Alcohol and Sleep: A Cautionary Tale

These days an old friend of mine is sliding deeper into dependence on alcohol. It’s sad and hard to watch. George stays with us twice a year while visiting his family, who live a few miles away. These family visits are fraught with discord. So by 5 p.m. George is often back at our house for the night—wine or whiskey in hand.

New research explains how alcohol dependence causes insomnia that persists for many years after withdrawal.

Alcohol abuse may harm sleep for many yearsThese days an old friend of mine is sliding deeper into dependence on alcohol. It’s sad and hard to watch.

This friend—I’ll call him George –stays with us twice a year while visiting his family, who live a few miles away. These family visits are fraught with discord. So by 5 p.m. George is often back at our house for the night—wine or whiskey in hand.

George suffers terrible insomnia. But you’d never know it during our happy hour, when he comes alive. He’s always ready with a toast to friends whose home, he says, is an oasis of calm next to the turbulence of his family. Toxic family relationships are George’s main topic of conversation during happy hour: his mother, a woman without much warmth whose love her sons still compete for; a bullying older brother; and a sister-in-law who stokes the rivalry already going between the brothers at every opportunity.

Visits in the Past

In the past George’s negative feelings toward his family would eventually work themselves out—helped by the Finian’s—and then he’d get around to asking my husband and me about our lives. George can be a wonderfully attentive listener. He’s also got wide-ranging interests and concerns.

A few years ago he confessed to worrying about the high doses of Ambien he needed to take to get even 3 or 4 hours of sleep. I can attest to the brevity of George’s nights. His room light has been on when I was up for bathroom calls at 1 or 2 a.m. And no sooner am I down the stairs at 5:30 than he’s in the kitchen asking for strong coffee. It doesn’t matter how wasted he feels, he says. Once he wakes up in the morning, it’s impossible to get back to sleep.

On This Visit, Changes

Our happy hour conversation didn’t get very far on George’s recent visit. Each night he glommed onto the family drama and could not let it go. Nor could he stop drinking. One night he drank a beer and then a bottle of Pinot Noir and, just as he was heading toward the pantry for more, my husband and I fled up the stairs, begging off because of tiredness. Really it was the relentless talk about his family we wanted to escape. At midnight I tiptoed downstairs to adjust the heat and there was George, still drinking and talking on the phone.

In the morning, he came down behind me for his coffee. But when I put the water on, he changed his mind: he was going back upstairs for a little more shut-eye, he said.

That’s odd, I thought to myself. Never in all his other visits had George gone back to bed. Once he was up, he was up for good. My hunch was that he’d taken a sleeping pill quite a bit later than usual and, deciding it wasn’t working, got out of bed only to be hit by sudden sleepiness when the Ambien finally kicked in.

Reflecting on the Situation

George’s situation has taken a turn for the worse–there’s no denying it—and this is upsetting enough. But when I consider what lies in store for him, no scenario I can imagine looks good.

Continuing to drink at the level he’s drinking now is compromising his overall health, and plainly it’s hurting his sleep. But new research shows that even if George does someday go in for alcohol treatment, his sleep may be irreparably harmed.

Science Suggests Why

Adenosine is a neurotransmitter important to sleep, and it’s through adenosine that alcohol exerts its effects on the sleep-wake system, say researchers at the University of Missouri, following a series of lab experiments. In rats never before exposed to alcohol, a single dose resulted in the rats falling asleep more quickly and sleeping more deeply. It did this by increasing available adenosine in the rats’ basal forebrain, an area crucial to sleep. In turn, the adenosine suppressed the activity of wake-promoting neurons there, thus promoting sleep.

But in rats habituated to alcohol, withdrawal from alcohol had the opposite effect. It resulted in the rats experiencing significantly more wakefulness during both their activity and sleep periods–behavior that mimics the severe insomnia experienced by humans during acute alcohol withdrawal.

Excessive wakefulness would normally lead to a robust build-up of adenosine in the basal forebrain. But during alcohol withdrawal this did not happen in the rats. Sustained use of alcohol down-regulates the adenosine system and blunts the sleep system, the researchers concluded, making it harder to fall and stay asleep.

Long-Lasting Effects

It’s not just during acute withdrawal that alcoholics experience poor sleep. Clinical studies have shown that sustained withdrawal from alcohol in humans causes insomnia and sleep fragmentation for years to come.

My blog topics are usually more uplifting. But the only word for the story on alcoholism and sleep is bleak. However you choose to manage your insomnia—whether it’s CBT, meditation, sleep aids, alternative treatments or some combination of these–steer clear of alcohol, a harmful soporific close at hand.

Stressed-out Rats, Insomnia & Sleeping Pills

What can rats tell us about insomnia and sleeping pills? Plenty, it turns out.

I’m getting ready to give a talk on stress-related insomnia and I’ve come across a fascinating study published five years ago. Neuroscientists at Harvard used rats to uncover a novel insight about what may be going on in the human brain when stress interferes with our sleep, and a better way to calm the brain down.

rat-wheelWhat can rats tell us about insomnia and sleeping pills? Plenty, it turns out.

I’m getting ready to give a talk on stress-related insomnia and I’ve come across a fascinating study published five years ago. Neuroscientists at Harvard used rats to uncover a novel insight about what may be going on in the human brain when stress interferes with our sleep, and a better way to calm the brain down.

To introduce psychological stress—the type of stress that often underlies insomnia—in their rodent subjects, the investigators placed half of the rats in dirty cages previously occupied by a male competitor. (The other rats, placed in clean cages, were used as controls.) The smell of the rival rat—even though that rat was no longer present—and the inability to escape from the rival rat’s territory created a normal stress response in the cage exchange rats. Their temperature went up, and there was a big increase in neural activity in the brain. Clearly these rats were stressed out.

But it was not the initial stress response that the researchers wanted to study. They wanted to study what happened when the acute stress had subsided, when the rats finished exploring their new surroundings and finally went to sleep.

The control rats slept normally. But cage exchange rats took longer to fall asleep, woke up more frequently during the sleep period, and slept about 25 percent less than the control rats. All this was expected.

The Big Revelation

The news came when investigators looked at what was going on inside the rats’ brains.

Previously, scientists had assumed that sleep and wake-time were whole-brain states. Either the arousal system was in control (completely inhibiting the sleep system) or the sleep system was in control (completely inhibiting the wake system). There were no halfway states.

But analyzing the neural activity in the brains of the cage-exchange rats, the Harvard researchers did find evidence of what they call “an intermediate state.” What did it look like?

The sleep-promoting areas of the brain were fully active, reflecting strong sleep drive and clear evidence that parts of the brain were deeply asleep. At the same time, neurons in key areas of the brain active during wakefulness were firing away like crazy. Areas associated with fear, anxiety, and emotional processing were behaving as if the rats were wide awake.

“These results suggest that both sleep-promoting areas and part of the arousal system are most likely simultaneously activated during the period of stress-induced sleep disturbances,” the scientists said.

A Better Kind of Sleeping Pill

How did investigators get the sleep of cage-exchange rats to look normal? Not by enhancing activity of the sleep system—that system was already fully engaged. They enabled normal sleep by blocking activity in the areas of stress-induced arousal.

Most sleeping pills on the market today put us to sleep by enhancing activity of the sleep system. But the rat study, say these Harvard scientists, suggests that a more appropriate target for sleep medications would be tamping down activity in the arousal and emotion centers of the brain.

Does stress interfere with your sleep? How do you deal with it?