Improved Sleep Quality Could Aid Recovery From Alcohol Dependence


WASHINGTON – If sleep disturbance can be managed, patients in the early stages of treatment for alcoholism may be less likely to relapse, said Peter D. Friedmann, M.D.

A growing literature suggests that the sleep abnormalities that accompany both acute and chronic abstinence from alcohol may contribute to craving and urges to resume drinking. “We became interested in this notion of whether we could intervene in sleep and therefore improve abstinence,” said Dr. Friedmann of Brown University in Providence, R.I.

Dr. Friedmann found significant associations between poor sleep quality and the presence of risk factors for relapse among 130 sleep-disturbed adults in recovery from alcohol dependence. He presented a cross-sectional analysis of baseline patient data at the annual conference of the Association for Medical Education and Research in Substance Abuse. The data stem from a recently initiated study in which the patients are taking 50–150 mg of trazodone for 12 weeks to improve sleep quality.

Overall, patients who reported poor sleep quality were significantly more likely to be in worse physical health based on the SF-12 Health Survey physical health subscale, to have worse depressive symptoms based on the Beck Depression Inventory, and to report a desire to drink when they couldn't fall asleep, Dr. Friedmann said at the conference, which was sponsored by Brown Medical School.

Most of the patients were male (84%) and white (83%), with an average age of 41 years. They were highly dependent drinkers who had consumed alcohol on approximately 25 of the 30 days before they were admitted to the detox program. The average score on the Beck inventory was 20.8, and the average global score on the Pittsburgh Sleep Quality Index–in which sleep disturbance is a score higher than 5–was 11.7.

The study excluded people with brain disorders and those who were actively suicidal, as well as patients who had medical conditions that affected sleep, those taking psychotropic medications, or those with contraindications to trazodone. The patients completed a 19-item self-report questionnaire, with variables including the number of drinks per day and questions about depression, physical health, and psychiatric status.

Despite the limitation of the self-reports, “I'm going to conclude that sleep disturbances relate to some significant factors for relapse [in alcohol-dependent patients], including depression,” Dr. Friedmann said. However, separating the antidepressant effects from the sleep-inducing effects of trazodone at the study's end will be a challenge, he noted.

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