The long and difficult road for recovering alcoholics may be further complicated by sleep problems, as new research finds.
[Photo: Dr. Todaro Brooks]
The sleep patterns of patients in inpatient alcohol rehabilitation were studied by recent University of Maryland School of Public Health graduate Dr. Alyssa Todaro Brooks, together with her mentor Dr. Kenneth Beck and Dr. Craig Fryer (both from the University of Maryland) and four of her colleagues at the National Institutes of Health Clinical Center and the National Institute on Alcohol Abuse and Alcoholism, both in Bethesda.
This is a relatively new topic of research, Dr. Todaro Brooks said. The prospective, repeated measures study assesses sleep experiences among alcohol-dependent people undergoing inpatient detoxification and treatment at a clinical research facility. The study looked at patients across the transition periods associated with the rehabilitation process: the initial adjustment to becoming an inpatient and then the transition from inpatient to outpatient status.
Through Dr. Todaro Brooks’ full-time work at an inpatient rehabilitation center, she knew from speaking to the nursing staff that patients were not sleeping well. “I quickly learned that sleep was of clinical importance to rehab. So, I became interested in sleep disturbance in rehabilitation.”
Most of the patients in the study were also dealing with PTSD, anxiety, and depression. “It reminded me that an intervention really has to consider all these other co-morbid chronic diseases they’re facing,” she said.
The researchers found that one of the most important predictors of sleep quality is self-efficacy: if patients thought they would be able to fall asleep, then they were more likely to succeed. “It was mentioned in interviews time and again,” Todaro Brooks said. She also pointed to the problematic issue that alcoholics often self-medicate by drinking to fall asleep and stay asleep. “Once they are sober, they’re missing the depressant to help them prepare for sleep. That’s what we’re thinking, moving forward.”
The researchers used mixed methods of inquiry, doing in-depth, semi-structured interviews with patients. Patients were interviewed once while they were in the inpatient facility, and once about a month after they were discharged.
This study was small, with only 33 patients. Dr. Todaro Brooks looks forward to the next step in her work, a study with 116 subjects. This next project will involve intervention, and is tentatively slated for the summer of 2017. It will incorporate cognitive behavior therapy for insomnia, and include some mind-body techniques, she said. “It’s a very interesting and vulnerable population.”
“Critical Transitions: A Mixed Methods Examination of Sleep from Inpatient Alcohol Rehabilitation Treatment to the Community” is the second in a planned series of three publications from Dr. Todaro Brooks’ dissertation work. The first piece, published in 2014, was a literature review of alcohol-related sleep disorders.