Relationship between Alcohol Use and Sleep in Heavy Drinkers Jeanne M. Gabriele, Ph.D. 1, Patricia M. Dubbert, Ph.D. 2,3, Kathryn A. Roecklein, Ph.D. 4, & Julie Schumacher, Ph.D. 3 1 Pennington Biomedical Research Center, 2 G.V. (Sonny) Montgomery VA Medical Center, 3 University of Mississippi Medical Center, 4 University of Pittsburgh
Alcohol: Does it Help or Hinder Sleep? In low doses, alcohol may increase sleep duration At moderate and larger doses, alcohol may disrupt sleep Alcohol consumed in the evening reduces sleep onset latency Large doses consumed in the evening may result in sleep disturbances later in the night (Landolt et al., 1996; NIAAA, 1988; Stone, 1980)
Alcohol Dependence and Sleep Disturbance Higher prevalence of insomnia among those with alcohol dependence Among a sample of relapsed alcoholics, 60% had insomnia during 6 mths prior to treatment In comparison to patients without insomnia, patients with insomnia: More likely to report alcohol use for sleep (Janson et al., 2001; Brower et al., 2001)
Prevention and Treatment of Hypertension Study (PATHS) VA Cooperative Study #996 A multi-site randomized clinical trial to determine whether an intervention to lower alcohol intake in moderate to heavy drinkers with above optimal blood pressure reduces blood pressure at 6 months relative to an assessment control condition.
PATHS Inclusion Criteria Age: 21-79 Alcohol intake: >21 drinks/wk DBP: 80 to 99 mm Hg SBP: <179 mm Hg Hypertensive meds discontinued 2 wks prior to screening
PATHS Exclusion Criteria Alcohol or psychoactive substance dependence Alcohol-attributed medical complications Major psychiatric illness Cardiovascular end- organ damage Severe or secondary hypertension Malignancies Seizure disorders Coaugulpathies Current pregnancy
Current Study Purpose: To assess relationships among sleep, alcohol use, and health behaviors in PATHS participants Participants: 613 male veterans participating in PATHS with complete baseline data Excluded: Participants with missing data (n=16), females (n=5) and participants taking sleep medications more than once a week (n = 7)
Baseline Assessment Sleep Hrs of sleep per night Difficulty falling asleep (yes/no) Waking during the night (yes/no) Snoring (4 pt scale) Alcohol Use Average drinks/day Average drinking days/month Health Behaviors Caffeine consumption Physical activity Smoking
Participant Characteristics Age: M = 56.96 yrs; SD = 11.13 BMI: M = 27.96; SD = 4.71 Ethnicity: 74.8% Caucasian 19.7% African American 4.8% Hispanic <1% other
Sleep M hrs of sleep per night = 6.79 hrs (SD( = 1.34) 24% reported difficulty falling asleep 71.4% reported waking during the night Snoring 12.4% report never snoring 17.2% reported rarely snoring 50.8% reported sometimes snoring 19.5% reported often snoring
Alcohol Use in Previous 6 Mths Avg drinking days/mo: 24.54 days 43.6% reported drinking daily Avg drinks per day: 5.96 drinks
Health Behaviors Smoking: 12.7% never smoked 48.5% former smokers 38.7% current smokers; M = 11.25 cigs/day Physical Activity: 57.0% reported accumulating 150 min/wk Daily Caffeine Intake: M = 4.87 caffeinated drinks M = 377.88 mg of caffeine
Analyses Regression analyses with each sleep variable as a dependent variable Step 1: Demographic variables and health behaviors related to sleep outcome Step 2: Days/Mo of alcohol use and Avg drinks/day Step 3: Interaction Term (Days/Mo x Drinks/day) * All variables centered in analyses
Regression Analysis Assessing Relationships Among Alcohol Use and Sleep Duration Step 1 Step 2 Step 3 Variable β β β Age.13* Days per Mo Drinks per Day Days/mo * Drks/day R 2.02** ΔR 2 * p <.05; ** p <.01;
Regression Analysis Assessing Relationships Among Alcohol Use and Sleep Duration Step 1 Step 2 Step 3 Variable β β β Age.13*.10* Days per Mo.09 Drinks per Day -.03 Days/mo * Drks/day R 2.02**.03* ΔR 2.01* * p <.05; ** p <.01;
Alcohol Use Related to Sleep Duration Step 1 Step 2 Step 3 Variable β β β Age.13*.10*.07 Days per Mo.09.15** Drinks per Day -.03 -.12* Days/mo * Drks/day -.20** * p <.05; ** p <.01; R 2.02**.03*.06* ΔR 2.01*.03** Interaction explored: For those who consumed alcohol on less than 28 days/mo, no relationship between amt of alcohol consumed and hrs of sleep For those who consumed alcohol on 28 or greater days per mo, increasing amts of alcohol is associated with decreased sleep duration
Regression Analysis Assessing Relationships Among Alcohol Use and Snoring Step 1 Step 2 Step 3 Variable β β β Cohabiting.10* Employed.09* BMI.17** Days per mo Drinks per day Days/mo * Drks/day * p <.05; ** p <.01; R 2.05** ΔR 2
Regression Analysis Assessing Relationships Among Alcohol Use and Snoring Step 1 Step 2 Step 3 Variable β β β Cohabiting.10*.10* Employed.09*.10* BMI.17**.18** Days per mo.12 Drinks per day.08 Days/mo * Drks/day R 2.05**.06** ΔR 2.01 * p <.05; ** p <.01;
Alcohol Use Does Not Explain Any Variance in Snoring Step 1 Step 2 Step 3 Variable β β β Cohabiting.10*.10*.10* Employed.09*.10*.10* BMI.17**.18**.18** Days per mo.12.10 Drinks per day.08.12* Days/mo * Drks/day.10 * p <.05; ** p <.01 R 2.05**.06**.07** ΔR 2.01.01
Results of Logistic Regression Analysis Predicting Difficulty Falling Asleep Age -.04** Yrs education -.04 Employed.85* Health Status -.45** Physically active.27 Days per month Drinks per day Days/mo * Drks/day * p <.05; ** p <.01; = addition of step significant Step 1 Step 2 Step 3 β β β Exp(B)
Results of Logistic Regression Analysis Predicting Difficulty Falling Asleep Age -.04** -.04** Yrs education -.04 -.03 Employed.85*.87** Health Status -.45** -.43** Physically active.27.24 Days per month -.33** Drinks per day -.03 Days/mo * Drks/day * p <.05; ** p <.01; = addition of step significant Step 1 Step 2 Step 3 β β β Exp(B)
Results of Logistic Regression Analysis Predicting Difficulty Falling Asleep * p <.05; ** p <.01; = addition of step significant Step 1 Step 2 Step 3 β β β Exp(B) Age Yrs education Employed Health Status Physically active Days per month Drinks per day -.04** -.04.85* -.45**.27 -.04** -.03.87** -.43**.24 -.33** -.03 -.03** -.03.88** -.42**.25 -.43**.11.97.07 2.40.66 1.29 1.01 1.12 Days/mo * Drks/day.20* 1.22
Exploration of Interaction between Frequency and Amount of Alcohol Use When consumed < 5 drinks per day, days alcohol consumed negatively associated with difficulty falling asleep (β( = -.59, p <.05) When consumed > 5 drinks per day, days alcohol consumed not associated with difficulty falling asleep
Amount and Frequency of Alcohol Use Associated with Waking During the Night Step 1 Step 2 Step 3 β β β Exp(B) Health Status -.28** Caffeine.00 Days per mo Drinks per day Days/mo * Drks/day * p <.05; ** p <.01; = addition of step significant
Amount and Frequency of Alcohol Use Associated with Waking During the Night Step 1 Step 2 Step 3 β β β Exp(B) Health Status -.28** -.26** Caffeine.00.00 Days per mo.33** Drinks per day.44** Days/mo * Drks/day * p <.05; ** p <.01; = addition of step significant
Amount and Frequency of Alcohol Use Associated with Waking During the Night Step 1 Step 2 Step 3 β β β Exp(B) Health Status -.28** -.26** -.25**.78 Caffeine.00.00.00 1.00 Days per mo.33**.30* 1.35 Drinks per day.44**.51** 1.67 Days/mo * Drks/day.11 1.11 * p <.05; ** p <.01; = addition of step significant
Findings in this sample largely consistent with previous literature Higher doses of alcohol have negative influence on total sleep time Higher doses of alcohol associated with waking after sleep onset However, contrary to previous findings, days of alcohol use was associated with early insomnia only among those consuming lower amounts of alcohol Perhaps individuals with difficulty falling asleep using alcohol to self-medicate
Limitations Cross-sectional sectional study Sleep measures Sleep hours in whole numbers Waking during the night and difficulty falling asleep assessed using yes/no questions Snoring assessed using 4-pt 4 scale
Future research questions How does reducing alcohol intake influence sleep outcomes in heavy drinkers? Does the presence of sleep difficulties at baseline influence alcohol treatment success?
PATHS Funding Sources Veteran Affairs Cooperative Studies Program National Heart, Lung, and Blood Institute National Institute on Alcohol Abuse and Alcoholism