Alcohol and Insomnia Signs, Symptoms and Treatment

If you’ve ever struggled with insomnia or are currently struggling with it, you know that it can be extremely difficult to find methods that work long-term to help you sleep. While meditation, dietary restrictions, daily bedtime routines, certain over-the-counter remedies and regular exercise may promote healthy sleep patterns, studies have shown that some insomniacs turn to alcohol as a sleep aid because of its sedating effects.¹

Although alcohol may promote early sedation or sleepiness, because of certain neurological effects, as well as its reinforcing properties, it could further disrupt the natural sleep cycle and, ultimately, lead to issues such as dependence or an alcohol use disorder.¹ Studies have shown that 28% of insomniacs reported using alcohol to help them sleep.¹ It was also reported that at 1-year follow-up, those who had reported 2 or more weeks of insomnia were more likely to have met the diagnostic criteria for alcoholism.¹ 

Whether you use alcohol occasionally or nightly to fall asleep, it’s important to know the risks associated with frequent alcohol use and how it may lead a co-occurring disorder in the future.

What Is Insomnia?

Insomnia is a sleep disorder characterized by difficulty in falling asleep and/or staying asleep. According to the National Institutes of Health, more than 40 million Americans suffer from chronic sleep disorders and an additional 20 million report occasional sleep problems.²

Individuals can have either short-term (acute) or long-term (chronic) insomnia.³ Acute insomnia generally lasts just a few days or weeks and is often related to stress, worry, or traumatic events. It is characterized as irregularities in the quality, quantity, or timing of sleep.^1,3,4 Chronic insomnia can last for months or longer and is most often the result of other underlying issues such as drug or alcohol abuse, medical conditions or as a side effect of some medications. ^3,4 

Insomnia can be diagnosed by a primary care physician who will look at medical and psychiatric history as well as issues in a person’s life that could contribute to the development of insomnia, such as work, relationships, new or ongoing forms of stress, as well as any tobacco, caffeine, or other substance use.⁴ You may also be asked to do a physical exam which may involve blood tests to rule out other medical issues that might cause the disorder.⁴ 

Some patients may also undergo a polysomnogram (PSG) sleep study to more closely investigate whether an underlying sleep disorder is causing insomnia.⁴ This involves an overnight stay at a sleep center in order for physicians to record brain activity, heart rate, eye movements, and blood pressure.⁴ PSG also monitors how much air is moving through your nose while you breathe, the amount of oxygen in your blood, snoring, and chest movements to see whether an effort to breathe is being made.⁴

Insomnia Risk Factors

There are several factors that can increase a person’s risk for insomnia which include:^3,4,5

• Stress.
• Substance use (e.g., alcohol, drugs, caffeine).
• Depression or distressing emotional issues, such as those caused by the death of a loved one.
• Low income/financial worries.
• Frequent shifts in work hours.
• Traveling with time changes.
• An inactive lifestyle.
• Being African American (studies show that African Americans do not sleep as well, take longer to fall asleep, and can have breathing issues that may disturb sleep).
• Uncomfortable sleeping conditions (e.g., noise, a room that’s too hot or too cold).

Insomnia can also develop at any age but is seen more in older adults and affects women more often than men.⁴

Signs and Symptoms Of Insomnia

The most common symptom of insomnia is the inability to fall or stay asleep. Other symptoms may include:^3,4

• Lying awake for long periods before you can fall asleep.
• Sleeping for short periods.
• Staying awake for much of the night.
• Feeling like you haven’t slept when you awaken in the morning.
• Waking up too early.

Because lack of sleep can lead to other issues, insomnia may also cause individuals to experience feelings of anxiety, depression or irritability.⁴ Sleepiness can also create dangerous situations such as dozing off while driving.⁴ Driver sleepiness is responsible for almost 20% of all serious car crash injuries not involving alcohol.⁴

Anxiety, Depression & Alcohol Use

Anxiety and depression, as well as many other psychiatric disorders, are closely linked with disrupted sleep. Evidence has shown that people with depression are 10 times more likely to suffer from insomnia and those with anxiety have a high risk of developing the sleep disorder.⁶ Conversely, chronic insomnia can also increase the risk of anxiety disorders.² 

Since people with insomnia are more likely to feel anxious or depressed, they may be more likely to use alcohol as a way of numbing or managing their symptoms.⁷ Around 20% of Americans with anxiety or mood disorders like depression also have an alcohol or substance use disorder.⁷ Similarly, 20% of people with an alcohol or substance use disorder also suffer from anxiety or depression.⁷

What is Alcohol Use Disorder?

When a person develops compulsive patterns of alcohol abuse, experiences a loss of control over use, and a negative emotional state when not drinking, they may be suffering from an alcohol use disorder.⁸ AUD is a chronic, relapsing disease that is diagnosed based on an individual meeting at least 2 of 11 criteria outlined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) within the same 12-month period.⁸

People who are at risk of AUD may experience and exhibit certain feelings and behaviors such as:⁸

• Feeling that they should cut down on their drinking.
• Feeling bad or guilty about drinking.
• Feeling that they need a drink first thing in the morning (for example, to get rid of a hangover).
• Spending a lot of time drinking.
• Giving up important activities to drink.
• Getting into risky situations because of drinking.

Women who consume no more than 3 standard drinks per day and no more than 7 per week are considered to be in a low-risk category for developing AUD. This low risk group for men includes those who consume no more than 4 drinks per day and no more than 14 per week.⁹ People who exceed these parameters are at relatively higher risk of developing AUD. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), a standard drink has 14 grams of pure alcohol, which can typically be found in:¹⁰

• 5 ounces of wine (12% alc. content).
• 8 ounces of malt liquor (7% alc. content).
• 12 ounces of beer (5% alc. content).
• 5 ounces or a “shot” of 80-proof (40% alc. content) distilled spirits or liquor (e.g., whiskey, vodka, gin, rum).

Is Alcohol Abuse More Prevalent Among Insomnia Sufferers?

Research supports a strong relationship between sleep disorders like insomnia and substance abuse issues such as alcoholism.^1,11 In fact, alcohol is the is most-widely used sleep-promoting agent by the general public.¹² In a survey, 13% of respondents reported having used alcohol to assist in sleep in the preceding year, while 2% of those consumed alcohol continuously for a month in order to promote sleep.¹²

Studies also found that, among patients with an AUD diagnosis, reported insomnia rates were 25–72% higher than the general population.¹³ According to the American Society of Addiction Medicine (ASAM), insomnia is a common comorbidity of mental disorders, and the risk relationship between the two is bidirectional.¹⁴ This means that insomnia increases the risk of mental disorders (i.e., alcoholism) and alcoholism increases the risk of insomnia.¹⁴ The direction of the relationship may also change over time and is not always clear.¹⁴

In individuals without AUD who use alcohol to fall asleep, it has been shown that with frequent use, its intended effect (sleep) can become lighter and more easily disrupted.¹² As tolerance builds to alcohol’s sedative effects, it’s already questionable utility as a sleep aid diminishes even more. As sleep worsens as a result, it can also lead to a feeling of fatigue when an individual is awake.¹²

It is not uncommon for those in early alcohol recovery to experience insomnia in connection with decreased sleep efficiency, increased sleep latency (time to fall asleep), and decreased total sleep time.¹⁵ One study found that the prevalence of insomnia ranged from 36% to 72% in patients admitted for alcoholism treatment.¹¹ In some cases, the sleep problems prevalent among people in treatment for AUD may persist long after they have achieved abstinence.¹³

The Treatment of Co-Occurring Insomnia and Alcoholism

To treat insomnia, the first line of defense is often lifestyle changes to relieve acute symptoms and make it easier to fall or stay asleep.⁴ Other methods may include cognitive-behavioral therapy (CBT) for chronic insomnia suffers to help relieve anxiety.⁴ In some instances, prescription medications may also be used to re-establish a regular sleep schedule, though some of these have abuse potential of their own.⁴

Research on treating insomnia in people with alcoholism is somewhat limited.^15,16 However, due to an association between insomnia and relapse, treatment for AUD should absolutely address the insomnia issue during the recovery process via a substance abuse treatment program.¹³

While in treatment, other psychological, medical, and social problems that may contribute to insomnia should be addressed early on.¹³ Still, sleep may not immediately improve with abstinence and may even lead to more sleep disruptions during the first 2-3 weeks of recovery.¹² Because of this, there is an increased risk of relapse as individuals struggle to find normal sleep patterns without the assistance of alcohol.¹²

Typically, sedative–hypnotic medications, such as benzodiazepines and nonbenzodiazepines (e.g., Ambien), are prescribed to treat sleep issues.¹³ Yet, for individuals struggling with AUD, these medications are likely to be avoided as they have inherent abuse potential and may lead to withdrawal symptoms when stopping use.¹³ While medications such as trazodone or gabapentin are effective in alleviating insomnia in individuals within recovery, other treatment methods, such as biofeedback, relaxation training, CBT, and sleep hygiene therapy may also be helpful.¹⁷