Table of Contents
Effects Of Alcohol On Sleep, Sleep Disorders, Hormonal Function & Alcohol Use Disorder Treatment
Alcohol and Sleep
The immediate and short-term effects of alcohol on sleeping patterns are reducing the time it takes to fall asleep. This effect on the first half of sleep may be partly the reason some people with alcohol and sleep disorders use alcohol as a sleep aid. However, this is offset by having more disrupted sleep in the second half of the night. Alcohol should not be used as a sleep aid, and regular use of alcohol as a sleep aid may result in alcohol dependence.
Alcohol can have either a stimulating effect that increases sleep latency (time to fall asleep) or a sedating effect that induces sleep, depending on dose and the interval from drinking to bedtime. Stimulating alcohol effects on sleep are noted at low doses and as blood alcohol levels rise, usually in the first hour after use. In contrast, sedating effects occur at high doses and as blood levels fall.
Interestingly, few studies have focused on the stimulant properties of alcohol, which may not only relate to insomnia but to the vulnerability to alcohol use problems over time. Late afternoon (“happy hour”) drinking, as much as six hours before bedtime, also disrupts sleep, even though alcohol is no longer in the brain at bedtime. This phenomenon suggests a relatively long-lasting change in sleep regulation.
How Does Alcohol Affect Sleep?
Alcohol’s sedating effects are dose-dependent for moderate consumption (0.4–0.8 g/kg; 2–3 drinks; a standard drink is considered 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of distilled spirits, each contains approximately 0.5 ounces of alcohol) and last for several hours. With increasing amounts, up to six drinks, the effects of alcohol on sleep such as sleep latency generally decreases.
As with other short-acting sedatives, rebound occurs and arousal is heightened 2–3 hours after blood alcohol concentrations fall close to zero. Clinically, arousals increase in association with increased catecholamine concentration later in the night. Metabolized at a rate of approximately one glass of wine per hour, after 5 drinks at 10 p.m., the alcohol level will be near zero at 3 a.m., with an increase in arousal from this time onwards. REM rebound occurs in the second half of the night associated with intensive dreaming or nightmares.
These effects contribute to sleep fragmentation. Tolerance to effects of alcohol on sleep architecture develops, with normalization of polysomnographic changes after 3–9 nights of use in normal subjects. Tolerance to the sedative effects occurs after 3 to 7 days of exposure. However, little is known about the long-term effects of alcohol on sleep in persons without alcohol dependence.
Alcohol and Sleep Disorders
Alcohol and insomnia have been associated with subsequent morbidity and mortality, in addition to causing or worsening somatic symptoms that contribute to the quality-of-life decline.
Historically, alcohol has been used as a sedative. However, recognition of the complexities of the relationship between alcohol and insomnia is important for several reasons. Sleep disturbance may be a sign of alcohol abuse or dependence. As such, clinical alertness to alcohol and insomnia as a symptom of addiction problems might facilitate timely intervention.
Sleep disturbance is common among patients in remission from alcohol use disorders, and understanding this relationship may help clinicians assist patients in recovery. Recognition of alcohol problems among insomniacs might also lead clinicians to alter their treatment of sleep complaints, limiting, for example, their use of sedative-hypnotic agents. 
Sleep consists of two states: rapid eye movement (REM) and non-REM sleep (NREM). Non-REM sleep is divided into four stages. Stage 1 is the lightest stage, from which it is easiest to arouse the sleeper, and stage 2 is intermediate. Stages 3 and 4 are referred to as slow-wave sleep or delta sleep per electroencephalogram (EEG). Sleep typically begins with stage 1 sleep and progresses to deeper stages of NREM sleep when entry into the first period of REM sleep occurs.
REM and NREM sleep then alternate in approximately 90-minute cycles. The states of sleep are homeostatically regulated such that deprivation of REM sleep leads to pressure to enter REM and is accompanied by a rebound increase in REM once begun. Similar effects are observed after slow-wave sleep deprivation.
Alcohol is commonly used as a sleep aid–that is, an agent for initiating sleep. Alcohol consumed in the evening has generally predictable effects on REM sleep, slow-wave sleep, and sleep time and continuity, but effects on sleep latency (time to fall asleep) are more variable. 
Alcohol and Night Time
If you are having trouble sleeping during the nighttime, talk to your doctor about how to improve your sleep quality. He or she may be able to rule out underlying sleep disorders like sleep apnea and suggest appropriate sleep aids. 
Better sleep habits can also help. Some tips to improve sleep habits include:
- Get regular exercise, but no later than a few hours before bed
- Avoid caffeine, alcohol, or nicotine in the evening
- Reserve the bed for sleeping and sex only
- Keep your bedroom at a cool temperature
- Set regular wake and bed times
Studies show that when people drink alcohol before sleeping, growth hormone secretions decrease, despite the fact that drinking causes an increase in non-REM sleep. In fact, researchers have observed that the more someone drinks, the less growth hormone are secreted. For men, alcohol consumption can lead to a hormone imbalance that reduces the body’s testosterone levels, alters normal sperm structure, and leads to male breast enlargement. For women, heavy drinking can lead to early menopause, irregular menstrual cycles, and menstrual cycles without ovulation.
The main reason people enjoy alcohol is that it affects the release of “feel good” hormones including dopamine, serotonin, and oxytocin. But, by interfering with the hormone system, alcohol can affect blood sugar levels, impair reproductive functions, interfere with calcium metabolism and bone structure, affect hunger and digestion, and increase the risk of osteoporosis. 
Why You Should Avoid Alcohol Just Before Bedtime
Behavioral studies suggest that up to 2 to 3 standard drinks before bedtime initially promote sleep, but these effects diminish in as few as 3 days of continued use.  Many people suffering from alcohol and insomnia will take a drink before bedtime to help them fall asleep. After an initial stimulating effect, alcohol’s sedating effects can reduce the time required to fall asleep.
But alcohol’s effects do not end there. Research shows that alcohol consumed within an hour of bedtime will disrupt sleep in the second half of the sleep period, causing the person to sleep fitfully—awakening from dreams and not being able to get back to sleep easily.
Over time, the drink before bedtime works even less effectively. With continued consumption, studies found alcohol’s sleep-inducing effects decrease, while its sleep disturbance effects increase.
This is particularly true for elderly adults because drinking produces higher levels of alcohol in their blood and brain compared to younger drinkers. Consequently, older adults who have a drink before bedtime can experience an increased risk for falls and injuries if they get up and walk during the night. 
Alcohol Use Disorder Treatment
For those with severe alcohol use disorder, sleep disturbances may also include the following:
- Daytime fatigue
- Decrease in quality sleep
- Frequent awakenings
- Longer time required to fall asleep
It seems reasonable to think that people with an alcohol use disorder who quit drinking would return to normal sleep patterns, but actually, the sudden cessation of alcohol consumption can result in alcohol withdrawal syndrome, which can produce pronounced insomnia and persistent sleep fragmentation.
Lack of sleep is one of the most common symptoms mentioned by those who are going through alcohol withdrawal after they stop drinking. After the alcohol withdrawal symptoms subside, people with an alcohol use disorder can experience some improvement in sleep patterns, but for some, normal sleep patterns may never return, even after years of sobriety. 
When caring for only one of the two active illnesses diagnosed, your recovery can fracture and be uneven. With missing critical treatment for the second illness such as insomnia or other mental disorders, clients miss out on essential dual diagnosis therapy to address the underlying causes of the entire illness. Resulting in poor and failing recovery outcomes. When both illnesses are diagnosed, specialists with advanced training can best care for patients. Leading to improving long-term recovery outcomes. Lasting recovery outcomes demand full comprehensive treatment of both illnesses.
Ignoring one illness will likely result in the other getting worse. Recovery outcomes can be significantly improved with integrated dual diagnosis treatment. We Level Up TX dual diagnosis treatment center has developed a dual therapy program track. Providing a runway for more successful evidence-based modalities for clients suffering from co-existing disorders such as alcohol and insomnia sleep disorder.
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[1-2,5] Disturbed Sleep and Its Relationship to Alcohol Use – National Center for Biotechnology Information, U.S. National Library of Medicine
 Alcohol and a Good Night’s Sleep Don’t Mix – https://www.webmd.com/sleep-disorders/news/20130118/alcohol-sleep
 How Alcohol Can Impair the Body’s Hormone System – https://www.verywellmind.com/alcohol-and-hormones-66570#:~:text=By%20interfering%20with%20the%20hormone,increase%20the%20risk%20of%20osteoporosis.
 The Link Between Alcohol Consumption and Sleep Disorders – https://www.verywellmind.com/alcohol-and-sleep-66571
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