Naps & Sleep Restriction: Could This Be a Happy Marriage?

Lesley Gale was a light sleeper who began to have insomnia about 8 years ago. She consulted doctors and tried the remedies they proposed, but nothing seemed to work. Investigating on her own, she came upon a treatment called sleep restriction therapy, or SRT.

“I had heard of SRT before,” Gale wrote in an e-mail, “having seen a couple of documentaries on TV about it, and then did further reading on the Internet. But for years I dismissed it instantly as being absolutely impossible for me.” Napping was off limits during SRT, and this was a deal breaker.

Sleep restriction for insomnia may be easier to comply with if insomniacs are allowed a brief afternoon napLesley Gale was a light sleeper who began to have insomnia about 8 years ago. She consulted doctors and tried the remedies they proposed, but nothing seemed to work. Investigating on her own, she came upon a treatment called sleep restriction therapy, or SRT.

“I had heard of SRT before,” Gale wrote in an e-mail, “having seen a couple of documentaries on TV about it, and then did further reading on the Internet. But for years I dismissed it instantly as being absolutely impossible for me, as I’m sure a lot of other people initially react.

“‘I need my 8 hours,’ I thought. I couldn’t possibly stay awake until the early hours of the morning—I’m a confirmed morning lark, not a night owl.” Having to stay up late was not the only problem Gale foresaw. Napping, too, was off limits during SRT, and for years, this was a deal breaker. “I can’t live without naps,” she said.

SRT and Naps

SRT, a behavioral treatment for insomnia, involves restricting time in bed for a while and then slowly adding time back in as sleep improves. Restricting time in bed is helpful because it enables a robust build-up of sleep drive during the day. The greater your sleep drive at bedtime, the more readily you’ll fall asleep and the more likely you are to sleep through the night. Anything that interferes with the build-up of sleep drive will retard your progress. So napping is generally discouraged.

But napping has never been strictly prohibited. In the first weeks of SRT, insomniacs tend to experience mild sleep deprivation, which can sometimes result in overwhelming sleepiness during the day. Sleepiness is dangerous if you’re driving a car or operating machinery. People are advised to avoid such dangers by taking a nap, but to keep the nap short. “No more than 30 minutes,” is the advice my sleep therapist gave me.

A New Perspective on Napping

Then a few months ago, I read about a study being conducted by Nicole Lovato, a postdoctoral research associate at Flinders University. The purpose of Lovato’s study is to find out if adding a 20-minute afternoon nap before 5 p.m. to the SRT protocol will not only keep from undermining the treatment but will actually increase its success.

“Even though we know this treatment [SRT] works very well,” Lovato said, quoted in Medical Express, “a lot of patients feel so sleepy that they find it difficult to adhere to their new bedtime, which is often much later than the time they normally go to bed. . . . We’re hoping that daytime napping will make it easier for patients to adhere to their bedtime and get through the day when they’re undertaking sleep restriction therapy.”

Unlike long naps, short naps are unlikely to interfere with the sleep restriction process. When you first fall asleep, you’re in the lighter stages of sleep, and hovering in the lighter stages will not diminish sleep drive. During long naps, on the other hand, you’re likely to descend into deep sleep. Deep sleep is the stuff that reverses sleep drive, and that is what you want to avoid.

A Testimonial

I wanted to have the results of Lovato’s study in hand before blogging about it. But I mentioned the study in the comment section of another blog, and Lesley Gale, whose desperation to find a solution to her insomnia had prompted her to start SRT despite her reservations, saw the comment and responded this way:

“I’m only 2 weeks into SRT, and I was so excited when I read . . . about naps maybe being OK with SRT,” Gale wrote. “Not being able to have naps has really put me off trying SRT before. But a ‘micro nap’ has worked wonders for me twice this week. About 10 minutes each time, I felt invigorated afterwards, and it didn’t affect my nighttime sleep at all.

“I can’t express what a massive relief it has been! Will keep this new favourite tool only for when I’m feeling really, really sleepy during the daytime. Just having that possibility in the back of my mind has made me feel so much more relaxed about making it through till bedtime.”

The Results Aren’t In Yet, but . . .

Reading Gale’s story has prompted me to go ahead and write about adding brief naps to SRT. People are sometimes desperate for ways to manage their insomnia, and if being allowed a 10- or 20-minute power nap in the afternoon before 5 p.m. might make SRT more palatable and easier to comply with, surely the benefits of mentioning it will outweigh the harm. If you try it out, though, make sure to set an alarm clock to keep your nap short and sweet.

Is Short Sleep an Inborn Trait?

We’re often warned about getting less than 7 to 8 hours of sleep a night. Short sleepers—variously defined as people who sleep 5 hours and less or less than 6—are more susceptible than normal sleepers to a host of problems: cardiovascular disease, obesity, diabetes, cancer, and dementia. Many people with insomnia fall within that 5- to 6-hour range. Rarely do we get encouraging news about our prospects for a healthy life.

But recent research on genetic mutations tells a different story. Not only does it begin to explain some of the differences in sleep duration among human beings. It also suggests that short sleep may not necessarily have adverse effects on our health and quality of life.

Sleep differences in fraternal twins may occur due to different DNA sequencingWe’re often warned about getting less than 7 to 8 hours of sleep a night. Short sleepers—variously defined as people who sleep 5 hours and less or less than 6—are more susceptible than normal sleepers to a host of problems: cardiovascular disease, obesity, diabetes, cancer, and dementia. Many people with insomnia get just 5 or 6 hours of sleep a night. Rarely do we get encouraging news about our prospects for a healthy life.

But recent research on genetic mutations tells a different story. Not only does it begin to explain some of the differences in sleep duration among human beings. It also suggests that short sleep may not necessarily have adverse effects on our health and quality of life.

Short Sleep but Not Insomnia

One of these studies was published in the journal Science in 2009. In it, investigators were looking at the DNA sequences of people who naturally tended to wake up early. They located a genetic mutation in a mother and daughter who typically slept 6 to 6½ hours a night.

The women’s nights were consistently shorter than the nights of other members of their family, who did not have the mutation and who slept about 8 hours. Yet they woke up feeling well rested in the morning, with no sign of insomnia at night or fatigue during the day.

The mutation occurred in a protein (known as BHLHE41) in which one amino acid was substituted for another. This genetic variant did not interact in the usual way with nearby genes controlling circadian rhythms. So the expectation might be that this variant would have some effect on the timing of sleep, and it did. The mother and daughter were early awakeners. But it also affected the duration of their sleep, predisposing them to shorter sleep.

More Genetic Variants

Then in August 2014 another team of researchers, examining the DNA sequencing in twins and unrelated subjects, announced the discovery of 2 new genetic variants of the same protein, BHLHE41. These researchers were looking for genetic factors in humans that confer resistance to sleep loss. One of the 2 variants they identified had a big impact on both sleep and performance after sleep deprivation.

The carrier of the novel variant was a 27-year-old man whose fraternal twin, also male, did not have the mutation. The sleep-related differences between the twins were fascinating:

  1. The carrier twin slept an average of 5 hours a night—over an hour less than his brother.
  2. Despite his shorter nights, the carrier had a similar amount of nonrapid eye movement sleep (NREM sleep) as his twin. NREM sleep is composed of light sleep and deep sleep, which is associated with restorative processes.
  3. After going 38 hours without any sleep at all, the carrier twin slept 8 hours while his brother slept 9½. Yet an analysis of brainwaves showed that the carrier had higher delta power during NREM sleep, suggesting greater sleep drive.

Response to Sleep Deprivation

The brothers’ response to sleep loss was fascinating, too. After a full night without sleep, they underwent standardized testing every 2 hours to measure their cognitive vulnerability to sleep deprivation.

It wasn’t the more normal sleeper who fared better on the tests. It was the short sleeper—the carrier of the mutation—who had “significantly fewer average lapses of performance” on the tests. Based on these results and results of other studies, the researchers conclude that this novel variant of the BHLHE41 is associated both with short sleep and resistance to the effects of sleep loss.

Whether it also protects people from the health problems linked to short sleep remains to be seen. But regarding obesity, the study is reassuring. The body mass index (BMI) of the noncarrier twin was on the heavy side of “healthy,” but the carrier’s BMI was well within the healthy range.

We hear a lot about the problems associated with short sleep. But occasionally some bit of research comes along showing that our prospects for healthy lives may not be so bad after all.

Timing Your Exercise for Optimal Sleep

It’s pretty well established now that exercise is good for sleep. Compared with couch potatoes, exercisers generally fall asleep more quickly, sleep more soundly, and feel more alert during the day.

The timing of your workout can also affect your sleep. Lack of exposure to sunlight can be a setup for insomnia, and now that the days are short, you may be able to improve your sleep by making exercise more regular or exercising at a different time of day.

exercising at the same time of day everyday helps your sleepIt’s pretty well established now that exercise is good for sleep. Compared with couch potatoes, exercisers generally fall asleep more quickly, sleep more soundly, and feel more alert during the day.

The timing of your workout can also affect your sleep. Lack of exposure to sunlight can be a setup for insomnia, and now that the days are short, you may be able to improve your sleep by making exercise more regular or exercising at a different time of day.

Challenging Gospel

First, let’s look at a new study that turns conventional thinking on its head. You’ve probably read that you shouldn’t exercise too close to bedtime. Exercise increases your heart and breathing rate, increases the stress hormones circulating in the blood, and delays secretion of melatonin. None of this is compatible with sleep—when your body is in rest-and-relax mode.

Still, there’s little evidence that vigorous exercise in the run-up to bedtime is harmful to sleep. So Swiss researchers set out to study the effects of evening exercise on 52 young adults who routinely exercised 2 or 3 nights a week. Specifically, they wanted to find out if the amount of exertion in the hours before bedtime would have a negative effect on sleep.

Surprising Results

Following an evening of normal exercise, subjects were hooked up to an EEG machine for the recording of brain activity during sleep. In bed, they completed a questionnaire to assess how vigorously they’d exercised and how they felt. Then the EEG recordings began, no more than 70 minutes after exercise stopped.

Surprisingly, the more vigorous the exercise,

  • the more tired subjects felt
  • the more quickly they fell asleep
  • the deeper and more efficient their sleep was, and
  • the fewer awakenings they had.

Not only did the results show that vigorous exercise late in the evening was not harmful to sleep. On the contrary, it actually improved sleep in many ways.

This study shows that evening workouts may be beneficial to the sleep of healthy young adults. Whether the results would generalize to other populations is still unknown, but the results bode well for people who want to exercise but can’t find time during the day.

Exercise and the Circadian System

What about people with insomnia and older adults? Evening exercise may be OK for us (or not), but when should we exercise to maximize our chances for sound sleep? Following is the gist of what little is known.

One key to using exercise to benefit sleep is to make the activity regular. Scheduled exercise is known to improve the function of the circadian system, and sleep tends to be more stable when internal rhythms are in sync.

Sunlight is the main external cue that keeps your internal circadian rhythms in sync with the earth’s 24-hour light/dark cycle. But exercise has a lesser synchronizing effect on circadian rhythms. Especially near the winter solstice, when you’re exposed to the least amount of sunlight all year, regular exercise may be a good way to keep insomnia at bay.

The Best Time of Day

Regarding optimal timing, one study found that long-term fitness training in the middle of the day improved the consolidation of the sleep/wake cycle in older men.

Other studies suggest that in older adults with insomnia, sleep quality is more likely to improve with exercise scheduled late in the afternoon or early in the evening. Research from the 1980s is supportive of this claim. Exercise heats the body up and eventually triggers an internal cooling mechanism favorable to sleep—specifically, deep sleep. So you may be able to improve the quality and depth of your sleep by scheduling exercise sessions later in the day. I have.

But the timing of your workout may be less important to sleep than doing it at the same time every day. So experiment to find out when exercise is more appealing (or least unappealing!) and seems to help with your sleep. Then make it part of your routine.

If you exercise, when do you do it, and does it help your sleep?

Short Sleepers, Steer Clear of Colds and Flu!

Cold and flu season has arrived. If you have insomnia or your sleep is on the short side of normal, it’s a good idea to take extra precautions to avoid these nasty bugs.

Why? Research shows that poor and short sleepers are more susceptible to infection than people who sleep a solid 7 to 8 hours. This heightened vulnerability has to do with the immune system, which is seemingly compromised in short sleepers, just as it’s compromised in the sleep deprived.

Here’s a quick explanation of why we short sleepers need to go the extra mile to stay healthy, followed by a list of suggestions for how to do it.

Short sleepers and people with insomnia should take extra measures to avoid colds and fluCold and flu season has arrived. If you have insomnia or your sleep is on the short side of normal, it’s a good idea to take extra precautions to avoid these nasty bugs.

Why? Research shows that poor and short sleepers are more susceptible to infection than people who sleep a solid 7 to 8 hours. This heightened vulnerability has to do with the immune system, which is seemingly compromised in short sleepers, just as it’s compromised in people who are sleep deprived.

Here’s a quick explanation of why we short sleepers need to go the extra mile to stay healthy, followed by a list of suggestions for how to do it.

Sleep Fortifies the Immune System

Like other bodily systems, the immune system needs constant grooming to function well. The shoring up of systems takes place mostly during sleep, when other internal processes requiring energy go offline. This frees up metabolic resources to tend to other important matters, such as the one we’re exploring now: boosting our adaptive immune response to invading viruses.

When the body detects a virus, during sleep this triggers a series of events involving the production and mobilization of specialized chemicals and defender cells. They work together to produce antibodies tailored to fight that virus. In the process they forge a sort of long-term immunological memory. A goodly store of antibodies is tantamount to a standing army, ready to spring into action whenever the virus rears its head.

Deep sleep—sometimes reduced in short sleepers and insomniacs—plays a critical role in the operation. Just as deep sleep enables the cementing of facts we’ve learned or experiences we’ve had into long-term memory, so it facilitates the building of antibodies and strengthens immunological memory. Insufficient deep sleep may hamper the formation of antibodies and result in a less vigorous immune response.

Short Sleep and Immune System Compromise

Researchers have long hypothesized the existence of a link between poor or short sleep and compromised immunity, and recent studies lend support to the claim. The results of these three studies speak volumes:

  1. When 143 healthy men and women were given nasal drops containing a virus, those who slept less than 7 hours on average were almost 3 times more likely to develop a cold. People who experienced more wake time at night were over 5 times more likely to develop a cold.
  2. When 125 healthy men and women received the standard 3-dose hepatitis B vaccination series, people with shorter sleep duration produced fewer antibodies and were less likely to be protected from hepatitis B after the final immunization.
  3. In a large prospective study of sleep length and pneumonia risk, women who slept an average of 5 hours or less (and those who slept 9 hours or more) were significantly more likely to develop pneumonia.

What’s a Short Sleeper to Do?

“Get plenty of sleep” was W.C. Fields’ famous cure for insomnia, and, yes, here the advice is apt. But if “plenty of sleep” is not in the cards for all of us, we can still take steps to avoid coming down with colds and flu. As rhinoviruses are spread through the air and contact with objects bearing germs, here are recommendations from one who’s been there, done that, and decided that in this case, vigilance bordering on obsessiveness is the right way to go.

  • Get a flu shot—the earlier, the better. If you’re 65 or older and haven’t had one already, get the pneumonia vaccine.
  • Wash your hands with soap and warm water frequently and at length.
  • Put a little bottle of hand sanitizer in your car and in every handbag you carry. Use it in lieu of washing your hands—after handling money, touching doorknobs, signing for purchases with credit cards.
  • Clean public surfaces like computer keyboards and telephones with antiseptic wipes.
  • Out and about, avoid using your hands when possible. Light switches can be turned on and doors pushed open with forearms, elbows, and shoulders.
  • Carry a gauze mask or a scarf you can wrap around your mouth and nose if you’re going to be traveling by plane or using public transportation and happen to sit near someone who’s sick.
  • When a family member is sick at home, avoid sharing towels, and wipe down telephones and faucet handles often.
  • Get regular exercise. (Exercise, too, has a protective effect against colds.)

Some of these suggestions may sound a bit extreme. Yet if it’s true that short sleepers are more vulnerable to colds and flu, why not err on the side of caution this time?

What measures do you take to avoid colds and flu? Please share them!

Deep Sleep for Insomniacs: Closer Than We Thought?

Could more deep sleep be the solution to insomnia? Investigators have toyed with the idea for years. People with insomnia tend not to get as much deep, or slow-wave, sleep as normal sleepers. Finding a way to prolong slow-wave sleep might make our sleep feel sounder and more restorative.

Last week’s discovery of a sleep node in the brainstem associated with the initiation of slow-wave sleep is promising news in this regard.

Sleep node in the brain could one day help insomnia sufferers sleep like babiesCould more deep sleep be the solution to insomnia? Investigators have toyed with the idea for years. People with insomnia tend not to get as much deep, or slow-wave, sleep as normal sleepers. Finding a way to prolong slow-wave sleep might make our sleep feel sounder and more restorative.

Last week’s discovery of a sleep node in the brainstem associated with the initiation of slow-wave sleep is promising news in this regard. Not only does it point to a new target for treatment. The procedure scientists at Harvard Medical School and University at Buffalo School of Medicine and Biomedical Sciences used to obtain their results suggests that the possibility of altering sleep via genetic modification may not be as remote as it sounds.

A Look at the Research

These researchers set out to study an area deep in the brainstem of humans and other mammals. It’s located in the medullary parafacial zone, or PZ. The PZ contains neurons that produce GABA, the main neurotransmitter responsible for calming the brain at night. These neurons are always active during normal slow-wave sleep.

They wanted to find out whether simply activating these neurons would induce slow-wave sleep in mice, and they used a novel protocol to find out. Rather than stimulating the GABA neurons with electrodes, a process that disturbs surrounding neurons, they targeted the GABA neurons by altering a gene.

“To get the precision required for these experiments,” said Patrick Fuller, senior author of the paper, “we introduced a virus into the PZ that expressed a ‘designer’ receptor on GABA neurons only but didn’t otherwise alter brain function.” Using innovative tools that enabled them to control the GABA neurons remotely, they turned the neurons on.

The result? The mice fell quickly into a deep sleep—as if they’d been knocked out with a sedative. But no sleep medication was involved.

The ability to induce slow-wave sleep by means of a single genetic modification is an encouraging development. “We are at a truly transformative point in neuroscience,” said Caroline E. Bass, co-author of the paper, “where the use of designer genes gives us unprecedented ability to control the brain.”

Other Treatments That Enhance Deep Sleep

Scientists have worked to develop other therapies that boost slow-wave sleep. But none are available for people with insomnia.

  • Development of sleep medications such as eplivanserin and pimavanserin was abandoned due to concerns about safety and side effects.
  • Transcranial magnetic stimulation (TMS)–a treatment in which an instrument sends a harmless magnetic signal through the scalp and skull into the brain, activating electrical impulses and inducing slow waves–is currently approved for the treatment of depression. Some studies have suggested that TMS is helpful in treating insomnia, and a clinical trial of TMS for insomnia is now under way at the University of Florida. But it hasn’t been approved as a therapy for insomnia yet.

Which brings us back to designer genes that modify sleep. I’ve always thought they were pie in the sky for my generation. But the results of this experiment suggest they may become a reality sooner than I thought.

 

Six Misconceptions about Sleep and Insomnia

Most of us know that drinking coffee after dinner will probably disrupt our sleep and that regular exercise will improve it. But some ideas I see tossed out about sleep and insomnia are not quite accurate. Here are six misconceptions followed by information that is evidence based.

insomnia | many people have beliefs and attitudes about sleep that are not factualMost of us know that drinking coffee after dinner will probably disrupt our sleep and that regular exercise will improve it. But some ideas I see tossed out about sleep and insomnia are not quite accurate. Here are six misconceptions followed by information that is evidence based. Find sources by clicking the links in the blog.

Insomnia mainly has to do with a lack of REM sleep (when most dreaming occurs).

Overall, studies comparing people with insomnia to normal sleepers show that insomnia is associated with reductions in both deep sleep and REM sleep. Deep sleep enables the consolidation of memories for factual information and events, and persistent insomnia tends to interfere with this process. Shortened REM sleep, on the other hand, leads to alterations in the processing of emotion—another symptom of insomnia.

The fact that I don’t remember my dreams means I don’t get enough REM sleep.

No evidence shows that sufficient REM sleep is tied to the remembering of dreams. What does seem to be true is that people who remember dreams typically wake up more often during REM sleep than people who don’t remember dreams. But these awakenings are so brief that the dreamer may not be aware of them.

I need several hours of deep sleep to function well.

Young children spend about a third of the night in deep sleep. But the amount of deep sleep humans get declines dramatically during adolescence. The average middle-aged adult spends about 15 percent of the night in deep sleep, and older adults may get as little as 10 percent. As critical as deep sleep is to our ability to function, it accounts for a small percent of the total sleep we get. Our descents into deep sleep occur mostly in the first part of the night.

Rates of insomnia are highest among people in high-status, high-stress jobs.

Stress has a huge impact on sleep, and high stress reactivity may be a defining characteristic of people who develop insomnia. But all else equal, people who earn large salaries are not the ones most likely to toss and turn at night. People of low socioeconomic status with lower education levels are more vulnerable to insomnia than surgeons and CEOs.

Waking up for a stretch in the middle of the night is a sign that something is wrong with my sleep.

Not necessarily. Historical evidence suggests that until the widespread use of electric lighting, this segmented sleep pattern was not unusual. People went to bed soon after nightfall and woke up later to make love, tend to animals and crops, or simply lie awake with their minds adrift. Then they went back to sleep for the rest of the night.

Being awake in the middle of the night may be inconvenient, and with strategic use of light and sleep compression you may be able to whittle that wakefulness down. But if you’re functioning OK in the daytime, being awake at night does not signal something amiss.

If my sleep is lousy, I should make a point of going to bed earlier.

If you have insomnia, going to bed early will likely make the problem worse. The arousal system is fully engaged in the hours leading up to bedtime, early research has shown: most people have a hard time falling asleep in the evening. Here’s a better rule of thumb: If your sleep is lousy, make a point of staying up until you feel sleepy. Only then should you go to bed.

Questions or doubts about sleep or insomnia? Share them here, and I’ll do my best to respond and clarify.

Yoga for Seniors with Insomnia: Thumbs Up

Once on a whale-watching cruise, when the ship was rocking from side to side and I was clinging to the gunwale for dear life, I watched an 81-year old woman walk down the center of the boat with nothing to steady herself. The secret to her amazing sense of balance, she said, was 60 minutes of yoga practice every day.

A growing body of research shows that yoga also has a place among alternative treatments for insomnia. A new study of the effects of yoga on the sleep and functioning of older adults suggests how and why.

Yoga increases deep sleep and improves sleep quality in older adultsOnce on a whale-watching cruise, when the ship was rocking from side to side and I was clinging to the gunwale for dear life, I watched an 81-year old woman walk down the center of the boat with nothing to steady herself. The secret to her amazing sense of balance, she said, was 60 minutes of yoga practice every day.

 

A growing body of research shows that yoga also has a place among alternative treatments for insomnia.

One goal of yoga, said Jonathan Halpern, lead author of a new study exploring the sleep benefits of yoga in older adults, is to put a stop to the fluctuations of the mind. “As primary insomnia is very often related to stress, anxiety and uncontrolled thoughts and emotions,” Halpern told me, “you can appreciate how reducing the fluctuations of the mind even to some extent would have a positive effect on insomnia.”

Yoga in this study also led to improvements in several areas of daytime functioning, including stamina and mood.

Highlights of the Study

Sixty-seven subjects ages 60 and above completed the study. Those who received training in yoga attended 12 weeks of classes twice a week and did daily practice at home. Treatment included practice in yoga postures and three types of meditative exercises. Subjects who stuck with the protocol made significant gains:

  • In contrast to the control subjects, who received no treatment, the yoga subjects reported longer, more efficient sleep and improved sleep quality.
  • Those who practiced yoga at least 25 minutes daily also experienced 11.5 percent more deep sleep. This is an impressive result. As humans age, we get less deep sleep, when the secretion of growth hormone and the synthesis of brain proteins occur. Any activity that promotes deep sleep is likely to make sleep feel sounder and more restorative.
  • Yoga subjects also experienced improved daytime functioning: they reported managing better physically and socially, and feeling less depression, fatigue and stress.

“Daytime functioning is a general measure,” Halpern said, “but it probably results from the fact that people slept better at night, were less tired during the day and therefore could perform better physically, mentally and emotionally. Not at all rocket science,” he added. (For more on how yoga improves stress tolerance, click here.)

So if you’re older and open to alternative treatments for insomnia, yoga is worth checking out.

If you’ve tried yoga, what health benefits did you notice it had for you?

Worry, Insomnia and Alcohol

Worry is the most common reason people cite for sleep problems, and worry and sleep disturbance invite the use of alcohol. Worried insomnia sufferers are twice as likely as people without sleep disturbances to become problem drinkers.

But I’ve spoken and corresponded with quite a few people who say an occasional drink or two before bedtime gives them a good night’s sleep. Here’s a look at the effects of alcohol on the brain and differences in how people respond to it.

worry-insomnia-alcoholWorry is the most common reason people cite for sleep problems, and worry and sleep disturbance invite the use of alcohol. About 30 percent of the people with persistent insomnia report using alcohol to get to sleep, and 13 percent take their last drink within 30 minutes of bedtime. Worried insomnia sufferers are twice as likely as people without sleep disturbances to become problem drinkers. (Find links and sources for this blog below.)

The possibility of developing alcohol dependence should give pause to insomniacs who drink, particularly those prone to drinking right before bed. It’s better to abstain within three hours of turning in.

That said, I’ve spoken and corresponded with quite a few people who say an occasional drink or two before bedtime gives them a good night’s sleep. Here’s a look at the effects of alcohol on the brain and differences in how people respond to it.

Under the Influence

Why does alcohol make people sleepy? Not a great deal is known about how and where alcohol acts to promote sleep. At least three key substances are involved.

  1. GABA is the main inhibitory neurotransmitter in the central nervous system, crucial to shutting the brain down at night. When GABA neurons are firing, the lights in the rest of the brain go out. Popular sleeping pills like Ambien and Lunesta work by enhancing the action of the GABA system. Studies have shown that alcohol does, too, especially at low doses.
  2. Glutamate is the main excitatory neurotransmitter in the brain, responsible for keeping us awake and alert. Studies have shown that alcohol interferes with activity at a particular glutamate receptor. This, too, would have a calming effect on the brain.
  3. Adenosine is a substance that affects the signalling of neurotransmitters like GABA and glutamate. In a recent study of alcohol’s effects on rats, alcohol increased the amount of adenosine available in an area of the brain important to sleep and waking. This inhibited the firing of orexin neurons, which are normally active during periods of wakefulness. The sleep-wake system in humans is very similar to that of rats. So the increased levels of adenosine that occur with alcohol use would tend to promote sleep.

Alcohol in People without Sleep Problems

Alcohol has somewhat different effects on insomniacs and normal sleepers. The average person who has a couple drinks before bedtime

  • falls asleep more quickly than usual
  • may sleep more deeply in the first half of the night
  • experiences disrupted sleep in the second half of the night, characterized by prolonged periods of dreaming, light sleep, and wakefulness.

Tolerance to alcohol’s sedative effects develops within three nights. The only way to continue getting the same effects is to increase the amount of alcohol consumed.

Alcohol in People with Insomnia

When insomniacs, who on average get less deep sleep than normal sleepers, drink near bedtime, research shows we

  • fall asleep more quickly
  • get more deep sleep than we normally would, even as much as normal sleepers
  • may not experience disrupted sleep in the second half of the night.

No wonder we head for the Chardonnay when the going and the sleeping get tough. Alcohol tends to improve our sleep at first. But insomniacs, too, habituate in less than a week. Just like normal sleepers, we have to drink more and more to keep getting the same effect and we risk developing alcohol dependence. Also, regular use of alcohol for sleep eventually degrades sleep quality and worsens insomnia.

So if you’ve got persistent sleep problems and you like to drink, use alcohol in the same way you would any other drug with serious side effects: with caution.

How does drinking at night affect your sleep?

References

1) David Armstrong and Alex Dregan, “A Population-Based Investigation into the Self-Reported Reasons for Sleep Problems, PLoS One 9 (2014).

2) C.D. Jefferson et al., “Sleep Hygiene Practices in a Population-Based Sample of Insomniacs,” Sleep 28 (2005): 611-5.

3) R.M. Crum et al., “Sleep Disturbance and Risk for Alcohol-Related Problems,” American Journal of Psychiatry 161 (2004): 1197-203.

4) Timothy Roehrs and Thomas Roth, “Sleep, Sleepiness, and Alcohol Use,” National Institute on Alcohol Abuse and Alcoholism.

5) R. Sharma, P. Sahota, and M.M. Thakkar, “Role of Adenosine and the Orexinergic Perifornical Hypothalamus in Sleep-Promoting Effects of Ethanol,” Sleep 37 (2014): 525-33.