From the Guidelines
Alcohol use is not recommended for individuals with insomnia due to its adverse effects on sleep quality and potential for abuse. According to the clinical guideline for the evaluation and management of chronic insomnia in adults 1, alcohol is not a suitable treatment for insomnia because of its short duration of action, adverse effects on sleep, exacerbation of obstructive sleep apnea, and potential for abuse.
Alternatives to Alcohol for Insomnia
Instead of using alcohol, individuals with insomnia can try practicing good sleep hygiene, such as:
- Maintaining a consistent sleep schedule
- Creating a dark and cool bedroom environment
- Avoiding screens before bedtime
- Establishing a relaxing pre-sleep routine Non-alcoholic options like valerian extracts or melatonin (with small but consistent effects on sleep latency) may also be considered 1.
Treatment Options for Chronic Insomnia
For chronic insomnia, cognitive behavioral therapy for insomnia (CBT-I) is a more effective long-term solution than medication. If medication becomes necessary, it is essential to discuss appropriate options with a healthcare provider, rather than relying on alcohol or other non-recommended treatments. The guideline emphasizes the importance of educating patients about the risks and abuse/misuse of medications, as well as the need for periodic attempts to reduce the frequency and dose to minimize side effects 1.
From the Research
Alcohol Use and Insomnia
- Insomnia has been implicated in the development, maintenance, worsening, and relapse of alcohol use disorder (AUD) 2.
- Abstinence or a decrease in alcohol use may improve insomnia symptoms, and sleep education is a cornerstone intervention that should be completed by more structured behavioral therapies or Cognitive Behavioral Therapy for Insomnia (CBT-I) 2.
- CBT-I is the recommended first-line treatment of combined insomnia and AUD, with a high level of evidence 2, 3, 4, 5.
Treatment Options
- CBT-I encompasses sleep hygiene, stimulus control, sleep restriction, cognitive therapy, and relaxation training 3, 4.
- Pharmacological treatments, such as mirtazapine, gabapentin immediate release, and quetiapine, may be added in case of insufficient response or non-availability of CBT-I, but benzodiazepines and other GABA-A agonists should be avoided 2.
- CBT-I has been found to be an effective treatment for patients with insomnia and comorbid mental disorders, including depression, post-traumatic stress disorder (PTSD), and alcohol dependency 5.
Mechanisms of Change
- Changes in dysfunctional beliefs about sleep have been identified as a cognitive mediator of insomnia symptom improvement following CBT-I 6.
- There is limited evidence in support of changes in hyperarousal-related mediators, and no significant effect of time in bed as a mediator 6.
- Further research is needed to establish the temporal precedence of mediator changes and to explore the role of other potential mediators 6.