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Holiday nightcap? Drinking before bed may be counterproductive

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If you've ever taken a drink of alcohol before bed to help you fall asleep, you're not alone - approximately 20 percent of Americans do so regularly. But new research from the University of Missouri shows that while a nightcap can make you sleepy in the short term, regular alcohol consumption before bed interferes with the body's sleep regulator and can actually cause insomnia.

A study published last month in Alcohol helps us understand alcohol's effects in a new way. It was previously thought that alcohol shifts the circadian rhythm, the body's "internal clock," resulting in simply being sleepy sooner; in fact, it disrupts the mechanism by which the brain "feels" tired. Alcohol increases the production of adenosine, a naturally occurring chemical that accumulates outside cells when you've been awake for a long time; it signals the need for sleep by blocking "wakefulness" receptors in the basal forebrain. Adenosine levels decrease during sleep, maintaining the brain's sleep/wake homeostasis.

Alcohol-induced adenosine wears off too quickly, which makes for less restful sleep in the short term, and can compromise the brain's ability to maintain homeostasis in the long term (i.e., insomnia).

I asked Stanford sleep expert Brandon Peters, MD, to weigh in and he told me:

I concur that alcohol should not be used as a sleep aid. Though alcohol may induce sleepiness, as it quickly wears off it fragments sleep, leading to awakenings. Alcohol also can relax the muscles of the upper airway and contribute to obstructive sleep apnea and snoring. It is recommended that alcohol not be consumed for the several hours preceding bedtime.

What to do instead? Peters suggests:

Rather than relying on an alcohol-containing nightcap, insomnia can be improved with changes as part of a structured cognitive-behavioral therapy for insomnia (CBTI) program. Sleeping pills are also not a preferred option; you don't need medication to feel hungry, so why would you need medication to feel sleepy? Sleep is a natural process that can be enhanced with simple interventions. If difficulty falling or staying asleep persists beyond 3 months, assistance should be sought from a board-certified sleep specialist.

Photo by Stephen Janofsky

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