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)