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Alcohol & Insomnia: Alcohol’s Effect on Sleep Quality

When you are getting restful sleep, it’s easy to take sleep for granted. However, if you’ve ever struggled with insomnia, you may have a deeper appreciation for how vital sleep is to your overall health and wellbeing.

In fact, when a person’s sleep is poor, they are at an increased risk for numerous health problems including diabetes, heart disease, depression, and obesity.1 High-quality sleep is vital, and having healthy sleeping habits can help ensure that you get the high-quality sleep that your body needs. Some people consume alcohol at night to unwind or help them feel drowsy. And while alcohol can act as a sedative that slows down brain activity,2 the research suggests alcohol consumption generally has a negative impact on sleep quality.  In fact, between 35 and 70% of individuals who use alcohol have insomnia.3 It may seem surprising, considering that alcohol is a depressant, yet alcohol is known to interfere with fundamental aspects of sleep quality.

What is Insomnia?

Generally speaking, insomnia is defined as either a problem falling asleep, staying asleep, or waking up early and being unable to get back to sleep. The loss of sleep is enough to cause problems in day-to-day life and is occurring at least 3 nights per week for over 3 months.5

Insomnia is a common problem and the most common of all sleep disorders, with an estimated one-third of American adults reporting insomnia symptoms.5 Estimates suggest that almost 10% of people in the United States struggle with short-term insomnia. And of those, around 20% will develop chronic insomnia which can last for years.4

And not sleeping enough carries significant consequences, risks, and can even be potentially dangerous. Decreased attention and concentration as a lack of sleep is common, and persistent insomnia is associated with an increased risk of depression, hypertension, and heart attacks. Those with insomnia may miss work, have reduced productivity, and an overall reduced quality of life.

If a person is tired due to insomnia, they are also at increased risk for accidents. One study found that people with insomnia had more than a 20% risk of an accident in their home over the past year, over a 10% risk of a work-related accident, 9% fell asleep while driving, and over 4% had a car accident related to their insomnia.6

As such, people with insomnia often try to self-treat the condition. An estimated 15% to 30% of people report drinking to manage insomnia. While alcohol can initially cause sedation, over time, alcohol causes major disruptions in the quality of sleep.

How Does Alcohol Affect Your Sleep?

Initially, a little alcohol before bed might seem helpful for insomnia. However, people can rapidly develop tolerance to the sedating effects of alcohol. A small study shows quite explicitly how quickly alcohol becomes ineffective when used repeatedly for sleep. In volunteers struggling with insomnia without a history of alcohol use, alcohol or placebo was given nightly before bed. Initially, smaller amounts of alcohol did increase total sleep time and deep sleep. However, these effects were quickly lost within a week. As the study continued, subjects who had been given alcohol before bed were inclined to increase alcohol consumption, up to almost the equivalent of 3 beers a night. The study clearly demonstrates how quickly tolerance develops for alcohol which puts a person at risk for developing alcohol use disorders.7

With higher doses, especially over long-term consumption, alcohol may have even worse effects on sleep.8 Higher doses of alcohol have been shown to disrupt sleep, particularly during the second half of the night.

Studies also show that alcohol may exacerbate sleep-disordered breathing such as snoring and even obstructive sleep apnea. Heavy drinkers appear to be at increased risk of exacerbating sleep apnea, and this combination can increase a person’s risk of heart attack, stroke, and sudden death.

Can Alcohol Cause Insomnia?

As previously mentioned, alcohol can indeed both promote and hinder sleep. Research suggests that alcohol’s negative impact on sleep varies and is dose related. Indeed, a growing number of studies demonstrate an association between alcohol dependence and sleep-related disorders like insomnia. The prevalence of insomnia for those struggling with alcohol dependence is estimated to run between 36% and 91%, which is well above average.9 Research has also  associated binge drinking with disrupted sleep. Specific brain cells in the forebrain promote a state of wakefulness. Alcohol appears to inhibit neurotransmitters that activate these brain cells. This can disturb the whole sleep-wake cycle, disrupting sleep and potentially predisposing a person to insomnia.10

Alcohol’s Effects on REM Sleep

Sleep has two basic types: rapid eye movement (REM) sleep and non-REM sleep.11 Alcohol consumption has been shown to potentially disrupt virtually all aspects of sleep, including both REM and non-REM sleep.3

Although the research is a bit unclear and the results mixed, use of alcohol appears to decrease REM sleep overall. In general, research shows reduced quality of sleep with long-term alcohol use. These sleep quality issues can continue for months or years upon discontinuation of alcohol use, but may improve over time with abstinence.3

Why Does Alcohol Make Me Sleepy?

Since alcohol has sedating effects, it can make people feel sleepy. One of the main effects of alcohol is on enhancing the function of the neurotransmitter gamma-aminobutyric acid (GABA), the body’s main inhibitory neurotransmitter.2 In basic words, GABA slows everything down. This slowing of brain activity can contribute to a sense of tiredness, making a person feel more sleepy.

And while this may seem like a reason to use alcohol to manage insomnia, with continued use, you quickly develop a tolerance to alcohol’s sedating effects.7 This rapid development of tolerance is associated with increased self-administration of alcohol before bedtime, which could potentially escalate to an alcohol use disorder.

How Does Alcohol Withdrawal Affect Sleep?

For people struggling with alcohol dependence, insomnia and disturbed sleep are a common symptom of withdrawal. Estimates suggest between 36 and 72% of people in withdrawal from alcohol have insomnia. During withdrawal and recovery, it is harder to fall asleep and total sleep time decreases. Deep sleep is also reduced. Problems with sleep can continue for months or longer for some patients as they recover from chronic alcohol dependence.12

FAQs Regarding Insomnia & Alcohol Use

Sources:

  1. Centers for Disease Control and Prevention. (2017). Sleep and Sleep Disorders: Data and Statistics.
  2. Wallner, M., & Olsen, R. W. (2008). Physiology and pharmacology of alcohol: the imidazobenzodiazepine alcohol antagonist site on subtypes of GABAA receptors as an opportunity for drug development? British journal of pharmacology, 154(2), 288–298.
  3. Angarita, G. A., Emadi, N., Hodges, S., & Morgan, P. T. (2016). Sleep abnormalities associated with alcohol, cannabis, cocaine, and opiate use: a comprehensive review. Addiction science & clinical practice, 11(1), 9.
  4. Dopheide J. A. (2020). Insomnia overview: epidemiology, pathophysiology, diagnosis and monitoring, and nonpharmacologic therapy. The American journal of managed care, 26(4 Suppl), S76–S84.
  5. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  6. https://www.ajmc.com/view/insomnia-overview-epidemiology-pathophysiology-diagnosis-and-monitoring-and-nonpharmacologic-therapy
  7. Léger, D., Bayon, V., Ohayon, M. M., Philip, P., Ement, P., Metlaine, A., Chennaoui, M., & Faraut, B. (2014). Insomnia and accidents: cross-sectional study (EQUINOX) on sleep-related home, work and car accidents in 5293 subjects with insomnia from 10 countries. Journal of sleep research, 23(2), 143–152.
  8. https://www.ajmc.com/view/insomnia-overview-epidemiology-pathophysiology-diagnosis-and-monitoring-and-nonpharmacologic-therapy
  9. Roehrs, T., & Roth, T. (2018). Insomnia as a path to alcoholism: tolerance development and dose escalation. Sleep, 41(8), zsy091.
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775419/
  11. Chakravorty, S., Chaudhary, N. S., & Brower, K. J. (2016). Alcohol Dependence and Its Relationship With Insomnia and Other Sleep Disorders. Alcoholism, clinical and experimental research, 40(11), 2271–2282.
  12. Thakkar, M. M., Sharma, R., & Sahota, P. (2015). Alcohol disrupts sleep homeostasis. Alcohol (Fayetteville, N.Y.), 49(4), 299–310.
  13. National Institutes of Health (August 13, 2019). Brain Basics: Understanding Sleep.
  14. Kolla, B. P., Mansukhani, M. P., & Schneekloth, T. (2011). Pharmacological treatment of insomnia in alcohol recovery: a systematic review. Alcohol and alcoholism (Oxford, Oxfordshire), 46(5), 578–585.
  15. Pietilä, J., Helander, E., Korhonen, I., Myllymäki, T., Kujala, U. M., & Lindholm, H. (2018). Acute Effect of Alcohol Intake on Cardiovascular Autonomic Regulation During the First Hours of Sleep in a Large Real-World Sample of Finnish Employees: Observational Study. JMIR mental health, 5(1), e23.
  16. Burgos-Sanchez, C., Jones, N. N., Avillion, M., Gibson, S. J., Patel, J. A., Neighbors, J., Zaghi, S., & Camacho, M. (2020). Impact of Alcohol Consumption on Snoring and Sleep Apnea: A Systematic Review and Meta-analysis. Otolaryngology–head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 163(6), 1078–1086.
  17. Brower, K. J., Wojnar, M., Sliwerska, E., Armitage, R., & Burmeister, M. (2012). PER3 polymorphism and insomnia severity in alcohol dependence. Sleep, 35(4), 571–577.
  18. Guo, Y., Hu, H., Liu, Y., Leng, Y., Gao, X., Cui, Q., Chen, J., Geng, B., & Zhou, Y. (2018). Gender differences in the relationship between alcohol consumption and insomnia in the northern Chinese population. PloS one, 13(12), e0207392. https://doi.org/10.1371/journal.pone.0207392
  19. Rognmo, K., Bergvik, S., Rosenvinge, J. H., Bratlid, K. L., & Friborg, O. (2019). Gender differences in the bidirectional relationship between alcohol consumption and sleeplessness: the Tromsø study. BMC public health, 19(1), 444. https://doi.org/10.1186/s12889-019-6801-6
  20. Roehrs, T., & Roth, T. (2001). Sleep, sleepiness, and alcohol use. Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism, 25(2), 101–109.
Last Updated on October 12, 2021
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