Alcoholism: Links to Insomnia

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Alcoholism: Links to Insomnia




Guest:  Dr. Robert Malcolm - Psychiatry & Behavioral Sciences

Host:  Dr. Linda Austin – Psychiatry


Dr. Linda Austin:  I’m Dr. Linda Austin.  I’m interviewing Dr. Robert Malcolm who is Professor of Psychiatry at the Medical University of South Carolina.  Dr. Malcolm, let’s talk about an area of research interest for you which is actually a confluence of two areas of interest that I know you’ve been heavily involved in, alcoholism, on the one hand, or alcohol use, and insomnia.  Just what is the connection between those two?


Dr. Robert Malcolm:  Well, Dr. Austin, alcohol affects sleep, and sleep can affect alcohol use, interestingly enough.  You know, it’s a widespread belief that many of us have that alcohol helps you sleep at night.  You know, that’s partly true and partly untrue.  Alcohol helps us fall asleep.  But after that initial getting to sleep more quickly, alcohol disrupts sleep in many ways during the night.  First of all, we have more awakenings.  We have more shallow sleep.  We abolish two important forms of sleep, delta sleep, which is this deep sleep that’s important for restoring muscle integrity, physical feelings of well-being the next day, and REM sleep is at least suppressed in the first half of the night.  So, in the second half of the night, REM comes back.  That’s what we call dreaming sleep, as you know.  So, alcohol, in total, is a loss for us at night.  So, I recommend to my patients not to drink within two hours of going to bed because it’s disruptive of sleep in the long run, throughout the night.


Dr. Linda Austin:  Are some individuals more susceptible to this than others?


Dr. Robert Malcolm:  We believe that, although that has not been well worked out in research studies.  But there are people who seem to be immune to that process and other people who are very disrupted by drinking alcohol.  Think of it like caffeine.  There are many people who can drink a cup of coffee and go to bed that night and not have any problem sleeping.  But many more people who drink caffeine any time during the afternoon have disrupted sleep that night.  The same is true of alcohol.


Dr. Linda Austin:  When you talk about changes in the so-called sleep architecture, the issue of the delta sleep and the REM sleep, many people drink every night before going to bed.  Does that mean, then, that they develop chronic deficits in particular types of sleep?


Dr. Robert Malcolm:  That’s what our research and other researchers show, that those people who are chronically drinking every night, particularly those people who are drinking in the range of three to four, or more, standard drinks per night, a standard drink being 12 ounces of beer, 6 ounces of wine, or 1 and a half or two ounces of a distilled spirit.  Those people really do develop very disruptive sleep patterns.  They often sleep for shorter periods of time.  They often have suppression of their delta sleep and their REM sleep.


One of the interesting stories about these people, and this has been studied, is that if they stop drinking, for whatever reason, either voluntarily or through treatment, or for some involuntary reason, and you follow those people out for years, you see improvements in things.  REM sleep starts to regenerate and come back.  But delta sleep often remains suppressed and doesn’t come back, even over three to four, to five years, after the person’s become abstinent.  So there are almost like semi-permanent or permanent effects of the alcohol on the sleep.


Dr. Linda Austin:  And what is the effect, then, of permanently losing your delta sleep?


Dr. Robert Malcolm:  Well, people complain of more muscle aches, of physically not being restored.  They also complain of more ailments, like infections and things like that.  Now, whether or not these things are all connected, we’re not quite sure yet. 

Fibromyalgia is another thing that comes to mind.  People complain more of fibromyalgia, of soreness in specific muscles, trigger points, things like that, when they don’t get this longer sleep.


Dr. Linda Austin:  How about chronic use of sleeping pills, can that have the same effect?


Dr. Robert Malcolm:  It can.  Chronic use of sleeping pills is very similar to alcohol.  It can suppress REM sleep.  It can suppress delta sleep.  Although, I have to say, some of the newer medications that are only what we call partial GABA agonists are less likely to do that than the older benzodiazepine sleeping pills.


Dr. Linda Austin:  Are there absolute limits on a daily or weekly basis as to how much one can drink and not feel adverse effects?


Dr. Robert Malcolm:  Well, these are based on large studies of people.  They’re statistical analyses.  But, for men, the cutoff is about five drinks per day, for women, about four standard drinks per day, meaning that when you’re in that category of four or five standard drinks per day, you’re really at risk for a lot of things.  You’re at risk for physical trauma.  You’re at risk for an automobile accident.  You’re at risk for a DUI.  The list goes on an on.  You’re at risk for certain cancers developing over your lifetime.  Those are the cutoffs.  And that many drinks at any one sitting, even once a month, can put a person at risk for those kinds of problems.


Dr. Linda Austin:  How about a weekly limit, is there a cap on that?


Dr. Robert Malcolm:  Well, again, some of the epidemiologists debate this.  But many of them would agree on about 21 drinks per week.


Dr. Linda Austin:  For men?


Dr. Robert Malcolm:  For men, and slightly less for women, maybe 14 for women.


Dr. Linda Austin:  Dr. Malcolm, thanks so much for talking with us.


Dr. Robert Malcolm:  Thank you.


If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection:  (843) 792-1414.


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