Alcohol & Sleep: Impacts & How to Cope

How Does Alcohol Affect Sleep?

Alcohol can substantially impact one’s quality and quantity of sleep, affecting the time it takes to fall and stay asleep. It affects daily functioning, with alertness and cognition being most impacted. Consumption of alcohol, even up to 6 hours before bed, known as “happy hour drinking,” can interfere with the natural sleep cycle, with excessive doses and frequent use having the most substantial effects on sleep, daytime functioning, and overall physical and mental health.

Negative impacts of alcohol on sleep may include:

Increased Insomnia

Insomnia is difficulty falling or staying asleep and affects approximately 30% of the general population.¹ It is not uncommon for people to use alcohol as a sleep aid, as 15%-28% of adults in one study reported using alcohol to help with sleep onset.² Although alcohol is a sedative, it can have stimulating effects at low doses, as blood alcohol levels rise in the first hour after ingestion, making it more difficult to fall asleep.

However, alcohol also has components that can reduce the time it takes to fall asleep, and it’s uncertain which effect a person will experience. Additionally, frequent use of alcohol as a sleep aid leads to tolerance, with its sedative effects waning within about a week of repeated use. Chronic alcohol use can worsen insomnia. While alcohol intoxication may initially make a person feel drowsy and fall asleep faster, it can also lead to more frequent awakenings during the night and difficulty falling back asleep (sleep-maintenance insomnia).

Altered Sleep Stages

A healthy night of sleep for an adult is, on average, four 90-minute cycles, with transition time between cycles. Each cycle contains four non-rapid-eye-movement (NREM) stages and one rapid-eye-movement (REM) sleep stage. In moderate to high doses, alcohol increases the duration of NREM slow-wave sleep, stages 3 and 4, also known as deep restorative sleep. However, it suppresses REM sleep, which is involved in memory consolidation and learning.

Even though slow-wave sleep is lengthened, the overall restorative quality of sleep is not necessarily greater than without alcohol. Indeed, people who use alcohol to fall asleep show reduced daytime alertness and increased fatigue the following day.³ As blood alcohol levels decline through the sleep period, sleep becomes increasingly fragmented, with frequent awakenings due to arousal and the need to urinate, further contributing to sub-optimal sleep. Upon withdrawal from alcohol use, REM-rebound or compensatory extended time in REM can further disrupt sleep architecture.

Worsening of Sleep Apnea

Affecting upwards of 38% of the population, many of whom are untreated and/or undiagnosed, sleep apnea is a disorder characterized by frequent pauses or interruptions in breathing (i.e., apneas) during sleep.⁴ The condition results in frequent brief awakenings to allow for oxygen inhalation. Untreated sleep apnea causes excessive daytime sleepiness and many secondary problems, including disturbances in health, daily functioning, mood, and relationships.

Alcohol exacerbates apnea-related sleep disruption by relaxing upper airway muscles, allowing soft tissue at the back of the throat to obstruct the air pathway. Alcohol also reduces the brain’s ability to arouse during an apnea episode, thus prolonging the time between oxygen inhalations. Even modest amounts of alcohol significantly increase the severity and frequency of apneas, leading to even greater sleep debt. Indeed, the combination of alcohol and sleep apnea can be hazardous and deadly, with an increased risk of impaired driving, motor vehicle accidents, heart attack, stroke, and sudden death.⁵

Other Effects on Sleep

Alcohol can increase the likelihood of sleepwalking, particularly in people taking certain ADHD, antihistamine, and antidepressant medications, and it can increase periodic leg movements that can impede sleep.⁶ It can also lead to esophageal reflux, stomach upset, and frequent need to urinate, all of which can cause frequent awakenings and difficulty falling asleep, as well as possible injury from unsteadiness during trips to the bathroom.⁷

Increased Use of Stimulants

With alcohol’s tendency to lead to poor sleep and fatigue the following day, many people will turn to stimulants, like caffeine, or even illicit drugs like cocaine, to help boost alertness. Stimulants can, in turn, make it difficult to fall asleep the subsequent night, leading to a vicious cycle of substance use — both licit and illicit — to achieve sleep that is still less than satisfactory.

Risk of Substance Misuse & Dependence

The chronic sleep disturbance that frequent or excessive alcohol use sets in motion can grow into an unhealthy misuse of stimulants to boost alertness during the day and subsequent use of increasingly stronger sedatives at night, with many of these products holding a risk for dependence.

Chronic use of uppers and downers can take a toll on the body and brain, causing several secondary symptoms and conditions. A health professional can help develop a treatment plan for improving sleep through healthier, safer means.

Exacerbation of Medical Conditions

Getting proper sleep is crucial to healthy immune and other body system functions. Alcohol-induced sleep disturbances can worsen a wide range of medical conditions, including (but not limited to) liver disease, heart problems, and psychological disorders. Alcohol can also interfere with the metabolism of medications, resulting in an exacerbation of existing medical conditions.

Increased Mental Health Disorder Symptoms

For individuals with mental health conditions like depression or anxiety, alcohol may initially provide a sense of relaxation and calmness. However, it can actually worsen symptoms over time and lead to further sleep disturbances. Sleep has a significant impact on mental health. Additionally, alcohol (especially in moderate to high doses) can interfere with neurotransmitter levels in the brain, leading to changes in mood as well as the ability to use previously learned coping mechanisms to deal with mental health symptoms.

Situational factors like grieving the loss of a loved one or a job can spur a person to consume alcohol to numb emotional pain. In such cases, alcohol may be used in excess or with increased frequency, contributing to secondary problems of a physical, mental, occupational, or social nature.

How to Cope With Alcohol-Related Sleep Problems

Chronic alcohol use is not a viable solution to helping one fall asleep. Even though it may initially help with sleep onset, the quality of sleep suffers, and over time maladaptive sleep and waking habits can ensue. There are several things you can try to improve sleep quality and quantity, ranging from behavioral strategies to psychotherapy to lifestyle changes.

Below are tips for reducing the negative effects of alcohol on sleep:

Follow Good Sleep Hygiene:

Good sleep hygiene refers to a set of practices and habits that promote healthy and restorative sleep. Following sleep hygiene practices can prepare the body and mind for sleep, improving sleep quality and quantity.

Sleep hygiene practices include:

• Maintaining a consistent sleep schedule
• Keeping your sleep environment dark, cool, and quiet
• Avoiding stimulating activities before bed
• Avoiding naps
• Curbing caffeine intake, especially late in the day
• Practicing relaxation techniques like meditation and deep breathing,
• Exercising regularly, but not right before bed

Avoid Drinking Before Bed

Consuming liquids (alcoholic and non-alcoholic) before bed will increase the likelihood that you will need to use the bathroom as you try to fall asleep or in the middle of the night. Try to limit all liquids at least an hour before bedtime and avoid alcoholic drinks for at least three hours before bed. “Happy hour” drinking can still affect one’s ability to fall asleep hours later, but it has less of an effect on sleep than drinking right before bed. Consuming no more than two drinks should also help.

Avoid Binge Drinking:

Binge drinking, or consuming large amounts of alcohol in a short period of time, can disrupt the natural sleep cycle, fragment sleep with frequent awakenings, and lead to fatigue the next day, in addition to any ‘hangover’ that awaits the next morning. Although alcohol can help one fall asleep when used infrequently, sleep quality suffers greatly, impacting one’s ability to function safely and effectively the following day. Such fatigue may lead to the consumption of caffeine and perhaps napping, which can cause insomnia the following night, and a vicious cycle of sleep dysregulation may ensue.

Consider Abstinence

Frequent use of alcohol renders it ineffective as a sleep aid and can also lead to problems with health, work, relationships, mental health, and overall well-being. Abstaining from alcohol is a more sustainable and effective approach to managing one’s sleep problems.

Abstinence, however, may require medical guidance, as withdrawal and recovery from dependence can also lead to sleep disturbances, such as greater difficulty falling asleep, frequent awakenings, reduced restorative sleep (slow wave sleep), and prolonged REM periods (REM rebound), all of which may lead to fatigue during the day.^{8, 9, 10} During this adjustment period, consider alternative strategies for improving sleep and consult a health professional for ways to reduce or stop drinking.

Avoid Caffeine & Other Stimulants (e.g., Nicotine)

Alcohol consumption at night is often followed by caffeine use the next day in the form of coffee, soda, or energy drinks. Caffeine and other stimulants (such as nicotine) can interfere with sleep the following night, especially if consumed after 2 pm. While it is tempting to get that late afternoon boost, it may actually perpetuate sleep problems.

Avoid Naps

Activity over the course of the day builds up a need for the brain to sleep. Napping relieves some sleep pressure, which may feel refreshing for the rest of the day but can impede one’s ability to fall asleep at a reasonable time that night. It is very easy for resulting insomnia to commence a vicious cycle of daytime napping and nighttime insomnia. For some, it may be tempting to then use alcohol as an easily accessible and inexpensive sleep aid, but as discussed above, it often will disrupt sleep over the course of the night.

If you take a nap, consider setting an alarm and resting your eyes for no more than 20 minutes. The key is to avoid your brain from entering slow-wave sleep, the deep restorative phase. As long as you keep rest brief, it can be refreshing without affecting your ability to fall asleep later that night.

Exercise

Exercise during the day is highly recommended for promoting sleepiness later that night. Try to finish exercising at least two hours before bed, as it can be initially stimulating while your body is still in a state of arousal. Daily exercise can reduce stress, contribute to a healthier physical and mental state, and regulate your sleep/wake cycle, known as your circadian rhythm, especially when performed outside.

Relaxation

Relaxation techniques, such as deep breathing, meditation, tapping, and yoga, can help individuals struggling to fall and stay asleep, thus reducing the temptation to turn to alcohol as a sleep aid. Studies have also shown that relaxation tools can help reduce alcohol consumption, making it a useful multipurpose tool to improve sleep, decrease substance misuse, and improve mental health.^{11, 12}

Medication

Using alcohol as a sleep aid is not an effective long-term solution. There are pharmaceuticals that may be more effective and safer to use. Ask your primary care physician or psychiatrist about the best way to improve your sleep.

Often an individual’s mental health issues may be the root cause of sleep difficulties and alcohol use. In such cases, antidepressant or antianxiety medication could alleviate these issues, leading to a decreased reliance on alcohol and an improved ability to fall asleep.

On a related note, if you are taking medication for other health conditions, discuss sleep problems with your doctor. Sometimes insomnia and agitation can be side effects, and an adjustment to your medication regimen is warranted.

Consider Psychotherapy

There is a substantial overlap between alcohol use, sleep disorders, and mental health. For example, anxiety and depression can cause difficulty falling asleep and lead to alcohol use. Getting to the root cause of one’s mental health symptoms and learning healthier coping strategies can have a positive impact on both sleep and overall wellness.

When to Seek Professional Help

If you or some you care about is drinking alcohol in excess, or has problems sleeping, it can be beneficial to get help before a vicious cycle worsens. Drinking begets sleep problems, and sleep disturbance can make some consider alcohol use. In fact, studies have shown that sleep problems are more common in individuals who misuse or are dependent on alcohol than in the general population.^{13, 14} Furthermore, a person with alcoholism is more likely to relapse if they are also experiencing disturbed sleep.^{15, 16}

Early intervention for both alcohol misuse and sleep problems is key to preventing the worsening of symptoms and improving the likelihood of a successful outcome. Treatment will vary with severity and identification of the primary cause of symptoms. In severe cases of alcohol dependence, hospitalization or an inpatient or outpatient treatment clinic may be necessary to stabilize the person and help them through detoxification and withdrawal.

Unfortunately, a formal sleep evaluation is often not a routine part of treatment for alcohol and substance misuse, so you may have to advocate for yourself or a loved one to involve a sleep specialist in your treatment plan.

Sleep problems and alcohol misuse both can interfere with daily functioning. If you’re noticing symptoms of these conditions but are unsure how to proceed, you may want to find the right therapist by looking into online psychiatry services who can help determine the best approach to treatment.

In My Experience

In my experience, sleep is the foundation for health and wellness. There is no shortage of sleep deprivation studies demonstrating the importance of sleep to virtually every aspect of life, affecting our physiological systems, mental health, cognition, and mood. Yet, sleep problems are pervasive in our society, and sleep evaluations are often overlooked or not sought. The interplay between alcohol and sleep is of particular concern since alcohol consumption can disrupt the natural sleep cycle and worsen existing sleep problems.

I would encourage anyone experiencing sleep difficulty or excessive daytime sleepiness to see their primary care physician and discuss if a sleep evaluation would be appropriate. It is important to be transparent about alcohol and other substance use with your medical team so that they can best identify and treat the root cause of sleep problems and/or alcohol misuse. Just as alcohol and sleep debt can spiral downward, prioritizing healthy sleep habits and limiting alcohol consumption can contribute to an upward spiral of health and well-being.