Sleep disorders in addictions: State of the art and management

INTRODUCTION: Sleep complaints are frequent among patients suffering from addiction. Conversely, sleep disturbances have been identified as risk factors for developing an addiction. METHODS: This study is a narrative literature review aiming to provide an overview of the current scientific knowledge on the links between major addictions (alcohol, tobacco, cannabis, and gambling) and sleep disorders. RESULTS: The scientific literature confirms the presence of both objective and subjective sleep alterations in major substance use disorders and pathological gambling, during periods of consumption as well as during withdrawal. For instance, 60-70% of patients with alcohol use disorder present with insomnia, and alcohol consumption increases the risk of developing obstructive sleep apnea by 25%. These interactions between addictions and sleep disorders are bidirectional: sleep disorders are identified both as risk factors for developing an addiction and for relapse among patients attempting abstinence, while addictions are identified as factors impairing sleep quality. Cognitive Behavioral Therapy for Insomnia (CBT-I), the first-line treatment for insomnia, has demonstrated its effectiveness in the management of insomnia in the context of cannabis and alcohol use disorders, leading to improvements not only in sleep symptoms but also in addictive symptoms. CONCLUSIONS: Addictions and sleep disorders interact in a bidirectional manner. The specific management of sleep disorders in this population could represent an interesting therapeutic target. However, further studies are needed to develop specific and targeted therapeutic tools to improve both prognosis and quality of life in these patients.