Individuals with alcohol dependence (AD) often have sleep-related disorders such as insomnia, circadian-rhythm sleep disorders, breathing-related sleep disorders, movement disorders, and parasomnias such as sleep-related eating disorder, sleepwalking, nightmares, sleep paralysis, and REM sleep behavior disorder. The last comprehensive review on this topic was published in March 2005. This review examines the various aspects of insomnia associated with AD, especially using findings over the last decade, and employing updated diagnostic criteria for sleep disorders found in the third edition of the International Classification of Sleep Disorders.
The authors reviewed 135 studies retrieved from four databases -- Pubmed, Medline, Embase and Google Scholar -- to gather abstracts from American, European, and other international databases for the period January 1, 1967 to December 31, 2015. Searches were limited to human subjects, the English language, and research directly evaluating the relationships between alcohol use/disorders and sleep complaints/disorders. Wherever multiple studies were found on the same topic, the largest and/or most rigorous studies were evaluated. The literature review extended. Manuscript references were cross-checked for possible additional studies; likewise, the last two literature reviews on this subject along with their references were checked.
A significant proportion of the literature has focused on insomnia, and the association between AD and insomnia appears to be bi-directional in nature. AD may also be associated with circadian abnormalities, short sleep duration, obstructive sleep apnea, and sleep-related movement disorder. Insomnia treatment with cognitive behavioral therapy shows promise for treatment of sleep disorder in the context of alcohol dependence, as do newer medications such as ramelteon, which can alleviate sleep initiation and/or maintenance disorders.
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