Many insomniacs take an alcoholic drink before bedtime in order to reduce sleep latency. While alcohol does reduce sleep latency, drinking large amounts has been shown to result in poorer quality of sleep and awakening during the night. It is not known whether any impairment of sleep quality occurs when small amounts are used at bedtime. The risk of excess alcohol consumption in persons with alcohol problems makes this an inappropriate treatment for them. Sleep-disorders breathing, a dyssomnia affecting millions of people, is made worse by alcohol.

Sleep problems are often experienced by people who cut back on their alcohol consumption. Alcoholics in recovery programs have to remember this.

From the National Institute on Alcohol Abuse and Alcoholism:

Alcohol and Sleep in Those Without Alcoholism

Alcohol consumed at bedtime, after an initial stimulating effect, may decrease the time required to fall asleep. Because of alcohol's sedating effect, many people with insomnia consume alcohol to promote sleep. However, alcohol consumed within an hour of bedtime appears to disrupt the second half of the sleep period. The subject may sleep fitfully during the second half of sleep, awakening from dreams and returning to sleep with difficulty. With continued consumption just before bedtime, alcohol's sleep-inducing effect may decrease, while its disruptive effects continue or increase. This sleep disruption may lead to daytime fatigue and sleepiness. The elderly are at particular risk, because they achieve higher levels of alcohol in the blood and brain than do younger persons after consuming an equivalent dose. Bedtime alcohol consumption among older persons may lead to unsteadiness if walking is attempted during the night, with increased risk of falls and injuries.

Alcoholic beverages are often consumed in the late afternoon (e.g., at "happy hour" or with dinner) without further consumption before bedtime. Studies show that a moderate dose of alcohol consumed as much as 6 hours before bedtime can increase wakefulness during the second half of sleep. By the time this effect occurs, the dose of alcohol consumed earlier has already been eliminated from the body, suggesting a relatively long-lasting change in the body's mechanisms of sleep regulation.

The adverse effects of sleep deprivation are increased following alcohol consumption. Subjects administered low doses of alcohol following a night of reduced sleep perform poorly in a driving simulator, even with no alcohol left in the body. Reduced alertness may potentially increase alcohol's sedating effect in situations such as rotating sleep-wake schedules (e.g., shift work) and rapid travel across multiple time zones (i.e., jet lag). A person may not recognize the extent of sleep disturbance that occurs under these circumstances, increasing the danger that sleepiness and alcohol consumption will co-occur.

Effects of Alcohol on Sleep in Those With Alcoholism

Active Drinking and Withdrawal. Sleep disturbances associated with alcoholism include increased time required to fall asleep, frequent awakenings, and a decrease in subjective sleep quality associated with daytime fatigue. Abrupt reduction of heavy drinking can trigger alcohol withdrawal syndrome, accompanied by pronounced insomnia with marked sleep fragmentation. Decreased SWS during withdrawal may reduce the amount of restful sleep. It has been suggested that increased REM may be related to the hallucinations that sometimes occur during withdrawal. In patients with severe withdrawal, sleep may consist almost entirely of brief periods of REM interrupted by numerous awakenings.

Recovery and Relapse. Despite some improvement after withdrawal subsides, sleep patterns may never return to normal in those with alcoholism, even after years of abstinence. Abstinent alcoholics tend to sleep poorly, with decreased amounts of SWS and increased nighttime wakefulness that could make sleep less restorative and contribute to daytime fatigue. Resumption of heavy drinking leads to increased SWS and decreased wakefulness. This apparent improvement in sleep continuity may promote relapse by contributing to the mistaken impression that alcohol consumption improves sleep. Nevertheless, as drinking continues, sleep patterns again become disrupted.

Researchers have attempted to predict relapse potential using measures of sleep disruption. Gillin and colleagues measured REM sleep in patients admitted to a 1-month alcoholism treatment program. Higher levels of REM predicted those who relapsed within 3 months after hospital discharge in 80 percent of the patients. A review of additional research concluded that those who eventually relapsed exhibited a higher proportion of REM and a lower proportion of SWS at the beginning of treatment, compared with those who remained abstinent. Although additional research is needed, these findings may facilitate early identification of patients at risk for relapse and allow clinicians to tailor their treatment programs accordingly.

Sleep Disorders

Dyssomnias

Parsomnias

"It’s been a hard day’s night
I’ve been workin´ like a dog
It’s been a hard day’s night
And I’ll be sleepin´ like a log…. "

(John Lennon and Paul McCartney)