Alcohol – No Rx for insomnia

Alcohol before bed: No Rx for insomnia

Research suggests having a drink before bed can worsen insomnia, not ease it

Many people think of alcohol as a substance that can help them relax after a long day at the office or even act as a sleeping aid after a stressful or active day.

But a drink before bed can have a serious effect on sleep, often aggravating insomnia rather than eliminating it. And for those people at risk for alcohol dependence, drinking regularly before bed, over time, could lead to dependency.

In fact, ongoing research at the Addiction Research Center at the University of Michigan Health System shows a strong relationship between alcohol dependence and insomnia, defined as trouble falling asleep, staying asleep or feeling dissatisfied with sleep. The study revealed that up to 75 percent of people surveyed who were alcohol dependent had difficulty with insomnia. However, alcohol’s effect on sleep is not limited to those who are alcohol dependent.

"Alcohol disrupts sleep," says Kirk Brower, M.D., a U-M addiction psychiatrist who leads the research. "It may help people initially fall asleep, but as it wears off when blood alcohol levels drop during sleep, it will cause a person to wake up or have restless sleep."

Alcohol dependence, also affects other areas of a person’s life. When a person is alcohol dependent, he or she may drink more than intended, even though there may be a desire to stop or cut down. Due to an impaired control over alcohol, a person who is alcohol dependent will continue to drink despite adverse consequences. Alcoholism often refers to a severe, chronic and progressive form of alcohol dependence, which worsens over time without treatment.

A vicious cycle can develop when people become dependent on alcohol to help them sleep. The alcohol may work initially, but over time, it can disrupt sleep, causing a person to feel the need to drink even more before bed to fall asleep. Ultimately, Brower says, this cycle leads to an increased use of alcohol.

"There’s really a spectrum of drinking before bed," says Brower. "Some people have one drink, the so-called ’nightcap,’ while other may drink more heavily, causing an even greater disruption to sleep. But sleep laboratory tests have also shown that even one drink before bed can be disruptive to sleep."

Taking an even closer look at the effect of alcohol on sleep, Brower and his colleagues at U-M have studied the sleeping patterns of people who had been diagnosed as alcohol dependent. The study was based on the patients’ self-reporting of their sleep patterns and overnight stays at a U-M sleep laboratory.

The study followed the patients for about five months after they began treatment for alcohol dependence. The researchers found that those people who complained the most about sleep, experienced the most insomnia, and had the most disruptive sleep while at the sleep laboratory, were more likely to relapse to alcohol use and dependence then those who did not complain of insomnia.

Following the study, Brower says he and his colleagues decided to explore ways to help alcohol dependent people with their sleep problems to prevent them from using an alcoholic "nightcap" as a solution.

Alcohol dependence is often a matter of life and death, says Brower. In many cases, it can lead to automobile accidents, liver and brain disease and some forms of cancer. It can also impair relationships and job performance, taking a toll on a person’s entire life.

"We are always looking for ways to help people with sleep and other problems without resorting to sleeping pills that have some abuse potential because they are habit forming," says Brower. "There are a variety of other medications out on the market that are not necessarily designed for sleep, but are used to treat other disorders such as depression or epilepsy. We’ve found that some of those medications work quite well in people with alcohol dependence."

Sometimes, however, the first and most difficult step for a person facing alcohol dependence is to admit they have a problem. Often, Brower says, it is the people surrounding that person that initially recognize there is a problem.

"For people who don’t think they have a problem, we may ask them to demonstrate that by abstaining completely from alcohol for several weeks or longer. People who can abstain readily at will are unlikely to have alcohol dependence. People who cannot are candidates for treatment.

But there is treatment for alcohol dependence such as various forms of counseling and medications like disulfiram and naltrexone. Brower is the executive director of Chelsea Arbor Treatment Center, which provides these treatments.

"Treatment works," Brower says. "Studies have shown that about two-thirds of people who undergo treatment for the condition either significantly reduce their drinking or are able to abstain from alcohol completely."

Facts about the effect of alcohol on sleep:

For one in ten Americans who are alcohol dependent, a drink before bed can have a serious effect on their sleep, in most cases creating insomnia rather than eliminating it.

A recent study conducted by the Addiction Research Center at the U-M Health System showed that up to 75 percent of people who are alcohol dependent experience insomnia.

Drinking before bed can develop into a vicious cycle. When one drink isn’t enough to avoid sleeplessness or restless sleep, most often alcohol consumption is increased before bed to aid with sleep.

About two-thirds of people who undergo treatment for alcohol dependency either significantly reduce their drinking or are able to abstain from its use. Often it’s necessary to correct other problems, such as sleep disorders, that may result in alcohol use to treat the dependence successfully.

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