Pharmacotherapy for Sleep Problems in Patients Recovering from Alcoholism

Sleep disturbance is common among patients in recovery from alcoholism and can precipitate relapse. Little is known about how physicians currently manage sleep disturbance in these patients, although a spectrum of potential treatments is available. Researchers surveyed a random sample of physician members of the American Society of Addiction Medicine by mail (311 respondents; 62% response rate) to examine their use of pharmacotherapy for sleep disturbance among patients in early recovery from alcoholism.

• Physicians reported that 65% of their patients in the first 3 months after detoxification had a sleep disturbance.
• Sixty-four percent of physicians had recommended a medication to at least 1 of these patients to improve sleep; however, only 22% offered medication to more than half of such patients.
• Trazodone was the most commonly chosen medication (38% of respondents), followed by antihistamines (12%), other sedating antidepressants (7%), nonbenzodiazepines (4%), and benzodiazepines (3%).

Comments:

The authors accurately note that physicians’ reluctance to offer pharmacotherapy for sleep disturbance following detoxification is consistent with the traditional view that patients in recovery should avoid medications. The key question of whether treatment of sleep disturbance in early recovery will lower the likelihood of recurrent drinking awaits empiric evaluation. Although this study has limitations (most significantly the use of self-reported physician practices), it does describe current practices of addiction experts in caring for sleep disturbance post-detoxification and highlights our limited understanding of pharmacotherapy’s effectiveness for this condition.

Jeffrey H. Samet, MD, MA, MPH

Reference:

Friedmann PD, Herman DS, Freedman S, et al. Treatment of sleep disturbance in alcohol recovery: a national survey of addiction medicine physicians. J Addict Dis. 2003;22(2):91–103.
(view abstract)