Sleep problems, both real and perceived, may make it harder to recover from alcohol dependence, new research suggests.

Studies have found that anywhere from one-third to three-quarters of alcoholics in the early stages of recovery complain of insomnia. In the new study, researchers found that alcoholics’ sleep problems - particularly their perceptions of their sleep problems - helped predict their odds of relapse.

In general, study participants believed they were having more difficulty falling asleep than they actually were, but failed to perceive how much trouble they were having staying asleep during the night.

And those perceptions were better at predicting relapse into drinking than objective measures of sleep quality were.

“What we found is that those patients who had the biggest disconnect between their perception of how they slept and their actual sleep patterns were most likely to relapse,” Dr. Deirdre Conroy, the study’s lead author, said in a statement.

“This suggests that long-term drinking causes something to happen in the brain that interferes with both sleep and perceptions of sleep,” she said. “If sleep problems aren’t addressed, the risk of relapse may be high.”

The findings also suggest that recovering alcoholics should be given both objective and subjective tests of sleep quality, according to Conroy and her colleagues at the University of Michigan, Ann Arbor.

The study, published in the journal Alcoholism: Clinical & Experimental Research, included 18 newly abstinent alcoholics who were suffering from insomnia.

The patients spent two nights in the sleep clinic to their sleep quality objectively measured by polysomnography. They also reported their own impressions of their sleep quality, including how long they thought it took them to fall asleep, and how much time they thought they spent awake during the night.

In general, Conroy’s team found, patients overestimated the length of time they needed to fall asleep, but underestimated how much time they spent awake during the night. Those whose perceptions were farthest from reality were more likely to start drinking again over the next three months.

“On average,” Conroy said, “the participants that were less accurate about how they were sleeping were more likely to return to drinking.”

The findings suggest many recovering alcoholics may mistakenly think they are sleeping through the night when, in fact, their brains are waking up. On the other hand, they may believe they are having more trouble falling asleep than they actually are.

Poor sleep quality may lead to mood disturbances during the day - which, Conroy noted, could make alcoholism recovery more difficult. The specialists treating them should be aware of this possibility, she said.

Taking both objective and subjective measures of sleep quality might help spot patients who are at particular risk of relapse, the researchers conclude.

They are currently studying whether “talk therapy” for sleep problems can help people who are beginning treatment for alcohol dependence.

SOURCE: Alcoholism: Clinical & Experimental Research, December 2006.