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Expert Opin Pharmacother. 2020 Feb;21(3):297-306. doi: 10.1080/14656566.2019.1705279. Epub 2020 Jan 3.

Management of insomnia in alcohol use disorder.

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Département de psychiatrie et d'addictologie, AP-HP, Hopital Bichat - Claude Bernard, Paris, France.
NeuroDiderot, Inserm, Université de Paris, Paris, France.
Department of Epidemiology, Paris Hospital Group - Psychiatry & Neurosciences, Paris, France.
Pôle MOPHA, CH Le Vinatier, Service Universitaire d'Addictologie de Lyon (SUAL), Bron, France.


Introduction: Insomnia has been implicated in the development, maintenance, worsening, and relapse of alcohol use disorder (AUD).Areas covered: The authors review the possible pharmacological and non-pharmacological treatment options of insomnia for patients with alcohol-use disorder and provide their expert opinion.Expert opinion: Abstinence, or at least a decrease in alcohol use, may improve insomnia symptoms. Second, sleep education is a cornerstone intervention that should be completed by more structured behavioral therapies or Cognitive Behavioral Therapy for Insomnia (CBT-I). CBT-I is the recommended first-line treatment of combined insomnia and AUD (high level of evidence). Third, in case of insufficient response or non-availability of CBT-I, pharmacological treatments might be added. In addition, CBT-I may take several weeks to be effective, and these medications could be proposed to patients with severe symptoms or psychiatric comorbidities. Mirtazapine, gabapentin immediate release, and quetiapine exhibit a moderate level of evidence. Melatonin, topimarate, trazodone, and acamprosate, have a low level of evidence. Benzodiazepines and other GABA-A agonists should be avoided. A particular attention should be provided to patients who use alcohol to help fall asleep as a higher risk of relapse exists after stopping treatment.


Insomnia; addictive disorders; alcohol; circadian rhythms; mental disorders; sleep

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