Alcohol and Insomnia

Alcohol and Insomnia Problems

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 effects 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.

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, 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 alcohol’s effect 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 moderate alcohol consumption on sleep in persons without alcohol dependence.

Causes of Insomnia

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. [1]

How Alcohol Affects People With Insomnia

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. [2]

How Does Alcohol Affect Sleep?

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. [3]

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. [4]

Alcohol is Not a Sleep Aid

If you are having trouble sleeping, 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. [5]

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

Alcohol and Insomnia as a Co-Occurring Disorder

Problem drinkers may suffer from depression and/or anxiety independently of their drinking, or during or after heavy drinking.

Disturbed sleep from alcohol use may be difficult to differentiate from signs and symptoms of psychiatric disorders. Difficulty falling asleep, early morning awakening, fatigue, and decreased concentration complicate the assessment of affective symptoms. Moreover, sleep problems often exacerbate primary psychiatric symptoms.

For example, even small amounts of alcohol have been associated with the development of anxiety and mood symptoms among asymptomatic persons. Alcohol exerts effects on next-day behavior and mood that outlast its blood levels.

Alcohol-induced cognitive disruption may also impair previously successful coping mechanisms. Patients and clinicians might interpret these alterations in alertness, judgment, impulse control, decision-making, and mood as symptoms of recurrent primary psychiatric disorders, rather than considering the effects of alcohol.

The sleep of individuals with depressive and/or anxiety disorders resembles the sleep of persons with alcoholism. Similar REM sleep changes occur during withdrawal in alcoholics with and without secondary depression.

The interactions between alcohol use disorders, affective disorders, and sleep disturbance remain understudied, but it is clear that sleep problems in substance-using patients often have more than one cause. Whether alcohol and insomnia cause depression, anxiety, or alcoholism, or whether such disorders cause sleep problems, remains unclear.

Perhaps longitudinal studies could disentangle whether sleep disturbance is a non-causal indicator of an underlying process that predisposes individuals to affective disorders and/or alcoholism, or whether alcohol and insomnia have a causal role in the development of these disorders.

Treatment for Alcohol and Insomnia

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. [6]

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, clients miss out on essential 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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