A new study highlights the critical role of stress and depression in linking insomnia and hazardous drinking. Researchers reveal how understanding these connections can influence treatment strategies.
Researchers have long recognized the close relationship between insomnia and hazardous drinking, with estimates suggesting that between one-third and 91% of troubled sleepers misuse alcohol. However, a new study reveals a critical piece of the puzzle: the roles of perceived stress and depression in this relationship.
The findings, published recently in the journal Alcohol, highlight that the direction of influence between insomnia and heavy drinking — whether insomnia leads to drinking or vice versa — determines whether stress or depression plays a more significant role.
“We were most interested in how insomnia leads to drinking, and we found that seems to occur primarily through stress. But when we switched pathways, it appeared that drinking primarily led to insomnia through depression,” senior author Jessica Weafer, an associate professor of psychiatry and behavioral health in The Ohio State University College of Medicine, said in a news release.
Weafer emphasized the potential treatment implications of these findings.
“If people who have insomnia are experiencing a lot of stress, then if we can target the stress, that might reduce the likelihood that their insomnia would lead to heavy drinking,” she added. “That’s the long-term ideal, or hope, that this work could have an impact on treatment.”
Insomnia and hazardous drinking can significantly disrupt lives, affecting job performance and increasing the risk of chronic illnesses, such as cardiovascular disease and Alzheimer’s. Alcohol use disorder (AUD) is characterized by the continuation of drinking despite facing major interpersonal, health or safety issues.
This study draws attention to an often-overlooked interplay between sleep difficulties and problem drinking. Weafer notes the prevalence of both conditions co-occurring.
“The number of people with AUD who also have insomnia is very, very high. It’s striking, and important,” she added.
The researchers conducted the study with 405 participants, who completed surveys assessing their insomnia severity, drinking behaviors, perceived stress and depression symptoms. The data revealed how these psychological factors mediate the relationship between insomnia and alcohol use.
First study author Justin Verlinden, a cognitive neuroscience doctoral student at the University of Kentucky, described the multifaceted nature of their analysis.
“There are so many different pathways that could explain insomnia and alcohol use. We wanted to connect the dots and see if there’s anything there,” he said in the news release.
The study found that when evaluating the pathways separately, stress and depression both mediated the relationship between insomnia and heavy drinking. However, analyzing both factors together provided unique insights.
“If you look at stress and depression separately, we find there is an indirect relationship between insomnia and drinking as well as drinking and insomnia — meaning a good chunk of the relationship between insomnia and drinking can be explained through perceived stress or depression,” Verlinden added.
Examining stress and depression within the same model produced enlightening results. When insomnia led to heavy drinking, stress, beyond any shared symptoms with depression, played a predominant role.
Conversely, when drinking led to insomnia, the unique symptoms of depression not shared with stress were more significant.
“The finding was very surprising, but showed the benefit of looking at both stress and depression in the same model, to see how those pathways might differ depending on what the directionality is,” Weafer added.
These insights represent a snapshot of the complex relationship between insomnia, stress, depression and hazardous drinking. To gain a deeper understanding, the researchers aim to expand the timeline of their study, collecting data over 12 months to trace the evolving relationships among these factors.
Additionally, the team is evaluating the effectiveness of digital cognitive behavioral therapy for insomnia, notably using an online program named SHUTi (Sleep Healthy Using the Internet), in individuals with heavy drinking behaviors. Early results are promising, showing that SHUTi can reduce insomnia in heavy drinkers.
This study, supported by the National Institute on Alcohol Abuse and Alcoholism and the University of Kentucky, aims to improve treatment strategies and outcomes for those entangled in the cycle of poor sleep and hazardous drinking.
Co-authors of the study include Mairead Moloney of the University of Miami and Olga Vsevolozhskaya and Lauren Whitehurst of the University of Kentucky.
Source: Ohio State University