Negative emotions may help explain the link between insomnia and dangerous drinking, according to a small study involving veterans with Alcohol Use Disorder (AUD). The findings provide new insight into why insomnia might linked to AUD. Insomnia symptoms are highly prevalent in people with substance use disorders (SUDs). Among veterans with AUD, for example, almost 2 in 3 experience insomnia. Sleep problems are also linked to negative mood and difficulty regulating emotions, which in turn are associated with risky alcohol use. Previous research has shown that treating insomnia can lead to a reduction in alcohol-related problems, though the mechanism for this is not known. For the study in Alcohol: Clinical & Experimental Research, investigators examined negative emotions as a key link between insomnia symptoms and alcohol problems among US military veterans.
Researchers worked with 67 Veterans in treatment for AUD who also met the criteria for Insomnia Disorder (91% male, 84% White, average age 46). The participants were randomized to receive either five sessions of Cognitive Behavioral Treatment–Insomnia, including tracking their adherence to treatment recommendations over five weeks, or a handout on sleep hygiene. They were assessed for insomnia symptoms, alcohol craving and consumption, drinking-related problems (such as feeling unhappy because of alcohol use), symptoms of post-traumatic stress disorder, depression, anxiety, emotional regulation, and current negative affect. These evaluations occurred before treatment, immediately after treatment, and six weeks later. The researchers used statistical analysis to explore associations between sleep, mood, and alcohol-related experiences.
Among both groups—people receiving either CBT-I or the sleep hygiene handout—those who experienced reduced insomnia symptoms also reported decreases in negative emotionality. The benefits included lower PTSD, depression, and anxiety symptoms and improved emotional regulation and affect. These changes, in turn, predicted reductions in alcohol cravings and heavy drinking. Increases in negative mood were linked to subsequent increases in alcohol cravings. Changes in insomnia symptoms or negative mood were not associated with changes in alcohol-related problems. Nor did CBT-I offer additional improvements in negative emotionality relative to the sleep hygiene recommendations, perhaps because of participants’ weak engagement in the cognitive therapy component or for reasons to do with the study methods. Nevertheless, the study suggests that negative emotionality may help explain links between insomnia symptoms and alcohol-related outcomes.
Improving sleep is a means of easing negative mood, which in turn can provide relief from alcohol cravings and heavy drinking. If these study results can be replicated in larger, more diverse samples, they could inform more effective treatments for AUD. CBT-I may be a promising treatment for people who are more open to addressing their insomnia than their, say, PTSD or depression. Although CBT-I may not lead to improved mood for everyone, it can be combined with other interventions that might impact mood, such as mindfulness or emotional regulation skills training. Additional research is needed, including more extensive trials.
