Chapter 1:
Background: Sleep disturbances are common among individuals with Alcohol Use Disorder (AUD) and often persist into recovery. Although psychological interventions such as Cognitive Behavioural Therapy for Insomnia (CBT-I) and Motivational Interviewing (MI) are well-established treatments for AUD, their impact on sleep outcomes remain underreported. This systematic review aims to explore how psychological interventions for AUD impact sleep outcomes during and after treatment; and whether improvements in sleep outcomes precede improvements in alcohol outcomes, or vice versa.
Method: A systematic review was conducted. Scopus, PsycInfo and Medline were searched in February 2025. Included studies involved adults with AUD who underwent psychological interventions for AUD, with sleep outcomes measured over time. Sixteen studies met the inclusion criteria and underwent quality appraisal using the Critical Appraisal Skills Programme (CASP) checklists.
Results: Psychological interventions varied, but CBT-I consistently produced significant improvements across multiple sleep parameters, although these did not translate into improvements in alcohol-related outcomes. Broader AUD treatments were associated with improvements in both alcohol and subjective sleep quality. Integrated treatments addressing comorbid PTSD or depression improved sleep indirectly, often through symptom reduction. However, the direction and mechanisms linking sleep and alcohol outcomes remained unclear.
Conclusion: Psychological interventions for AUD can improve sleep, particularly with insomnia-specific approaches like CBT-I. However, improvements in sleep do not consistently translate into improvements in alcohol outcomes. Future research should prioritise integrated treatments, objective sleep measures, and long-term follow-up.
Practitioner points:
● Sleep disturbances are highly prevalent in individuals with AUD and therefore should be routinely assessed during treatment.
● Sleep-focused components (e.g., CBT-I) should be considered for individuals with AUD and comorbid insomnia, given their effectiveness on sleep.
● Further research should evaluate long-term sleep outcomes and integration of sleep-focused interventions within AUD treatment.
Chapter 2:
Background: Alcohol Use Disorder (AUD) is associated with difficulties. Digital interventions offer tools for alcohol reduction, yet limited research has examined impacts on sleep. This study aims to identify drinking trajectories among Drink Less app users and explore how changes in alcohol consumption relate to changes in sleep.
Method: A secondary data analysis was conducted using data from app users over a 30-day period (N = 15,457). Latent class analysis was used to identify drinking trajectories, and linear mixed models were used to examine changes in sleep.
Results: Four drinking trajectories were found: “light drinking throughout (37.7%)”, “moderate drinking, decreasing (7.8%)”, “heavy drinking, decreasing (20.3%)”, and “heaviest drinking, decreasing (34.1%)”. Groups showed improvements in sleep over 30-days F(1, 158,459) = 539.93, p < .001, however, the rate of improvement differed between trajectories F(3, 158,459) = 20.86, p < .001. The “light drinking throughout” group had better sleep at baseline and demonstrated the steepest improvements (β = 0.032, p < .001), whereas moderate and heavier drinking groups demonstrated comparatively shallower rates of sleep improvement over time.
Conclusion: Users demonstrated improvements in sleep over 30 days of app use, with the steepest rate of improvement among light drinkers. Future research should explore whether integrating sleep-focused interventions within digital interventions enhances both sleep and alcohol-related outcomes.
Practitioner points:
● Sleep may improve during digital alcohol reduction interventions, although the rate of improvement will vary depending on the rate of changes in drinking over time.
● App users who maintain light drinking throughout the first month report better sleep at baseline and a steeper rate of improvement in sleep over time, relative to other groups, although group differences are small.
● Future research should explore whether digital alcohol interventions may benefit from targeted sleep-focused support.
