Alcohol and insomnia

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. When a person’s sleep is poor, they are at an increased risk for numerous health problems including diabetes, heart disease, depression, and obesity. 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, but little do they know that alcohol and insomnia are very related. And while alcohol can act as a sedative that slows down brain activity, the research suggests alcohol consumption generally has a negative impact on sleep quality.  Between 35 and 70% of individuals who abuse alcohol have insomnia. It may seem surprising, considering that alcohol is a depressant, yet alcohol is known to interfere with fundamental aspects of sleep quality.

Alcohol and insomnia
Some people consume alcohol at night to unwind or help them feel drowsy, but little do they know that alcohol and insomnia are very related.

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.

Insomnia is a common problem and the most common of all sleep disorders, with an estimated one-third of American adults reporting insomnia symptoms. 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.

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 overall reduced quality of life.

Alcohol and insomnia
Alcohol and insomnia are very related. With higher doses, especially over long-term consumption, alcohol may have even worse effects on sleep.

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. 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 and Insomnia 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 a 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 demonstrates how quickly tolerance develops for alcohol which puts a person at risk for developing alcohol use disorders.

Alcohol and insomnia are very related. With higher doses, especially over long-term consumption, alcohol may have even worse effects on sleep. 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.

Alcohol and insomnia
Alcohol and insomnia: 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.

Alcohol and Insomnia Causes

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. 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.

Alcohol’s Effects on REM Sleep

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

Although the research is a bit unclear and the results mixed, the use of alcohol appears to decrease REM sleep overall. In general, research shows the 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.

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. 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. 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 common symptoms of alcohol 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.

Therapies for Primary Insomnia

Behavioral therapy: Behavioral therapy is now considered the most appropriate treatment for persons with sleeplessness without any medical, psychiatric, or environmental cause. It consists primarily of short-term cognitive-behavioral therapies. The focus is primarily on sleep hygiene or factors presumed to cause insomnia. As such, these therapies seek to modify maladaptive sleep habits and to educate persons about healthier sleep practices.

Stimulus control therapy: The purpose of this therapy is to re-establish the connection between the bed and sleep by prohibiting the person from engaging in nonsleep activities while in bed. The following instructions are given:

  • Go to bed only when sleepy.
  • Use the bed and bedroom only for sleep and intimacy.
  • Avoid trying to force sleep (go into another room whenever unable to fall asleep within 20 to 30 minutes, and return to bed only when sleepy again).
  • Get up at the same time each morning regardless of how much one has slept the previous night.
  • Avoid daytime napping.

Sleep restriction therapy: This involves limiting the amount of time the person spends in bed to the actual amount of time the person usually spends sleeping. This results in sleep deprivation, which accumulates and causes more rapid sleep onset on subsequent nights. As sleep improves, the person is allowed to gradually increase time in bed by 15 to 30 minutes.

Relaxation therapies: The person is taught to identify and control tension. Relaxation-based interventions are advised based on the observation that persons with insomnia often display high levels of arousal both at night and during the daytime. The various techniques available to deactivate the arousal system are:

  • The person is taught progressive muscle relaxation through a series of exercises that consist of first tensing and then relaxing each muscle group in a systematic way.
  • The biofeedback technique is a training technique that enables an individual to gain some element of voluntary control over certain body parameters (for example, heart rate, rate of breathing). This technique provides immediate feedback regarding the levels of tension and teaches a person how to relax in a short time.
  • Imagery training and thought stopping teach the person how to focus on neutral or pleasant things instead of focusing on racing thoughts.
Alcohol and insomnia
Alcohol and insomnia: Relaxation-based interventions are advised based on the observation that persons with insomnia often display high levels of arousal both at night and during the daytime.

Cognitive therapy: This consists of identifying person-specific activities associated with thinking that disrupts sleep, challenging their validity, and replacing them with substitutes such as reattribution training (a simple technique that has been used successfully to help persons to recognize that their minds play a part in causing their physical symptoms), reappraisal, and attention shifting.

Paradoxical intention: This method consists of persuading a person to engage in his or her most feared behavior (for example, staying awake). This serves to eliminate performance anxiety so that sleep may come more easily.

Treatment for alcoholism

When it comes to Alcoholism treatment, it is normal to think of 12-step programs or 28-day inpatient rehab, but it becomes difficult to think of more options of treatment for this condition. There are a variety of treatment methods currently available. According to the National Institute on Alcohol Abuse and Alcoholism, there are three types of treatment: 

  • Behavioral Treatments: are aimed at changing drinking behavior through counseling. They are led by health professionals and supported by studies showing they can be beneficial.
  • Medications: Three medications are currently approved in the United States to help people stop or reduce their drinking and prevent relapse. They are prescribed by a primary care physician or other health professional and may be used alone or in combination with counseling.
  • Mutual-Support Groups: Alcoholics Anonymous (AA) and other 12-step programs provide peer support for people quitting or cutting back on their drinking. Combined with treatment led by health professionals, mutual-support groups can offer a valuable added layer of support. Due to the anonymous nature of mutual-support groups, it is difficult for researchers to determine their success rates compared with those led by health professionals.

Reclaim Your Life From Alcohol and Insomnia

Alcohol and insomnia are very related. With higher doses, especially over long-term consumption, alcohol may have even worse effects on sleep. We Level Up California can provide you, or someone you love, the tools to recover from alcohol addiction with professional and safe treatment. Feel free to call us to speak with one of our counselors. We can inform you about this condition by giving you relevant information. Our specialists know what you are going through. Please know that each call is private and confidential.

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 pharmacology154(2), 288–298.

[3] Roehrs, T., & Roth, T. (2018). Insomnia as a path to alcoholism: tolerance development and dose escalationSleep41(8), zsy091.

[4] Chakravorty, S., Chaudhary, N. S., & Brower, K. J. (2016). Alcohol Dependence and Its Relationship With Insomnia and Other Sleep DisordersAlcoholism, clinical and experimental research40(11), 2271–2282.

[5] Thakkar, M. M., Sharma, R., & Sahota, P. (2015). Alcohol disrupts sleep homeostasisAlcohol (Fayetteville, N.Y.)49(4), 299–310.

[6] National Institutes of Health (August 13, 2019). Brain Basics: Understanding Sleep.