Previous research has linked insomnia with the subsequent onset of alcohol abuse, nicotine dependence, and drug abuse/dependence in some adults. A study in the April issue of Alcoholism: Clinical & Experimental Research is the first longitudinal study to examine and find an association between sleep problems during early childhood and substance abuse during adolescence.
"Early childhood sleep problems appear to be a robust risk marker for substance use in adolescence," said Maria M. Wong, research assistant professor in the department of psychiatry at the University of Michigan and first author of the study. "However, while sleep problems in early childhood also predicted attention problems and anxiety/depression in later childhood, these problems did not mediate the sleep-drug onset relationship."
Wong and her colleagues examined 257 boys drawn from a community sample of high-risk families (as part of an ongoing longitudinal study of the development of risk for alcohol and other substance-use disorders). All families were Caucasian. Early childhood (3 to 5 years of age) sleep problems were rated by the boys’ mothers; late childhood (9 to 11 years of age) attention problems, anxiety/depression, and aggression were also rated by the boys’ mothers; and early adolescent (12 to 14 years of age) substance use was assessed through self-report questionnaires.
Researchers found that the mothers’ ratings of their children’s sleep problems at ages three to five years could significantly predict the onset of any use of alcohol, cigarettes, marijuana and illicit drugs at 12 to 14 years of age. Wong said the findings in this study are similar to those observed in adult studies.
Tim Roehrs, director of research at the Sleep Disorders Center of Henry Ford Hospital, concurs. "In adults, prospective survey data do indicate that sleep problems are predictive of later alcohol-use problems while controlling for depression and anxiety disorders," he said. "Some of my own laboratory studies that have assessed sleep and alcohol drinking, for example, show that disturbed sleep is associated with the self-administration of alcohol before sleep, that tolerance develops within six nights, and then larger alcohol doses are self-administered."
Roehrs added that, although sleep experts will likely not be surprised by these findings, general pediatric health professionals may be, "particularly that attention and anxiety-depression problems are not the mediators of this association."
Since onset of substance use during this early adolescent period is known to be predictive of more subsequent alcohol and drug problems as well as greater probability of later alcohol-use disorders, the sleep-problem ‘marker’ has potential utility as a very early indicator of the risk of developing alcohol problems.
"Not all children who had sleep problems in early childhood developed an early onset of alcohol and other drugs," said Wong. "However, about half of the children who had sleep problems began using substances at an early age, such as 14 years. It seems clear that children’s and adolescents’ sleep problems may potentially be a risk marker for later substance-use problems. Parents should pay attention to their children’s complaints about insomnia and overtiredness. If necessary, they should discuss those problems with pediatricians and other health care professionals. They may also want to pay attention to their children’s sleep hygiene, that is, ensuring a regular sleep schedule, adequate amounts of sleep, and encouraging their children to engage in relaxing activities right before bed time."
Wong is hopeful that, if sleep problems can be identified early on and treated, then early onset of alcohol and other drug use may be prevented. She and her coauthors plan to add to this study’s subjective ratings by collecting objective sleep data through use of an actigraph, which looks like an electronic wrist watch and records day-to-day activities, amount of movement during sleep, and sleep duration, as well as polysomnography, the study of brain waves during sleep in the laboratory.
Roehrs agreed that it is very important to confirm the existence of sleep disturbances in these children with standard laboratory assessments. "The next step should be to begin to determine the nature of that disturbance," he said. "Does the sleep disturbance indicate that there is a pathophysiology of the sleep or circadian systems? Importantly, will treatment of the sleep problem reduce the risks?"
Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.
Articles were written based on the following published research:
Wong, M.M., Brower, K.J., Fitzgerald, H.E., & Zucker, R.A. Sleep problems in early childhood and early onset of alcohol and other drug Use in adolescence. (April 2004). Alcoholism: Clinical & Experimental Research, 28(4) 578-587.