CRSD-DSP is a particular subtype of circadian rhythm sleep disorders that is characterized by going to bed later in the night and awakening later in the morning. This later sleep-wake timing may interfere alcohol-induced sleep disorder with daily activities and patients may present with complaints of insomnia, sleepiness and impaired daytime functioning. Circadian rhythm sleep disorders may be easily assessed in a clinic setting using sleep diaries, actigraphy or with the help of rating scales that evaluate the patient’s propensity for sleep at a particular time during the 24-hour period. Prior research has linked alcohol use with the blunting of circadian rhythms in healthy adults 5, and, alcohol use disorder (AUD) with insomnia and a nocturnal delay in the rise of melatonin level (a marker of circadian activity) 6,7. Early theories regarding the neurobiology of sleep focused on the role of a group of compounds called monoamine neurotransmitters, particularly serotonin and norepinephrine (Jouvet 1969). Because alcohol also was known to affect these compounds, investigators speculated that alcohol disrupted sleep by altering the actions of monoamine neurotransmitters (Johnson et al. 1970; Smith et al. 1971; Zarcone et al. 1978).
The Science Behind Alcohol’s Impact on Sleep Quality
Alcohol can lead to several disruptions in sleep quality, including fragmented sleep patterns and problems with breathing during sleep. As the night progresses, the effects of alcohol wear off, causing increased light sleep and frequent awakenings, which leads to fragmented and low-quality sleep. In the initial stages of sleep with alcohol, deep sleep is increased, while REM sleep and light sleep are decreased. Later in the night, deep sleep decreases, REM sleep remains decreased, and light sleep increases. There is scant literature on the treatment of sleep problems in patients with sedative-hypnotic use disorder. Pregabalin has shown promise in decreasing insomnia and the use of benzodiazepines and to bolster abstinence43,44.
- Sedating antidepressant medications such as trazodone or doxepin are often used in the United States to treat insomnia and insomnia co morbid with depression.
- Neuroadaptation means that in response to the chronic exposure to alcohol, the brain adjusts its baseline activities to compensate for alcohol’s effects on brain-cell functioning.
- PSG is the term used to refer to the continuous recording of multiple physiological parameters during sleep that differentiate sleep and wake and the two distinct sleep states NREM and REM sleep.
- Future research would be improved by consistent reporting of both sleep and alcohol use outcomes.
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- Alcohol relaxes upper airway dilator muscles (decreasing airway patency) increasing nasal and pharyngeal resistance (58,59), and it prolongs the time required to arouse or awaken after an apnea occurs (60).
Can Sleep Problems Predispose People to Alcoholism?
- Ordinarily, alcoholism treatment programs assume that sobriety is the best treatment for restoring a patient’s natural sleep rhythms.
- The potential for improving drinking outcomes by treating sleep disturbance is being investigated.
- Theories suggest that for certain people drinking has a different and stronger impact that can lead to alcohol use disorder.
- You might not recognize how much you drink or how many problems in your life are related to alcohol use.
- Recommendations for future research are provided along with special considerations for treating insomnia in this population, including avoiding cross-dependent sedatives, such as benzodiazepines and benzodiazepine receptor agonists (BzRAs).
Chronotype is a product of both the homeostatic sleep drive and the circadian timing 10. Chronotype can be conceptualized as being categorical (“morning”, “evening”, and “indeterminate” or “neither” types) or dimensional (ranging from extreme morningness to extreme evenigness) in nature. The “evening” type (greater eveningness) individual prefers a later bedtime and a later rise time and has a greater need for sleep.
Alcohol Dependence and its Relationship with Insomnia and Other Sleep Disorders
Alcohol also selectively depresses hypoglossal nerve activity and alters carotid body chemoreceptor function. Behavioral studies suggest that up to 2 to 3 standard drinks before bedtime initially promotes sleep, but these effects diminish in as few as 3 days of continued use. Clinical investigations support a relationship between sleep disturbance and alcohol use, but variability in the definition and measurement of these domains and a preponderance of cross-sectional studies make uncertain the strength and direction of the association. In contrast, therapy seeking is evident if the drug has demonstrated efficacy for the disorder or condition being treated.
Conversely, the “morning” type individual (greater morningness) prefers an earlier bedtime and an earlier rise time. As children grow older and approach adolescence, many of them may experience a shift towards eveningness, a phenomenon seen commonly in boys 11. Beyond the second decade of life, individuals tend to revert back towards morningness 12. The clinical significance of eveningness is that emerging evidence has linked it with an increased risk for psychopathology such as alcohol misuse 5.
Additional evidence what is Oxford House regarding the role of norepinephrine derives from two other strains of selectively bred mice—long-sleep and short-sleep mice—which differ in their sedative response to alcohol. As the names imply, long-sleep mice have longer sleep times than short-sleep mice following acute exposure to alcohol. Furthermore, low alcohol doses, which can be stimulating in humans (Roehrs and Roth 1995), have been shown to raise nor-epinephrine levels in the cortex of rats (Rossetti et al. 1992).
Methods of non-pharmacological sleep intervention delivery
Rotating shift workers and night workers report a disproportionate use of sedating drugs, especially alcohol, to improve sleep and stimulants especially caffeine to improve alertness (18, 19). Restless legs syndrome (RLS) affects 10-15% of individuals with alcohol-induced sleep disorder. RLS is a neurological condition characterized by an uncontrollable urge to move the legs, usually due to uncomfortable sensations. Individuals with RLS may experience worsening symptoms after consuming alcohol, particularly in the evening or at night, leading to difficulty falling or staying asleep. In addition to disorders of the circadian rhythm, human beings also exhibit a trait-like preference for their timing of sleep and wakefulness that is called chronotype (also known as morningness-eveningness and circadian preference).
