Disturbed sleep and its relationship to alcohol use.
OBJECTIVE
To review evidence of an association between disturbed sleep and alcohol use.


METHODS
We searched MEDLINE, PSYCHINFO, ETOH, BIBLIOSLEEP and the Rutgers Alcohol Studies databases between January 1966 and August 2002. Search terms included alcohol-related disorders or alcoholism in combination with sleep, sleep initiation and maintenance disorders, or sleep apnea syndromes. The search produced over 440 citations. We reviewed 107 relevant articles, of which 60 included quantitative measures of both alcohol use and sleep.


RESULTS
Behavioral studies suggest that up to 2 to 3 standard drinks before bedtime initially promotes sleep, but these effects diminish in as few as 3 days of continued use. Clinical investigations support a relationship between sleep disturbance and alcohol use, but variability in the definition and measurement of these domains and a preponderance of cross-sectional studies make uncertain the strength and direction of the association.


CONCLUSIONS
The association of insomnia with alcohol use disorders suggests that the clinical evaluation of patients with sleep problems should include a careful assessment of alcohol use. Future studies of this relationship should employ prospective designs with standardized, validated measures of both sleep and alcohol use. Rigorous treatment studies for chronic insomnia in alcohol dependent patients are also needed.
Brown Medical School, Division of General Internal Medicine, Rhode Island Hospital, Providence, RI 02903, USA.
Michael D
MD
Stein
Peter D
PD
Friedmann
D000428:Alcohol Drinking / Q000009:adverse effects*; D019973:Alcohol-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008403:Mass Screening; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D012894:Sleep Stages; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D013223:Statistics as Topic