Objective: This study was an investigation of the frequencies of insomnia a
nd its self-medication with alcohol in a group of alcoholic patients, as we
ll as the relationship of these variables to alcoholic relapse.
Method: The subjects were 172 men and women receiving treatment for alcohol
dependence. They completed a sleep questionnaire, measures of alcohol prob
lem severity and depression severity, and polysomnography after at least 2
weeks of abstinence.
Results: On the basis of eight items from the Sleep Disorders Questionnaire
, 61% of the subjects were classified as having symptomatic insomnia during
the 6 months before treatment entry. Compared to patients without insomnia
, patients with insomnia were more likely to report frequent alcohol use fo
r sleep (55% versus 28%), had significantly worse polysomnographic measures
of sleep continuity, and had more severe alcohol dependence and depression
. Among 74 alcoholics who were followed a mean of 5 months after treatment,
60% with baseline insomnia versus 30% without baseline insomnia relapsed t
o any use of alcohol, a significant difference. Insomnia remained a robust
predictor of relapse after application of logistic regression analysis to c
ontrol for other variables. A history of self-medicating insomnia with alco
hol did not significantly predict subsequent relapse.
Conclusions: The majority of alcoholic patients entering treatment reported
insomnia symptoms. Given the potential link between insomnia and relapse,
routine questions about sleep in clinical and research settings are warrant
ed.