recovery. Neuropsychopharmacol Rep 2020; 40:211-223. [PMID: 32543111 PMCID: PMC7722668 DOI: 10.1002/npr2.12117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/28/2020] [Accepted: 05/07/2020] [Indexed: 01/12/2023] Open
Abstract
Alcohol use disorder (AUD) is characterized by dysfunction in motivational, mood-stress regulation, and sleep systems that interact in complex ways to heighten the risk of relapse during abstinence. Emerging data suggest that excessive and chronic alcohol use disrupts sleep homeostasis and, in abstinence, subjects with AUD are known to experience insomnia that may persist for weeks to years, which we propose to refer to as insomnia associated with alcohol cessation (IAAC). The purpose of this review is to provide an update of pharmacological approaches to therapy including compounds in development, to raise awareness of the prevalence of and unmet need in IAAC and highlight differences in treatment consideration for IAAC as compared to insomnia disorder. We performed a search of select electronic databases to identify studies of pharmacological agents used to treat sleep disturbances in abstinent or treatment-seeking patients with alcohol use disorder. The search, conducted in June 2019 and updated in December 2019, yielded 1,188 abstracts after duplicates were removed, of which 36 full-text articles were assessed for eligibility. Eighteen studies were included, 15 randomized controlled trials and three open-label studies. Several classes of medications including antidepressants, anticonvulsants, and antipsychotics have been evaluated for their effectiveness in treating sleep disturbances in abstinent or treatment-seeking patients with AUD. None of these medications are approved by the FDA for the treatment of IAAC, and the currently available evidence for these agents is limited. Randomized, controlled clinical trials are warranted to evaluate the efficacy and safety of medications in the treatment of IAAC.
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Affiliation(s)
- Timothy A. Roehrs
- Henry Ford Health SystemSleep Disorders and Research CenterDetroitMIUSA
- Department of Psychiatry and Behavioral NeuroscienceSchool of MedicineWayne State UniversityDetroitMIUSA
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Luca G, Peris L. Sleep Quality and Sleep Disturbance Perception in Dual Disorder Patients. J Clin Med 2020; 9:jcm9062015. [PMID: 32604951 PMCID: PMC7355436 DOI: 10.3390/jcm9062015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/21/2020] [Accepted: 06/25/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Sleep problems are particularly frequent in psychiatric disorders, but their bidirectional intersection is poorly clarified. An especial link between substance use and sleep seems to exist. While dual disorder patients are certainly at higher risk of experiencing sleep problems, very limited research is available today. Methods: Forty-seven dual disorder hospitalized patients were included in this first study. A complete psychiatric evaluation was performed, and sleep habits, patterns and potential disorders were evaluated with specific sleep scales, as well as anxiety. Results: The global prevalence of insomnia symptoms was considerably higher compared with the general population. Different abuse patterns as a function of concurrent psychiatric diagnosis were found, with no significant gender differences. The association between the investigated sleep parameters and any specific substance of abuse was minor. The addict behavior started in more than half of the patients prior to the main psychiatric diagnosis and close to the beginning of sleep problems. Men had a higher prevalence of insomnia symptoms, together with a higher incidence of anxiety. Overall, subjective daytime functioning was not altered as a consequence of poor sleep. Conclusion: Dual disorder patients face significant sleep disturbances, with low sleep quality. The role of sleep in addiction and dual disorders deserves greater research.
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Gendy MNS, Lagzdins D, Schaman J, Le Foll B. Melatonin for Treatment-Seeking Alcohol Use Disorder patients with sleeping problems: A randomized clinical pilot trial. Sci Rep 2020; 10:8739. [PMID: 32457492 PMCID: PMC7250869 DOI: 10.1038/s41598-020-65166-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/19/2020] [Indexed: 12/30/2022] Open
Abstract
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.
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Affiliation(s)
- Marie N S Gendy
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, M5S 2S1, Ontario, Canada.,Department of Pharmacology, University of Toronto, Medical Science Building, 1 King's College Cir, Toronto, M5S 1A8, Ontario, Canada
| | - Dina Lagzdins
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, M5S 2S1, Ontario, Canada
| | - Jessika Schaman
- Alcohol Research and Treatment Clinic, Acute Care Program, CAMH, Toronto, M6J 1H4, Ontario, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, M5S 2S1, Ontario, Canada. .,Alcohol Research and Treatment Clinic, Acute Care Program, CAMH, Toronto, M6J 1H4, Ontario, Canada. .,Campbell Family Mental Health Research Institute, CAMH, 33 Russell Street, Toronto, M5S 2S1, Ontario, Canada. .,Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, M5G 1V7, Ontario, Canada. .,Department of Pharmacology, University of Toronto, Medical Science Building, 1 King's College Cir, Toronto, M5S 1A8, Ontario, Canada. .,Department of Psychiatry, Division of Brain and Therapeutics, University of Toronto, 250 College Street, Toronto, M5T 1R8, Ontario, Canada. .,Institute of Medical Sciences, University of Toronto, 27 King's College Cir, Toronto, M5S 1A8, Ontario, Canada.
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15
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Reid-Varley WB, Ponce Martinez C, Khurshid KA. Sleep disorders and disrupted sleep in addiction, withdrawal and abstinence with focus on alcohol and opioids. J Neurol Sci 2020; 411:116713. [PMID: 32087437 DOI: 10.1016/j.jns.2020.116713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/30/2019] [Accepted: 01/29/2020] [Indexed: 10/25/2022]
Affiliation(s)
- William-Bernard Reid-Varley
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Caridad Ponce Martinez
- Department of Psychiatry, Division of Addiction Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Khurshid A Khurshid
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, United States of America; Department of Psychiatry, Massachusetts Lung and Allergy Center, University of Massachusetts, United States of America.
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16
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Koob GF, Colrain IM. Alcohol use disorder and sleep disturbances: a feed-forward allostatic framework. Neuropsychopharmacology 2020; 45:141-165. [PMID: 31234199 PMCID: PMC6879503 DOI: 10.1038/s41386-019-0446-0] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/09/2019] [Accepted: 06/13/2019] [Indexed: 11/09/2022]
Abstract
The development of alcohol use disorder (AUD) involves binge or heavy drinking to high levels of intoxication that leads to compulsive intake, the loss of control in limiting intake, and a negative emotional state when alcohol is removed. This cascade of events occurs over an extended period within a three-stage cycle: binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation. These three heuristic stages map onto the dysregulation of functional domains of incentive salience/habits, negative emotional states, and executive function, mediated by the basal ganglia, extended amygdala, and frontal cortex, respectively. Sleep disturbances, alterations of sleep architecture, and the development of insomnia are ubiquitous in AUD and also map onto the three stages of the addiction cycle. During the binge/intoxication stage, alcohol intoxication leads to a faster sleep onset, but sleep quality is poor relative to nights when no alcohol is consumed. The reduction of sleep onset latency and increase in wakefulness later in the night may be related to the acute effects of alcohol on GABAergic systems that are associated with sleep regulation and the effects on brain incentive salience systems, such as dopamine. During the withdrawal/negative affect stage, there is a decrease in slow-wave sleep and some limited recovery in REM sleep when individuals with AUD stop drinking. Limited recovery of sleep disturbances is seen in AUD within the first 30 days of abstinence. The effects of withdrawal on sleep may be related to the loss of alcohol as a positive allosteric modulator of GABAA receptors, a decrease in dopamine function, and the overactivation of stress neuromodulators, including hypocretin/orexin, norepinephrine, corticotropin-releasing factor, and cytokines. During the preoccupation/anticipation stage, individuals with AUD who are abstinent long-term present persistent sleep disturbances, including a longer latency to fall asleep, more time awake during the night, a decrease in slow-wave sleep, decreases in delta electroencephalogram power and evoked delta activity, and an increase in REM sleep. Glutamatergic system dysregulation that is observed in AUD is a likely substrate for some of these persistent sleep disturbances. Sleep pathology contributes to AUD pathology, and vice versa, possibly as a feed-forward drive to an unrecognized allostatic load that drives the addiction process.
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Affiliation(s)
- George F Koob
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 6700B Rockledge Drive, Room 1209, MSC 6902, Bethesda, MD, 20892-6902, USA.
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, 20892-6902, USA.
| | - Ian M Colrain
- SRI Biosciences, SRI International, Menlo Park, CA, USA
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
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17
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Kolla BP, Mansukhani MP, Biernacka J, Chakravorty S, Karpyak VM. Sleep disturbances in early alcohol recovery: Prevalence and associations with clinical characteristics and severity of alcohol consumption. Drug Alcohol Depend 2020; 206:107655. [PMID: 31744670 DOI: 10.1016/j.drugalcdep.2019.107655] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Bhanu Prakash Kolla
- Department of Psychiatry and Psychology, Mayo Clinic, 2nd ST SW, Rochester, MN 55905, USA; Center for Sleep Medicine, Mayo Clinic, 2nd ST SW, Rochester, MN 55905, USA.
| | - Meghna P Mansukhani
- Department of Psychiatry and Psychology, Mayo Clinic, 2nd ST SW, Rochester, MN 55905, USA
| | - Joanna Biernacka
- Department of Biostatistics, Mayo Clinic, 2nd ST SW, Rochester, MN 55905, USA
| | - Subhajit Chakravorty
- Department of Psychiatry, Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Victor M Karpyak
- Department of Biostatistics, Mayo Clinic, 2nd ST SW, Rochester, MN 55905, USA
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Hühne A, Hoch E, Landgraf D. DAILY-A Personalized Circadian Zeitgeber Therapy as an Adjunctive Treatment for Alcohol Use Disorder Patients: Study Protocol for a Randomized Controlled Trial. Front Psychiatry 2020; 11:569864. [PMID: 33519541 PMCID: PMC7840704 DOI: 10.3389/fpsyt.2020.569864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 12/09/2020] [Indexed: 01/23/2023] Open
Abstract
Background: Hallmarks of alcohol use disorder (AUD) are disturbances of circadian rhythms and everyday structures. While circadian rhythms dictate the timing of daily recurring activities such as sleep, activity, and meals, conversely, these activities represent time cues, so called Zeitgebers, that the circadian system uses to synchronize with the environment. Here we present a study protocol for our newly developed therapy approach for AUD patients, in which we take advantage of this mutual influence and stabilize and strengthen their circadian system by creating strict daily schedules for daily Zeitgeber activities. Since every person has a circadian system with its own characteristics and is subject to social obligations, the daily plans are personalized for each test person. Our hypothesis is that a regular exposure to Zeitgebers stabilizes behavioral and physiological circadian rhythms and thereby reduces the risk of alcohol relapses and depressive symptoms and facilitates physical recovery in AUD patients during the 1st weeks of their addiction therapy. Methods/design: The study is a 6-weeks single site trial with a controlled, randomized, single-blinded, parallel-group design including patients with a diagnosis of AUD. The study runs parallel to the standard addiction therapy of the clinic. Patients are randomly assigned to either an intervention group (DAILY) or a sham control group (placebo treatment). Questionnaires and physiological assessments of both groups are conducted before and immediately after the intervention or control treatment. According to our hypothesis, the primary outcomes of this study are improvements of regularity, alcohol consumption, and relapse rate in AUD patients compared to AUD patients receiving control treatment. Secondary outcomes are reduced depressive symptoms and increased physical recovery. Discussion: This study is a randomized controlled trial to investigate the efficacy of a personalized circadian Zeitgeber therapy as an adjunctive treatment for alcohol use disorder patients. The overall goal of this and more extended future studies is the development of an adjunctive therapy for AUD patients that is uncomplicated in its use and easy to implement in the clinical and everyday routine. Trial registration: This study is registered at the German Clinical Trial Register with the trial number DRKS00019093 on November 28, 2019.
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Affiliation(s)
- Anisja Hühne
- Circadian Biology Group, Department of Molecular Neurobiology, Clinic of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University, Munich, Germany.,Munich Medical Research School, Ludwig Maximilian University, Munich, Germany
| | - Eva Hoch
- Cannabinoid Research and Treatment Group, Division of Clinical Psychology and Psychological Treatment, Department of Psychology, Clinic of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Dominic Landgraf
- Circadian Biology Group, Department of Molecular Neurobiology, Clinic of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University, Munich, Germany
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19
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Campbell EJ, Norman A, Bonomo Y, Lawrence AJ. Suvorexant to treat alcohol use disorder and comorbid insomnia: Plan for a phase II trial. Brain Res 2019; 1728:146597. [PMID: 31837287 DOI: 10.1016/j.brainres.2019.146597] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/29/2019] [Accepted: 12/09/2019] [Indexed: 11/16/2022]
Abstract
Alcohol use disorder (AUD) is a complex neuropsychiatric disease state in which currently approved pharmacotherapeutics are of relatively low effect at a population level. One reason for this may be that current pharmacotherapeutics focus on the reward pathway in relapse prevention, rather than addressing AUD from a holistic perspective. Importantly, one often overlooked symptom of AUD is sleep disruption. In recent years, an efficient, relatively low risk and economic strategy that has proven successful in other disorders is the repositioning or repurposing of drugs approved for the treatment of other indications. Suvorexant, a dual orexin receptor antagonist, has been licensed for the treatment of insomnia in the USA, Australia and Japan. The orexin system also plays a role in the emotional dysregulation that occurs during withdrawal from alcohol use and in alcohol-seeking behaviours. These two factors prompted the planning of a clinical trial into the use of suvorexant to treat insomnia in alcohol dependent individuals during and 24 weeks post-acute alcohol withdrawal. In this review we outline the comorbid nature of AUD and sleep disruptions. We then highlight the role of the orexin system in both sleep-wake regulation and AUD. Finally, we discuss our plan for a Phase II double blind placebo controlled trial examining the effectiveness of suvorexant for the treatment of comorbid insomnia and AUD.
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Affiliation(s)
- Erin J Campbell
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Victoria 3010, Australia
| | - Amanda Norman
- St Vincent's Hospital Melbourne, Department of Addiction Medicine, The University of Melbourne, Victoria 3010, Australia
| | - Yvonne Bonomo
- St Vincent's Hospital Melbourne, Department of Addiction Medicine, The University of Melbourne, Victoria 3010, Australia
| | - Andrew J Lawrence
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Victoria 3010, Australia.
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20
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Panin F, Peana AT. Sleep and the Pharmacotherapy of Alcohol Use Disorder: Unfortunate Bedfellows. A Systematic Review With Meta-Analysis. Front Pharmacol 2019; 10:1164. [PMID: 31680952 PMCID: PMC6811753 DOI: 10.3389/fphar.2019.01164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/10/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Sleep disorders are commonly associated with acute and chronic use of alcohol and with abstinence. To date, there are four approved drugs to treat alcohol use disorder (AUD): disulfiram, acamprosate, naltrexone, and nalmefene. These AUD therapies reduce the craving and risk of relapse into heavy drinking, but little is known about their effect on sleep. As recent evidences indicate a crucial role of sleep disorders in AUD, claiming that sleep problems may trigger alcohol abuse and relapses, it is fundamental to clarify the impact of those drugs on the sleep quality of AUD patients. This systematic review aims to answer the question: how does the pharmacotherapy for AUD affect sleep? Methods: We searched PubMed, Embase, CINAHL Plus, Cochrane, and Scopus using sleep- and AUD pharmacotherapy-related keywords. The articles included were appraised using the CASP checklists, and the risk of bias was assessed following the Cochrane risk-of-bias assessment tool. Finally, we pooled sleep outcomes in a meta-analysis to measure the overall effect. Results and Conclusion: We included 26 studies: only three studies focused on sleep as a main outcome, two with polysomnography (objective measurement), and one with subjective self-reported sleep, while all the other studies reported sleep problems among the adverse effects (subjective report). The only study available on disulfiram showed reduced REM sleep. Acamprosate showed no/little effect on self-reported sleep but improved sleep continuity and architecture measured by polysomnography. The two opioidergic drugs naltrexone and nalmefene had mainly detrimental effect on sleep, giving increased insomnia and/or somnolence compared with placebo, although not always significant. The meta-analysis confirmed significantly increased somnolence and insomnia in the naltrexone group, compared with the placebo. Overall, the currently available evidences show more sleep problems with the opioidergic drugs (especially naltrexone), while acamprosate seems to be well tolerated or even beneficial. Acamprosate might be a more suitable choice when patients with AUD report sleep problems. Due to the paucity of information available, and with the majority of results being subjective, more research on this topic is needed to further inform the clinical practice, ideally with more objective measurements such as polysomnography.
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Affiliation(s)
- Francesca Panin
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, United Kingdom
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21
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Sliedrecht W, de Waart R, Witkiewitz K, Roozen HG. Alcohol use disorder relapse factors: A systematic review. Psychiatry Res 2019; 278:97-115. [PMID: 31174033 DOI: 10.1016/j.psychres.2019.05.038] [Citation(s) in RCA: 161] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 12/12/2022]
Abstract
A relapsing-remitting course is very common in patients with an Alcohol Use Disorder (AUD). Understanding the determinants associated with alcohol resumption remains a formidable task. This paper examines relapse determinants based on a systematic review of recent alcohol literature (2000-2019). Relevant databases were consulted for articles that contained information about specific relapse determinants and reported statistical significance of each relapse determinant in predicting relapse. Relapse was broadly defined based on the characterization in the included articles. From the initial identified 4613 papers, a total of 321 articles were included. Results encompass multiple relapse determinants, which were ordered according to biopsychosocial and spiritual categories, and presented, using a descriptive methodology. Psychiatric co-morbidity, AUD severity, craving, use of other substances, health and social factors were consistently significantly associated with AUD relapse. Conversely, supportive social network factors, self efficacy, and factors related to purpose and meaning in life, were protective against AUD relapse. Despite heterogeneity in different methods, measures, and sample characteristics, these findings may contribute to a better therapeutic understanding in which specific factors are associated with relapse and those that prevent relapse. Such factors may have a role in a personalized medicine framework to improve patient outcomes.
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Affiliation(s)
- Wilco Sliedrecht
- De Hoop GGZ, Provincialeweg 70, 3329 KP Dordrecht, the Netherlands.
| | - Ranne de Waart
- Mentrum/Arkin, Wisselwerking 46-48, 1112 XR Diemen, the Netherlands.
| | - Katie Witkiewitz
- The University of New Mexico (UNM), MSC 03-2220, Univ of New Mexico, Albuquerque, NM 87131, USA.
| | - Hendrik G Roozen
- The University of New Mexico (UNM), Center on Alcoholism, Substance Abuse, and Addictions (CASAA), MSC 11 6280, 1 Univ of New Mexico, Albuquerque, NM 87106, USA.
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22
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Lee JY, Kim W, Brook JS. Triple comorbid trajectories of alcohol, cigarette, and marijuana use from adolescence to adulthood predict insomnia in adulthood. Addict Behav 2019; 90:437-443. [PMID: 30590309 DOI: 10.1016/j.addbeh.2018.11.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/16/2018] [Accepted: 11/16/2018] [Indexed: 12/18/2022]
Abstract
Approximately 9% of adults report the symptoms of insomnia, and there are a number of adverse consequences of insomnia. This could be a public health concern. The current study seeks plausible longitudinal predictors of insomnia for prevention purposes. A community sample of 674 participants (53% African Americans and 47% Puerto Ricans; 60% were females) were recruited from the Harlem Longitudinal Development Study. We applied a growth mixture model to obtain the triple trajectories of alcohol, cigarette, and marijuana use. Logistic regression analyses were then conducted to examine the associations between the triple trajectory groups from mean age 14 to 36 and insomnia at age 36. The estimated prevalence of insomnia is 7.1%. A five-group triple trajectory model was selected: A) Increasing use of all three substances (18%); B) Moderate use of alcohol and marijuana, and high use of cigarette (11%); C) Moderate use of alcohol and cigarette, and experimental use of marijuana (3%); D) Moderate use of all three substances (5%); and E) No or low use of all three substances (63%). Among the five trajectory groups, the increasing use of all three substances group (AOR = 2.71, p-value = .011) was associated with an increased likelihood of having insomnia as compared to the no or low use of all three substances group. Treatment programs to quit or reduce the use of alcohol, cigarette, and marijuana may help decrease the prevalence of insomnia. This could lead to improvements in individualized treatments for patients who have symptoms of insomnia and who also use substances.
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23
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Oftedal S, Kolt GS, Holliday EG, Stamatakis E, Vandelanotte C, Brown WJ, Duncan MJ. Associations of health-behavior patterns, mental health and self-rated health. Prev Med 2019; 118:295-303. [PMID: 30476503 DOI: 10.1016/j.ypmed.2018.11.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 11/19/2018] [Accepted: 11/22/2018] [Indexed: 12/31/2022]
Abstract
Diet quality, physical activity, alcohol use, smoking, sleep and sitting-time are behaviors known to influence health. The aims of this study were to identify how these behaviors co-occur to form distinct health-behavior patterns, and to investigate the relationship between these patterns, and mental and self-rated health. Members of the Australian 10,000 Steps project were invited to participate in an online survey in November-December 2011. The participants self-reported demographic and behavioral characteristics (fruit and vegetable intake, fast food, soft drink and alcohol consumption, smoking, physical activity, sitting-time and sleep), frequency of mental distress and self-rated health. Latent Class Analysis was used to identify health-behavior patterns. Latent class regression was used to examine relationships between behavior patterns, mental and self-rated health, and socio-demographic and economic factors. Data were analyzed in October 2017. Complete datasets were obtained from 10,638 participants. Four latent classes were identified, characterized by 'Low-Risk Behavior', 'Poor Sleep, Low-Risk Daytime Behavior', 'Sound Sleep, High-Risk Daytime Behavior' and 'High-Risk Behavior'. The latter two classes, both characterized by high-risk daytime behaviors, were associated with poor self-rated health. Participants in classes with high-risk daytime behaviors were more likely to be younger, non-partnered, non-university educated, from lower income households and work longer hours. Classes characterized by poor sleep quality were associated with higher frequency of mental distress. Findings suggest that experiencing poor sleep is partly independent of daytime behaviors, demographic and socioeconomic factors, but has a strong association with mental health.
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Affiliation(s)
- Stina Oftedal
- School of Medicine & Public Health, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Gregory S Kolt
- School of Science and Health, Western Sydney University, Penrith, NSW 2751, Australia
| | | | - Emmanuel Stamatakis
- Epidemiology Unit, Charles Perkins Centre, University of Sydney, Australia; Prevention Research Collaboration, School of Public Health, University of Sydney, Australia
| | - Corneel Vandelanotte
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, QLD 4700, Australia
| | - Wendy J Brown
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Mitch J Duncan
- School of Medicine & Public Health, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
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Abstract
BACKGROUND Insomnia is a major public health issue affecting between 6% to 10% of the adult population in Western countries. Eszopiclone is a hypnotic drug belonging to a newer group of hypnotic agents, known as new generation hypnotics, which was marketed as being just as effective as benzodiazepines for this condition, while being safer and having a lower risk for abuse and dependence. It is the aim of the review to integrate evidence from randomised controlled trials and to draw conclusions on eszopiclone's efficacy and safety profile, while taking methodological features and bias risks into consideration. OBJECTIVES To assess the efficacy and safety of eszopiclone for the treatment of insomnia compared to placebo or active control. SEARCH METHODS We searched the Cochrane Central Register of Controlled trials (CENTRAL), MEDLINE, Embase, PsycINFO, PSYNDEX and registry databases (WHO trials portal, ClinicalTrials.gov) with results incorporated from searches to 10 February 2016. To identify trials not registered in electronic databases, we contacted key informants and searched reference lists of identified studies. We ran an update search (21 February 2018) and have placed studies of interest in awaiting classification/ongoing studies. These will be incorporated into the next version of the review, as appropriate. SELECTION CRITERIA Parallel group randomised controlled trials (RCTs) comparing eszopiclone with either placebo or active control were included in the review. Participants were adults with insomnia, as diagnosed with a standardised diagnostic system, including primary insomnia and comorbid insomnia. DATA COLLECTION AND ANALYSIS Two authors independently extracted outcome data; one reviewer assessed trial quality and the second author cross-checked it. MAIN RESULTS A total of 14 RCTs, with 4732 participants, were included in this review covering short-term (≤ 4 weeks; 6 studies), medium-term (> 4 weeks ≤ 6 months; 6 studies) and long-term treatment (> 6 months; 2 studies) with eszopiclone. Most RCTs included in the review included participants aged between 18 and 64 years, three RCTs only included elderly participants (64 to 85 years) and one RCT included participants with a broader age range (35 to 85 years). Seven studies considered primary insomnia; the remaining studies considered secondary insomnia comorbid with depression (2), generalised anxiety (1), back pain (1), Parkinson's disease (1), rheumatoid arthritis (1) and menopausal transition (1).Meta-analytic integrations of participant-reported data on sleep efficacy outcomes demonstrated better results for eszopiclone compared to placebo: a 12-minute decrease of sleep onset latency (mean difference (MD) -11.94 min, 95% confidence interval (CI) -16.03 to -7.86; 9 studies, 2890 participants, moderate quality evidence), a 17-minute decrease of wake time after sleep onset (MD -17.02 min, 95% CI -24.89 to -9.15; 8 studies, 2295 participants, moderate quality evidence) and a 28-minute increase of total sleep time (MD 27.70 min, 95% CI 20.30 to 35.09; 10 studies, 2965 participants, moderate quality evidence). There were no significant changes from baseline to the first three nights after drug discontinuation for sleep onset latency (MD 17.00 min, 95% CI -4.29 to 38.29; 1 study, 291 participants, low quality evidence) and wake time after sleep onset (MD -6.71 min, 95% CI -21.25 to 7.83; 1 study, 291 participants, low quality evidence). Adverse events during treatment that were documented more frequently under eszopiclone compared to placebo included unpleasant taste (risk difference (RD) 0.18, 95% CI 0.14 to 0.21; 9 studies, 3787 participants), dry mouth (RD 0.04, 95% CI 0.02 to 0.06; 6 studies, 2802 participants), somnolence (RD 0.04, 95% CI 0.02 to 0.06; 8 studies, 3532 participants) and dizziness (RD 0.03, 95% CI 0.01 to 0.05; 7 studies, 2933 participants). According to the GRADE criteria, evidence was rated as being of moderate quality for sleep efficacy outcomes and adverse events and of low quality for rebound effects and next-day functioning. AUTHORS' CONCLUSIONS Eszopiclone appears to be an efficient drug with moderate effects on sleep onset and maintenance. There was no or little evidence of harm if taken as recommended. However, as certain patient subgroups were underrepresented in RCTs included in the review, findings might not have displayed the entire spectrum of possible adverse events. Further, increased caution is required in elderly individuals with cognitive and motor impairments and individuals who are at increased risk of using eszopiclone in a non-recommended way.
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Affiliation(s)
- Susanne Rösner
- Forel KlinikIslikonerstrasse 5Ellikon an der ThurSwitzerland8548
| | | | | | | | - Michael Soyka
- University of MunichPsychiatric HospitalNußbaumstr. 7MunichGermany80336
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Yaya S, Wang R, Shangfeng T, Ghose B. Alcohol consumption and sleep deprivation among Ghanaian adults: Ghana Demographic and Health Survey. PeerJ 2018; 6:e5750. [PMID: 30324025 PMCID: PMC6183558 DOI: 10.7717/peerj.5750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/12/2018] [Indexed: 01/31/2023] Open
Abstract
ABSTRACT Heavy consumption of alcohol has shown to be associated with sleep disturbances among adult and elderly people in high income settings. So far, the relationship between alcohol drinking and sleeping pattern has not been studied in an African setting. Therefore, in this study we investigated whether alcohol consumption has any influence on sleeping hours among adult men and women in Ghana. METHODS Data for this survey were extracted from Ghana Demographic and Health Survey (GDHS 2008). GDHS is the only cross-sectional survey conducted on men and women aged above 15 years that collected information on variables such as sleeping hours and alcohol consumption. The analysis was controlled for various demographic, socioeconomic, household level factors, and smoking. RESULTS Prevalence of sleeping 1-3 h, 4-6 h, and >7 h was respectively 1.5% (1.2-2.0), 14.1% (12-16.5), and 84.4% (82.1-86.4), and that of alcohol use was 26.9% (23.4-30.6). In the multivariable regression analysis, compared with non-drinkers, those reported drinking had significantly lower odds of sleeping for at least 7 h. In the adjusted model, drinkers had 0.8 times (adjusted OR = 0.803, (95% CI [0.690-0.935])) lower odds of sleeping for at least 7 h. The odds for sleeping 4-6 h were not statistically significant. In the stratified analysis, the odds of sleeping for at least seven were comparatively lower among women (adjusted OR = 0.657, (95% CI [0.509-0.849]) then among men (adjusted OR = 0.867, (95% CI [0.740-0.965]). CONCLUSION Men and women who reported consuming alcohol had significantly lower odds of getting adequate sleep (>7 h). The sleep-disrupting effect of alcohol appeared to be more prominent among women than among men. Currently there is not sufficient evidence on alcohol consumption and sleep disorder among Ghanaian population or any other country in the region. Further studies are required to understand sleeping patterns and the burden of alcohol drinking in this population to design intervention programs.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
| | - Ruoxi Wang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
| | - Tang Shangfeng
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, China
| | - Bishwajit Ghose
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
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Campbell EJ, Marchant NJ, Lawrence AJ. A sleeping giant: Suvorexant for the treatment of alcohol use disorder? Brain Res 2018; 1731:145902. [PMID: 30081035 DOI: 10.1016/j.brainres.2018.08.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/23/2018] [Accepted: 08/01/2018] [Indexed: 01/12/2023]
Abstract
There are currently 3 FDA approved treatments for alcohol use disorder (AUD) in the USA, opioid receptor antagonists such as naltrexone, disulfiram and acamprosate. To date, these have been largely inadequate at preventing relapse at a population level and this may be because they only target certain aspects of AUD. Recently, suvorexant, a dual orexin receptor antagonist, has been FDA approved for the treatment of insomnia. Importantly, sleep disruptions occur during both acute and prolonged alcohol exposure and sleep deprivation is a potent factor promoting relapse to alcohol use. In this mini review article, we explore the therapeutic potential of suvorexant for the treatment of AUD. In particular, we highlight that in addition to altering the motivational properties of alcohol, suvorexant may also address key physiological components associated with alcohol withdrawal and abstinence, such as sleep disruptions, which should in turn help reduce or prevent relapse.
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Affiliation(s)
- Erin J Campbell
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria 3052, Australia; Florey Department of Neuroscience and Mental Health, The University of Melbourne, Victoria 3010, Australia
| | - Nathan J Marchant
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria 3052, Australia; Florey Department of Neuroscience and Mental Health, The University of Melbourne, Victoria 3010, Australia; Department of Anatomy & Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Andrew J Lawrence
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria 3052, Australia; Florey Department of Neuroscience and Mental Health, The University of Melbourne, Victoria 3010, Australia.
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Paljärvi T, Martikainen P, Leinonen T, Vuori E, Mäkelä P. Purchases of prescription drugs before an alcohol-related death: A ten-year follow-up study using linked routine data. Drug Alcohol Depend 2018; 186:175-181. [PMID: 29597151 DOI: 10.1016/j.drugalcdep.2018.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/22/2017] [Accepted: 02/20/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Physician's intention to prescribe drugs could potentially be used to improve targeting of alcohol interventions and enhanced disease management to patients with a high risk of severe alcohol-related harm within outpatient settings. METHODS Comparison of ten-year incidence trajectories of 13.8 million reimbursed purchases of prescription drugs among 303,057 Finnish men and women of whom 7490 ultimately died due to alcohol-related causes (Alc+), 14,954 died without alcohol involvement (Alc-), and 280,613 survived until the end of 2007. RESULTS 5-10 years before death, 88% of the persons with an Alc+ death had received prescription medication, and over two-thirds (69%) had at least one reimbursed purchase of drugs for the alimentary tract and metabolism, the cardiovascular system, or the nervous system. Among persons with an Alc+ death, the incidence rate (IR) for purchases of hypnotics, and sedatives was 1.38 times higher (95% confidence interval (CI):1.32,1.44) compared to those with an Alc- death, and 4.07 times higher (95%CI:3.92,4.22) compared to survivors; and the IR for purchases of anxiolytics was 1.40 times higher (95%CI:1.34,1.47) compared to those with an Alc- death, and 3.61 times higher (95%CI:3.48,3.78) compared to survivors. CONCLUSIONS Using physician's intention to prescribe drugs affecting the alimentary tract and metabolism, cardiovascular system and nervous system could potentially be used to flag patients who might benefit from screening, targeted interventions or enhanced disease management. In particular, patients who are to be prescribed anxiolytics, hypnotics, and sedatives, and antidepressants may benefit from enhanced interventions targeted to problem drinking.
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Affiliation(s)
- Tapio Paljärvi
- Alcohol, Drugs and Addictions Unit, National Institute for Health and Welfare, Helsinki, Finland; Division of Population Medicine, Cardiff University, Cardiff, United Kingdom.
| | - Pekka Martikainen
- Population Research Unit, University of Helsinki, Finland; Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Sweden; The Max Planck Institute for Demographic Research, Rostock, Germany
| | | | - Erkki Vuori
- Department of Forensic Medicine, University of Helsinki, Finland
| | - Pia Mäkelä
- Alcohol, Drugs and Addictions Unit, National Institute for Health and Welfare, Helsinki, Finland
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Hodges CJ, Ogeil RP, Lubman DI. The effects of acute alcohol withdrawal on sleep. Hum Psychopharmacol 2018; 33:e2657. [PMID: 29676057 DOI: 10.1002/hup.2657] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 02/25/2018] [Accepted: 03/08/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Although sleep disturbances are prominent during alcohol withdrawal, less is known about the specific components of sleep that are disturbed prior to and during acute detoxification. This study aimed to determine whether specific sleep components are affected prior to and during acute detoxification and their relationship to psychological distress. METHODS Twenty-nine participants were recruited from a residential detoxification service in Melbourne, Australia, and completed both subjective methods of sleep and distress, in addition to wearing an actigraphy device. RESULTS Daytime dysfunction, sleep quality, and sleep disturbances were the components that were most disturbed in the month prior to admission, and poor sleep efficiency was detected during acute withdrawal using actigraphy. A significant association was found between sleep and psychological distress in this group. CONCLUSIONS Specific disturbances in sleep are experienced prior to and during acute alcohol withdrawal, suggesting that tailored interventions may be effective in the treatment of sleep deficits during these periods.
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Affiliation(s)
- Christopher J Hodges
- School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Rowan P Ogeil
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.,Turning Point, Eastern Health, Richmond, Victoria, Australia
| | - Dan I Lubman
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.,Turning Point, Eastern Health, Richmond, Victoria, Australia
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Perney P, Lehert P. Insomnia in Alcohol-Dependent Patients: Prevalence, Risk Factors and Acamprosate Effect: An Individual Patient Data Meta-Analysis. Alcohol Alcohol 2018; 53:611-618. [DOI: 10.1093/alcalc/agy013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Pascal Perney
- Service d’Addictologie, Hôpital Caremeau, Place du Pr Debré, Nîmes, France
- université Montpellier 1, 2 rue de l'école de Médecine, Montpellier, France
- CESP, UMR 1018, INSERM, UPS, UVSQ. P. Descartes. Hôpital Paul Brousse – Bat 15/16 – 16 avenue PV Couturier 6 Villejuif Cedex, France
| | - Philippe Lehert
- Statistics Department, Faculty of Economics, University of Louvain, 181 chaussée de Binche, Mons, Belgium
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Brooks AT, Krumlauf M, Beck KH, Fryer CS, Yang L, Ramchandani VA, Wallen GR. A Mixed Methods Examination of Sleep Throughout the Alcohol Recovery Process Grounded in the Social Cognitive Theory: The Role of Self-Efficacy and Craving. HEALTH EDUCATION & BEHAVIOR 2018; 46:126-136. [DOI: 10.1177/1090198118757820] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sleep disturbances can accompany alcohol use disorders during various phases of the disease. This analysis utilized a mixed methods approach to assess whether sleep-related beliefs and/or behavior of individuals who are alcohol dependent were associated with sleep quality both pre- and postdischarge from a clinical research facility providing inpatient alcohol rehabilitation treatment. Individuals with higher self-efficacy for sleep (SE-S) reported better sleep quality at both time points. Individuals with fewer dysfunctional beliefs about sleep had poorer sleep quality at both time points. Individuals with higher unhealthy sleep-related safety behaviors had poorer sleep quality at both time points. In a linear regression model, only the difference in SE-S scores from pre- to postdischarge (β = −.396, p = .01) and the postdischarge Penn Alcohol Craving Score (β = .283, p = .019) significantly predicted the change in sleep quality. Thus, those whose SE-S scores increased and those with lower postdischarge craving scores were more likely to experience a decrease on Pittsburgh Sleep Quality Index scores from pre- to postdischarge even after controlling for covariates. References to behavior or personal factors were often discussed during the qualitative interviews in tandem with the environment. Participants reported both (1) self-medicating anxiety with alcohol and (2) self-medicating the inability to fall asleep with alcohol. Given the success of behavioral sleep interventions in various populations and the unique potential contributions of mixed methods approaches to examine sleep and alcohol use, assessing sleep-related cognitions and behaviors of individuals with severe alcohol use disorders may be important in understanding sleep quality and subsequent relapse.
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Affiliation(s)
- Alyssa T. Brooks
- National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Michael Krumlauf
- National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Kenneth H. Beck
- University of Maryland School of Public Health, College Park, MD, USA
| | - Craig S. Fryer
- University of Maryland School of Public Health, College Park, MD, USA
| | - Li Yang
- National Institutes of Health Clinical Center, Bethesda, MD, USA
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Cranford JA, Arnedt JT, Conroy DA, Bohnert KM, Bourque C, Blow FC, Ilgen M. Prevalence and correlates of sleep-related problems in adults receiving medical cannabis for chronic pain. Drug Alcohol Depend 2017; 180:227-233. [PMID: 28926791 PMCID: PMC5648597 DOI: 10.1016/j.drugalcdep.2017.08.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/20/2017] [Accepted: 08/18/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE To examine the prevalence and correlates of sleep problems in a sample of medical cannabis patients. PROCEDURES Adults ages 21 and older (N=801,M age=45.8) who were seeking medical cannabis certification (either for the first time or as a renewal) for chronic pain at medical cannabis clinics in southern Michigan completed baseline measures of cannabis use, sleep, pain, and other related constructs. FINDINGS Over half of the sample (59%) met criteria for past 1-month sleep disturbance, defined as at least one sleep problem occurring on 15 or more nights in the past month. Most participants (86%) reported that sleep problems were due to their current pain. Approximately 80% of participants reported using cannabis in the past 6 months to improve sleep and, among these participants, cannabis was rated as helpful for improving sleep. Sleep-related cannabis side effects were rare (35%), but sleep-related cannabis withdrawal symptoms were relatively common (65%). Statistically significant correlates of past 1-month sleep disturbance included a) being female, b) being white, c) being on disability, d) not having a medical cannabis card, and e) frequency of using cannabis to help sleep. CONCLUSIONS Sleep problems are highly prevalent and frequent in medical cannabis patients and are closely tied to pain. Sleep-related cannabis withdrawal symptoms are relatively common but their clinical relevance is unknown. The association between frequency of cannabis use to help sleep with higher odds of sleep problems will need to be clarified by longitudinal studies.
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Affiliation(s)
- James A. Cranford
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, United States,
| | - J. Todd Arnedt
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, United States,
| | - Deirdre A. Conroy
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, United States,
| | - Kipling M. Bohnert
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, United States, ,VA Center for Clinical Management Research (CCMR), Veterans Health Administration, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, United States
| | - Carrie Bourque
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, United States,
| | - Frederic C. Blow
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, United States, ,VA Center for Clinical Management Research (CCMR), Veterans Health Administration, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, United States
| | - Mark Ilgen
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109-2700, United States, ,VA Center for Clinical Management Research (CCMR), Veterans Health Administration, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, United States
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Effect of Circadian Rhythm Disruption and Alcohol on the Oxidative Stress Level in Rat Brain. Am J Ther 2017; 23:e1801-e1805. [PMID: 26580580 DOI: 10.1097/mjt.0000000000000363] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Alcohol abuse is often associated with disrupted circadian rhythms and sleep, and the link seems to be bidirectional. In addition, it has been shown that exposure to constant illumination may increase lipid peroxidation in tissues. In this study, we investigated the effects of circadian rhythm disruption (CRD) and chronic alcohol intake (A) alone and in combination (CRD+A), on the oxidative stress in total rat brain homogenate. Our results demonstrated that lipid peroxidation was increased in the brain samples of all experimental animals compared with the control ones. The oxidative stress levels increased in the order: C<CRD<A<(CRD+A). Furthermore, xanthine oxidase activity changed in the order: C<CRD<A=CRD+A. It was proposed that chronic alcohol intake, if accompanied with CRD, might lead to significantly higher lipid peroxidation in the brain, than if present alone. Our data suggest that ethanol metabolites may be involved in the increase of the brain xanthine oxidase activity in rats with chronic alcohol intake.
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Rawashdeh O, Clough SJ, Hudson RL, Dubocovich ML. Learned motivation drives circadian physiology in the absence of the master circadian clock. FASEB J 2016; 31:388-399. [PMID: 27733449 DOI: 10.1096/fj.201600926r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 09/28/2016] [Indexed: 01/23/2023]
Abstract
The suprachiasmatic nucleus (SCN)-often referred to as the master circadian clock-is essential in generating physiologic rhythms and orchestrating synchrony among circadian clocks. This study tested the hypothesis that periodic motivation induced by rhythmically pairing 2 reinforcing stimuli [methamphetamine (Meth) and running wheel (RW)] restores autonomous circadian activity in arrhythmic SCN-lesioned (SCNX) C3H/HeN mice. Sham-surgery and SCNX mice were treated with either Meth (1.2 mg/kg, i.p.) or vehicle in association, dissociation, or absence of an RW. Only the association of Meth treatment and restricted RW access successfully reestablished entrained circadian rhythms in mice with SCNX. RW-likely acting as a link between the circadian and reward systems-promotes circadian entrainment of activity. We conclude that a conditioned drug response is a powerful tool to entrain, drive, and restore circadian physiology. Furthermore, an RW should be recognized as a potent input signal in addition to the conventional use as an output signal.-Rawashdeh, O., Clough, S. J., Hudson, R. L., Dubocovich, M. L. Learned motivation drives circadian physiology in the absence of the master circadian clock.
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Affiliation(s)
- Oliver Rawashdeh
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Shannon J Clough
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Randall L Hudson
- Department of Physiology and Biophysics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Margarita L Dubocovich
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA;
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Angarita GA, Emadi N, Hodges S, Morgan PT. Sleep abnormalities associated with alcohol, cannabis, cocaine, and opiate use: a comprehensive review. Addict Sci Clin Pract 2016; 11:9. [PMID: 27117064 PMCID: PMC4845302 DOI: 10.1186/s13722-016-0056-7] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/08/2016] [Indexed: 01/27/2023] Open
Abstract
Sleep abnormalities are associated with acute and chronic use of addictive substances. Although sleep complaints associated with use and abstinence from addictive substances are widely recognized, familiarity with the underlying sleep abnormalities is often lacking, despite evidence that these sleep abnormalities may be recalcitrant and impede good outcomes. Substantial research has now characterized the abnormalities associated with acute and chronic use of alcohol, cannabis, cocaine, and opiates. This review summarizes this research and discusses the clinical implications of sleep abnormalities in the treatment of substance use disorders.
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Affiliation(s)
- Gustavo A Angarita
- Yale University Department of Psychiatry, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA
| | - Nazli Emadi
- Yale University Department of Psychiatry, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA
| | - Sarah Hodges
- Yale University Department of Psychiatry, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA
| | - Peter T Morgan
- Yale University Department of Psychiatry, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, USA.
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Soleimani R, Modabbernia MJ, Habibi S, Roudsary MH, Elahi M. The Effect of Cognitive Behavior Therapy in Insomnia due to Methadone Maintenance Therapy: A Randomized Clinical Trial. IRANIAN JOURNAL OF MEDICAL SCIENCES 2015; 40:396-403. [PMID: 26379345 PMCID: PMC4567598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 05/31/2014] [Accepted: 06/15/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Sleep disturbance is a common complaint of patients undergoing methadone maintenance therapy (MMT). There are limited studies about the effect of different treatments on insomnia due to MMT. In this study, we evaluated the effect of cognitive-behavioral treatment for insomnia (CBTI) on sleep disorders in patients undergoing MMT. METHODS Twenty-two patients with insomnia due to MMT (aged 18-60 years) participated in this randomized double-blind clinical trial. The intervention group received CBTI from a clinical psychologist for 8 weeks, whereas the control group received behavioral placebo therapy (BPT). The duration of individual sessions was 45 minutes, which was conducted once a week. The primary outcome was sleep disturbance assessed with Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using SPSS software version 19. RESULTS Eleven patients were assigned to each group. Two groups were matched according to demographic characteristics (age, marital status, education, and daily methadone doses). Although PSQI score was significantly reduced during weeks 5 and 8 after both interventions, there was a significant difference in intervention versus time interaction (P<0.02). The effects of CBTI versus placebo were significantly different (P<0.001). The time course was also significant (P<0.001). CONCLUSION This study showed that CBTI is more effective than BPT in overall sleep quality. We recommend further studies, with a larger sample, on CBTI in patients undergoing MMT.
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Affiliation(s)
- Robabeh Soleimani
- Assistant Professor of Psychiatry, Addiction and Behavioral Sciences Research Center, Shafa Hospital, Guilan University of Medical Sciences, Iran
| | - Mohammad Jafar Modabbernia
- Associate Professor of Psychiatry, Addiction and Behavioral Sciences Research Center, Shafa Hospital, Guilan University of Medical Sciences, Iran
| | - Sharareh Habibi
- Resident of Psychiatry, Addiction and Behavioral Sciences Research Center, Shafa Hospital, Guilan University of Medical Sciences, Iran,Correspondence: Sharareh Habibi, MD; Shafa Hospital, 15 Khordad Street, Mosalla Square, Rasht, Guilan, Iran Tel: +98 131 6666268 Fax: +98 131 6666268
| | - Maryam Habibi Roudsary
- Resident of Psychiatry, Addiction and Behavioral Sciences Research Center, Shafa Hospital, Guilan University of Medical Sciences, Iran
| | - Masoumeh Elahi
- Clinical Psychologist, Addiction and Behavioral Sciences Research Center, Shafa Hospital, Guilan University of Medical Sciences, Iran
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Ogeil RP, Phillips JG, Rajaratnam SMW, Broadbear JH. Risky drug use and effects on sleep quality and daytime sleepiness. Hum Psychopharmacol 2015; 30:356-63. [PMID: 26010431 DOI: 10.1002/hup.2483] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 03/05/2015] [Accepted: 03/26/2015] [Indexed: 12/29/2022]
Abstract
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.
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Affiliation(s)
- Rowan P Ogeil
- Eastern Health Clinical School and School of Psychological Sciences, Monash University, Victoria, Australia.,Turning Point, Eastern Health, Victoria, Australia
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37
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Ogeil RP, Phillips JG. Commonly used stimulants: Sleep problems, dependence and psychological distress. Drug Alcohol Depend 2015; 153:145-51. [PMID: 26049205 DOI: 10.1016/j.drugalcdep.2015.05.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/21/2015] [Accepted: 05/21/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Caffeine and nicotine are commonly used stimulants that enhance alertness and mood. Discontinuation of both stimulants is associated with withdrawal symptoms including sleep and mood disturbances, which may differ in males and females. The present study examines changes in sleep quality, daytime sleepiness and psychological distress associated with use and dependence on caffeine and nicotine. METHODS An online survey comprising validated tools to assess sleep quality, excessive daytime sleepiness and psychological distress was completed by 166 participants (74 males, 96 females) with a mean age of 28 years. Participants completed the study in their own time, and were not offered any inducements to participate. RESULTS Sleep quality was poorer in those dependent upon caffeine or nicotine, and there were also significant interaction effects with gender whereby females reported poorer sleep despite males reporting higher use of both stimulants. Caffeine dependence was associated with poorer sleep quality, increased daytime dysfunction, and increased levels of night time disturbance, while nicotine dependence was associated with poorer sleep quality and increased use of sleep medication and sleep disturbances. There were strong links between poor sleep and diminished affect, with psychological distress found to co-occur in the context of disturbed sleep. CONCLUSIONS Stimulants are widely used to promote vigilance and mood; however, dependence on commonly used drugs including caffeine and nicotine is associated with decrements in sleep quality and increased psychological distress, which may be compounded in female dependent users.
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Affiliation(s)
- Rowan P Ogeil
- Eastern Health Clinical School, Monash University, Victoria, Australia; Turning Point, Eastern Health, 54-62 Gertrude St., Fitzroy, Victoria, Australia.
| | - James G Phillips
- Psychology Department, Auckland University of Technology, Auckland, New Zealand
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Willoughby AR, de Zambotti M, Baker FC, Colrain IM. Partial K-Complex Recovery Following Short-Term Abstinence in Individuals with Alcohol Use Disorder. Alcohol Clin Exp Res 2015; 39:1417-24. [PMID: 26175209 DOI: 10.1111/acer.12769] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 05/05/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The K-complex (KC) is a brain potential characteristic of nonrapid eye movement (NREM) sleep resulting from the synchronous activity of a large population of neurons and hypothesized to reflect brain integrity. KC amplitude is lower in individuals with alcohol use disorder (AUD) compared with age-matched controls, but its recovery with short-term abstinence has not been studied. Therefore, we investigated whether the KC shows significant recovery over the first 4 months of abstinence in individuals with AUD. METHODS A total of 16 recently abstinent AUD individuals (46.6 ± 9.3 years) and 13 gender and age-matched healthy controls (41.6 ± 8.3 years) were studied on 3 occasions: the Initial session was within 1 month of the AUD individuals' last drink, then 1 and 3 months later. Overnight electroencephalogram was recorded while participants were presented with tones during stage 2 NREM sleep to elicit KCs. RESULTS At the Initial session, AUD participants showed significantly lower KC amplitude and incidence compared with controls. In the AUD individuals, KC amplitude increased significantly from the Initial to the 1-month session. KC incidence showed a marginally significant increase. Neither KC amplitude nor incidence changed from the 1-month to the 3-month session. No changes in KC amplitude or incidence across sessions were observed in the control group. CONCLUSIONS Our results demonstrate partial KC recovery during the first 2 months of abstinence. This recovery is consistent with the time course of structural brain recovery in abstinent AUD individuals demonstrated by recent neuroimaging results.
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Affiliation(s)
| | | | - Fiona C Baker
- Center for Health Sciences , SRI International, Menlo Park, California.,Brain Function Research Group, University of the Witwatersrand, Johannesburg, South Africa
| | - Ian M Colrain
- Melbourne School of Psychological Sciences University of Melbourne, Melbourne, Victoria, Australia
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Magnée EHB, de Weert-van Oene GH, Wijdeveld TAGM, Coenen AML, de Jong CAJ. Sleep disturbances are associated with reduced health-related quality of life in patients with substance use disorders. Am J Addict 2015; 24:515-22. [PMID: 26073849 DOI: 10.1111/ajad.12243] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 04/16/2015] [Accepted: 04/26/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Sleep problems and substance use are strongly linked. Sleep problems play a role in the etiology of substance use, but also may be a result of it. After detoxification, sleep problems may worsen leading to relapse. Nowadays, most substance dependence treatment programs aim at recovery rather than total abstinence, and in that view health-related quality of life (HRQL) is a relevant construct. This article describes the association between self-perceived sleep problems and HRQL in a naturalistic population of polydrug-using inpatients. METHODS At the start of treatment, 388 polydrug-using inpatients completed questionnaires concerning their sleep quality and HRQL. Three categories were established based on reported sleep problems: patients without sleep problems (21.6%), those with clinically relevant sleep problems (34.5%), and patients with sleep disorders (43.8%). RESULTS Mean grades for quality of sleep were M = 7.3 (sd 1.7), M = 6.6 (sd 1.7) and M = 5.3 (sd 1.9) for the three categories, respectively. In addition, patients in the disorder category perceived a lower HRQL than those in the other categories. In the explanation of HRQL, both sleep problems and sleep disorders added significantly to the model when controlling for baseline characteristics. DISCUSSION AND CONCLUSIONS Our findings stress the need for clinicians to pay attention to the quality of sleep of recovering polydrug users, since this may play an important role in the recovery process. Monitoring sleep during treatment is advocated. This study adds to the knowledge about the way HRQL and sleep are related in a naturalistic sample of substance-dependent patients.
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Affiliation(s)
- Ellis H B Magnée
- Department of Addiction and Korsakov Care, Vincent van Gogh Institute, Oostrum, the Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, Nijmegen, the Netherlands
| | - Gerdien H de Weert-van Oene
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, Nijmegen, the Netherlands.,Victas, Addiction Treatment Center, Utrecht, the Netherlands
| | - Toon A G M Wijdeveld
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, Nijmegen, the Netherlands
| | - Anton M L Coenen
- Donders Institute, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Cor A J de Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University, Nijmegen, the Netherlands
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de Zambotti M, Willoughby AR, Baker FC, Sugarbaker DS, Colrain IM. Cardiac autonomic function during sleep: effects of alcohol dependence and evidence of partial recovery with abstinence. Alcohol 2015; 49:409-15. [PMID: 25957854 DOI: 10.1016/j.alcohol.2014.07.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 07/24/2014] [Accepted: 07/25/2014] [Indexed: 02/03/2023]
Abstract
Chronic alcoholism is associated with the development of cardiac and peripheral autonomic nervous system (ANS) pathology. The aim of the present study was to evaluate the extent to which recovery in ANS function could be demonstrated over the first 4 months of abstinence. Fifteen alcoholics (7 women) were studied on three occasions: within a month of detoxification, at approximately 2 months post-detox, and at 4 months post-detox. Thirteen control subjects (6 women) were also studied on three occasions with inter-study intervals matching those of the alcoholics. Six alcoholics relapsed, 48.7 ± 27.9 days following the initial PSG session. ANS function was assessed in the first part of stable non-rapid eye movement sleep. Frequency-domain power spectral analysis of heart rate variability (HRV) produced variables including: heart rate (HR), total power (TP; an index representing total HR variability), High Frequency power (HFa; an index reflecting cardiac vagal modulation), HF proportion of total power (HFprop sympathovagal balance), and HF peak frequency (HFpf; an index reflecting respiration rate). Overall, high total and high frequency variability and low sympathovagal balance and myocardial contractility are considered as desired conditions to promote cardiovascular health. At initial assessment, alcoholics had a higher HR (p < 0.001) and respiratory rate (p < 0.01), and lower vagal activity (HFa; p < 0.01) than controls. Alcoholics showed evidence of recovery in HR (p = 0.039) and HFa (p = 0.031) with 4 months of abstinence. Alcoholics with higher TP at the initial visit showed a greater improvement in TP from the initial to the 4 month follow-up session (r = 0.75, p < 0.05). Alcoholics showed substantial recovery in HR and vagal modulation of HRV with 4 months of abstinence, with evidence that the extent of recovery in HRV may be partially determined by the extent of alcohol dependence-related insult to the cardiac ANS system. These data support other studies showing recovery in a number of ANS, central nervous system, and behavioral domains with abstinence, even in those with long-term dependence.
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Affiliation(s)
| | | | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA; Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Ian M Colrain
- Center for Health Sciences, SRI International, Menlo Park, CA, USA; Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia.
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Brower KJ. Assessment and treatment of insomnia in adult patients with alcohol use disorders. Alcohol 2015; 49:417-27. [PMID: 25957855 DOI: 10.1016/j.alcohol.2014.12.003] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 12/03/2014] [Indexed: 11/25/2022]
Abstract
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.
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Hartwell EE, Bujarski S, Glasner-Edwards S, Ray LA. The Association of Alcohol Severity and Sleep Quality in Problem Drinkers. Alcohol Alcohol 2015; 50:536-41. [PMID: 26018218 DOI: 10.1093/alcalc/agv046] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 04/23/2015] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Emily E Hartwell
- Department of Psychology, University of California, Los Angeles, CA, USA Integrated Substance Abuse Program, University of California, Los Angeles, CA, USA
| | - Spencer Bujarski
- Department of Psychology, University of California, Los Angeles, CA, USA
| | | | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, CA, USA Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA Brain Research Institute, University of California, Los Angeles, CA, USA
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Poluektov MG, Pchelina PV, Palman AD. Sleep disorders in alcoholism. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:34-39. [DOI: 10.17116/jnevro20151154234-39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Wallen GR, Brooks AT, Whiting B, Clark R, Krumlauf MC, Yang L, Schwandt ML, George DT, Ramchandani VA. The prevalence of sleep disturbance in alcoholics admitted for treatment: a target for chronic disease management. FAMILY & COMMUNITY HEALTH 2014; 37:288-297. [PMID: 25167069 PMCID: PMC4167872 DOI: 10.1097/fch.0000000000000040] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
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.
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Affiliation(s)
- Gwenyth R Wallen
- National Institutes of Health Clinical Center (Dr Wallen, Mss Brooks and Yang, and Mr Krumlauf) and National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health (Mss Whiting and Clark and Drs Schwandt, George, and Ramchandani), Bethesda, Maryland
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Logan RW, Williams WP, McClung CA. Circadian rhythms and addiction: mechanistic insights and future directions. Behav Neurosci 2014; 128:387-412. [PMID: 24731209 DOI: 10.1037/a0036268] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Circadian rhythms are prominent in many physiological and behavioral functions. Circadian disruptions either by environmental or molecular perturbation can have profound health consequences, including the development and progression of addiction. Both animal and humans studies indicate extensive bidirectional relationships between the circadian system and drugs of abuse. Addicted individuals display disrupted rhythms, and chronic disruption or particular chronotypes may increase the risk for substance abuse and relapse. Moreover, polymorphisms in circadian genes and an evening chronotype have been linked to mood and addiction disorders, and recent efforts suggest an association with the function of reward neurocircuitry. Animal studies are beginning to determine how altered circadian gene function results in drug-induced neuroplasticity and behaviors. Many studies suggest a critical role for circadian rhythms in reward-related pathways in the brain and indicate that drugs of abuse directly affect the central circadian pacemaker. In this review, we highlight key findings demonstrating the importance of circadian rhythms in addiction and how future studies will reveal important mechanistic insights into the involvement of circadian rhythms in drug addiction.
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Affiliation(s)
- Ryan W Logan
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Wilbur P Williams
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Colleen A McClung
- Department of Psychiatry, University of Pittsburgh School of Medicine
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Abstract
Rapidly emerging evidence continues to describe an intimate and causal relationship between sleep and emotional brain function. These findings are mirrored by long-standing clinical observations demonstrating that nearly all mood and anxiety disorders co-occur with one or more sleep abnormalities. This review aims to (a) provide a synthesis of recent findings describing the emotional brain and behavioral benefits triggered by sleep, and conversely, the detrimental impairments following a lack of sleep; (b) outline a proposed framework in which sleep, and specifically rapid-eye movement (REM) sleep, supports a process of affective brain homeostasis, optimally preparing the organism for next-day social and emotional functioning; and (c) describe how this hypothesized framework can explain the prevalent relationships between sleep and psychiatric disorders, with a particular focus on posttraumatic stress disorder and major depression.
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Affiliation(s)
- Andrea N Goldstein
- Helen Wills Neuroscience Institute, University of California, Berkeley, California 94720-1650;
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Abstract
Alcohol acts as a sedative that interacts with several neurotransmitter systems important in the regulation of sleep. Acute administration of large amounts of alcohol prior to sleep leads to decreased sleep-onset latency and changes in sleep architecture early in the night, when blood alcohol levels are high, with subsequent disrupted, poor-quality sleep later in the night. Alcohol abuse and dependence are associated with chronic sleep disturbance, lower slow-wave sleep, and more rapid-eye-movement sleep than normal, that last long into periods of abstinence and may play a role in relapse. This chapter outlines the evidence for acute and chronic alcohol effects on sleep architecture and sleep electroencephalogram, evidence for tolerance with repeated administration, and possible underlying neurochemical mechanisms for alcohol's effects on sleep. Also discussed are sex differences as well as effects of alcohol on sleep homeostasis and circadian regulation. Evidence for the role of sleep disruption as a risk factor for developing alcohol dependence is discussed in the context of research conducted in adolescents. The utility of sleep-evoked potentials in the assessment of the effects of alcoholism on sleep and the brain and in abstinence-mediated recovery is also outlined. The chapter concludes with a series of questions that need to be answered to determine the role of sleep and sleep disturbance in the development and maintenance of problem drinking and the potential beneficial effects of the treatment of sleep disorders for maintenance of abstinence in alcoholism.
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Affiliation(s)
- Ian M Colrain
- Center for Health Sciences, SRI International, Menlo Park, CA, USA; Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Vic., Australia.
| | - Christian L Nicholas
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Vic., Australia
| | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA; Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
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Angarita GA, Canavan SV, Forselius E, Bessette A, Pittman B, Morgan P. Abstinence-related changes in sleep during treatment for cocaine dependence. Drug Alcohol Depend 2014; 134:343-347. [PMID: 24315572 PMCID: PMC4396819 DOI: 10.1016/j.drugalcdep.2013.11.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 11/02/2013] [Accepted: 11/02/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Former sleep studies among non-treatment seeking chronic cocaine users had captured polysomnographic changes for as long as three weeks of abstinence. METHODS 20 cocaine dependent participants, randomized to placebo in an ongoing clinical trial, received 12 days of inpatient substance abuse treatment followed by 6 weeks of outpatient cognitive behavioral therapy. Polysomnographic recording was performed on consecutive nights during the 1st and 2nd inpatient and 3rd and 6th outpatient weeks. Number of days abstinent was determined from thrice weekly urine toxicology and self-report. Polysomnographic sleep was compared between study week 1 and 2, using paired t-tests. Trajectory of total sleep time (TST) was modeled both as a linear and a quadratic function of days abstinent. RESULTS Despite reporting an improvement in overall sleep quality, polysomnographic sleep worsened from week 1 to 2. Among all participants, TST and stage 2 sleep time decreased, while REM sleep latency increased. Among participants who began the study with a positive urine test, there was also a decrease in REM and a trend for decreased slow wave sleep. TST compared to number of days abstinent (up to 54 days) was best fit with a quadratic model (p=0.002), suggesting the possibility of an improvement in total sleep time with extended abstinence. CONCLUSIONS This is the first polysomnographic characterization of sleep in a large sample of cocaine users in treatment. Present findings confirm earlier results of poor and deteriorating sleep early in abstinence, and raise the possibility of improvement after an extended abstinence.
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Affiliation(s)
- G. A. Angarita
- Psychiatry, Yale University School of Medicine, New Haven, CT, United States,Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, CT, United States
| | - S. V. Canavan
- Psychiatry, Yale University School of Medicine, New Haven, CT, United States,Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, CT, United States
| | - E. Forselius
- Psychiatry, Yale University School of Medicine, New Haven, CT, United States,Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, CT, United States
| | - A. Bessette
- Psychiatry, Yale University School of Medicine, New Haven, CT, United States,Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, CT, United States
| | - B. Pittman
- Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - P.T. Morgan
- Psychiatry, Yale University School of Medicine, New Haven, CT, United States,Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, CT, United States
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