Sage Journals: Discover world-class research

Abstract

Study Objectives

To review evidence of an association between disturbed sleep and alcohol use.

Design

We searched MEDLINE, PSYCHINFO, ETOH, BIBLIOSLEEP and the Rutgers Alcohol Studies databases between January 1966 and August 2002. Search terms included alcohol-related disorders or alcoholism in combination with sleep, sleep initiation and maintenance disorders, or sleep apnea syndromes. The search produced over 440 citations. We reviewed 107 relevant articles, of which 60 included quantitative measures of both alcohol use and sleep.

Measurements and Results

Behavioral studies suggest that up to 2 to 3 standard drinks before bedtime initially promotes sleep, but these effects diminish in as few as 3 days of continued use. Clinical investigations support a relationship between sleep disturbance and alcohol use, but variability in the definition and measurement of these domains and a preponderance of cross-sectional studies make uncertain the strength and direction of the association.

Conclusions

The association of insomnia with alcohol use disorders suggests that the clinical evaluation of patients with sleep problems should include a careful assessment of alcohol use. Future studies of this relationship should employ prospective designs with standardized, validated measures of both sleep and alcohol use. Rigorous treatment studies for chronic insomnia in alcohol dependent patients are also needed.

Keywords

Disturbed sleep alcohol use insomnia

Get full access to this article

View all access options for this article.

References

Katz

D A

and McHorney

C A

. 1998. Clinical correlates of insomnia in patients with chronic illness. Arch Int Med, 58: 1099–1107.

Kuppermann

, Lubeck

Mazonson

. 1995. Sleep problems and their correlates in a working population. J Gen Int Med, 10: 25–32.

Wiley

and Camacho

. 1980. Life-style and future health: Evidence from the Alameda County Study. Prev Med, 9: 1–21.

Kupfer

. 1997. Management of insomnia. NEJM, 336: 341–6.

Klink

, Quan

, Kaltenborn

and Lebowitz

. 1992. Risk factors associated with complaints of insomnia in a general adult population. Arch Int Med, 152: 1634–7.

Ford

D E

and Kamerow

D B

. 1989. Epidemiologic study of sleep disturbances and psychiatric disorders. JAMA, 262(11): 1479–84.

Dufour

M C

, Archer

and Gordis

. 1992. Alcohol and the elderly. Clin Ger Med, 8: 127–41.

Schuckit

M A

and Irwin

. 1988. Diagnosis of alcoholism. Med Clin N Am, 72: 1133–53.

Castenada

, Sussman

and Westrich

. 1996. A review of the effects of moderate alcohol intake on the treatment of anxiety and mood disorders. Clin Psych, 57: 207–12.

10.

Reite

, Buysse

, Reynolds

and Mendelson

. 1995. The use of polysomnography in the evaluation of insomnia. Sleep, 18: 58–70.

11.

Roehrs

, Papineau

, Rosenthal

and Roth

. 1999. Ethanol as a hypnotic in insomniacs: Self administration and effects on sleep and mood. Neuropsychopharm, 20: 279–86.

12.

Gresham

S C

, Webb

W B

and Williams

R C

. 1963. Alcohol and caffeine: Effect on inferred visual dreaming. Science, 140: 1226–7.

13.

Prinz

, Roehrs

, Vitaliano

, Linnoila

and Weitzman

. 1980. Effect of alcohol on sleep and nighttime plasma growth hormone and cortisol concentrations. J Clin Endoc Metab, 1: 759–64.

14.

Petrucelli

, Roehrs

T A

, Wittig

R M

and Roth

. 1994. The biphasic effects of ethanol on sleep latency. Sleep Research, 23: 75

15.

Roehrs

, Zwyghuizen-Doorenbos

, Timms

, Zorick

and Roth

. 1989. Sleep extension, enhanced alertness and the sedating effects of ethanol. Pharm Biochem Behav, 34: 321–4.

16.

Zwyghuizen-Doorenbos

, Roehrs

, Lamphere

, Zorick

and Roth

. 1988. Increased daytime sleepiness enhances ethanol's sedative effects. Neuropsychopharm, 1: 279–86.

17.

Maclean

A W

and Cairns

. 1982. Dose-response effects of ethanol on the sleep of young men. J Stud Alc, 43: 434–44.

18.

Landolt

H P

, Roth

, Dijk

D J

and Borberly

A A

. 1996. Late-afternoon ethanol intake affects nocturnal sleep and the sleep EEG in middle-aged men. J Clin Psychopharm, 16: 428–36.

19.

Roehrs

, Claiborue

, Knox

and Roth

. 1994. Residual sedating effects of ethanol. Alc Clin Exp Res, 18: 831–4.

20.

Rundell

O H

, Lester

B K

, Griffiths

W J

and Williams

H L

. 1972. Alcohol and sleep in young adults. Psychopharm, 26: 201–18.

21.

Ancoli-Israel

and Roth

. 1999. Characteristics of insomnia in the United States: Results of the 1991 National Sleep Foundation Survey. Sleep, 22(Suppl 2): S347–53.

22.

Johnson

E O

, Roehrs

, Roth

and Breslau

. 1998. Epidemiology of alcohol and medication as aids to sleep in early adulthood. Sleep, 21(2): 178–86.

23.

Costa

, Silva

J A

, Chase

, Sartorius

and Roth

. 1996. Special report from a symposium held by the World Health Organization and the World Federation of Sleep Research Societies: An overview of insomnias and related disorders-recognition, epidemiology, and rational management. Sleep, 19: 412–16.

24.

Walsh

J K

, Humm

, Muehlback

M J

, Sugerman

J L

and Schweitzer

P K

. 1991. Sedative effects of ethanol at night. J Stud Alc, 52: 597–600.

25.

Ohayon

M M

, Caulet

, Philip

, Guilleminault

and Priest

R G

. 1997. How sleep and mental disorders are related to complaints of daytime sleepiness. Arch Int Med, 157: 2645–52.

26.

Aldrich

M S

. 1989. Automobile accidents in patients with sleep disorders. Sleep, 12: 487–94.

27.

Johnson

J E

. 1997. Insomnia, alcohol, and over-the-counter drug use in old-old urban women. J Comm Health Nursing, 14: 181–8.

28.

Baum-Baicker

. 1985. The psychological benefits of moderate alcohol consumption: A review of the literature. Drug Alc Depend, 15: 305

29.

Bixler

E O

, Kales

, Soldatos

C R

, Kales

J D

and Healey

. 1979. Prevalence of sleep disorders in the Los Angeles Metropolitan Area. Am J Psych, 136(1): 1257–62.

30.

Carskadon

, Demendt

, Mitler

, Guilleminault

, Zarcone

and Spiegel

. 1976. Self-report versus sleep laboratory findings in 122 drug-free subjects with complaints of chronic insomnia. Am J Psych, 133: 1382–8.

31.

Baekeland

and Hoy

. 1971. Reported vs. recorded sleep characteristics. Arch Gen Psych, 24: 548–51.

32.

Janson

, Lindberg

, Gislason

, Elmasry

and Boman

. 2001. Insomnia in men-A 10 year prospective population based study. Sleep, 24(4): 425–30.

33.

Tachibana

, Izumi

, Honda

, Horiguchi

, Manabe

and Takemoto

. 1996. A study of the impact of occupational and domestic factors on insomnia among industrial workers of a manufacturing company in Japan. Occup Med, 46(3): 221–7.

34.

Harma

, Tenkanen

, Sjoblom

, Alikoski

and Heinsalmi

. 1998. Combined effects of shift work and lifestyle on the prevalence of insomnia, sleep deprivation and daytime sleepiness. Scand J Work Environ Health, 24(4): 300–7.

35.

Fabsitz

R R

, Sholinsky

and Goldberg

. 1997. Correlates of sleep problems among men: The Vietnam Era Twins Registry. J Sleep Res, 6: 50–6.

36.

Baekeland

, Lundwall

, Shanahan

T J

and Kissin

. 1974. Clinical correlates of reported sleep disturbance in alcoholics. Q J Stud Alcohol, 35: 1230–41.

37.

Feuerlein

. 1974. The acute alcohol withdrawal syndrome: findings and problems. Br J Addict, 69: 141–8.

38.

Caetano

, Clark

R L

and Greenfield

T K

. 1998. Prevalence, trends, and incidence of alcohol withdrawal symptoms: Analysis of general population and clinical samples. Alc Health Res World, 22: 73–9.

39.

Foster

J H

, Marshall

E J

and Peters

T J

. 1998. Predictors of relapse to heavy drinking in alcohol dependent subjects following alcohol detoxification-The role of quality of life measures, ethnicity, social class, cigarettes and drug use. Addict Biol, 3: 333–43.

40.

Mello

N K

and Mendelson

J H

. 1970. Behavioral studies of sleep patterns in alcoholics during intoxication and withdrawal. J Pharmacol Exp Ther, 175(1): 94–112.

41.

Brower

K J

, Aldrich

M S

, Robinson

E AR

, Zucker

R A

and Greden

J F

. 2001. Insomnia, self-medication, and relapse to alcoholism. Am J Psych, 1568: 399–404.

42.

Allen

R P

, Wagman

A M

, Funderburk

F R

and Wells

D T

. 1980. Slow wave sleep: A predictor of individual differences in response to drinking?. Biol Psych, 15: 345–8.

43.

Gillin

J C

, Smith

T L

, Irwin

, Kripke

D F

and Schuckit

. 1990. EEG sleep studies in “pure” primary alcoholism during subacute withdrawal: Relationships to normal controls, age and other clinical variables. Biol Psych, 27: 477–88.

44.

Thompson

P M

, Gillin

J C

, Golshan

and Irwin

. 1995. Polygraphic sleep measures differentiate alcoholics and stimulant abusers during short-term abstinence. Biol Psych, 38: 831–6.

45.

Johnson

L C

, Burdick

J A

and Smith

. 1970. Sleep during alcohol intake and withdrawal in the chronic alcoholic. Arch Gen Psych, 22: 406–18.

46.

Segal

B M

, Kushnarev

V M

, Urakov

I G

and Misionzhnik

E U

. 1970. Alcoholism and disruption of the activity of deep cerebral structures: Clinical-laboratory research. Q J Stud Alcohol, 31: 587–601.

47.

Begleiter

and Porjesz

. 1979. Persistence of a “subacute withdrawal syndrome” following chronic ethanol intake. Drug Alc Depend, 4: 353–7.

48.

Wellman

. 1954. The late withdrawal symptoms of alcoholic addiction. Can Med Assoc J, 70: 526–59.

49.

Kissin

. 1979. Biological investigation in alcoholics. J Stud Alcohol, 8: S146–81.

50.

Drummond

S PA

, Gillin

J C

, Smith

T L

and DeModena

. 1998. The sleep of abstinent pure primary alcoholic patients: Natural course and relationship to relapse. Alc Clin Exp Res, 22: 1796–1802.

51.

Williams

H L

and Rundell

O H

. 1981. Altered sleep physiology in chronic alcoholics; reversal with abstinence. Alc Clin Exp Res, 2: 318–25.

52.

Mackenzie

, Funderburk

F R

and Allen

R P

. 1994. Controlled drinking and abstinence in alcoholic men: Beliefs influence actions. Int J Addict, 29: 1377–92.

53.

Gillin

J C

, Smith

T L

, Irwin

, Butters

, DeModena

and Schukit

. 1994. Increased pressure of rapid eye movement sleep at time of hospital admission predicts relapse in non-depressed patients with primary alcoholism at 3-month follow-up. Arch Gen Psych, 51: 189–97.

54.

Clark

, Gillin

Golshan

. 1998. Increased REM sleep density at admission predicts relapse by three months in primary alcoholics with a lifetime diagnosis of secondary depression. Biol Psych, 43: 601–7.

55.

Brower

, Aldrich

and Hall

. 1998. Polysomnographic and subjective sleep predictors of alcoholic relapse. Alc Clin Exp Res, 22: 1864–71.

56.

Allen

R P

, Wagman

A MI

, Fund

E R

and Burke

F R

. 1977. Slow wave sleep changes: Alcohol tolerance and treatment implications. Adv Exp Med Biol, 85: 629–40.

57.

Block

A J

, Hellard

D W

and Slayton

P C

. 1987. Effect of alcohol ingestion on breathing of asymptomatic subjects. Arch Intern Med, 147: 1145–7.

58.

Robinson

R W

, White

D P

and Zwillich

C W

. 1985. Moderate alcohol ingestion increases upper airway resistance in normal subjects. Am Rev Resp Dis, 132: 1238–41.

59.

Dawson

, Lehr

, Bigby

B G

and Mitler

M M

. 1993. Effect of bedtime ethanol on total inspiratory resistance and respiratory drive in normal nonsnoring men. Alc Clin Exp Res, 17: 256–62.

60.

Krol

R C

, Knuth

S L

and Bartlett

. 1984. Selective reduction of genioglossal muscle activity by alcohol in normal human subjects. Am Rev Resp Dis, 129: 247–50.

61.

Scrima

, Broudy

and Nay

K M

. 1982. Increased severity of obstructive sleep apnea after bedtime alcohol ingestion: diagnostic potential and proposed mechanism of action. Sleep, 5: 318–28.

62.

Aldrich

M S

, Shipley

J E

, Tandon

, Kroll

P D

and Brower

K J

. 1993. Sleep-disordered breathing in alcoholics: Association with age. Alc Clin Exp Res, 17: 1179–83.

63.

Mamdani

, Hollyfield

, Ravi

S D

, Dorus

and Borge

G F

. 1989. Prevalence of sleep apnea among abstinent chronic alcoholic men. Sleep Res, 18: 349

64.

Bassetti

and Aldrich

M S

. 1996. Alcohol consumption and sleep apnea in patients with TIA and ischemic stroke. Sleep Res, 25: 400

65.

Aldrich

M S

and Chervin

R D

. 1997. Alcohol use, obstructive sleep apnea, and sleep-related motor vehicle accidents. Sleep Res, 26: 308

66.

Aldrich

M S

and Shipley

J E

. 1993. Alcohol use and periodic limb movement of sleep. Alc Clin Exp Res, 17: 192–6.

67.

Berlin

R M

and Qayyum

. 1986. Sleepwalking: Diagnosis and treatment through the life cycle. Psychosomatics, 27: 755–60.

68.

Roberts

R E

, Shema

S J

and Kaplan

G A

. 1999. Prospective data on sleep complaints and associated risk factors in an older cohort. Psychosomatic Med, 61: 188–96.

69.

Kales

J D

, Kales

Bixler

E O

. 1984. Biopsychobehavioral correlates of insomnia, V: Clinical characteristics and behavioral correlates. Am J Psych, 141: 1371–6.

70.

Jacobs

E A

, Reynolds

C F

, Kupfer

D J

, Lovine

P A

and Ehrenpreis

A B

. 1988. The role of polysomnography in the differential diagnosis of chronic insomnia. Am J Psych, 145: 346–9.

71.

Benca

R M

, Obermeyer

W H

, Thisted

R A

and Gillin

. 1992. Sleep and psychiatric disorders. A meta-analysis. Arch Gen Psych, 49: 651–68.

72.

Merikangas

K R

, Angst

Eaton

. 1996. Comorbidity and boundaries of affective disorders with anxiety disorders and substance misuse: Results of an international task force. Br J Psych, 30: 58–67.

73.

Davidson

K M

. 1995. Diagnosis of depression in alcohol dependence; changes in prevalence with drinking status. Br J Psych, 166: 199–204.

74.

Bliwise

N G

. 1992. Factors related to sleep quality in healthy elderly women. Psychol Aging, 71: 83–8.

75.

Chait

L D

and Perry

J L

. 1994. Acute and residual effects of alcohol and marijuana, marijuana alone and in combination, on mood and performance. Psychopharm, 115: 340–9.

76.

Haack

M R

, Harford

T C

and Parker

D A

. 1988. Alcohol use and depression symptoms among female nursing students. Alc Clin Exp Res, 12: 365–7.

77.

Chang

P P

, Ford

D E

, Mead

L A

, Cooper

P L

and Klag

M J

. 1997. Insomnia in young men and subsequent depression. The John Hopkins Precursor Study. Am J Epi, 146: 105–14.

78.

Longo

L P

and Johnson

. 1998. Treatment of insomnia in substance abusing patients. Psych Annals, 28: 154–9.

79.

Greeff

A P

and Conradie

W S

. 1998. Use of progressive relaxation training for chronic alcoholics with insomnia. Psych Rep, 82: 407–12.

80.

Ciraulo

D A

, Barnhill

J G

Ciraulo

A M

. 1997. Alterations in pharacodynamics of anxiolytsic in abstinent alcoholics: subjective responses, abuse liability, and electroencephalographic effects of alprazolam, diazepam and buspirone. J Clin Pharm, 37: 64–73.

81.

Ciraulo

D A

and Nace

E P

. 2000. Benzodiazepine treatment of anxiety or insomnia in substance abuse patients. Am J Addict, 9: 276–84.

82.

Sellers

E M

, Ciraulo

D A

Dupont

R L

. 1994. Al-prazolam and benzodiazepine dependence. J Clin Psych, S54: 64–75.

83.

Mueller

T I

, Godenberg

I M

, Gordon

A L

, Keller

M B

and Warshaw

M G

. 1996. Benzodiazepine use in anxiety disordered patients with and without a history of alcoholism. J Clin Psych, 57: 83–9.

84.

Miller

N S

and Gold

M S

. 1991. Introduction-benzodiazepines: A major problem. J Sub Abuse Treatment, 8: 3–7.

85.

Friedmann

P D

, Herman

D S

, Freedman

, Lemon

S C

, Ramsey

and Stein

M D

. 2003. Treatment of sleep disturbance in alcohol recovery: A national survey of addiction medicine physicians. J Addict Dis, 22(2): 91–103.

86.

Wiesbeck

G A

, Weihers

H G

, Chick

and Boening

. 2000. The effects of ritanserin on mood, sleep, vigilance, clinical impression, and social functioning in alcohol-dependent individuals. Alc Alcoholism, 35: 384–89.

87.

Malcolm

, Myrick

, Roberts

, Wang

and Anton

R F

. 2002. The differential effects of dedication on mood, sleep disturbance, and work ability in outpatient alcohol detoxification. Am J Addictions, 11: 141–50.

88.

Karam-Hage

and Brwoer

. 2000. Gabapentin treatment for insomnia associated with alcohol dependence. Am J Psych, 157: 151

Disturbed Sleep and Its Relationship to Alcohol Use

Abstract

Study Objectives

Design

Measurements and Results

Conclusions

Keywords

Get full access to this article

References