Anxiety, Sleep Disturbance, and Alcohol-Related Problems

Previous research has shown that people reporting sleep disturbances are at increased risk of depression, panic disorder, and possibly alcohol abuse. To examine whether sleep loss due to worry increases risk of developing alcohol-related problems, investigators analyzed interview data from a population-based sample of 1537 individuals in Baltimore in 1981 and again 12 years later. Key findings from analyses adjusted for possible confounders (e.g., age, sex, race, education) include the following:

• The risk of developing an alcohol-related problem (defined as having any of the alcohol-related symptoms used to diagnose DSM-III-R abuse or dependence) was significantly higher among those who reported at baseline more-than-usual sleep loss due to worry, compared with those who reported no sleep disturbances.
• This increased risk was significant in subjects who reported at baseline both more-than-usual sleep loss due to worry and ever having an anxiety disorder (relative risk, RR, 3.8) or symptoms of dysphoria (RR 2.7). It was not significant in those without anxiety (RR 1.8) or dysphoria (RR 1.4).
• Simple insomnia (disturbed sleep that was not necessarily associated with worry) did not increase risk of subsequent alcohol-related problems.

Comments:

This study suggests that patients with anxiety or mood symptoms who also report disturbed sleep due to worry may be at particular risk of developing alcohol-related problems. These patients may choose to self-medicate with alcohol at night to help relieve anxiety and induce sleep. The findings argue for increased attention to effective management of insomnia in patients with anxiety or other mood symptoms.

R. Curtis Ellison, MD

Reference:

Crum RM, Storr CL, Chan Y, et al. Sleep disturbance and risk for alcohol-related problems. Am J Psychiatry. 2004;161(7):1197–1203.
(view abstract)