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 FAAN FAHA FAASM, editor. (

Dr. Culebras of SUNY Upstate Medical University at Syracuse received an honorariums from Jazz Pharmaceuticals for a speaking engagements.

)
Originally released November 22, 1993; last updated January 12, 2021; expires January 12, 2024

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, consuming alcohol before bed is used to ease pain, anxiety, or depression, and aid in falling asleep among other ailments (Haighton et al 2018). 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). 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. This has been shown repeatedly and in large samples of individuals who consume heavy alcohol weekly (Zheng et al 2020).

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).

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