Sleep and alcohol use are firmly intertwined. We know that 30% of people with insomnia turn to alcohol to help them sleep. We also know that insomnia is one of the greatest predictors of relapse in alcoholics. So what is the problem with alcohol and sleep?
Initially, alcohol induces sleep. It does this by acting on areas of the brain in a fashion similar to sleeping pills. In the first half of the night it increases deep sleep and suppresses REM (dream) sleep. However, as it is metabolized, body temperature increases and stress hormones are released. This results in frequent arousals and difficulty remaining asleep. There also may be a marked increase in REM sleep resulting in vivid and disturbing dreams. In most studies, tolerance to the sleep-promoting effects is noted within a week. This may result in consuming ever increasing amounts of alcohol to facilitate sleep.
In abstinent alcoholics, abnormalities of sleep may persist for up to two years. There is prolonged suppression of deep sleep and increased amounts of light and REM sleep. This results in the perception of their sleep as being of poor quality and non-restorative. It also can result in frequent nightmares and disturbing dreams. All of this can and often does lead the individual to resume drinking again.
Another problem posed by alcohol as it relates to sleep is sleep apnea. Alcohol relaxes the muscles of the upper airway and causes the collapse which occurs in sleep apnea much more likely and severe. It also depresses the brain’s ability to respond quickly and effectively to the obstruction, thus making for a potentially more dangerous situation in those with untreated sleep apnea.
The important points relating to alcohol and sleep are first, alcohol should never be used as a sleep aid; second, problems with sleep in recovering alcoholics should be addressed quickly; and last, sleep disorders such as sleep apnea and nightmare disorder can be worsened by alcohol.
By Robert Rosenberg