Sleep-Wake Disorders

Sleep disturbance is common in people with alcohol use disorders and may resolve with abstinence or significant reductions in use. Symptomatic management may be required and if problems persist after 6 weeks to 3 months of abstinence or significantly reduced consumption, they may require more careful assessment and treatment.  Evidence is limited to a small number of studies on insomnia. Psychological interventions (CBT for Insomnia CBT-I) appear to show a greater benefit over control compared to the pharmacotherapies that have been tested in improving sleep and are recommended as the first line of treatment.   

Care should be taken that pharmacotherapy targeting alcohol use disorders such as naltrexone does not have the unintended consequence of worsening insomnia. Gabapentin, quetiapine, trazodone (not available in Australia) and other agents have been trialled in small studies with inconsistent results and further research is required.  There is little evidence that treating sleep disorders pharmacologically improves alcohol related outcomes.  

Chapter Recommendation Grade of recommendation
21.43 Sleep hygiene and psychoeducation about sleep are recommended as the first line intervention for insomnia that lasts beyond withdrawal GPP
21.44 Behavioural interventions including CBT-I and progressive muscle relaxation are recommended as second line interventions for insomnia GPP