An article published in Psychiatric Times in 2017 reported that while around 10 to 15 percent of the general population experience insomnia, this increases to between 30 and 80 percent of those with an active alcohol use disorder - and upwards of half of all patients report disturbed sleep during alcohol withdrawal.
Research suggests that alcoholics who report drinking alcohol to help them sleep are at a higher risk for sleep disturbances and relapse when they attempt to get sober. One study found that although sleep disturbances affected two-thirds of patients at admission, sleep problems were not associated with alcohol relapse at 12 months. In contrast, those who reported using alcohol as a sleep aid upon admission were three times more likely to have relapsed at 12 months.
Another study found that those who felt it took a long time to fall asleep were more likely to relapse. Research investigating the effect of alcohol on sleep using objective data collected from sleep studies has confirmed that alcohol reduces total sleep time and suppresses REM sleep.
It is clear then, that sleep disturbances can be a very real challenge for those trying to get sober, particularly since sleep problems can persist even after years of sobriety.
Insomnia treatment options when dependent on alcohol
As pointed out by the Psychiatric Times article, clinicians will likely be hesitant to prescribe sleeping pills due to the risk of abuse and the perception that sleep disruption associated with alcohol withdrawal is only a short-term challenge. Alternatives to sleeping pills should therefore be considered. These can include:
- Cognitive behavioral therapy for insomnia (CBT-I). This treatment has been found to be effective at improving sleep for those with substance use disorders - and it comes with minimal side-effects.
- Sleep hygiene education. Good sleep hygiene must be practiced consistently over several weeks but tends only to be effective at treating insomnia when combined with other therapies or when practiced as a component of CBT-I.
- Progressive relaxation therapy. One study found that alcoholic men who took 10 sessions of progressive relaxation over a two-week period reported significantly improved sleep quality (drinking outcomes were not studied).
- Light therapy. Disruption to the circadian rhythm is quite common among those with alcohol use disorders. Using a light therapy box could help.
- Melatonin supplements. During abstinence or alcohol withdrawal, there may be a delay in the rise of melatonin levels at night. Small studies have suggested that melatonin supplements may reduce insomnia severity in alcohol-dependent individuals.
The importance of assessment and treatment
As pointed out in an article published in the journal Alcohol, abstinence is the best first-line treatment for insomnia for those with an alcohol disorder. Assessment and treatment is particularly important since continuing to drink will reduce the effectiveness of insomnia treatments.
Not only is insomnia associated with relapse, it is also linked to suicidal thoughts — so it should never be ignored. If you are undergoing treatment for insomnia but aren't getting results, it may be worth asking your doctor for a sleep study since other sleep disorders such as sleep apnea, periodic limb movement disorder (PLMD), or restless legs syndrome may be hampering your progress. Those with alcohol dependency have been found to have higher rates of sleep apnea and PLMD in particular.