How Does Alcohol Affect Sleep?
Many of us fall into the trap of thinking that a nightcap before bed will lull us to a night of restful sleep only to find ourselves wondering whether the sleep we’re getting is as restful as we think it is. In reality, alcohol might help us get to sleep initially, but it can disrupt our sleep cycles throughout the night.
When I was diagnosed with early-onset chronic insomnia, I started a bedtime ritual that included a glass of wine to help me get to sleep. For a while, that glass of wine did the trick, at least it seemed to, by helping me fall asleep faster. I also loved the feeling of the heat behind my eyes and the flush that warmed my whole body—signals alerting me that my remedy was working. But it wasn’t long before I needed two glasses of wine to help me “relax” and before I knew it, I was drinking up to half a bottle in the evening before bed.
A few months later, I noticed that the more I drank, the more abrupt and unsettling my middle-of-the-night wakings became. This phenomenon was so puzzling to me that I decided to poll a few friends to see if they’d experienced the same thing. “Does a nightcap interfere with your good night’s sleep,” I asked, “instead of promoting it?”
My friends agreed that they seemed to wake up more frequently after drinking, but, like me, had no idea why. So I asked two experts, Jacob Balinky, MSN, PMHNP, medical director at Portland Mental Health and Wellness, and Jeffrey M. Egler, M.D.Physician Executive, Adventist Health Medical Director, to answer some questions and help me understand why alcohol woke me up so rudely after it lulled me to sleep.
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1) Myth or fact: Alcohol helps you fall asleep faster.
“The short answer is ‘yes, maybe,’” says Egler. “Anyone that has a history of drinking alcohol, particularly at night, has probably experienced it’s sometimes sedating and somnolent effects. So this can lead to sleepiness and initiation of sleep. But this effect is typically only reliable if drinking is relatively infrequent. This perceived benefit can diminish in as little as three nights of consecutive use. So chronic use may not really help to fall asleep unless persistently higher doses are used with time. This is due to a phenomenon frequently associated with chronic alcohol use called ‘tolerance’ where typical doses, i.e. 1-2 drinks, start to have less effect and larger amounts are required to experience the same previous effect.”
2) So why does alcohol seem to help you fall asleep faster, but then disrupt your sleep?
Balinky explains that ETOH (alcohol) is a CNS depressant—which means that it makes it easier to “pass out” or enter what we call an ethanol-induced coma or loss of consciousness. This is not normal sleep or even sleep at all, technically. None of the physical signs notable on a brain scan that occur during sleep are noted in an ethanol-induced loss of consciousness. What we refer to as “sleep architecture” or the normal processes required to achieve the rejuvenation effects of sleep does not occur in this state.
3) Passing out versus sleeping, I didn’t know there was a difference.
“The difference between them relates to sleep architecture,” says Egler. “‘Passing out’ might refer to falling asleep deeply when extremely tired. In this case, sleep stages and cycles are typically maintained although persons may spend more time in deeper, more restorative sleep. But ‘passing out’ may also refer to extreme somnolence induced from excessive amounts of alcohol. In this case, as is the case with the use of any sedative, sleep architecture, or the normal stages and cycle of sleep is not maintained. And the sleep is generally not as restorative.”
3) Tell me more about sleep cycles.
“There are two types of sleep,” explains Balinky. “REM or rapid eye movement stage, and then there is stage 2-4 NREM or nonrapid eye movement type stages, the stages of which get progressively deeper from 2-4. Level 4, the deepest level, is the level where you do most of the body’s recuperative and rebuilding/healing work. REM is a very active sleep stage neurologically, with lots of synapses lighting up and filing the information of the day away from short-term to long-term memory.”
4) I have a friend who says she cured her insomnia with a nightly drink. What are your thoughts on a nightcap before bed?
“For most, it’s probably not a good idea,” says Egler. “With increasing amounts of alcohol, sleep latency decreases and one may fall asleep faster. But there is then a rebound once the alcohol effect wears off. This rebound stimulation from the alcohol depressant effect can interfere with sleep in the middle of the night. Alcohol typically interferes with normal sleep architecture. One normally goes through stages of sleep including deep and REM sleep stages. Alcohol can prevent entering these necessary and restorative stages or reduce the time spent in them.”
5) Another thing, a few drinks before bedtime would occasionally give me nightmares. Any idea why?
Balinky explains, “Alcohol is disinhibition which makes you more likely to do things you regret while in this state, get hurt, fall, etc. Alcohol also increases blood pressure, which can increase stroke risk or thrombus. Your time in REM stage sleep is rushed and incomplete which leads to an increase in vivid dreams and nightmares and an increase in the possibility of night terrors. Alcohol also interferes with long and short-term memory because of the way it inhibits synaptic actions and reduces REM stage efficacy.”
6) What do you recommend for people who don’t have issues with alcohol but have a history of dependence on other substances. Is it safe for them to have alcohol before bed to help with sleep?
Egler says, “I think we’ve established thus far that alcohol for sleep on a regular basis is probably an ill-advised strategy for long-term use and obtaining optimal, ideal quality and quantity sleep. And that is speaking of the general population. That being said, as it’s not a great idea for anyone really, it’s an even worse idea for someone with a history of addiction. And utilizing it as a treatment for anxiety, depression, and/or sleep is a recipe for disaster. Frequent use for any reason can lead to dependence and/or tolerance. But in general, what I hope we’ve established here is that the frequent use of alcohol as a treatment strategy for sleep is less than ideal for anyone.”
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The experts agree that while alcohol might masquerade as a sleep aid, it’s really a sleep disruptor. As Jacqui Hathaway Levin wrote in a previous story about calming nighttime rituals in sobriety, “alcohol gives the impression that it’s helping us sleep, but drinking actually disturbs natural sleeping cycles. It makes us more anxious. Replacing your nightcap with a cup of chamomile or lavender tea can feel good to your nervous system and help your body prepare for sleep.”
When I finally traded in my wine glass for a teacup, I was surprised to find how rested I felt in the morning. And for my serenity and emotional balance, there is no substitute for a good night’s sleep.