Staff Perspective: The Slippery Slope from a Bad Night’s Sleep…to an Alcohol Problem?
Have you ever said “I need a drink!” to a friend or colleague? Maybe you’d had a long, stressful day, or maybe you wanted to unwind and relax before bed. I think it’s endemic in our society to an extent, the use of having a drink – let me clarify, an alcoholic drink – to de-stress, and by extension for many, to try to get to sleep.
You’ll notice I said “try” there. We may perceive a benefit of drinking on our sleep for a night, but objective data have shown that drinking actually worsens sleep over time. In a recent study, Roehrs and Roth (2018) found that while the equivalent of four beers on one night did improve sleep ability, as measured by sleep efficiency among persons with insomnia, after six nights of continued drinking that effect was gone, and on top of that, study participants had an increase in light sleep over that time, meaning they spent less time in deep sleep.
In a separate experiment, participants with insomnia were given either alcohol or a placebo for eight nights, and then given six more nights to choose what they wanted to drink before bed (Roehrs & Roth, 2018). This was done with color-coded cups, where for the first seven nights participants got a red cup with either alcohol or placebo, and the eighth night they received a blue cup with the opposite so they got to try each color. Yes, colors were counterbalanced among the groups. On the choice nights, those who had been ‘primed’ with alcohol in the baseline period were more likely to choose the cup color that contained alcohol, doing so on 54% of nights, versus 37% among those who had received placebo the first week. When they did choose alcohol, participants who had been primed with baseline alcohol went for twice as many refills as the group who hadn’t, which ended up being about twice as many servings as earlier in the study.
It seems what we can take home from this study is essentially that tolerance to the benefits of acute/one time use of alcohol on sleep develops rapidly, in less than a week. Because of tolerance, it appears people may begin to increase the amount of alcohol they consume, presumably to try to get back that initial sleep benefit. Over time, it’s possible this pattern of escalating alcohol use as a sleep aid could result in problematic use of alcohol. For example, a recent study of Service members and Veterans found that baseline self-reported insomnia symptoms predicted heavy drinking and alcohol problems six months later (Short et al, 2019; note “alcohol problems” were not defined). Of course, since we know that chronic alcohol use disrupts sleep (Thakkar et al, 2015), those who use alcohol as a sleep aid seem to end up with problems with both alcohol and sleep.
There’s a lot of literature out there on the cyclical relationship between sleep and alcohol and other substances. To save you hours of reading, if you’re interested in this topic I encourage you to watch the recording of the CDPP webinar “Exploring the Relationship Between Sleep & Substance Use Disorders”. You can also listen to a short podcast of the BLUF, or bottom line up front for those who aren’t familiar with this military term, where Dr. Andy Santanello and I talk about what we’ll cover in the webinar. If you can’t catch either of those, suffice it to say I strongly recommend against the use of alcohol or any illicit substance as a sleep aid and if your patient is overusing substances, consider the role of poor sleep and providing sleep-focused treatment options.
Now, I know you’re wondering how you can volunteer for a study where you get free alcohol in color-coded cups. I don’t know if there are any ongoing studies, but in case you’re curious, participants received Absolute vodka mixed with tonic water in a 1:4 ratio (for the placebo, a few drops of vodka were floated on the tonic water to mimic the smell of an alcoholic beverage). My keen detective work has shown that you can get 750 ml of Absolute for under $20, and tonic water is usually only a dollar or so. I love getting things free, but I am not so sure disrupting my sleep for a week or more is worth the equivalent of $20!
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Diana Dolan, Psy.D., is a clinical social worker currently working as a Military Behavioral Health Social Worker with the Center for Deployment Psychology (CDP) at the Uniformed Services University (USU) in Bethesda, Maryland.
References
Roehrs, T., & Roth, T. (2018). Insomnia as a path to alcoholism: tolerance development and dose escalation. SLEEP 41(8): doi: 10.1093/sleep/zsy091
Short, N.A., Allan, N.P., Oglesby, M.E., Moradi, S., Schmidt, N.B., & Stecker, T. (2019). Prospective associations between insomnia symptoms and alcohol use problems among former and current military service personnel. Drug & Alcohol Dependence 199: 35-41. doi: 10.1016/j.drugalcdep.2019.02.018
Thakkar, M.M., Sharma, R., & Sahota, P. (2015). Alcohol disrupts sleep homeostasis. Alcohol 49(4) 299-310. doi: 10.1016/j.alcohol.2014.07.019
Have you ever said “I need a drink!” to a friend or colleague? Maybe you’d had a long, stressful day, or maybe you wanted to unwind and relax before bed. I think it’s endemic in our society to an extent, the use of having a drink – let me clarify, an alcoholic drink – to de-stress, and by extension for many, to try to get to sleep.
You’ll notice I said “try” there. We may perceive a benefit of drinking on our sleep for a night, but objective data have shown that drinking actually worsens sleep over time. In a recent study, Roehrs and Roth (2018) found that while the equivalent of four beers on one night did improve sleep ability, as measured by sleep efficiency among persons with insomnia, after six nights of continued drinking that effect was gone, and on top of that, study participants had an increase in light sleep over that time, meaning they spent less time in deep sleep.
In a separate experiment, participants with insomnia were given either alcohol or a placebo for eight nights, and then given six more nights to choose what they wanted to drink before bed (Roehrs & Roth, 2018). This was done with color-coded cups, where for the first seven nights participants got a red cup with either alcohol or placebo, and the eighth night they received a blue cup with the opposite so they got to try each color. Yes, colors were counterbalanced among the groups. On the choice nights, those who had been ‘primed’ with alcohol in the baseline period were more likely to choose the cup color that contained alcohol, doing so on 54% of nights, versus 37% among those who had received placebo the first week. When they did choose alcohol, participants who had been primed with baseline alcohol went for twice as many refills as the group who hadn’t, which ended up being about twice as many servings as earlier in the study.
It seems what we can take home from this study is essentially that tolerance to the benefits of acute/one time use of alcohol on sleep develops rapidly, in less than a week. Because of tolerance, it appears people may begin to increase the amount of alcohol they consume, presumably to try to get back that initial sleep benefit. Over time, it’s possible this pattern of escalating alcohol use as a sleep aid could result in problematic use of alcohol. For example, a recent study of Service members and Veterans found that baseline self-reported insomnia symptoms predicted heavy drinking and alcohol problems six months later (Short et al, 2019; note “alcohol problems” were not defined). Of course, since we know that chronic alcohol use disrupts sleep (Thakkar et al, 2015), those who use alcohol as a sleep aid seem to end up with problems with both alcohol and sleep.
There’s a lot of literature out there on the cyclical relationship between sleep and alcohol and other substances. To save you hours of reading, if you’re interested in this topic I encourage you to watch the recording of the CDPP webinar “Exploring the Relationship Between Sleep & Substance Use Disorders”. You can also listen to a short podcast of the BLUF, or bottom line up front for those who aren’t familiar with this military term, where Dr. Andy Santanello and I talk about what we’ll cover in the webinar. If you can’t catch either of those, suffice it to say I strongly recommend against the use of alcohol or any illicit substance as a sleep aid and if your patient is overusing substances, consider the role of poor sleep and providing sleep-focused treatment options.
Now, I know you’re wondering how you can volunteer for a study where you get free alcohol in color-coded cups. I don’t know if there are any ongoing studies, but in case you’re curious, participants received Absolute vodka mixed with tonic water in a 1:4 ratio (for the placebo, a few drops of vodka were floated on the tonic water to mimic the smell of an alcoholic beverage). My keen detective work has shown that you can get 750 ml of Absolute for under $20, and tonic water is usually only a dollar or so. I love getting things free, but I am not so sure disrupting my sleep for a week or more is worth the equivalent of $20!
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Diana Dolan, Psy.D., is a clinical social worker currently working as a Military Behavioral Health Social Worker with the Center for Deployment Psychology (CDP) at the Uniformed Services University (USU) in Bethesda, Maryland.
References
Roehrs, T., & Roth, T. (2018). Insomnia as a path to alcoholism: tolerance development and dose escalation. SLEEP 41(8): doi: 10.1093/sleep/zsy091
Short, N.A., Allan, N.P., Oglesby, M.E., Moradi, S., Schmidt, N.B., & Stecker, T. (2019). Prospective associations between insomnia symptoms and alcohol use problems among former and current military service personnel. Drug & Alcohol Dependence 199: 35-41. doi: 10.1016/j.drugalcdep.2019.02.018
Thakkar, M.M., Sharma, R., & Sahota, P. (2015). Alcohol disrupts sleep homeostasis. Alcohol 49(4) 299-310. doi: 10.1016/j.alcohol.2014.07.019