Sleep-Related Beliefs, Behaviors and Risk for Relapse in Alcohol Use Disorder

sad person with alcohol
sad person with alcohol
Greater risk for relapse was observed in patients with lower self-efficacy for sleep and more dysfunctional beliefs about sleep.

Sleep-related behaviors can predict relapse in patients with alcohol use disorder (AUD), according to study data published in the International Journal of Behavioral Medicine. Specifically, greater risk for relapse was observed in patients with lower self-efficacy for sleep and more dysfunctional beliefs about sleep.

Alyssa Todaro Brooks, PhD, from the National Institutes of Health Clinical Center, Bethesda, Maryland, led study efforts to assess the relationship between sleep behaviors and risk for relapse in patients with AUD. This clinical trial enrolled individuals who received inpatient care for AUD for at least 21 days and were willing to complete a sleep diary over the 4 weeks after discharge. Demographic and clinical data were captured at inpatient admission, including age, gender, marital status, race/ethnicity, and alcohol use behaviors. Outcomes of interest included self-reported sleep quality based on the Pittsburgh Sleep Quality Index, as well as dysfunctional beliefs/attitudes about sleep and sleep-related behaviors.

Beginning 1 week before hospital discharge, patients were provided with actigraphy-based wristwatches to measure gross motor activity and sleep. Watches were worn for up to 4 weeks post-discharge. The main actigraphy outcomes were sleep efficiency, wake after sleep onset, and time in bed. Multivariable logistic regression was used to identify baseline predictors of sleep outcomes and risk for relapse.

The study cohort comprised 149 patients (mean age, 47.3±11.64 years; 66.4% men), with 30 patients experiencing relapse in the 4 weeks after discharge. Patients who relapsed were more likely to report sleep disturbances before discharge (P =.017), had lower self-efficacy for sleep after discharge (P =.035), reported more dysfunctional beliefs about sleep before discharge (P =.027), and engaged in more sleep-related behaviors both before (P =.006) and after discharge (P =.04).

Independent of relapse experience, patients’ average sleep duration improved significantly from week 1 to week 4 post-discharge. In regression models, patients with more sleep-related behaviors were at higher odds for relapse (odds ratio [OR], 1.046; 95% CI, 1.006-1.088; P =.026), whereas married patients were less likely to relapse (OR, 0.119; 95% CI, 0.015-0.983; P =.048). In the model predicting sleep quality, lower self-efficacy for sleep and higher pre-discharge anxiety (both P <.001) were associated with lower sleep quality. Actigraphy-based measures were not significantly different between patients who did and did not relapse.

As study limitations, the investigators noted the relatively small study cohort and the use of a single study site, which may limit generalizability. Additionally, some patients did not complete the actigraphy measurements or were lost to follow-up. Even so, results suggest a strong relationship between sleep disturbances and risk for relapse.

“Sleep-related beliefs and behaviors as well as sleep quality are important components of health-related quality of life, but may be particularly important among individuals with AUD,” the investigators concluded.


Brooks AT, Kazmi N, Yang L, Tuason RT, Krumlauf MC, Wallen GR. Sleep-related cognitive/behavioral predictors of sleep quality and relapse in individuals with alcohol use disorder [published online May 27, 2020]. Int J Behav Med. doi: 10.1007/s12529-020-09901-9