Sleep and Alcohol

Alcohol is a commonly used self- prescribed aid to facilitate sleep in people who suffer from difficulty falling asleep. It is relatively inexpensive and widely available. One  survey found that 13% of adults admit using alcohol for insomnia, versus 18% used medications and 5% used both (ref: Johnson, EO).

Alcohol’s hypnotic effect is tricky because it only lasts for a while, giving a false sense of a restful night. But in fact, it has a disruptive effect on your sleep quality when the individual enters the second half of sleep because the alcohol levels start to wear off.  This is called the withdrawal effect which also increases “light sleep” and decreases “deep sleep” (slow wave sleep) and “REM sleep.” In some way, it robs you of the good quality sleep.  Increased sweating and heart rate can also occur in the withdrawal phase. Frequent awakenings and difficulty going back to sleep are common symptoms, often leading to feeling not rested and suffering from daytime tiredness, groggy and the hang-over effect. Alcohol consumed even 6 hours prior to bedtime can increase wakefulness during sleep (ref: Landolt HP).

Elderly folks are especially vulnerable to the effect of alcohol on sleep because their alcohol level remains elevated compared to younger individuals. Alcohol can make their stability and concentration worse. They are at higher risk for falls during the night when they walk to the bathroom.

20% of alcohol is absorbed through the mouth, esophagus and stomach; the rest continues go on to the small intestines, where it is absorbed into the bloodstream. If the stomach is empty, absorption is more rapid. Food slows absorption. Alcohol is then metabolized in the liver. Alcohol can also make you dehydrated.

Alcohol does not have a favorable effect on our breathing during sleep because it has a depressant effect on respiration. Nighttime alcohol consumption worsens the snoring of those who already snore, but according to one study, it does not turn a non-snorer into a snorer (ref: Rieaman R). However, moderate amount of alcohol in the evening can significantly worsen pre-existing obstructive sleep apnea (ref: Scanlan MF). Mixing alcohol with sleeping pills can be dangerous because of their additive effect on depressing the individual’s respiration.

Tips on how to enjoy a glass of wine and still get a good night of sleep:

  • Avoid alcohol to self-treat your sleep problems. You might be suffering from sleep apnea which is a major cause for sleep disturbance. Alcohol will make the sleep apnea worse and can even drop your blood oxygen further. If you believe your have sleep apnea, you need to talk to your doctor so you can be screened and tested properly. If your doctor does not seem to be concerned about sleep apnea, and you still are, don’t stop there: find a local sleep medicine physician and go talk to them.
  • If you are out with friends for dinner, you can enjoy a drink or two. Just remember, it takes roughly an hour for your body to process the alcohol in a glass of wine. So if you had two glasses of wine, you need to be finished at least 2 hours before bedtime. Elderly folks will process the alcohol even slower. It is best to keep 4-6 hours between your last drink and bedtime.
  • If you need to take a hypnotic before bedtime to help you sleep, do not take it with alcohol. If you like a glass of wine once in a while, drink it with food (dinner) and keep it within 2-3 hours before taking your sleeping pill.
  • If you are suffering from insomnia, seek medical help instead of resorting to alcohol which can cause dependency.

References:

  • Johnson EO, Roehrs T, Roth T, Breslau N. Epidemiology of alcohol and medication as aids to sleep in early adulthood. Sleep. 1998 Mar 15;21(2):178-86.
  • Landolt, H.-P., et al. Late-afternoon ethanol intake affects nocturnal sleep and the sleep EEG in middle-aged men. J Clin Psychopharmacol 16(6):428-436, 1996
  • Dawson, A., et al. Effect of bedtime ethanol on total inspiratory resistance and respiratory drive in normal nonsnoring men. Alcohol Clin Exp Res 17(2):256-262, 1993.
  • Scanlan MF, Roebuck T, Little PJ, Redman JR, Naughton MT. Effect of moderate alcohol upon obstructive sleep apnoea. Eur Respir J. 2000 Nov;16(5):909-13.
  • Riemann R, Volk R, Müller A, Herzog M. The influence of nocturnal alcohol ingestion on snoring. Eur Arch Otorhinolaryngol. 2010 Jul;267(7):1147-56. Epub 2009 Dec 1.