The Effects of Alcohol on Sleep

[David Baxter PhD]

The Effects of Alcohol on Sleep
January 28, 2005

Question: What are the effects of alcohol on sleep?

Response from Karl Doghramji, MD
Professor of Psychiatry, Jefferson Medical College, Philadelphia, Pennsylvania; Director, Sleep Disorders Center, Thomas Jefferson University, Philadelphia, Pennsylvania

Alcohol is used extensively as a sleep aid in the general population. In a recent survey[1], 28% of insomniacs indicated that they had used alcohol to help them fall asleep. Occasional insomniacs used alcohol for an average of 3.6 nights/month, while chronic insomniacs used alcohol for an average of 6.8 nights/month. An equal number of occasional insomniacs and chronic insomniacs (67%) described alcohol as an effective or very effective method to induce sleep.

When ingested by normal individuals, alcohol leads to a more rapid induction of sleep. It also increases non-REM sleep and reduces REM sleep during the first portion of the night. However, alcohol is metabolized rapidly and blood concentrations are negligible by the middle of the night for most individuals who have a few drinks prior to bedtime, often resulting in withdrawal symptoms thereafter. These may include shallow sleep and multiple awakenings, REM rebound associated with nightmares or vivid dreams, sweating, and general activation[2,3]. Therefore, although alcohol may be effective in sleep induction, it impairs sleep during the second half of the night and can lead to a reduction in overall sleep time. As a result, it can also be associated with daytime somnolence. It is of interest that alcohol's negative effects on sleep are even observed when it is ingested in the late afternoon.

Insomnia is often a chronic condition, and chronic reliance on alcohol increases the risk of development of alcohol dependence and alcoholism. Alcoholism itself is also associated with the complaints of poor sleep characterized by prolonged time to fall asleep, multiple awakenings, and decreased delta and REM sleep.[4] Sleep changes can persist during months or years of abstinence, and recent studies indicate that certain alterations in sleep architecture, as well as subjective sleep complaints, predict relapse to alcoholism.[5] A variety of sleep disorders can be responsible for insomnia; these include sleep-related breathing disorders, such as obstructive sleep apnea syndrome. Alcohol increases the severity of the syndrome, and may cause snoring and induce apneas in individuals without a history of obstructive sleep apnea syndrome[6].

In conclusion, alcohol is a commonly used substance for sleep induction. However, it is a poor choice as a hypnotic because it can disrupt sleep even further, may lead to alcohol dependence and alcoholism, and may intensify sleep-related breathing disturbances.

References

1. Ancoli-Israel S, Roth T. Sleep. 1999;22(suppl 2):S347-S353.
2. Yules RB, Lippman ME, Freedman DX. Alcohol administration prior to sleep; the effect on EEG sleep stages. Arch Gen Psychiatry. 1967;16;94-97.
3. Madsen BW. Rossi L. Sleep and Michaelis-Menten elimination of ethanol. Clin Pharmacol Ther. 1980;27:114-119.
4. Adamson J, Burdick JA. Sleep of dry alcoholics. Arch Gen Psychiatry. 1973;28:146-149.
5. Landolt HP, Gillin JC. Sleep abnormalities during abstinence in alcohol-dependent patients. Aetiology and management. CNS Drugs. 2001;15:413-425.
6. Scanlan MF, Roebuck T, Little PJ, Redman JR, Naughton MT. Effect of moderate alcohol upon obstructive sleep apnoea. Eur Respir J. 2000;16:909-913. [/list]

 

[David Baxter PhD]

How A Nightcap May Hinder Rather Than Help Your Sleep

How A Nightcap May Hinder Rather Than Help Your Sleep
Using alcohol as a sleep aid is somewhat of a paradox: although alcohol can initially help someone fall asleep, it can also disrupt sleep in the latter part of the night. Clinicians already know that alcoholics often have significant sleep problems both while actively drinking as well as after they've stopped drinking. A study in the August 2003 issue of Alcoholism: Clinical & Experimental Research has found that alcoholics can continue to have sleep problems for many months after they quit drinking, that problems with sleep onset may be more pronounced than with sleep maintenance, and that many former alcoholics had sleep problems that predated the onset of alcohol dependence.

"Three or more drinks will cause the average person to fall asleep sooner than usual," said Shawn R. Currie, adjunct assistant professor , cross-appointed in psychiatry and psychology at the University of Calgary, and corresponding author for the study. "However, falling asleep faster is the only real benefit of alcohol for sleep. The more prevalent, disruptive effects include more frequent awakenings, worse sleep quality; reduction of deep sleep, and earlier-than-usual waking times, leading people to feel they did not get enough sleep."

An alcoholic who is actively drinking experiences similar, but more severe, types of sleep disruptions. An alcoholic who quits drinking often experiences sleep problems in the two to six months of abstinence following withdrawal. "They take a long time to fall asleep, have problems sleeping through the night, and feel their sleep is not restorative," said Currie. "Lab research supports claims of sleep disruption; overnight-sleep studies have documented reductions in deep sleep and abnormalities in REM sleep in persons with more than a year of sobriety."

"Sleep has a reputation among the recovering community of being one of the last things that fall back into place for an individual," added David Hodgins, professor of psychology at the University of Calgary. "It's also recognized as a potential precipitant of relapse. In the 12-step community, there's a little saying that describes the risk factors for relapse; it's called HALT. People who are Hungry, Angry, Lonely or Tired are at an increased risk of relapse. Certainly, one way a person can be tired is through sleep disruptions."

For this study, researchers examined 63 alcoholics in recovery (44 men, 19 women) who were experiencing insomnia. All underwent a multimodal sleep assessment that included a structured interview, daily sleep diaries, questionnaires, and sleep monitoring via actigraph recordings (an actigraph is a small, lightweight monitor that is worn on the non-dominant wrist, providing continuous recording of movement in the participant's natural sleep environment). Participants were further divided into two groups: those with short-term (less than 12 months) and long-term (more than 12 months) abstinence.

Researchers found that alcoholics with both short- and long-term abstinence can experience sleep problems for many months after they quit drinking.

"This study provides important, further validation of the significance of sleep problems in recovering alcoholics," said Currie. "Insomnia is a highly variable disorder; most insomniacs experience both good and bad nights of sleep in a typical week, so it is important to obtain several nights of data to get an accurate picture of how severe the problem is. Just as physicians like to obtain several readings of blood pressure before diagnosing hypertension, it is likewise important to obtain several nights of sleep information to diagnose a sleep disorder. The monitor that we used, in conjunction with participants' detailed sleep diaries, confirmed that alcoholics did indeed have persistent sleep disruptions that could not be attributed to a single bad night of sleep in a lab."

The study also found that, in general, problems with sleep onset were worse than with sleep maintenance.

"Most insomniacs have a combination of problems getting to sleep and problems staying asleep," said Currie. "Our results indicate that most recovering alcoholics have both types of insomnia but the onset problem is generally worse."

More than half of the participants reported sleep problems that predated the onset of alcohol dependence.

"The rate of chronic insomnia in the general adult population is about 10 to 15 percent," said Currie. "In our study, more than 50 percent of the alcoholics reported having sleep problems for many years before their drinking reached dependence levels. Although we cannot infer any causal connection between insomnia and alcoholism from this data, it is hard to ignore such a high rate of pre-existing sleep problems in the sample."

In addition, poor sleep hygiene was evident among the recovering alcoholics. "Sleep hygiene refers to behaviors that constitute good sleep habits, such as keeping a regular rising time, avoiding napping, and refraining from stimulants like caffeine in the evening," said Currie.

"Many people believe that having a drink will help their sleep," noted Hodgins. "In fact, many physicians will informally suggest the use of alcohol as a sleep aid. However, these findings warn against developing the habit of having, for example, a glass of wine to help go to sleep. More importantly, these findings lead to the idea of targeted interventions with alcoholics. Despite the very comprehensive and broad-based nature of most treatment programs, very, very few of them tackle sleep as an issue. But sleep is obviously a problem for some people and a relevant area of intervention. Trying to refrain from drinking can take a lot of vigilance, self-control and self-worth; it would be even more difficult for someone if they were exhausted."

Currie is currently wrapping up a study that involves a non-pharmaceutical treatment (cognitive-behavioural therapy) for sleep problems in recovering alcoholics. "It may be that sleep can be improved in recovering alcoholics through using an approach that emphasizes good sleep habits, relaxation and stress management," he said.

Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper included: Stewart Clark and Sonya Malhotra of the Addiction Centre in the Calgary Health Region; and Stephen Rimac of the University of Calgary. The study was funded by the Alberta Heritage Foundation for Medical Research.

 

[Daniel E.]

Alcohol disrupts women's sleep - CNN
February 15, 2011

...Though women may fare worse after a night's drinking, both men's and women's sleep will suffer, especially in the latter half of the night.

Despite the extensive research showing otherwise, people commonly - and mistakenly- use alcohol as a sleep aid, says Akram Khan, M.D., a sleep specialist at Oregon Health and Sciences University in Portland.

"People tend to drink thinking that they'll have a better quality of sleep, but you end up having this disruption," says Khan, who was not involved in the study. "That's happened to me, and I should know better. I'm the sleep doctor. But there I am, waking up at 3 a.m."

 

[David Baxter PhD]

A good reminder, Daniel.