Gina Johnson
Alcoholics may need a lot of sleep due to the negative impact of alcohol on sleep quality and duration. Alcohol alters the sleep cycle by disrupting the four stages of sleep, resulting in more deep sleep and less REM sleep initially, followed by an increase in light sleep later in the night. This can lead to frequent awakenings and poor sleep quality. Additionally, long-term alcohol use can cause or aggravate sleep disorders such as insomnia, sleep apnea, and circadian rhythm disruptions. Alcoholics may also experience severe withdrawal symptoms, including nausea, shaking, and anxiety, which can further contribute to sleep disturbances. Furthermore, end-stage alcoholism is associated with severe health complications, including liver disease, heart problems, brain damage, and an increased risk of certain cancers, all of which can impact sleep duration and quality.
| Characteristics | Values |
|---|---|
| Daytime sleepiness | 15.07% of subjects |
| Sleep duration | 6.91 hours |
| Alcohol consumption | 1.25 drinks per day |
| Sleepiness and alcohol consumption | An inverse relationship |
| Sleep duration and alcohol consumption | An interaction between heavy drinking and sleep duration predicted increased daytime sleepiness |
| Sleep and alcoholism | Sleep problems are more common among alcoholics than non-alcoholics |
| Sleep problems | Insomnia, decreased total sleep time, increased slow-wave sleep, decreased REM sleep, REM rebound |
| Sleep problems and alcoholism | Sleep problems may predispose some people to developing alcohol problems |
| Sleep problems and relapse | Sleep problems at the time of treatment are risk factors for relapse to drinking |
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What You'll Learn
Alcohol and sleep architecture
Alcohol acts as a sedative that interacts with several neurotransmitter systems that are important in the regulation of sleep. Acute administration of large amounts of alcohol prior to sleep leads to decreased sleep onset latency and changes in sleep architecture early in the night, when blood alcohol levels are high, with subsequent disrupted, poor-quality sleep later in the night. Alcohol abuse and dependence are associated with chronic sleep disturbance, lower slow-wave sleep, and more rapid eye movement sleep than normal, that last long into periods of abstinence and may play a role in relapse.
Alcohol initially acts as a sedative, shortening sleep onset latency and increasing slow-wave sleep in the first half of the night. However, as alcohol is metabolised, it becomes activating, leading to disrupted sleep in the second half of the night. This pattern of initial sleep augmentation followed by a period of poor-quality sleep can lead to a downward spiral, with insomnia being self-treated with alcohol to produce rapid sleep onset, subsequent poor sleep then leading to daytime sleepiness that is self-treated with caffeine, which exacerbates insomnia, requiring more alcohol to fall asleep, and so on.
Alcohol is a diuretic, increasing urine output, and therefore may cause people to wake up to go to the bathroom. Moderate amounts of alcohol, especially wine and spirits, have an early diuretic effect, especially in the elderly.
Heavy drinking and alcohol dependence are both associated with difficulty falling asleep. As many as three-quarters of people with alcohol dependence experience insomnia symptoms when they drink. Insomnia is also very common in people who are in withdrawal or early recovery from alcohol addiction. People with insomnia have an increased risk of developing alcohol use disorder, potentially because many individuals turn to alcohol as a sleep aid.
Alcohol use and dependence appear to interfere with circadian rhythms – biological patterns that operate on a 24-hour clock. Evidence suggests that consuming alcohol may decrease the body's sensitivity to cues, like daylight and darkness, which trigger shifts in body temperature and secretion of the sleep hormone melatonin. These fluctuations play a vital role in the sleep-wake cycle, and when they are weakened or absent, a person may feel alert when they want to sleep and sleepy when they want to be awake.
Heavy alcohol consumption has been independently associated with short sleep duration in some prior epidemiological studies. Short sleep duration has been linked with heavy alcohol consumption on one hand and with daytime drowsiness on the other. Heavy alcohol consumption has been linked with next-day symptoms of tiredness, and with impaired performance. It is therefore possible that sleepiness is reliably produced with a higher intensity and periodicity of alcohol consumption along with insufficient habitual sleep duration.
The sleep duration may be decreased by the heavy alcohol consumption itself, or from insufficiency based on the need or opportunity of functioning in a 24-hour society, and/or the presence of intrinsic sleep disorders like insomnia or obstructive sleep apnea syndrome.
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Alcohol and sleep disorders
Alcohol has a negative impact on sleep, compromising its quality and quantity. Alcohol disrupts the sleep cycle, interfering with the four stages of sleep and causing frequent wakings. This results in low-quality sleep and fatigue, which further deteriorates physical and mental health.
Alcohol's Impact on Sleep
Alcohol consumed before bed can lead to more deep sleep and less REM sleep initially. Later in the night, once the body has metabolised the alcohol, there is a rise in light sleep, causing frequent wakings and fragmented sleep. This can be especially harmful for people with obstructive sleep apnea (OSA) or central sleep apnea (CSA). Alcohol causes tongue and throat muscles to relax, and changes in blood vessels in the nose increase airway resistance in the nasal passages, making breathing more difficult.
Sleep Disorders and Chronic Sleep Problems
Long-term alcohol use can result in chronic sleep problems and disorders like insomnia and sleep apnea. As many as three-quarters of people with alcohol dependence experience insomnia symptoms when they drink. Insomnia is also common in people in withdrawal or early recovery from alcohol addiction.
Alcohol's effects on sleep can be both immediate and chronic. It can disrupt sleep architecture, cause sleep disorders, and interfere with circadian rhythms. Alcohol increases the likelihood and duration of breathing events during sleep for people with OSA or CSA. It also decreases the body's respiratory drive and increases the likelihood of pauses in breathing for those with CSA.
Alcohol and Insomnia
Heavy alcohol use can trigger insomnia, and people with insomnia have an increased risk of developing alcohol use disorder, as many individuals turn to alcohol as a sleep aid. A destructive pattern can develop where individuals drink alcohol to help them fall asleep but end up sleeping poorly. To counteract excessive sleepiness during the day, they rely on caffeine, which makes it hard to fall asleep at bedtime, and the cycle begins again.
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Alcohol and circadian rhythms
Alcohol has a complex interaction with the body's internal circadian rhythm (CR). The CR is a 24-hour rhythm governed by a master biological clock—a tiny region of the brain that coordinates circadian rhythm activity throughout the body.
The body's temperature (Tb) varies throughout the day in a predictable rhythm, and examining changes in the body's temperature rhythm offers a way of assessing the circadian system. Tb has a unique and reciprocal relationship with alcohol and the mammalian CR. A change in one of these components often leads to changes in another.
Alcohol-Induced Changes in Body Temperature
Alcohol produces a dysregulation of the thermoregulatory system. This thermodysregulation raises the animal's temperature to higher than normal (hyperthermia) when the surrounding or ambient temperature is warm and, conversely, decreases the animal's temperature to lower than normal (hypothermia) when the outside temperature is cooler. However, when mice are given the opportunity to choose their ambient temperature, they seek out colder temperatures after alcohol is administered.
Alcohol's Effects on the Circadian Rhythm of Body Temperature
Alcohol-induced hypothermia decreases the rate of chemical reactions, thereby slowing the rate of elimination. Through various metabolic mechanisms, Tb has been reported to affect the rate of alcohol elimination by up to 50 to 60 per cent.
Sensitivity to Alcohol as a Function of Time of Day
Sensitivity to alcohol is also altered according to the time of day that the alcohol is consumed. In rats, sensitivity is commonly thought to increase at night compared with daytime. However, other, more straightforward explanations may account for these circadian effects. For instance, the sedative effects of alcohol may cause a decrease in the normally high levels of activity seen in these animals during the night, or a "basement" effect of Tb may occur, whereby the already low daytime Tb cannot be reduced any further.
Alcohol Preference as a Function of Time of Day
As nocturnal animals, many rodents engage in a greater degree of activity during the night than in the day. Studies have reported that rats and other rodents prefer alcohol to a greater degree when in a dark environment, in that these animals drink more alcohol during the dark period of an alternating light-dark (L:D) schedule. Likewise, animals placed in constant dark (D:D) environments will drink significantly more than animals placed on L:D schedules.
Influence of Alcohol on the CR of Body Temperature
The involvement of the suprachiasmatic nucleus (SCN), the main timekeeping centre of the body, in Tb regulation is unclear. Research has suggested that although this section of the brain does not respond directly to individual homeostatic fluctuations of Tb, it does act as an overall regulator, ensuring that the organism can adapt to fluctuations in the environmental cycle.
Alcohol's Direct Effects on the Circadian Pacemaker
Few experiments have taken a systematic approach toward elucidating alcohol's direct effects on CR. Recently, however, a study examined the effects produced when alcohol was administered at various times throughout the day. Under a 12:12 L:D cycle, a number of time- and dose-dependent alterations in circadian Tb parameters were demonstrated.
First, alcohol-treated animals showed significantly shorter Tb rhythm periods or cycles. Second, animals exhibited a dose-dependent decrease in Tb rhythm when alcohol was administered at 7:00 p.m. Third, several acrophase changes were uncovered in response to alcohol administration. The study found that phase delays were produced when alcohol was administered at 11:00 p.m. Those delays were believed to result from the initial hypothermia typically induced by alcohol. When alcohol was administered at 1:00 a.m., phase advances were observed. These advances cannot be explained in the same way as the phase delays—that is, as an indirect result of alcohol-induced hypothermia. This finding further strengthens the theory that alcohol acts directly on the central pacemaker.
The areas of chronopharmacokinetics and chronopharmacodynamics are now stable pillars in the foundation of alcohol chronopharmacology. Furthermore, in the area of chronergy, it is becoming clearer that alcohol sensitivity and preference vary with circadian timing. However, studies supporting alcohol's ability to influence the circadian phase are limited.
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Alcohol and insomnia
Alcohol can have a significant impact on sleep, and this impact can be both acute and chronic. While some people may find that drinking alcohol helps them fall asleep more easily, it ultimately disrupts sleep patterns and leads to low-quality sleep. Alcohol consumption can result in more deep sleep and less REM sleep initially, but later in the night, once the body has metabolized the alcohol, there is a rise in light sleep, leading to frequent wakings and fragmented sleep. This can leave individuals feeling tired and fatigued the next day.
Alcohol's effects on sleep can be particularly detrimental for those who snore or have sleep apnea, as it aggravates symptoms and increases the likelihood and duration of breathing pauses during sleep. It can also interfere with the brain's ability to receive chemical messages involved in breathing, increasing the risk of central sleep apnea.
Heavy alcohol use and alcohol dependence are associated with insomnia, a sleep disorder characterized by difficulty falling and staying asleep. As many as three-quarters of people with alcohol dependence experience insomnia symptoms, and the opposite is also true—people with insomnia have an increased risk of developing alcohol use disorder, possibly because they turn to alcohol as a sleep aid. This can create a destructive pattern where individuals drink at bedtime to help them fall asleep but then experience poor sleep, leading to excessive sleepiness during the day and reliance on caffeine, making it hard to fall asleep again at night.
In addition, alcohol use and dependence can interfere with circadian rhythms, weakening the body's sensitivity to cues like daylight and darkness, which are vital for the sleep-wake cycle.
Alcohol can also lead to severe health complications that impact sleep, including liver disease, heart problems, brain damage, and a weakened immune system.
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Alcohol and sleep quality
Alcohol is rapidly absorbed into the bloodstream and remains there until metabolised by the liver. Drinking alcohol before bed increases the likelihood of more N3 sleep, or "deep sleep", and less REM sleep. Later in the night, once the body has metabolised the alcohol, there is a rise in N1 sleep, the lightest stage of sleep, leading to frequent wakings and fragmented sleep.
Alcohol also disrupts sleep by contributing to and aggravating sleep disorders such as insomnia, sleep apnea, and snoring. It can also interfere with circadian rhythms, decreasing the body's sensitivity to cues like daylight and darkness, which are vital for the sleep-wake cycle.
Heavy drinking and alcohol dependence are associated with difficulty falling asleep. As many as three-quarters of people with alcohol dependence experience insomnia symptoms when they drink. Conversely, people with insomnia have an increased risk of developing alcohol use disorder, as many individuals turn to alcohol as a sleep aid.
Alcohol also has negative effects on the body's systems and processes. It can lead to liver cirrhosis and inflammation, increasing the risk of liver failure. It raises blood pressure, increasing the risk of heart disease and stroke. Heavy drinking can cause thiamine deficiency, leading to brain damage and cognitive impairment. Alcohol also weakens the immune system and can cause gastrointestinal issues and malnutrition.
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Frequently asked questions
End-stage alcoholism is the final, most destructive stage of alcoholism. Typically, an individual reaches end-stage alcoholism after years of alcohol abuse. At this point, people who have spent years drinking may have developed health issues and mental health conditions in addition to their alcohol abuse.
End-stage alcoholism is associated with severe health complications, including liver disease, heart problems, brain damage, a weakened immune system, and a high risk of cancer.
Aside from the serious health consequences, people in the end-stage of alcoholism often neglect personal hygiene, relationships, and responsibilities. They will typically stash or hide alcohol around the house or workplace to ensure a drink is never very far away.
Alcohol negatively impacts sleep by altering sleep architecture, disrupting sleep patterns, and interfering with circadian rhythms. It can also aggravate snoring and sleep apnea, and increase the risk of developing insomnia.
Experts recommend avoiding alcohol at least 3 hours before bed. However, some people may benefit from abstaining altogether or avoiding alcohol for longer than 3 hours before bedtime.
