Slow Wave Sleep Changes: Alcohol Tolerance and Treatment Implications

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Abstract
Slow wave sleep abnormalities characterize the sleep of alcoholics. In this report, two questions are addressed: (1) Does the slow wave sleep loss in alcohol withdrawal relate to withdrawal treatment? (2) Do the slow wave sleep changes on and off alcohol relate to the clinical course of alcoholism? The first question was addressed by comparing recovery in sleep EEG and clinical measures following two types of alcohol withdrawal treatment. Eighteen subjects were randomly assigned to either a low dose ethanol or chlordiazepoxide treatment for alcohol withdrawal. The results indicate that chlordiazepoxide produces a marked synergism with alcohol withdrawal suppression of slow wave sleep. The second question was addressed by an experimental alcoholization study involving 9 subjects who drank for 5 consecutive days, with 18 ounces of 95 proof ethanol consumed daily. Changes in slow wave sleep from baseline (abstinent) values to those on alcohol showed faster rate of tolerance development for the low slow wave sleep subjects. The rate of tolerance development was significantly related to treatment outcome, with faster tolerance development associated with poorer treatment outcome. In this regard it is noted that the use of chlordiazepoxide in alcohol withdrawl needs to be reviewed for potentially prolonging tolerance "carryover" and thereby being counterproductive for treatment outcome.