Sleep and alcohol use and abuse

Deirdre A Conroy PhD (Dr. Conroy of the University of Michigan has no relevant financial relationships to disclose.)
Antonio Culebras MD, editor. (Dr. Culebras of SUNY Upstate Medical University has no relevant financial relationships to disclose.)
Originally released November 22, 1993; last updated May 28, 2017; expires May 28, 2020

This article includes discussion of sleep and alcohol use and abuse, sleep disorders associated with alcohol abuse to promote sleep, sleep disorders associated with alcoholism, sleep disorders associated with alcoholism abstinence, sleep disorders associated with moderate acute alcohol use. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

The author explains the basics of alcohol-related sleep disorders. She discusses the acute and chronic effects of alcohol on sleep as well as the management of sleep disorders during alcohol withdrawal and in recovering alcoholics. Insomnia in abstinent alcoholics is a common clinical problem that can increase the risk of relapse. Unfortunately, this is an area of only limited clinical research, though there are some data for the utility of cognitive-behavioral therapy for the treatment of insomnia in recovering alcoholics. The potential usefulness of ramelteon, gabapentin, and acamprosate for this condition is also discussed. New research has focused on the effects of ethanol on circadian rhythms. Child and adolescent sleep disturbances may predict alcohol abuse.

Key points

 

• Alcohol can have sedating effects on sleep initially, but can become sleep disruptive with chronic use.

 

• Objective and subjective sleep disturbances have been observed several years after drinking has stopped in recovering alcoholics.

 

• Persistent sleep disturbances are common and are related to relapse.

 

• Studies have shown that childhood and adolescent sleep disturbance may play a role in future drinking.

 

• Pharmacological and nonpharmacological treatments (eg, cognitive behavioral therapy for insomnia) have been shown to improve sleep in recovering alcoholics.

Historical note and terminology

Alcohol, long recognized for its hypnotic effects, was a staple of early medicine for both analgesic and sedative benefits. Even now, moderate consumption of alcohol, particularly wine, has been associated with a more active lifestyle and a better perception of health in Spanish elderly individuals (González-Rubio et al 2016). With the development of standardized EEG sleep recordings and other techniques of sleep disorders medicine, however, it quickly became apparent that alcohol use not only fails to improve sleep but actually severely disrupts it. The first reported recordings by Yules and colleagues showed a surprising disruption of early morning sleep even after a single moderate dose of alcohol before sleep (Yules et al 1966; Yules et al 1967). Other studies showed that even 1 moderate dose of alcohol at night leaves the individual more tired the next day and that chronic use of alcohol exacerbates several sleep disorders. Thus, the "nightcap," a highly esteemed folk medicine, is in fact a great thief of the night's sleep and the day's alertness.

Two alcohol-related sleep disorders were included in The International Classification of Sleep Disorders, Revised: Diagnostic and Coding Manual (ICSD-R) (American Academy of Sleep Medicine 2001). Alcohol-dependent sleep disorder referred to the chronic use of ethanol to induce sleep in the absence of alcohol abuse or dependence. A person with a diagnosis of alcohol abuse or dependence who complained of insomnia or excessive daytime sleepiness met criteria for “alcoholism associated with sleep disturbance” (unless the findings were due to another medical, mental, or sleep disorder). Nomenclature for alcohol-related sleep disorders was revised in The International Classification of Sleep Disorders, 2nd ed: Diagnostic and Coding Manual (ICSD-2) (American Academy of Sleep Medicine 2005). For each of the 8 categories of sleep disorders, the ICSD-2 has a “due to drug or substance” diagnosis. For example, a person with alcohol abuse or dependence who has insomnia temporally associated with alcohol “exposure, use or abuse, or acute withdrawal” meets criteria for “insomnia due to drug or substance” (in the absence of another sleep disorder, medical disorder, or psychiatric disorder causing the sleep disturbance). The ICSD-2 notes that, for coding purposes, the person should also be given a specific substance abuse and dependence diagnosis (eg, alcohol dependence). A person who drinks alcohol close to bedtime but does not meet criteria for alcohol abuse or dependence could be given a diagnosis of “inadequate sleep hygiene.” Nomenclature for The International Classification of Sleep Disorders, 3rd ed: Diagnostic and Coding Manual (ICSD-3) maintains the “due to drug or substance” diagnosis for sleep apnea, sleep related hypoventilation, parasomnias, sleep related movement disorder, insomnia, and hypersomnia. However, the ICSD-3 now acknowledges the difficulty in distinguishing between primary and secondary insomnia because insomnia may precede or become an independent disorder in the context of the drug or substance disorder. Therefore, ICSD-3 suggests it is inappropriate to use the term “secondary insomnia.” The ICSD also provides the ICD-10-CM coding for substance-induced disorder (eg, F10.xxx-F19.xxx), which contains the codes for substance-induced sleep disorders (American Academy of Sleep Medicine 2014).

The content you are trying to view is available only to logged in, current MedLink Neurology subscribers.

If you are a subscriber, please log in.

If you are a former subscriber or have registered before, please log in first and then click select a Service Plan or contact Subscriber Services. Site license users, click the Site License Acces link on the Homepage at an authorized computer.

If you have never registered before, click Learn More about MedLink Neurology  or view available Service Plans.