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Alcohol Use, Abuse and Sleep

J. Todd Arnedt, Ph.D.
Clinical Assistant Professor of Psychiatry & Neurology Director, Behavioral Sleep Medicine Program University of Michigan

Epidemiological studies show that about 15% of the population use alcoholic remedies to help them sleep on a regular basis. Why do people who have insomnia choose to turn to alcohol? J. Todd Arnedt, Ph.D. explains that those with insomnia perceive alcohol to be effective and beneficial as a sleep aide. He notes that more than 60% of the time people with insomnia choose alcohol, whereas those without any sleep condition choose alcohol only 20% of the time. In other words, Dr. Arnedt concludes that insomnia can lead to problem alcohol use. After a brief introduction to insomnia and alcoholism, Dr. Arnedt discusses the different stages of sleep: Non Rapid Eye Movement (NREM) and Rapid Eye Movement (REM) sleep. Dr. Arnedt highlights a study that administers alcohol to patients 30-60 minutes before bedtime. He shows that those who drank alcohol had reduced REM sleep, a faster Slow Wave Sleep (SWS), and took longer to even enter into REM than did the control group. Alcohol use tends to increase deep sleep at the beginning of the night and decrease REM sleep. The reverse is true in the second part of the night. Dr. Arnedt briefly touches on the circadian process, a regulatory mechanism of the sleep and wake cycle. He then focuses on the treatment options for insomnia: prescription medications with FDA approval, without FDA approval, non-prescription agents and cognitive-behavioral treatments. Trazodone and Gapabentin are two medications discussed in depth. Dr. Arnedt elaborates on Cognitive Behavioral Insomnia Therapy and why this is chosen over certain medications. He states that physicians are reluctant to prescribe medications to patients who have been found to have a history of abuse. He concludes his discussion by reinforcing the notion that more research is needed to improve sleep and reduce relapse.