Alcohol and Sleep: 96% of Alcoholics Have Sleep Issues Like Insomnia
Though alcohol consumption can make you drowsy, it gets in the way of restorative sleep. Alcohol and sleep are interrelated—alcohol use can cause sleep issues and sleep issues may contribute to alcohol misuse. You may also experience short– and long-term risks that come from having both inadequate sleep and AUD.
How Does Alcohol Affect Sleep?
It is possible to get insomnia from alcohol misuse.
Alcohol use can interfere with the quality sleep your body needs and can also disrupt your sleep-wake cycle.2,3
Rapid Eye Movement Sleep
Adequate sleep is necessary for various brain functions, including learning and memory. Stages 3 and 4 of the sleep cycle, in particular, play an important role in strengthening learning and memory. These are also the stages of sleep that alcohol affects the most.4
One sleep cycle is about 90 minutes and has 4 stages:5
- Stage 1 Light Sleep—Stage 1 is a short period when the transition from wakefulness to sleep occurs.
- Stage 2 Intermediary Sleep—Stage 2 is where you spend most of the sleep cycle. It is the period right before deep sleep.
- Stage 3 Deep Sleep—Stage 3 is the deep sleep that you need to feel refreshed in the morning.
- Stage 4 Rapid Eye Movement—Rapid eye movement (REM) sleep is the period when you dream the most and your eyes move rapidly from side to side behind closed eyelids. As the night goes on, you spend more and more time in this sleep stage.
Both deep sleep and REM sleep impact learning and memory.4
If you consume higher levels of alcohol, you are highly likely to spend less time in REM sleep.2
Your sleep circadian rhythm is the process of your body responding to light and darkness within a 24-hour period. Your body’s clock sets the typical schedule of being awake during the day and sleeping at night.6 This is why you typically feel alert and awake near the same time of day and less focused and tired around the same time of night. You may also experience a period of decreased energy at the same time every day, such as in the mid-afternoon.
Other circadian rhythms regulate the natural changes that happen to your body over 24 hours, such as fluctuations in temperature and blood pressure changes.7 These rhythms contribute to daily patterns like appetite.
Circadian rhythms exist in every cell of your body, and alcohol disturbs body functions down to the cellular level while it is being metabolized. In addition to the liver, tissues in the brain, stomach, and intestines also play a part in metabolizing alcohol. Alcohol creates changes in the cells of these organs that changes the organs’ circadian rhythms.7 This disturbance could change how you typically process food throughout the day or when you feel most focused due to the interference with your digestive system and brain.
Alcohol can also damage cells, releasing toxins. These toxins also affect circadian rhythms.7
Circadian rhythms also drive the body’s production of natural melatonin.7 Melatonin is a hormone that is involved with the sleep-wake cycle. Your brain makes melatonin in response to darkness, which contributes to sleep.8 Since alcohol disrupts circadian rhythms, it, in turn, inhibits melatonin production.7
What Is My Risk of Having Both Insomnia and Alcohol Use Disorder?
Having issues with both alcohol and insomnia is not uncommon. Research suggests that alcohol dependence can lead to insomnia, and insomnia can cause a dependence on alcohol.9
This connection is typically due to “self-medication.” If you struggle with sleep, you may use alcohol because of its sedating effects. However, because alcohol contributes to sleep disturbances, using more alcohol causes more sleep problems. This creates a cycle that can lead to profound insomnia and to chronic alcohol misuse or addiction.3
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In a small study of patients in an alcohol and drug recovery center, 80% of participants reported that alcohol was their drug of choice and 96% of those participants had experienced sleep problems, including insomnia. Furthermore, many other participants used other substances to help themselves sleep.10
Researchers report that common factors associated with having both insomnia and alcohol use disorder are:9
- Having a family history of alcohol addiction and/or family members with diagnosed alcohol use disorder
- Having a diagnosis of severe alcohol use disorder
- Using alcohol more frequently
- Having been abused physically or sexually
There is also growing research on the association between alcohol dependence circadian clock genes. In a sample in Poland of individuals with alcohol use disorder, all participants shared a few genes associated with insomnia.9 This preliminary research indicates that there could potentially be a genetic component to developing both addiction to alcohol and insomnia.
What Problems Could Arise from Having Both Insomnia and Alcohol Use Disorder?
You have a greater chance of experiencing certain problems if you struggle with both insomnia and alcohol use disorder. One is that your AUD can worsen, or you could relapse due after alcohol addiction treatment due to sleep issues.10
Another problem that could arise from having both insomnia and AUD is a co-occurring mental health condition. In one study of adolescents, researchers found that insomnia symptoms were associated with social anxiety disorder as well as AUD.11
Another study of people in the UK with both major depression and alcohol misuse found that a significant number of them had insomnia symptoms.12 Other mental health symptoms were also found to be a significant factor in a small 2020 study of individuals with alcohol dependence who also had insomnia symptoms.13
You might take over-the-counter (OTC) or prescription sleep aids. However, mixing either type of sleep aid with alcohol can be dangerous. The effects of this can be:14
- Slowed or difficulty breathing
- Impaired motor control
- Unusual behavior
- Memory problems
Therefore, it is important to seek the help of medical and mental health professionals so that you do not accidentally worsen your conditions or cause medical risks by trying to manage sleep or alcohol use issues on your own.
What Treatments Exist for Insomnia and Alcohol Use Disorder?
Medical providers are likely to recommend abstaining from alcohol when sleep disturbances are a major concern.15 If you struggle with both insomnia and alcohol misuse or addiction, psychotherapy and medication are potential treatments for both issues.
Cognitive-behavioral therapy (CBT) has well-documented use as a treatment for alcohol use disorder. It is one of the most common therapies used in alcohol treatment centers. CBT is known to improve alcohol consumption patterns, mood, coping skills, self-confidence, interpersonal functioning, and self-care among people struggling with AUD.16
CBT is based on the idea that psychological problems are in part due to unhelpful ways of thinking that lead to unwanted behaviors. Thus, you can learn new ways of thinking and acting that can help improve symptoms.17
CBT for insomnia may involve changing your thoughts about sleep or your drinking motives and changing your daily patterns that have contributed to poor sleep.18
For example, you may work with a therapist to establish better sleep hygiene. Sleep hygiene is a set of behaviors done to help promote quality sleep, such as following a relaxation routine before bed or going to bed and getting up at consistent times.17
There is no consensus among researchers or physicians on whether to use medication to treat insomnia in patients with alcohol use disorder.19 Some researchers believe that medications can work faster than therapy to help insomnia, however, only for as long as you take them. They also caution that each type of medication has risks and benefits and that these need to be weighed and monitored by medical providers.15
Some researchers believe that patients may benefit from medication primarily if sleep disturbances:19
- Are accompanied by daytime dysfunction
- Are accompanied by psychological distress
- Continue after 4 weeks of alcohol cessation
No specific medication has been found to be effective for the majority of patients with both insomnia and AUD. The effectiveness depends on individual factors.
For example, with some patients, certain medications helped to improve sleep quality in the short term but not the long term. Some patients with mild alcohol withdrawal symptoms had a better sleep with medication while those with severe withdrawal symptoms had better sleep with placebo.19
Some medications that medical providers might consider prescribing include:19
- Those that act like melatonin to establish your sleep circadian rhythm
- Antidepressants that cause drowsiness to help with sleep, such as Trazadone
- Anticonvulsants, like Gabapentin, because they slow down brain activity
- Extremely low doses of certain antipsychotic medications, like Seroquel, because they have a sedating effect
Sedating medications such as benzodiazepines, like Valium and Xanax, are first-line treatments for insomnia in individuals who do not have a history of misusing substances. However, benzodiazepines have a high risk of misuse and a high risk for overdose when combined with alcohol. Thus providers typically would not prescribe them for patients with both insomnia and AUD.19,20
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What Can I Do to Get Better Sleep?
Getting enough quality sleep is crucial for your mental, emotional, and physical health. There are sleep practices that you can begin to do now to help improve the quality of your sleep. You can:5
- Avoid alcoholic drinks before bed.
- Avoid caffeine and nicotine, especially late in the day.
- Exercise during the day, but no later than a few hours before going to bed.
- Establish a relaxing bedtime routine without electronics screens, such as reading a book, a warm bath, or journaling.
- Reserve your room for only sleep and intimate or bedtime activities; keep the room at a comfortable temperature and don’t watch TV or work in the bedroom. This can also help alleviate night sweats if you are experiencing mild alcohol withdrawal and detoxing at home.
- Set a daily schedule and go to bed and wake up at the same time each day, including on weekends.
- Do not lie in bed awake; if you cannot go to sleep, get up and do something relaxing like reading a book or listening to calm music until you feel drowsy.
- See a medical provider if your sleep problems persist. Sleep disturbances can indicate an underlying issue.
If you need treatment for alcohol misuse or addiction, call 800-839-1686Who Answers? for 24/7 assistance in locating treatment providers.
- Roth, T. (2007, August 15). Insomnia: Definition, Prevalence, Etiology, and Consequences. Journal of Clinical Sleep Medicine, 3(5), S7-S10.
- Ebrahim, I.O., Shapiro, C.M., Williams, A.J., & Fenwick, P.B. (2013). Alcohol and Sleep I: Effects on Normal Sleep. Alcoholism: Clinical & Experimental Research, 37(4), 539-549.
- He, S., Hasler, B.P., & Chakravorty, S. (2019). Alcohol and Sleep-related Problems. Current Opinion in Psychology, 30, 117-122.
- Harvard Medicine. (2007, December 18). Sleep, Learning, and Memory. Healthy Sleep.
- National Institutes of Health. (2019, August 13). Brain Basics: Understanding Sleep. National Institute of Neurological Disorders and Stroke.
- National Institutes of Health. (2021, September 9). Circadian Rhythms. National Institute of General Medical Sciences.
- Voigt, R.M., Forsyth, C.B., & Keshavarzian, A. (2013). Circadian Disruption: Potential Implications in Inflammatory and Metabolic Diseases Associated With Alcohol. Alcohol Research, 35(1), 87-96.
- National Institutes of Health. (2021). Melatonin: What You Need To Know. National Center for Complementary and Integrative Health.
- Chakravorty, S., Chaudhary, N.S., & Brower, K.J. (2016). Alcohol Dependence and Its Relationship With Insomnia and Other Sleep Disorders. Alcoholism: Clinical & Experimental Research, 40(11), 2271-2282.
- Mahfoud, Y., Talih, F., Streem, D., & Budur, K. (2009). Sleep Disorders in Substance Abusers: How Common Are They? Psychiatry, 6(9), 38-42.
- Blumenthal, H., Taylor, D.J., Cloutier, R.M., Baxley, C., & Lasslett, H. (2019). The Links Between Social Anxiety Disorder, Insomnia Symptoms, and Alcohol Use Disorders: Findings From a Large Sample of Adolescents in the United States. Behavior Therapy, 50(1), 50-59.
- Kolla, B.P., Biernacka, J.M., Mansudhani, M.P., Colby, C., & Coombes, B.J. (2021, December 01). Prevalence of Insomnia Symptoms and Associated Risk Factors in UK Biobank Participants with Hazardous Alcohol Use and Major Depression. Drug and Alcohol Dependence, 229(Part A), 109128.
- Chaudhary, N.S., Wong, M.M., Kolla, B.P., Kampman, K.M., & Chakravorty, S. (2020, October 01). The relationship between insomnia and the intensity of drinking in treatment-seeking individuals with alcohol dependence. Drug and Alcohol Dependence, 215, 108189.
- National Institute on Alcohol Abuse and Alcoholism. (2014). Mixing Alcohol with Medicines.
- Brower, K.J. (2015). Assessment and Treatment of Insomnia in Adult Patients with Alcohol Use Disorders. Alcohol, 49(4), 417-427.
- Epstein, E.E., McCrady, B.S., Hallgren, K.A., Gaba, A., Cook, S., Jensen, N., Hildebrandt, T., Holzhauer, C.G., & Litt, M.D. (2018). Individual Versus Group Female-specific Cognitive Behavior Therapy for Alcohol Use Disorder. Journal of Substance Abuse Treatment, 88, 27-43.
- American Psychological Association. (2021). What is Cognitive Behavioral Therapy?
- Miller, M.B., Metrik, J., McGeary, J.E., Borsari, B., McCrae, C.S., Maddoux, J., Arnedt, J.T., Merrill, J.E., & Carey, K.B. (2021). Protocol for the Project SAVE Randomised Controlled Trial Examining CBT for Insomnia Among Veterans in Treatment for Alcohol Use Disorder. British Medical Journal Open, 11(6).
- Roehrs, T.A., Auciello, J., Tseng, J., & Whiteside, G. (2020, June 15). Current and potential pharmacological treatment options for insomnia in patients with alcohol use disorder in recovery. Neuropsychopharmacology Reports, 40(3), 211-223.
- Edinoff, A.N., Nix, C.A., Hollier, J., Sagrera, C.E., Delacroix, B.M., A, T., Cornett, E.M., Kaye, A.M., & Kaye, A.D. (2021). Benzodiazepines: Uses, Dangers, and Clinical Considerations. Neurology International, 13(4), 594-607.