Mandatory is insomnia . Sleep disorders are the most common reason for alcoholics to go to a doctor, usually a neurologist. When questioned, it turns out that the patient complains of “upset nerves”.
Thus, insomnia of alcoholics is always accompanied by additional psychopathological symptoms. At the beginning of alcoholism – this is an asthenic symptom complex, with the course of the disease – it is affective instability (anger, short temper, imbalance).
Alcoholic sleep disorders are characterized throughout the illness by early awakening (at 4-5 in the morning) and the absence of a sense of relaxation, recovery of strength after sleep. The alcoholic has a feeling that he was asleep; in patients with neurasthenia this feeling often disappears. Early morning awakenings are often accompanied by anxiety, a feeling of vague anxiety.
In stage I of alcoholism, patients fall asleep quite well, but with the course of the disease, the state of intoxication becomes a necessary condition for falling asleep. A drunken dream is deep, albeit short. Nightmare dreams are obligatory in the nights following the continued drunkenness. Temporary abstinence is characterized by frightening dreams in which alcoholics see themselves as a persecuted victim. Sometimes a patient suddenly wakes up, seized with a sense of horror, not remembering a dream.
It should be said that subjectively patients with alcoholism suffer sleep disorders more easily than patients with neurosis, without making insomnia a problem in their lives. Usually they are able to put this disorder in a causal relationship with drunkenness, since the aggravation of insomnia over time is clearly associated with alcoholic excesses.
Alcoholics are more worried about experiences associated with nightmares. They would like to sleep better and ask for sleeping pills for this. Sleeping pills for alcoholics are contraindicated, because in these cases a drug addiction to them quickly forms (barbitura addiction, noxiron addiction). An increase in tolerance to alcohol is accompanied by an increase in tolerance to sleeping pills (cross tolerance).
Therefore, taking a therapeutic dose of sleeping pills does not have a hypnotic effect on the alcoholic. Only the first phase of the action of sleeping pills is manifested – excitatory. This euphoric sensation resembles the excitement that an alcoholic receives from alcohol. As a result, an alcoholic may begin to take sleeping pills for narcotic purposes either in pure form, or by combining it with alcohol to reduce the cost of intoxication. Either barbituratism or alcohol-barbituric polydrug abuse easily occurs. An alcoholic falls asleep from a 2-3-fold therapeutic dose of sleeping pills.
The doctor must strive to find in the patient a high tolerance to sleeping pills – this indicates either getting used to sleeping pills or getting used to alcohol.
The only situation in which the appointment of barbiturates to an alcoholic is permissible is the threat of a jail of alcoholic psychosis (absolute insomnia, an increase indicates either getting used to sleeping pills, or taking antipsychotics, delaying the consultation of a psychiatrist.