Ethanol, the type of alcohol found in alcoholic drinks, can exacerbate sleep problems. During abstinence, sleep disruption is one the greatest predictors of relapse.[1]
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Moderate alcohol consumption 30–60 minutes before bedtime catalyzes disruptions in sleep maintenance and sleep architecture that are mediated by blood alcohol levels.[2] Disruptions in sleep maintenance are most marked once alcohol has been completely metabolized from the body. Under conditions of moderate alcohol consumption where blood alcohol levels average 0.06–0.08% and decrease 0.01–0.02% per hour, an alcohol clearance rate of 4–5 hours would coincide with disruptions in sleep maintenance in the second half of an 8-hour sleep episode.[2] In terms of sleep architecture, moderate doses of alcohol facilitate "rebounds" in rapid eye movement (REM) and stage 1 sleep; following suppression in REM and stage 1 sleep in the first half of an 8-hour sleep episode, REM and stage 1 sleep increase well beyond baseline in the second half. Moderate doses of alcohol also increase slow wave sleep (SWS) in the first half of an 8-hour sleep episode.[2] Enhancements in REM sleep and SWS following moderate alcohol consumption are mediated by reductions in glutamatergic activity by adenosine in the central nervous system.[2] In addition, tolerance to changes in sleep maintenance and sleep architecture develops within 3 days of alcohol consumption before bedtime.[2]
Low doses of alcohol (one 12 oz. beer) are sleep-promoting by increasing total sleep time and reducing awakenings during the night. The sleep-promoting benefits of alcohol dissipate at moderate and higher doses of alcohol (two 12 oz. beers and three 12 oz. beers, respectively).[3] Previous experience with alcohol also determines whether or not alcohol is a "sleep promoter" or "sleep disrupter." Under free-choice conditions, in which subjects chose between drinking alcohol or water, inexperienced drinkers were sedated while experienced drinkers were stimulated following alcohol consumption.[4] In insomniacs, moderate doses of alcohol improve sleep maintenance.[5]
Sleepiness influences the severity of alcohol consumption. Conditions of sleep deprivation encourage more episodes of alcohol consumption.[2] Increased alcohol consumption during the winter months for Northern climate residents is attributed to escalations in fatigue.[6]
Sleep and hormonal disruptions following withdrawal from chronic alcohol consumption are the greatest predictors of relapse.[1] During abstinence, recovering alcoholics have attenuated melatonin secretion in the beginning of a sleep episode, resulting in prolonged sleep latencies.[7] Escalations in cortisol and core body temperatures during the sleep period contribute to poor sleep maintenance.[7][8]
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