From the Guidelines
Alcohol consumption should be limited to 1-2 standard drinks per day, and avoided within 3-4 hours of bedtime, to minimize its negative impact on sleep quality. According to the most recent and highest quality study, alcohol consumption negatively impacts sleep quality despite its initial sedative effects, disrupting normal sleep architecture and causing fragmented sleep in the second half of the night 1. This leads to less restorative sleep, increased awakenings, and potentially worsened sleep apnea symptoms.
Key Points to Consider
- The American College of Physicians recommends that adults with chronic insomnia disorder should be advised to avoid alcohol as a means to improve sleep, and instead consider cognitive behavioral therapy for insomnia (CBT-I) or other non-pharmacological interventions 1.
- The evidence suggests that CBT-I is a more effective treatment for chronic insomnia disorder than sleep hygiene education or pharmacotherapy, and should be considered as a first-line treatment 1.
- Limiting alcohol consumption to 1-2 standard drinks per day, and avoiding it within 3-4 hours of bedtime, can help minimize its negative impact on sleep quality 1.
- Establishing a consistent bedtime routine, keeping the bedroom cool and dark, avoiding screens before bed, and practicing relaxation techniques such as deep breathing or meditation can also help improve sleep quality 1.
Recommendations for Clinicians
- Clinicians should advise patients with chronic insomnia disorder to avoid using alcohol as a means to improve sleep, and instead recommend CBT-I or other non-pharmacological interventions.
- Clinicians should also educate patients on the importance of limiting alcohol consumption and avoiding it within 3-4 hours of bedtime to minimize its negative impact on sleep quality.
- Clinicians should consider recommending CBT-I as a first-line treatment for chronic insomnia disorder, and provide patients with information on how to access this treatment.
From the Research
Effects of Alcohol Consumption on Sleep
- Alcohol consumption can negatively impact sleep quality, with a low dose of alcohol (≤0.50 g∙kg-1 or approximately two standard drinks) reducing REM sleep and higher doses (≥0.85∙g kg-1 or approximately five standard drinks) shortening sleep onset latency but exacerbating subsequent REM sleep disruption 2.
- Heavy alcohol consumption has been shown to impair sleep quality, with a significant reduction in objective sleep efficiency and lower self-reported sleep quality, as well as increased next-day hangover severity and reduced activity levels 3.
- Daily alcohol consumption can moderate the relationship between anxiety and sleep quality, with people who sleep poorly being more likely to experience poor sleep quality if they consume alcohol daily 4.
- A dose-response association has been observed between higher alcohol consumption and worse sleep quality, with heavy drinkers having higher odds of having short sleep duration and snoring 5.
Factors Influencing the Relationship Between Alcohol Consumption and Sleep
- The type of alcoholic beverage consumed may influence sleep quality, with hard liquor being significantly associated with poor sleep quality, but not beer or wine 5.
- Individual factors, such as anxiety and daily alcohol consumption, can interact to affect sleep quality, highlighting the importance of considering these factors in the treatment of sleep disorders 4.
- Cognitive behavioral therapy (CBT) has been found to be an effective alternative to pharmacotherapy in the treatment of insomnia, and may be a useful approach for individuals who experience sleep disturbances due to alcohol consumption 6.