Alcohol and Sleep

In recent studies, people who took part in binge-drinking on a weekly basis were significantly more likely to have trouble falling and staying asleep. Alcohol is a central nervous system depressant that causes brain activity to slow down. Alcohol has sedative effects that can induce feelings of relaxation and sleepiness, but the consumption of alcohol — especially in excess — has been linked to poor sleep quality and duration. Studies have shown that alcohol use can exacerbate the symptoms of sleep apnea. Acamprosate, approved by the FDA in 2004 (Kragh, 2008), is a drug known to be a glutamate receptor antagonist. In line with this, acamprosate is reported to reduce blood (Nam et al., 2015) and brain (Frye et al., 2016) glutamate levels.

• Heavy consumption of alcohol over an extended period of time leads to increased tolerance and this tolerance is accompanied by adaptation of the neurotransmitter systems5.
• In fact, from the few polysomnography studies available, it seems that all these drugs decrease the REM sleep (Snyder et al., 1981; Staner et al., 2006; Sramek et al., 2014), similarly to antidepressants (see Wichniak et al., 2017), although with different mechanisms of action.
• One small study of three alcoholic men who received alcohol (7.6 ounces of pure alcohol) for 4 to 7 days assessed sleep characteristics over several days of withdrawal (Allen et al. 1971).
• But in the second half of the night, it may lead to fragmented sleep (more awakenings).
• A 2019 study found eight weeks of CBT-I reduced insomnia in veterans recovering from alcohol dependence.
• Most have been evaluated in non-alcoholic insomnia patients so their efficacy in alcoholic patients is uncertain.
• These differences are likely due to the working conditions night workers are subjected to, which make them particularly vulnerable to stress.

Conversely, during alcohol withdrawal, adenosine activity is lower than normal, which favors arousal and excessive REM sleep (i.e., REM rebound). Finally, proteins produced by the immune system (i.e., cytokines) have known effects on sleep and are altered in alcoholic individuals (Ehlers 2000; Krueger et al. 1999). Three epidemiological reports have addressed the issue of whether a history of insomnia can predict the development of alcohol abuse or dependence. A 1989 study by Ford and Kamerow (see Gillin 1998) used data collected during the Epidemiological Catchment Area survey, a national household survey. The investigators reported that in the general population, the incidence of alcohol abuse was 2.4 times higher in adults who experienced persistent insomnia during the previous year than in adults who had not. Several studies assessing abnormalities in SWS% during prolonged sobriety indicated that SWS% remained suppressed for 3 to 14 months (Drummond et al. 1998; Imatoh et al. 1986; Ishibashi et al. 1987; Williams and Rundell 1981).

Drinking Water Before Bed

Important next steps include, but are not limited to, consideration of different timescales, including within the same study design, and examination of key mediators and moderators of sleep–alcohol associations. The present paper reviews current evidence for prospective associations between sleep/circadian factors and alcohol involvement during adolescence and young adulthood, with an emphasis on the effects of sleep/circadian factors on alcohol use and related outcomes. This focus was selected in part because identifying modifiable sleep–alcohol relationships during this developmental period offers the potential for shifting the trajectory for alcohol-related problems before they develop into chronic AUD.

Chronic alcohol consumption also results in long-term alterations and neuroadaptation in the neurotransmitter systems affected by alcohol, and these alterations persist into the early stages of abstinence (Becker 1999; Koob and Roberts 1999; Littleton 1998). Neuroadaptation means that in response to the chronic exposure to alcohol, the brain adjusts its baseline activities to compensate for alcohol’s effects on brain-cell functioning. For example, because alcohol tends to enhance GABA activity and inhibit glutamate alcohol induced insomnia activity, neuroadaptation to chronic alcohol consumption includes decreased baseline activity of inhibitory GABA systems and increased activity of excitatory glutamate systems. These alterations compensate for alcohol’s effects, allowing the brain to maintain its “normal” activity levels in the presence of alcohol. When alcohol is discontinued, however, these alterations persist, at least for a while, resulting in increased arousal that manifests as withdrawal symptoms, including sleep disruption.

Screening, Data Extraction and Critical Appraisal

Consistent with previous studies (Clarke et al., 2015; Manber et al., 2008), CBT-I reduced symptoms of depression among individuals with comorbid AUD, with effect sizes ranging from small to large. Given the prevalence of depressive symptoms among patients with AUD (SAMHSA, 2016) and the promise of these findings, additional studies examining the impact of CBT-I on psychiatric outcomes among patients with AUD are warranted. While the association between sleep and alcohol use is bidirectional (Chakravorty et al., 2016), symptoms of insomnia seem to play a unique role in the development and maintenance of substance use disorders. Difficulty initiating and maintaining sleep have been identified as prospective predictors of alcohol and other drug use in studies of children (Wong et al., 2009), adolescents (Hasler et al., 2016; Miller et al., 2017), and adults (Breslau et al., 1996; Weissman et al., 1997). Moreover, in the context of alcohol treatment, insomnia symptoms have been shown to precede and predict relapse to alcohol use (Brower et al., 2001; Malcolm et al., 2007; Smith et al., 2014). Thus, persistent insomnia symptoms may be barriers to effective, long-term recovery from AUD.

• Recent longitudinal studies indicate considerable recovery in gray and white matter volumes with abstinence.
• More well-controlled studies are needed to characterize the phenomenology of sleep during recovery, to determine the efficacy of monotherapy and combined approaches to sleep treatment in alcoholic patients, and to evaluate the impact of such treatments on relapse and recovery in alcohol dependence.
• The majority of interventions were delivered in person, although one involved both in-person and telephone support (Arnedt et al., 2011).
• Although SWS% returns to baseline values during withdrawal, researchers should note that baseline values of SWS% in alcoholics are still lower than values from control subjects.

The studies included a total of 116 participants, of whom 29.3 percent (i.e., 34 patients) had an apnea index greater than 5. Unfortunately, only one study (Tan et al. 1985) calculated the proportion of control subjects with an apnea index greater than 5. However, the number of those control subjects (i.e., 12 persons, out of whom none had an apnea index greater than 5) was too small to provide an adequate comparison across the three studies. Sleep problems1 are more common among alcoholics than among non-alcoholics (Aldrich 1998; Ehlers 2000; National Institute on Alcohol Abuse and Alcoholism [NIAAA] 1998). For example, in the general population, insomnia in the previous 6 months affected 18 percent of alcoholic people, but only 10 percent of nonalcoholic people (Brower et al. 2000).

Alcohol Dependence and its Relationship with Insomnia and Other Sleep Disorders

Acamprosate shows some beneficial effects on sleep, reducing insomnia in some studies (Boeijinga et al., 2004; statistics not known), in line with a recent meta-analysis reporting lowered insomnia after 6 months of treatment with acamprosate versus placebo (Perney and Lehert, 2018). In fact, Perney and Lehert (2018) analyzed the raw sleep data collected from those trials. Moreover, two articles on acamprosate were excluded because they were not in English (Barrias et al., 1997; Ladewig et al., 1993) and another two studies were excluded because there was concomitant administration of other, potentially biasing, drugs (Besson et al., 1998; Chick et al., 2000). Finally, due to https://ecosoberhouse.com/ the high level of methodological heterogeneity across the included studies, we estimated that it was not appropriate to pool the data in a meta-analysis. But the results summarized in this review suggest beneficial effects of acamprosate (Table 3), particularly on parameters of sleep continuity and architecture that are usually affected by AUD, giving less fragmented sleep, increased deep sleep (stage 3), and increased REM sleep latency (Staner et al., 2006). Acamprosate, by reducing the glutamatergic neurotransmission (Mason and Crean, 2007; Frye et al., 2016), supports abstinence, and this might explain the reduced insomnia and the trend to reduce REM sleep (Jones, 2019).

To date, no controlled clinical trials have tested the hypothesis that treatment outcomes for alcoholism can be improved by concomitant treatment of sleep problems, and both pharmacological and nonpharmacological trials are warranted. The combination of several treatment approaches might be especially effective in this respect. Numerous neurotransmitter systems and other substances are involved in the regulation of sleep and various sleep stages.

Identifying people at risk of sleep disturbances as a result of their drinking may have important public health benefits. For instance, we used self-reported alcohol consumption data and self-reported sleep data and therefore these measures may be at risk of reporting bias. The population may not be representative of all older adults in the UK and it is unlikely that the full spectrum of drinking behavior is represented.

• The first database searches were conducted in December 2018 and then updated at the end of April 2019.
• Such studies should further explore the role of relevant moderators, with particular attention to sleep–alcohol associations for individuals with minoritized identities.
• MBM screened and reviewed articles for eligibility criteria, first reviewing titles and abstracts of all records and then requesting full texts of those that were potentially relevant.
• However, the relationship between the two disorders is complicated and closely linked.

Below, we’ll dive into how to stop alcohol insomnia with help from the RISE app, how long alcohol sleep problems last, and why alcohol causes sleep loss in the first place. Alcohol dependency is rarely the only issue a person in withdrawal is dealing with. This is why a comprehensive approach to treatment is often the key to a successful recovery. However, there are many coping skills a person can practice to improve their sleep.