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Sleep Matters in the Course and Treatment of Alcohol Dependence

Kirk Brower, MD
Professor of Psychiatry
Director, Multidisciplinary Alcoholism Research Training Program
Associate Director for Addiction Psychiatry,
Substance Abuse Section
Executive Director, Addiction Treatment Services
University of Michigan

This presentation focuses on the existence and implications of irregular sleep patterns in alcohol dependent individuals. Alcohol dependent individuals demonstrate abnormal REM sleep patterns as compared to healthy controls. Brower notes that sleep abnormalities are highly common among alcoholics; tend to be persistent despite subsequent sobriety; may exist prior to alcohol dependency; are associated with relapse; and are associated with suicidal ideation and behavior. Polysomnographies of alcohol dependent patients show an increase in sleep latency, awakenings, stage shifts, stage 1 sleep, and REM sleep (vivid dreaming), and a decrease in sleep efficiency, total sleep time, slow wave sleep, and REM sleep latency. These symptoms can persist for multiple years after achieving sobriety. Baseline sleep disturbances can lead to relapse, likely due to an increased sensitivity to stress and impaired executive functioning. Brower further demonstrates how the Homeostatic Sleep Drive and the Circadian Rhythm Physiology of alcohol dependent individuals are disturbed. Insomnia has implications for assessment and treatment of alcohol dependent individuals; sleep irregularities must be addressed in order to effectively treat the substance abuse itself. Both behavioral therapy and pharmacotherapy have been evidenced to assist with the treatment of insomnia for alcoholics; however, Brower suggests that more research is necessary.


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