Alcohol: The Real Reason You Can’t Sleep
If you know someone with sleep problems, they may tell you that their “sleep solution” is an occasional alcoholic drink before bed.
However, research continually shows that using alcohol for sleep issues is a very slippery slope. If you dig deep enough, you’ll find that alcohol is often involved in a variety of issues, including skewed sleep quality and quantity, used in tandem with other sleep aids, altered sleep patterns, and poor digestive health.
Some of the conclusions on alcohol’s effects in recent research are below:
- “Alcohol (vodka: 0.54 g/kg for men and 0.49 g/kg for women) reduced melatonin levels by 15% (males) and 19% (females), respectively, in comparison to placebo.”
- “People who use alcohol as a sleep aid are more tired and show lower daytime alertness than people who abstain from alcohol at night.”
- “Both insomnia and sleeping pill use increase with age, and alcohol is often used in conjunction with over-the-counter sleep medications.”
You see, alcohol use is very similar to sleep deprivation. When you first start drinking alcohol, you don’t notice the effects on your sleep. You feel normal, and your system counteracts the alcohol.
But over a few hours, alcohol starts to accumulate and eventually the side effects are inevitable. And, sleep deprivation is exactly the same. Initially, your body is able to “pick up the slack,” but eventually the effects catch up to you.
Alcohol: The Sleep ‘Aid’ Everyone Loves But No One Needs
Let’s talk about the stages of sleep first. They fall into two main categories:
- Stage I
- Stage II
- Stage III
- Stage IV
- REM (Stage V)
During the night, you progress through all 5 stages of sleep every 90 minutes. This is the natural cycle of sleep regulation that occurs during a normal night.
However, users skip or shorten certain stages when they consume any form of ethanol, the principal ingredient in alcoholic beverages.
An estimated 1 in 4 people with insomnia use alcohol on a semi-regular basis to fall asleep. Interestingly, as many as 67% of users report that it actually helps with sleep. Part of the problem with alcohol is that users don’t recognize the way it hinders their sleep quality.
Research has consistently shown that any short-term benefits of alcohol quickly dwindle with long-term use:
“The 0.6 g/kg ethanol dose increased total sleep time and stage 3–4 sleep on night 2, but these effects were lost by night 6 (p < .05).” 
Alcohol tends to increase non-REM sleep (at least initially) but also reduces REM sleep. This is especially problematic because REM sleep is where the human body repairs most of the physical damage that occurs throughout the day, such as muscle damage from exercise.
Unfortunately when you drink, the short-term increase in non-REM sleep associated with alcohol quickly deteriorates, leaving the user unrefreshed after a night of sleep and struggling to stay awake during the day.
But let’s break down the amount of alcohol. Using the 0.6g/kg guideline mentioned above, let’s say a 185-pound man consumes roughly 4.5 ounces of liquor, 15 ounces of wine, or 36 ounces of beer.
To put that into perspective, society considers a single serving to be 1.5 ounces of liquor, 5 ounces of wine, or 12 ounces of beer. In other words, 3 full servings of any alcoholic category starts the process of sleep deterioration.
Regardless of what you may think or how you feel, alcohol doesn’t improve your sleep. It just feels like it.
Alcohol and Your Brain
If the sleep ramifications aren’t enough to make you reconsider your alcohol intake before bed, perhaps cognitive decline might grab your attention.
Currently, there are over 5 million Americans living with Alzheimer’s. In 2020, our nation spent over $305 billion on treatment of dementia-related illnesses. Insurance covers a large portion of that. However, it’s expected that out-of-pocket expenses are more than $66 billion.
If those numbers still don’t put things into perspective, that equates to over $13,000 dollars spent per patient yearly.
You may wonder how that applies to the fact that you like to drink with dinner and don’t sleep well…
Within the body, there are two very important systems – lymphatic and glymphatic. They are both specifically designed for waste removal using an internal drainage system. Lymphatics run throughout the entirety of the body, while glymphatics are primarily regulated within the brain.
When you sleep, your glymphatic system essentially “takes out the trash” within your brain. It removes certain sticky proteins (amyloid beta and tau), which form due to normal metabolic function.
Unfortunately, exceedingly high doses of alcohol have a way of shutting down metabolite clearance within the glymphatic system of the brain:
“Chronic 1.5 g/kg alcohol intake induced reactive gliosis (i.e. injury to the central nervous system) and perturbed glymphatic function (i.e. metabolic detoxification), which possibly may contribute to the higher risk of dementia observed in heavy drinkers.” 
They researched this on mice, but it’s mechanistic. It would be exceptionally difficult for the research team to get this study passed by an institutional review board (IRB) to perform on humans, because of the ethics involved. So, use this research as a cautionary tale for now.
Excessive alcohol intake sets you up for long-term metabolic dysregulation within the brain because of its influence on sleep, the glymphatic system, and the connection between both.
Ethanol and Your Microbiome: Misused and Misunderstood
This is where things start to get tricky. Your microbiome is tied to every system in the human body, so it’s immensely complex. The microbiome is the network of bacteria (both helpful and harmful) in your gut that determines how you process your food, and other particles consumed.
Your gut contains over 80% of your immune system, because this is the primary location where we interact with the outside world via the food we consume. Therefore, it needs to be highly sensitized to determine friend vs foe.
When you mess with microbiome integrity, you open up a HUGE door to a host of pathology. In this case, the research has examined how alcohol coupled with night shift work essentially kicks open the door to microbiome dysfunction.
Here’s a quick excerpt:
“Both the night work (NW) and day work (DW) groups had no change in small bowel permeability with alcohol, but only in the NW group was there an increase in colonic and whole gut permeability.”
In essence, when you flip someone’s circadian rhythm by having them awake at night and asleep during the day, you increase the likelihood of auto-immune issues, food sensitivities, digestive distress, or even other pathologies, such as skin problems.
But, here’s the kicker…
When you add alcohol into the mix, you alter the genes controlling sleep regulation (named CLOCK, BMAL, PER1, CRY1, CRY2), and increase inflammation (named LPS-BP, LPS, IL-6) in the body.
In other words, you’ve initiated a few cellular cascades which have the potential to create smoldering chronic inflammation and sleep dysregulation.
Are you connecting the dots?
This has endless implications across every system in the body. This is much bigger than just a hangover.
I Still Want To Drink, So What Can I Do?
Granted, there are times when alcohol is part of life and the good times that come along with it. Think of festivities like holidays, graduation parties, and weddings.
Life is meant to be lived in balance. So, use guidelines that keep you healthy. Here are a few things to keep in mind before you drink:
- Try to drink further away from bedtime whenever possible. Have wine with dinner instead of right before bed.
- Stay hydrated throughout the rest of the day. Total water intake along with electrolyte intake and micronutrient status all play an important role in how alcohol affects you. When you are planning to drink, ensure you drink half your bodyweight in ounces of water during the day. Add electrolytes by salting your meals to taste, and eat a variety of potassium-rich foods.
- Be mindful of calories. Alcohol has 7 calories per gram, and liquid calories add up quickly. If you are going to drink, account for it within your daily calories if you have weight loss goals.
- Consistency trumps intensity (aka quantity). Like most things in life, it’s better to live in balance. Having one or two drinks once or twice a week is likely better than saving all your alcohol for one night and having 5-6+ drinks.
- If you work night shifts or swing shifts, consider avoiding alcohol entirely until you’ve swapped to day shifts. Given the research, alcohol coupled with night shifts is a recipe for disaster when it comes to circadian and GI changes.
While alcohol may not be the best choice for sleep in the long run, the occasional drink may be enjoyed in moderation if you have a system in place that keeps you happy and healthy.