A Slippery Slope: The Alcohol-Insomnia Connection

the alcohol insomnia connection

You’ve had a crazy day, and tomorrow will be no different. You might pour a glass of wine or reach for a beer to calm down before bedtime. Maybe a shot of whiskey. But hold on.

Researchers have examined this pattern, and a review of 27 studies shows that alcohol won’t improve your chances for a good night’s sleep. In fact, that pattern of drinking can cause a chain-reaction that is very bad for your health – even causing alcohol dependency.

Insomnia and Alcohol Use

The link between alcohol and insomnia is a common one, researchers say. But for some, it gets dangerous. Up to 15% of people with chronic insomnia also have an alcohol abuse problem. In fact, 70% of Americans drink alcohol — and half of them will develop a dependency. This especially true among the 10% of Americans who drink every single day.

You might not consider your evening glass of wine in that context, but those are the statistics.

Many people don’t start out with a dependence on alcohol. Insomnia starts during a stressful time or a medical problem. Insomnia is also entwined with depression and anxiety, as are medical conditions like pain and sleep apnea. Lifestyle can play a significant role in insomnia – including caffeine and overexposure to light from digital devices.

Once you’ve experienced insomnia, you’re likely to retain the pattern. One study in a medical center found that 16% of patients reported severe insomnia and 34% mild insomnia during the prior month; of the remaining 50%, most of them had sleep troubles as well. Two years later, 59% of those with insomnia and 83% with severe insomnia still had sleep problems.

What Exactly Is Insomnia?

Chronic insomnia is not merely getting to bed in the wee hours. You’ll probably get less sleep than you need, but that’s not insomnia.

Chronic insomnia is a pattern defined as difficulty falling asleep or staying asleep over a period longer than three weeks. People have always used alcohol as a sedative – that little glass of wine or beer before bedtime, or a shot of whiskey. They may not have realized the interaction between alcohol and their sleep problems. But the truth is, insomnia is linked with alcohol dependence.

Insomnia After Drinking Alcohol

While that drink or two will help you fall asleep quicker and sleep deeply for a while, your all-important rapid eye movement (REM) sleep will suffer.

Researchers have thought that alcohol interferes with a person’s circadian rhythm, the body’s built-in 24-hour clock, but new research shows that’s not the whole story. They have discovered that alcohol actually promotes sleep by affecting a person’s sleep homeostasis. This is the brain’s built-in regulatory mechanism that balances sleepiness and wakefulness.

Sleep homeostasis sets the body’s need for sleep according to how long they have been awake. If you lose sleep, your body produces adenosine to increase your need for sleep.

One group of investigators found that after extended periods of frequent drinking, subjects would fall asleep as expected. However, they would wake within a few hours and be unable to fall back asleep. These are all symptoms of insomnia.

They were in acute alcohol withdrawal, which created a significant increase in wakefulness with a reduction in rapid eye movement (REM) and non-rapid eye movement sleep. This caused insomnia-like symptoms and suggested an impaired sleep homeostasis.

The After-Effects of Alcohol And Insomnia

When REM sleep is disrupted, the result is daytime drowsiness, difficulty concentrating – the adverse effects of insomnia after drinking alcohol. REM is a mentally restorative type of sleep, so your memory can be affected.

In addition to disrupting REM sleep, alcohol also suppresses breathing and can lead to sleep apnea, a condition that involves pauses in breathing during the night.

Just one or two drinks will have a minimal effect on sleep, researchers say. But the more you drink before bedtime, the stronger the effect on sleep quality. And there’s the risk for regular practice resulting in alcohol dependence, they add. Their findings appeared in the April 2013 issue of Alcoholism: Clinical & Experimental Research.

Alcohol Withdrawal and Insomnia

In general, the severity of alcohol withdrawal symptoms will depend on how much – and how long – the person has been drinking.

Drinking disrupts the brain’s neurotransmitters that transmit messages. Alcohol enhances the effect of GABA, the neurotransmitter that produces calm and relaxation. However, chronic drinking eventually suppresses GABA so that more alcohol is necessary to get the desired relaxing effect – a pattern known as tolerance.

Chronic alcohol consumption also suppresses glutamate, the neurotransmitter that creates feelings of excitability. When heavy drinkers suddenly reduce their alcohol consumption, these neurotransmitters are no longer suppressed. They rebound, causing brain hyper excitability — anxiety, irritability, tremors.

Six to 12 hours after a person stops drinking, they experience minor alcohol withdrawal symptoms. They may still have a measurable blood alcohol level at that point. Symptoms include:

  • Mild anxiety
  • Sweating
  • Shaky hands
  • Nausea
  • Vomiting
  • Headache
  • Insomnia

That’s called a bad hangover, and if you’re drinking excessively, it will significantly affect your ability to function – including your job performance.

The Darkest Side of Alcohol And Insomnia

The dependency on alcohol is a slippery slope when you’re self-treating an insomnia problem.

In one study, those who reported insomnia in the past year were more than twice as likely to develop alcohol abuse – even if they had no psychiatric problems like depression. Alcohol is used by more than one in ten individuals as a hypnotic agent to self-medicate sleep problems. Studies show that insomnia increases the likelihood of developing alcohol problems.

Among insomniacs who drink, research shows there may be a tendency toward suicidal thoughts. The problem is more severe among those with a heavy dependency. A study of 304 patients in an addiction treatment program, those with severe insomnia were most likely to have suicidal tendencies.

After all, insomnia is a constant struggle with difficulty falling asleep, long nights lying awake, tossing and turning, with very little refreshing sleep. When there is very little REM sleep, there is no mental restoration. There’s little doubt that a person’s mood suffers. Depression and anxiety are exacerbated.

Quality of life is worse, leading to absenteeism at work and damaged relationships. Among patients in recovery from alcohol dependence, insomnia may persist for several months after abstinence begins. That is a highly vulnerable time that can contribute to relapse.

When alcohol-dependent people quit drinking, it’s extremely likely they will have insomnia in the early stages. Studies show that sleep disturbances increase the risk of relapse to alcohol.

Is There an Alcohol-Insomnia Cure?

Some effective medications can help manage insomnia, as well as natural therapies. These have proven to be very effective in non-alcoholic insomnia patients, but careful consideration must be given when the patient is a recovering alcoholic. Overdose when mixing medications with alcohol is a real concern.

A drug called gabapentin is showing promise for treating insomnia in people recovering from alcohol dependency. Gabapentin is a standard treatment for preventing and controlling seizures and convulsions, as well as nerve pain following shingles. Gabapentin is a synthetic version of the GABA, the “relaxation neurotransmitter.” Gabapentin is even available in generic form, so it’s not expensive.

In a gold-standard randomized clinical trial, researchers enrolled 21 volunteers including ten women with insomnia who were alcohol-dependent. The women took the medication gabapentin every night, and it proved to significantly delay the onset of heavy drinking for six weeks, which continued for another six weeks when the study ended. The women’s insomnia also improved while they were taking the medication.

How To Get Past the Insomnia-Alcohol Habit

Psychiatrists talk about seeing patients with insomnia who were dependent on alcohol. Others used alcohol regularly to help their sleep. Many more used all sorts of sleeping pills, tranquilizers and marijuana to get to bed at night.

Most alcoholics had severe sleep problems before they started drinking excessively, and those nights of insomnia got worse as their drinking increased.

Although alcohol can facilitate sleep onset, alcohol suppresses melatonin and significantly disrupts sleep and dreaming during the evening. Drinking also worsens snoring and sleep apnea, a serious condition in which breathing is compromised during sleep.

Do You Have Insomnia?

Insomnia symptoms are a pattern that can come and go. You may struggle one night or for many weeks. Doctors call it a chronic problem when insomnia occurs three nights every week for over a month.

No matter what you do, you just can’t get a good seven or eight hours of restful sleep.

People with insomnia usually have at least one these symptoms:

  • Feeling very tired
  • Trouble concentrating
  • Feeling depressed
  • Difficulty with work performance

If you have signs of insomnia – and have used alcohol to get to sleep – you may be at risk for alcohol dependence tied to your insomnia.

You can get a good night’s sleep without alcohol. Lifestyle changes are key –  including regular exercise, cutting caffeine, and finding ways to relax your mind. Meditation and progressive muscle relaxation have helped many people break the insomnia-alcohol link.

Nutritional supplements like melatonin have also been shown to help regulate the body’s circadian rhythm so you can get the sleep you need. Melatonin is not a narcotic and is a natural way to help take control of your sleep problems.

There’s Too Much at Stake Mixing Alcohol and Insomnia

If you don’t get between seven and nine hours of sleep at night, your body feels the side effects of sleep deprivation. Chronic health problems, including heart disease, high blood pressure, obesity, diabetes, kidney disease and stroke, are associated with insomnia and sleep deprivation. Drowsy driving is prevalent with insomnia – and contributes to an increased risk of death.

Smoking pot, using cocaine or opiates – that’s not the answer either. There’s overwhelming evidence that your sleep will suffer from the chronic use of these addictive substances. You’ll still have insomnia, too little REM sleep and a vicious cycle you can’t control.

Is It Time For Professional Help?

If lifestyle changes aren’t improving your sleep, it’s time to see a professional. Your doctor can help you get to the root of your sleep problem, and perhaps refer you to a specialist. Cognitive behavioral therapy is very effective in treating insomnia. In some cases, short-term natural medications can help break the insomnia-alcohol cycle.

Your doctor will first rule out medical problems that might cause insomnia. You may need blood tests to check for conditions like thyroid problems that can cause insomnia.

Your doctor may also recommend a polysomnogram (PSG), which is a sleep study. You’ll probably stay overnight at a sleep center for this study. The PSG will record your brain activity, heart rate, eye movements and blood pressure.

This study also records the oxygen in your blood, your breathing, snoring and other factors to see if you have a breathing disorder called sleep apnea. It’s worth it to see what’s wrong, to get to the root of your insomnia – to break the alcohol-insomnia link.