Psychiatr News March 2, 2007
Volume 42, Number 5, page 29
© 2007 American Psychiatric Association
Perception of Sleep Quality Linked to Drinking Relapse
David Milne
Self-reported sleep problems by recovering alcoholics in treatment may
be an ingredient in a recipe for relapse of their drinking behavior.
Clinicians who ask recovering alcoholics with insomnia about continuing
sleep problems are taking a step that may help prevent alcoholic patients from
relapsing. This finding arises from a 12-week study funded by the National
Institute on Alcohol Abuse and Alcoholism that suggested that sleep problems
contributed to relapse among alcoholics in recovery.
In addition, the alcoholic patients' subjective estimates of the quality of
their sleep predicted future drinking better than did objective measures
alone.
"Patients with the biggest disconnect between their perception of how
they slept and their actual sleep patterns were most likely to relapse,"
Deirdre Conroy, Ph.D., told Psychiatric News.
"This indicates that long-term drinking interferes with both sleep
and perception of sleep, and if sleep problems are not addressed, the risk of
relapse may be high," said Conroy, a fellow at the University of
Michigan's Addiction Research Center.
Conroy headed a study of recovering alcoholic insomniacs in collaboration
with members of the University of Michigan's Department of Psychiatry and
others. Their report appears in the December 2006 Alcoholism: Clinical and
Experimental Research.
The researchers evaluated sleep, sleep perception, and alcohol relapse in
21 men and women with a mean age of 44.6 who were in the early stages of
alcohol recovery. All suffered from insomnia and had abstained from alcohol
for at least one week before enrollment in the study. All had two nights of
polysomnography (PSG) sleep studies three weeks apart. After each PSG session,
they were asked how they slept, how long they thought it took them to fall
asleep, and how long they were awake during the night. Then during two
six-week periods, one the treatment phase and the other a posttreatment
follow-up, the researchers questioned the subjects on how much they drank.
When the PSG results were compared with the volunteers' subjective views of
how they had slept, 72 percent of them overestimated by an average of 21
minutes how long it had taken them to fall asleep. And 89 percent
underestimated by about 49 minutes how long they had been awake during the
night. During the first six-week follow-up period, the amount of alcohol that
subjects consumed was predicted by self-reported estimations of wakefulness in
the middle of the night and also by PSG study results. During the second
six-week period, drinking was predicted by both subjective estimations of
sleep and rapid eye movement sleep latency.
Since perceptions of how the volunteers slept were actually more accurate
in predicting their potential for relapse than were sleep-lab measurements,
Conroy believes that normalization of PSG in the presence of persisting sleep
complaints may be an insufficient goal of treatment.
She said that during early recovery from alcoholism, people think that it
takes them a long time to fall asleep and that once they did fall asleep, they
slept through the night. The reality is 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.
"An alcoholic in early recovery has a lot of wakefulness in the night
but is not necessarily picking up on this," Conroy said. "So it is
important for clinicians 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."
Poor sleep quality can lead to mood disturbances, so if recovering
alcoholics are irritable because they are not getting quality sleep at night,
they might be more vulnerable to relapse, she added.
An abstract of "Perception of Sleep in Recovering
Alcohol-Dependent Patients With Insomnia: Relationship With Future
Drinking" is posted at
<www.blackwell-synergy.com/doi/abs/10.1111/j.1530-0277.2006.00245.x>.
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