Recovering alcoholics with poor sleep perceptions will likely relapse

·         Alcohol can help people initially fall asleep, but leads to poor-quality sleep later in the night.

·         Escalated consumption of alcohol to aid sleep can lead to alcoholism.

·         Inaccurate sleep perceptions among alcoholics in early recovery may predict relapse to drinking.

Alcohol can initially have sleep-inducing effects among non-alcoholics, but once drinking becomes chronic, alcohol's effects on sleep become much more negative in nature. New findings indicate that individuals in early recovery from alcoholism who have inaccurate sleep perceptions are more likely to return to drinking.

Results are published in the December issue of Alcoholism: Clinical & Experimental Research.

"The usual perception of alcohol's effects on sleep in nonalcoholics is that it helps sleep," explained Deirdre A. Conroy, the corresponding author who conducted the research while a postdoctoral fellow at the University of Michigan. "In truth, alcohol may help people fall asleep but it usually leads to poor quality sleep in the second half of the night and overall less deep sleep. As people drink more regularly across nights to fall asleep, they become tolerant to the sedating effects of alcohol and subsequently use more alcohol each night to help fall asleep. This escalation in drinking can lead to alcoholism."

Conroy and her colleagues examined 18 individuals with insomnia (9 males, 9 females) who were also in early recovery from alcohol dependence. Each participant underwent polysomnography (PSG) for two nights, three weeks apart. Participants also provided morning estimates of sleep onset latency (SOL) or the time it takes to fall asleep, wake time after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE), a measure of sleep continuity. After complete PSG results were recorded, participants were asked to give information about their drinking habits during two consecutive six-week follow-up periods.

"Our study suggests that in early recovery from alcoholism, people perceived that it took them a long time to fall asleep and that they slept through the night," said Conroy. "The reality was that it did not take them as long to fall asleep as they thought it did, and their brain was awake for a large portion of the night. On average, the participants that were less accurate about how they were sleeping were more likely to return to drinking."

"In other words," added Timothy A. Roehrs, director of research at the Sleep Disorders and Research Center at Henry Ford Hospital, as well as professor of psychiatry and neurobehavioral sciences at Wayne State University School of Medicine in Detroit, "alcoholics perceive their sleep is disturbed and that is the reality. The clinician should pay attention to the alcoholic's sleep complaints as the complaint of poor sleep predicts relapse. Previous studies had shown that PSG findings predict relapse; this study now shows a complaint is sufficient."

Conroy explained that poor sleep quality can lead to mood disturbances. "If a recovering alcoholic is irritable because they are not getting quality sleep at night, they might be more vulnerable to return to drinking," she said. "[Previous] studies show that nonalcoholics with insomnia actually think they are sleeping worse than they are, so they may be more likely to seek appropriate treatment. Our study shows that an alcoholic in early recovery has a lot of wakefulness in the night but they are not necessarily picking up on this. It is important for the clinician working with the alcohol-dependent patient to have a differential of poor sleep quality in the back of their mind as a potential challenge for the patient throughout alcohol recovery."

Conroy and her colleagues will next examine the specifics of sleep problems among alcoholics. "Sleep across recovery from alcoholism may be more complex and variable over time than previously known," she said. "We plan to examine if sleep problems can be attributed to subtle disruptions in brain waves, in irregular biological rhythms, or both. We will also examine if using cognitive behavioral therapy for alcohol-dependent patients with insomnia will reduce the rate of relapse."

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Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "Perception of Sleep in Recovering Alcohol Dependent Patients with Insomnia: Relationship to Future Drinking," were: J. Todd Arnedt, Kirk J. Brower, Stephen Strobbe, Flavia Consens, Robert Hoffmann, and Roseanne Armitage of the University of Michigan in Ann Arbor, MI. The study was funded by the National Institute of Alcoholism and Alcohol Abuse.