Taking a good history of all the medications a patient is using — including illicit drugs and alcohol — is vital as virtually all drugs with a high abuse potential have an effect on sleep.1 Unfortunately, one of the most common substances patients use to aid in sleep induction is alcohol.2 Approximately 30% of people with insomnia report using alcohol to help promote sleep.1,2

Studies have shown that alcohol consumed in low quantities approximately 30 minutes before bed may improve sleep in those with insomnia.1,2 However, alcohol consumed in larger quantities may impair  the second half of sleep. When alcohol is completely metabolized during the night, it causes rebound wakefulness during the last hours of sleep.

Recently, researchers at the Sleep Disorders and Research Center in Detroit, Michigan, reported the risks of using alcohol as a sleep aid.2 Initially, alcohol appeared to improve sleep efficiency and increase sleep stages 3-4. After the sixth night of alcohol-induced sleep, however, the participants in the study lost any benefit from consuming alcohol. This caused participants to increase their self-administered alcohol quantity. 

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This is the major concern for patients who drink alcohol to help promote sleep: Repeated nightly use leads to the development of tolerance.1,2 Once a patient becomes tolerant to a substance, the patient needs more of the substance to achieve the same effect. Alcohol tolerance can lead to a myriad of health issues as well as alcoholism. I have had many patients who later became alcoholics say they started drinking for anxiety issues and to help them sleep.

Unfortunately, if a patient has been drinking for a long time and decides to stop, his or her sleep may be negatively affected. Abnormal sleep patterns can continue for up to 3 months in patients with alcoholism.1 This can cause negative feedback, with patients now believing that they need alcohol or sleep aids to help them sleep. Regular heavy drinking can cause maintenance insomnia, which is when a patient has difficulty maintaining sleep throughout the night.

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Alcohol is the third leading preventable cause of death in the United States.3 Approximately 88,000 people die of alcohol-related causes each year. Among persons aged 16 to 20 years alcohol is involved in 37% of all traffic deaths. Alcohol can also have detrimental effects on the body, including changes in mood and behavior, cardiac changes such as cardiomyopathy and arrhythmias, stroke, high blood pressure, cirrhosis, pancreatitis, and cancers of the mouth, esophagus, and breast.

Remember, it is vital to talk to your patients about alcohol or other substances that might influence sleep. In addition to causing insomnia, alcohol can also exacerbate other sleep disorders such as obstructive sleep apnea, restless leg syndrome, and periodic limb movements of sleep.

References

  1. Kryger MH, Roth T, Dement WC. Chapter 140: Medication and substance abuse. Principles and Practice of Sleep Medicine. Philadelphia, PA; Elsevier;2016:1380-1384.
  2. Roehrs T, Roth T Insomnia as a path to alcoholism: tolerance development and dose escalation. Sleep. 2018;41(8).
  3. National Institute on Alcohol Abuse and Alcoholism. Available at: https://www.niaaa.nih.gov/. Accessed September 12, 2018.

Topics:

Alcohol-Use Disorder Practice Management Sleep Disorders Sleep Medicine