Does Alcohol Affect How We Sleep?

Dr Pixie McKenna [00:00:07] Hello everybody and welcome to the Sleep Matters Podcast from Dreams. Everything you need to know about how to get a good night’s sleep and why it matters so much. I’m Dr. Pixie McKenna. And in this episode we’re chatting about the impact of alcohol on getting a good night’s sleep. And I’m really pleased to say I’m joined by Dr. Sara McNeillis and Sara is a specialist in the diagnosis and management of sleep disorders. So very much needed at the table today. And we also have Claire McCarten. Welcome Claire. Now Claire actually gave up drinking alcohol and she’s here to share the impact that it’s had on her life and of course her sleep. So I guess the first question is ladies how did you sleep last night?

Claire McCarten [00:00:51] Really well thanks. Good night sleep, no complaints there. Dr Pixie McKenna [00:00:55] And how about you? Dr Sara McNeillis [00:00:56] Yes I have a very good night’s sleep I’m pleased to say most of the time.

Dr Pixie McKenna [00:01:00] Good. Good. In your experience with regards to sleep so you obviously sleep well now. Yeah. What was the relationship in terms of alcohol and sleep for you Claire and what was the sort of backstory to it?

Claire McCarten [00:01:13] Yes. It wasn’t something that I really noticed at the time. Probably I started drinking as a teenager and drank throughout my 20s and my early 30s. It kind of got to the point where I was drinking about a bottle of wine a night. So I would have a bottle of wine with my dinner perhaps, I would go out for a few drinks after work. I didn’t think it was a huge amount to drink but it was every day. And because it was such a pattern, my sleep wasn’t really something that I thought about. So after drinking I would probably go to sleep at about 11 o’clock and go to sleep quite quickly, almost sort of passing out. But then I would always wake up at about 03:00 or 04:00 in the morning and I would feel really anxious and I would kind of be like sweating, like being hot and cold flushes. But because it was kind of every night. It wasn’t a big deal. And I would just go back to sleep and then I would wake up at 06:30 for work but I would just feel a bit tired in the morning and tired throughout the day, so I think I was just quite tired all the time. And then I would sort of get through the day and I would perk up when I had another little glass of wine with my dinner in the evening. So it turns into a bit of a pattern for me.

Dr Pixie McKenna [00:02:36] So the slippery slope there definitely I think.

Dr Sara McNeillis [00:02:39] I think that’s a very common factor. We all feel after a stressful day we need something to relax us and we know that alcohol has this kind of disinhibitory effect on the brain and takes away a lot of our initial anxieties in small amounts. But if it’s a regular event then obviously it’s going to impact on a lot of sleep processes which people weren’t aware of for a while. And new research has shown us that this is actually quite an important factor in maintaining good sleep. I see a lot of patients who have similar stories with this. Particularly those who were snorers. I see many snorers in my clinic and a lot of snorers say the snoring is much worse, much louder after a night’s drink. Dr Pixie McKenna [00:03:33] And do they join the dots between the alcohol and the sleep?

Dr Sara McNeillis [00:03:39] They often aren’t as aware as I’d expect somebody to be. But I think the eventuality of when their sleep, their daytime functions start suffering, then they start trying to unpick what’s going wrong with their sleep and that’s when people start thinking ‘Is it the drink at night with a meal? Is it not getting to bed on time? And there’s a number of factors due to that. We know that alcohol, although it gets you off to sleep quite quickly and a lot of patients of mine who can’t sleep use it as a method, it does wake you up in the middle of the night because the effects wear of much faster and the disruption you have with the patterns in sleep are slow to recover.

Dr Pixie McKenna [00:04:30] So it’s knocking us out because it’s obviously got a sedative effect but then once that wears off, is it that it’s waking us up in the middle of a particular cycle or it’s giving us just rubbish sleep? The sleep that we’re getting, I’m just guessing, is going to be rubbish sleep .

Dr Sara McNeillis [00:04:50] It’s not quality sleep. It’s not natural sleep for sure. And what happens is that when you build up a a disruption in sleep you build it up as a debt. So if you have suppressed your natural sleep it kind of catches up with you and with alcohol particularly in the middle of the night, you wake up because whatever sleep it has artificially given you, it’s not enough to continue sleep naturally. Your body processes of sleep are out of sync. And there’s a particular sort of process called Process S that a lot has been spoken about. This is the process that makes us sleepy as the day goes on. If you drink alcohol it boosts that process but then that process wears off much more quickly and then we burst out awake as Claire has just suggested at 03:00 in the morning.

Dr Pixie McKenna [00:05:50] Process S. Never heard of that.

Dr Sara McNeillis [00:05:51] And this is exactly the same process that we use coffee for, to try and stay awake. We kind of suppress that process by drinking coffee.

Dr Pixie McKenna [00:06:03] Did you take coffee? I mean how did you get through the day?

Claire McCarten [00:06:06] Coffee. Yeah absolutely. Coffee. And also probably eating a bit more junk food than I would now. So drinking impacted on a lot of areas of my life. So now that I don’t drink Process S makes total sense to me because I have more energy in the daytime so I find that I’m doing more active things in the day and then by about 21:30 at night I’m really tired. But to me that’s quite unusual because for years 21:30 would be ‘Oh let’s just have another glass of wine’. I’d almost have a sort of second wind at that point, so it was as if I wasn’t really accepting my natural state of being tired at that point in the evening. So I was kind of behaving in an unnatural way that my body didn’t want me to.

Dr Pixie McKenna [00:06:59] I guess it for you it was probably then a vicious circle. You had the alcohol to relax and then it got you off to sleep. And then the following day you felt rubbish and you thought ‘Ah, I can’t wait till it’s wine o’clock time’.

Claire McCarten [00:07:11] Yeah I was kind of stuck in a bit of a rut really. So I would work, come home, have a drink. Work, come home, have a drink. Socializing would be going out having a drink at the weekend. I’d probably be a bit hungover, but I’d think well everyone is, this is what everyone does. So I wouldn’t really think much of that but what I found with giving up drinking is that I just have so much more time and so I do different
things with my time. I exercise because I’ve got more time. I do more cooking. so I found I really enjoy cooking and that means I eat more healthily. So it’s really kind of like an all over change in routines and habits.

Dr Pixie McKenna [00:07:57] Your sleep is great now?

Claire McCarten [00:07:58] Yeah. My sleep is really good. That’s one of the first things I noticed when I gave up drinking was that I would just sleep through the night without waking up feeling anxious and that was a real revelation to me and cause that was something that I’d been doing for years and years. So it was lovely to wake up hangover free and just feel like my batteries were recharged and well rested. Dr Pixie McKenna [00:08:24] And for patients I guess similar to Claire when they can’t sleep. Is that one of the things you go through? Their alcohol consumption.

Dr Sara McNeillis [00:08:34] Yes you know we absolutely do yeah. We generally ask about their alcohol and caffeine consumption. We want to know what time they’re drinking, how much they’re drinking and when they go to sleep and when they sleep how long they stay asleep for. Exactly how Clare described. You use the wine or alcohol to get you off to sleep and it seems to be in most cases I must say, Friday nights seem to be that people consume the most and that consequently shortens their sleep time on that Friday night and then they end up catching up on a Sunday evening before they go to work on a Monday. So we look at these factors as sleep diaries and you know everyone knows the Friday night effect because you’ve worked really hard and I’m sure as a junior doctor I did the absolute the same thing. You finish off your hard working week.

Dr Pixie McKenna [00:09:32] I don’t know what you’re talking I never did that. [LAUGHS].

Dr Sara McNeillis [00:09:37] You just want to destress from the week. But now I also rarely drink because I think sleep is so important and it’s so so useful to have a good night’s sleep. And I find that now anything that affects that, I’m reticent to try and obstruct my sleep or reticent to try and use anything that would affect it in an adverse way.

Dr Pixie McKenna [00:10:09] It’s funny isn’t it. Exercise, where people might say well no I’m not going to do that, I’m not gonna eat that because actually that might not be really good for me because I’m going on a big run tomorrow. Whereas I don’t think people feel like that about sleep. I suppose we just don’t see it as a… we take it for granted and if we can’t sleep we just say we can’t sleep and if we can sleep really well, we say we can sleep really well. But we don’t necessarily try and work out why may I not be sleeping well? And actually are there things that I’m doing – particularly alcohol – that will ruin my night’s sleep tonight? And probably for the whole weekend.

Dr Sara McNeillis [00:10:53] But again as Claire alluded to, when you’re young you have so many more mechanisms of tolerance which tend to wear out as you age.

Dr Pixie McKenna [00:11:02] You have more time anyway.

Dr Sara McNeillis [00:11:05] Yes certainly [LAUGHS] – have you noticed that? Claire McCarten [00:11:06] Yeah, definitely.

Dr Sara McNeillis [00:11:07] I just think after a certain age you feel that you don’t have that mechanism of tolerance anymore.

Claire McCarten [00:11:11] Yeah, you definitely do. I know when I was certainly capable of having nights out when I was in my early 20s and then I’d be at work at 07:00 the next morning and I wouldn’t feel that bad. Yet as I got a bit older I definitely found that the hangovers were getting worse and that also I’d have a bit of a foggy head the next day at work. I wouldn’t have so much of a clear mind. So I think definitely I noticed the alcohol was catching up with me.

Dr Pixie McKenna [00:11:41] So in terms of binge drinking – is it the consistent tipping away? Or is it binge you know really really good Monday to Thursday blow out Friday Saturday? Which is it, or are both equally as bad for your sleep?

Dr Sara McNeillis [00:11:59] I think both are equally as bad but we know that binge drinking is probably going to adversely affect many body processes. It’s not just sleep. But I think a regular drink in the evening is all equally disruptive on sleep. We’ve not seen any studies that suggest that you can have one glass and sleep well. It is quite a profound substance that even one drink can affect your sleep.

Dr Pixie McKenna [00:12:32] When did you just go ‘I can’t do this anymore’?

Claire McCarten [00:12:36] So as I described, I’d had the kind of steady drinking pattern and I felt that that was totally under control. You know I’d always had a drink, I’d always held down quite a high functioning job. I’ve got two children, they were doing well. So everything seemed fine to me but then I had a sort of personal tragedy where my dad died very suddenly and I found that my drinking just spiraled out of control really really quickly. It wasn’t something that I expected to happen at all but it was really quite frightening – the way it kind of took over my life. And so it definitely got to the point where I thought I just can’t touch another drop of alcohol. This is really really dangerous for me.

Dr Pixie McKenna [00:13:22] And you just said that’s it?

Claire McCarten [00:13:23] Yeah yeah.

Dr Pixie McKenna [00:13:25] So did you feel that it wasn’t really an option to moderate your drinking? That you just needed to cut it out of your life?

Claire McCarten [00:13:33] So I had tried moderation and I think I’d always kind of moderate it throughout my life so every now and then I would have maybe a month off drinking. I would have a lot of dry periods. But I think looking back now that was kind of to justify my drinking so I can go a few weeks without drinking. So it’s fine. I drink for the rest of the time. You know it’s not a big deal. But certainly towards the end of my drinking, conscious moderation was not working and I was actually finding that it was more stressful than not drinking at all. Because I would count the units. How many units am I allowed today? And obsess over it. ‘Well I haven’t had a drink yesterday so I can have one today.’ And it was just a bit of obsessive thinking that it was much easier to cut that out of my life completely than to moderate. I think if you’re moderating – 1hy are you moderating? Do you know that that’s bad for you? And if you know that then why are you doing it? I was asking myself these questions and I thought actually drinking is really dangerous for me and the only way for me now to stop it progressing is to just stop completely.

Dr Pixie McKenna [00:14:50] Would you see that in your patients that they would rather… I mean I know from my patients that most people will say ‘Okay I’ll have five alcohol free days but I’m not giving up my weekend or I’ll have one treat day in the week.’ Do you find it difficult to make people give up completely?

Dr Sara McNeillis [00:15:09] I do. I find it incredibly difficult to try and get people to give up drinking completely and it does often take a significant event such as they’ve lost their job or they’ve been moved out of their room. I come to alcohol and and snoring because it seems to be a lot of my patients are heavy snorers with sleep disordered breathing and sleep problems, breathing problems at night. And then once something social such as you’ve been moved out of your bedroom, it’s then they seek help. And then even, it’s difficult to change a habit which has been there for a long time. And I say to my patients any habit can be modified, it takes time and you’ve got to want to do it. And sleep is equally a habit that we’ve got to want to promote, a good habit of sleeping. And if they do go for psychological help and assessment to deal with that as well. A lot of my patients do realize that once they are on treatment, say for example a severe sleep apnoea patient would have to use a mask every night . They don’t like using these masks and that would then switch them over to ‘I must give up drinking, I must become healthier generally. My sleep will improve without having to use this for the rest of my life. I think that’s a good thing. You know a transformation is a great thing and I love to see patients who have transformed their life patterns and improve their sleep and they come back and they feel so much better, they look better. Anecdotally I say to them you look better and it’s because they’re sleeping better.

Dr Pixie McKenna [00:17:06] It’s amazing isn’t it? Did it take a whil?. Did you notice when you stopped in terms of your sleep and general well-being?

Claire McCarten [00:17:13] Yeah. I mean I noticed fairly straight away that I was having really good night’s sleep. So that was amazing. And I think my health just started… I mean I hadn’t really thought I was in bad health but people started to say to me ‘Oh you look nice today’ or ‘Your skin looks really nice.’ And I realised that gradually over time my eyes looked a bit brighter and my skin was clearing up. So yeah. And I just felt healthier as well. I always say when I was drinking I had a lot of back pain. And when I gave up drinking and started exercising it just completely went away. And that was something that I’d suffered from for years. Also my anxiety, which I think went hand-in-hand with drinking. I don’t think I’m naturally such an anxious person but with the drinking that again became a sort of vicious cycle because I would be more confident once I’d had a few drinks but then I would need them to be confident. And so anxiety was caught up in that as well. That also started to improve and my confidence in general started to improve. I think that was more of a gradual process which is why I kind of think dry January isn’t really long enough. I think my first month giving up drinking it was still very much focusing on not drinking. Whereas now I just know I’m not going to drink so I can focus on staying healthy and doing other things and finding new hobbies doing what I like best and finding out who I am really. But that first month it was just like I’m not going to drink, I’m not going to drink. And so I think it’s nice once you get over that phase and you accept that and then you can move on from that.

Dr Pixie McKenna [00:19:11] Because I suppose you go from that stage where you’re not drinking to ‘I don’t drink.’ You know it’s like that point. There must be a point at which you describe yourself as a non drinker versus I am off alcohol. Claire McCarten [00:19:26] Yeah precisely. I think the first month it’s just like I’m having a dry month. But then when you push past that it just becomes a natural part of your life.

Dr Pixie McKenna [00:19:38] So how long is it since you’ve had a drink?

Claire McCarten [00:19:40] So it’s been two years since I’ve had a drink.

Dr Pixie McKenna [00:19:43] I’m going to ask you the question that everyone asks you. Do you miss it?

Claire McCarten [00:19:45] No honestly I really really don’t. I really don’t. And I’ve also met so many people who have given up drinking for the past two years and they’ve been a mixture of people of different ages, some have had alcoholic rock bottom. Others have just had their dry month, pushed past that and carried on with it because they liked it. And I’ve never met anyone who regrets giving it up.

Dr Pixie McKenna [00:20:13] Do you find that your patients when they remove alcohol as a part of the sleep issue that it becomes much easier to get them to change other habits? To change other bad sleep habits?

Dr Sara McNeillis [00:20:28] Yes absolutely it’s part of the whole sleep hygiene routine. And although there isn’t any strong evidence for the package of sleep hygiene. The first step of reduction or abstinence of alcohol is one step towards focusing on what is important, which is a good routine to promote good sleep and it goes hand-in-hand with exercising at the right time, eating the right meals at the right time and making sure you get regular bedtime hours and regular wake time hours to promote the natural process of sleep. And patients who do struggle with this and I don’t know how many people do struggle with changing habits that have developed over a long time. And I do say to them one step at a time, if you can do one thing at a time. Just keep going. One thing, the next thing, the next thing. Don’t try and set yourself such a big hard target of I’m going to give up drinking completely. Start with say I’m going to cut off drinking at this point because it’s going to affect my sleep after a certain amount of time such as don’t drink coffee until after 14:00 ideally. Although there’s a study that shows coffee just at bedtime doesn’t have as much effect on sleep as coffee three hours before bedtime. [00:21:56] And I’m mentioning coffee because a lot of patients use coffee as an antidote to the alcohol sedatives. If you go out for a meal you’re feeling a bit sleepy by the end of the meal, you have a coffee boost before you go home. [00:22:11] And then you’ve got this double whammy of this additive that’s trying get you to sleep. And then the coffee fighting it again. So I think look take one step at a time and so many patients who’ve made that change have said to me they are really happier overall. They are more productive at work. They are less troublesome for their families, such as not snoring loudly, not disturbing other people’s sleep. And this is the whole thing about sleep. [00:22:46] This is not just your sleep you might be disturbing. You might be disturbing a partner sleep and the health implications of disturbing anyone’s sleep in general, whether it is yourself or others is equal in some respects, in long term health respects.

Dr Pixie McKenna [00:23:03] It’s interesting isn’t it because I think there’s a whole educational piece around alcohol and its relationship with sleep because most of my patients, if they drink too much, will be worried about their liver or they’ll come because they’ve done something foolish and they’ve got themselves into a situation in which you
have to try and get them out of or there’s an event. But sleep. I don’t think I’ve ever had a patient come to see me that said I can’t sleep at night I think it’s because I’m drinking too much. They just don’t make the link.

Dr Sara McNeillis [00:23:39] They don’t. It’s very difficult to make that link because of the effects of alcohol getting you off to sleep. They don’t realise that the getting off to sleep is only part of the whole sleep process. Staying asleep is as important as getting off to sleep. So people don’t realise they think the early morning awakening that Claire had already alluded to is due to something else. And there’s I suppose that link is very very difficult to establish.

Dr Pixie McKenna [00:24:06] So what would your tips be? Your takeaway message to people, Claire? Because you’ve done this, you’ve lived this. You’ve been on both sides and you’re obviously happier on the side that you’re on now, which is great. What would you say to people who maybe can’t sleep and have similar habits to those you had previously?

Claire McCarten [00:24:27] Well I would to give it a go, giving up. It can be done. I’m living proof of that and I drank regularly for years and years. I’m so much happier now. My entire life has changed. My relationships with people are a lot better. Sleep is amazing. And I’m just so much healthier so I would encourage people if they feel that they have a problem with alcohol and that it’s interfering with their sleep in their everyday lives to not be ashamed of seeking help. You know it is an addictive substance so there’s no shame in being addicted to something addictive. The help is out there and people will be very understanding. I would say just give it a shot and see how it goes. Like I said before, the people that I’ve met who have given up drinking don’t look back. They all come out the other side much happier and healthier.

Dr Pixie McKenna [00:25:27] Did you do it on your own? Did you just say right, I’m done?

Claire McCarten [00:25:30] I made the decision yeah. I mean in the past I’d kind of tried to give up drinking but I hadn’t really been successful in that and just ended up drinking again. So for me it did take that big traumatic event and kind of going too far with my drinking. And it was obvious to everyone that you know I was in trouble with drinking. I made the decision on my own but I sought counselling. I went to AA at first and I worked on my support network. So I told my closest friends, because I thought it’s putting myself in a risky situation. I didn’t want to not go to pubs and meet them for a drink. So that was what we did. But I was careful to tell them beforehand you know what I haven’t been in a great way recently. I’m not going to be drinking tonight. And then they knew and it wasn’t a big deal. And if anything I found that quite a lot of my friends were relieved and that they’d had a few worries about their own drinking as well and they were quite happy to have a night with mocktails rather than triple vodkas all night long. It was actually a relief to them.

Dr Pixie McKenna [00:26:39] So if you think you need to you should just do it?

Claire McCarten [00:26:43] I think say yeah I mean I think if you have any doubts about your drinking then there’s probably a reason it needs to be looked into.

Dr Pixie McKenna [00:26:51] And for you, what would be the top tip for anyone who’s perhaps thinking they’re drinking too much and they’re not sleeping?

Dr Sara McNeillis [00:26:57] Well I think that to try and think about your whole sleep cycle and that if you’re not sleeping something’s affecting it. We’re naturally programmed to sleep and drinking is one of the main social things that we do. So I’d like people to make the link between drinking and sleep a lot more maybe. Again as Clare said seek help. Cut it back. Try and work out a good bedtime routine which does involve not drinking too much at least in the evening. Just awareness, awareness of that sleep is not something to be ignored. And alcohol does affect sleep.

Dr Pixie McKenna [00:27:43] Well do we all think we’ll sleep well tonight?
Claire McCarten [00:27:45] I hope so. Dr Pixie McKenna [00:27:47] Good. Thank you so much Claire. and Sara. I think that it’s really interesting because we’ve got it from both sides, the patients side, the doctors say – that’s really really good. Lots of tips for everybody there. That’s all from this episode of Sleep Matters from Dreams.