Alcoholics And Sleep: Day Time Naps Explained

Alcoholism is a progressive condition that affects over 14 million people in the US alone each year. It is a nonclinical term for alcohol addiction, which is characterised by an impaired ability to stop or control alcohol use despite adverse consequences. Alcoholism has three stages: early, chronic, and end-stage. In the early stage, a person may not appear to have a problem, but they are drinking heavily and may experience hangovers. In the chronic stage, the body develops a physical dependence, and withdrawal symptoms will occur if they stop drinking. In the end stage, the addiction has taken over, and the person may no longer be able to control their drinking impulses. They will likely experience very serious health and mental issues, and alcohol detox and treatment are usually necessary.

Alcohol and sleep architecture

Alcohol has a profound impact on sleep architecture, with effects depending on acute versus chronic use and dependence. While alcohol is initially sedating, this effect disappears after a few hours, resulting in fragmented and disturbed sleep in the second half of the night.

Acute Effects of Alcohol on Sleep

Alcohol is rapidly absorbed into the bloodstream and remains there until metabolised by the liver, typically at a rate of about one drink per hour. As a sedative, alcohol interacts with several neurotransmitter systems important in the regulation of sleep.

When consumed before bed, alcohol leads to decreased sleep onset latency and changes in sleep architecture early in the night, when blood alcohol levels are high. This includes 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, low-quality sleep.

Sleep in Alcoholism

Chronic alcohol use is associated with major sleep problems, with ongoing sleep and circadian disruption. Sustained alcohol abuse and dependence are associated with chronic sleep disturbance, lower slow-wave sleep, and more rapid eye movement sleep than normal, lasting long into periods of abstinence and possibly playing a role in relapse.

Possible Mechanisms

The acute effects of alcohol on sleep can be explained by its GABA agonist properties. The subsequent withdrawal of tonic input to the reticular nucleus of the thalamus allows the release of GABA and inhibition of thalamo-cortical circuits. The hyperpolarising effect of GABA causes the opening of low-threshold calcium ion channels and a pattern of synchronised burst firing that manifests as sleep spindles in the sleep EEG.

The suppression of REM sleep in the short term may be due to alcohol's effects on brainstem GABAergic systems. Long-term alcohol dependence may lead to downregulation of these systems, leading to increased REM sleep.

Treatment and Recovery

Given that sleep problems persist during alcohol recovery, treating sleep problems in alcoholic patients could aid recovery and decrease relapse rates. Cognitive-behavioural treatment for insomnia in alcohol-dependent patients has been found to be more effective than placebo in improving subjective sleep and reducing daytime fatigue.

Sleep disorders and circadian rhythms

Alcohol can disrupt sleep by contributing to sleep disorders and interfering with circadian rhythms. The effects of alcohol on sleep can be both acute and chronic, affecting heavy drinkers in the long term.

Snoring and Sleep Apnea

Alcohol tends to aggravate symptoms for people who snore or have sleep apnea, a disorder that causes repeated pauses in breathing during sleep. Alcohol causes tongue and throat muscles to relax and changes to blood vessels in the nose, leading to greater airway resistance in the nasal passages. These alterations significantly increase the likelihood and duration of breathing events during sleep.

Insomnia

Heavy alcohol use can trigger insomnia, a sleep disorder characterised by difficulty falling and staying 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.

While heavy alcohol use can trigger insomnia, the opposite is also true. People with insomnia have an increased risk of developing alcohol use disorder, potentially because many individuals turn to alcohol as a sleep aid.

Circadian Rhythm Disruptions

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.

Alcohol withdrawal and insomnia

Alcohol withdrawal insomnia is a common side effect of alcohol withdrawal. It can be a frustrating experience, and in some cases, it can even cause a relapse.

When you drink alcohol, it acts as a sedative, helping your body relax and fall asleep. However, over time, your body builds up a tolerance, and you need more alcohol to feel the same effects. This can lead to alcohol dependence, where you need alcohol to feel normal and experience negative symptoms when you're not drinking.

The more alcohol you consume, the more your body tries to compensate by making you more excitable to counteract the depressive effects of alcohol on your central nervous system. This leads to common alcohol withdrawal symptoms such as elevated heart rate, rapid breathing, shakes, and muscle cramps. As a result, many people experience insomnia during alcohol withdrawal.

Treating Alcohol Withdrawal Insomnia

A poor sleep cycle can negatively impact your mental and physical health and increase the risk of relapse for recovering alcoholics. Here are some tips to help treat alcohol withdrawal insomnia:

• Set a precise bedtime to help your body get used to a particular circadian rhythm.
• Avoid caffeine in the afternoon or evening, as it can interfere with winding down for sleep.
• Resist daytime naps, even after a poor night's sleep, to improve your chances of falling asleep at night.
• Create comforting bedtime rituals, such as drinking a cup of tea or reading a good book, to help you relax before sleep.

If you or a loved one is struggling with alcohol withdrawal insomnia, it's important to seek help. Alcohol treatment services can provide medically supervised alcohol detox and ongoing support to maintain your sobriety.

Alcohol-related health complications

Alcoholism, or alcohol addiction, can lead to a range of health complications, including liver damage, mental health issues, and an increased risk of cancer.

Liver Damage

Alcohol is a toxin that the liver must flush out of the body. Heavy drinking can cause liver cells to die, leading to permanent scarring (cirrhosis) and liver disease. Alcoholic fatty liver disease is a sign that the liver is not functioning properly.

Mental Health Issues

Alcohol affects the brain's communication pathways, making it harder to think and speak clearly, remember things, make decisions, and control body movements. Heavy drinking can also cause mental health issues such as depression and dementia, and increase the risk of suicide.

Increased Risk of Cancer

There is a clear link between heavy alcohol use and many types of cancer. Alcohol can damage cells in the mouth, throat, voice box, and oesophagus, and lead to cancers in the liver, breast, and intestines. It can also help cancer-causing chemicals, such as those found in tobacco, enter cells more easily.

Other Health Complications

Other health issues associated with alcoholism include:

• Heart problems: Heavy drinking can cause issues with pumping blood to the heart and increase the risk of dying from heart disease.
• Brain damage: Alcohol abuse can lead to conditions such as stroke and dementia.
• Pancreatitis: Alcohol can cause a buildup of digestive enzymes in the pancreas, affecting insulin production and increasing the risk of diabetes.
• Sleep disorders: Alcohol can disrupt sleep patterns and cause insomnia, snoring, and sleep apnea.
• Gout: Alcohol is high in purines, which can lead to a buildup of uric acid in the joints.
• Weakened immune system: Heavy drinking can hinder immune cells from fighting off viruses and bacteria, and harm the liver, which plays a vital role in the immune system.

Alcohol tolerance and cell resistance

Alcohol tolerance refers to the body's responses to the functional effects of ethanol, including direct tolerance, speed of recovery from insobriety, and resistance to the development of alcohol use disorder. Direct alcohol tolerance is largely dependent on body size, with larger-bodied people requiring more alcohol to reach insobriety than lightly built people. Alcohol tolerance may lead to alcohol dependence, which refers to physiological addiction where abstinence may cause withdrawal symptoms.

Alcohol tolerance is increased by regular drinking, with higher quantities of alcohol needed to achieve the same effects as before tolerance was established. This reduced sensitivity to the physical effects of alcohol consumption can lead to alcohol dependence. Heavy alcohol consumption over a period of years can result in "reverse tolerance", where the liver, damaged by chronic alcohol use, has a reduced ability to metabolize or break down alcohol. This means that small amounts of alcohol can lead to a high blood alcohol concentration (BAC) and more rapid intoxication.

The development of alcohol tolerance is thought to be due to neuroadaptations following chronic alcohol consumption. Tolerance can be classified as dispositional or metabolic, functional, acute, and chronic. Dispositional or metabolic tolerance relates to enhanced rates of clearance of ethanol from the body, with a more rapid metabolism and a steeper slope of the post-absorptive declining phase of the BAC curve. Functional tolerance refers to an alteration in sensitivity to alcohol, where nerve cells become heightened to counteract the inhibitory effects of alcohol. Acute tolerance occurs rapidly during a single exposure to ethanol, with the behavioural and psychomotor effects more pronounced on the rising limb of the BAC curve. Chronic tolerance is reflected in a progressive change in sensitivity to alcohol after a long period of continuous heavy drinking.

The inverse correlation between initial resistance and tolerance suggests that initial resistance phenotypes can explain many 'perceived' tolerance phenotypes. Tolerance should be measured as a relative increase in time to sedation between an initial and second exposure rather than an absolute change in time to sedation.

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