The Negative Connection Between Alcohol and REM Sleep: Part 3

Ironically, cutting back on alcohol can also disturb sleep - at first. Getting through the initial phase and continuing the course is easier knowing what to expect and how to prepare for it.

Short Answer:

Most people will experience sleep disturbances when they first cut back or quit drinking. It tends to be a short-term side effect that will correct itself within a few weeks, which is why experts strongly recommend avoiding alcohol to avoid delaying the process. There are a number of healthier options for handling sleep issues while your body adjusts to life with less alcohol.

What You’ll Learn:

• Why cutting back on alcohol can disrupt sleep at first

• Timeline for how long sleep problems tend to last

    ◦ First few days to the first few weeks

    ◦ Weeks to a few months

    ◦ Months to years

• Naltrexone sleep side effects that you may experience early on

• What actually helps you get through the initial sleep disturbances and stay the course

If you've ever tried to cut back on drinking and your sleep got worse, it wasn't a sign you needed to go back to your normal drinking pattern. If anything, it's a sign you were becoming too reliant on alcohol to get to sleep.

Part 3 in our series on the connection between REM sleep and alcohol highlights some sleep problems that are the result of reducing or quitting alcohol. We also explain what to expect if you’re taking naltrexone along with advice on how to improve your sleeping situation so that REM cycles aren’t shorted.

Why Cutting Back on Alcohol Can Disrupt Sleep - at First

One study of people in alcohol treatment, both abstinence and moderate drinking were linked to a significant drop in insomnia symptoms over six months. But the first days and weeks can feel like the exact opposite, with trouble falling asleep, waking in the middle of the night and unusually vivid dreams.

Sleep often gets worse after you cut back on alcohol largely because your brain has adapted to alcohol and needs time to readjust. Several changes overlap during the first weeks as adjustments are made.

Your brain has adapted to alcohol's sedation. With regular drinking, tolerance to alcohol's sleep-inducing effect builds quickly. In a study of people with insomnia, a moderate pre-sleep dose of alcohol improved sleep on the second night, but the benefit was gone by the sixth day. Animal research also suggests that alcohol dampens the adenosine system, the chemical signal that builds sleep pressure the longer you're awake, and that this impaired sleep regulation may help explain the insomnia seen in withdrawal. When alcohol is removed, you lose the sedation, but your sleep drive hasn't yet recalibrated.

REM sleep rebounds. REM is typically suppressed while you're drinking, and in studies of people with heavy drinking it tends to rebound quickly once drinking stops. In healthy volunteers who drank before bed for three nights, REM sleep also increased after they stopped. An initial surge of REM sleep can mean lighter, more restless sleep and a greater likelihood of nightmares.

Withdrawal symptoms can keep you awake. In people who have been drinking heavily and regularly, stopping can bring anxiety, irritability, sweating, shakiness, nightmares and insomnia. Symptoms tend to peak within 24 to 72 hours of the last drink but can go on for weeks and sleep changes can last for months. The more often you drink, the more likely withdrawal becomes.

You may be missing a nightly habit. Roughly 10-28% of people use alcohol as a sleep aid. If that's you, drinking was part of how you wound down, and taking it away leaves a gap in your brain and routine that hasn't filled yet.

Problems that alcohol was covering can show up. For some people, insomnia, anxiety or sleep apnea was there all along but it went undetected. This is why about a quarter of people in treatment still have sleep issues months to years after reducing or quitting alcohol.

One note about cutting back versus quitting alcohol: most of this research comes from people who drank heavily and then stopped completely. If you're drinking less rather than stopping, and especially if you weren't drinking heavily every day, it's reasonable to expect milder sleep disruptions.

Naltrexone Side Effects That Can Also Impact Sleep - at First

If you're also taking naltrexone to cut back on drinking, it can be hard to tell what's throwing off your sleep. Naltrexone lists sleep changes among its possible early side effects, and those can overlap with the sleep changes that come from drinking less.

Sleep Disturbances Are Possible But Rare

In an open-label safety study of about 570 people with alcohol dependence taking naltrexone, new-onset insomnia was reported by 3% and sleepiness was reported by 2%.

Unfortunately, the research on how naltrexone affects sleep is slim. Most of the data comes from side-effect reports rather than sleep-lab measurements. That leaves some room for error, but it’s clear that while sleep disturbances are possible, only a small percentage of people deal with it while taking naltrexone.

Sleep Disturbances Tend to be Short-Lived

A federal treatment guide describes naltrexone's side effects as generally mild and often diminishing over time. Typically, within a week or two things regulate and naltrexone no longer causes a person to lose sleep.

Timeline For How Long Sleep Disturbances Last After Drinking Less

For most people, the roughest stretch is the first few days to a few weeks, then sleep improves gradually from there. There's no single timeline, though. How long sleep issues last depends mainly on how much, how often and how long you were drinking.

First Few Days to a Few Weeks

Peak disruption. In people who drank heavily and regularly, withdrawal symptoms, including insomnia, tend to peak within 24 to 72 hours of the last drink and can continue for a few weeks.

Weeks to a Few Months

Gradual improvement. In people treated for alcohol dependence, insomnia symptoms fell significantly over six months among those who abstained or drank moderately, but not among those who returned to heavy drinking. In an alcohol-free-month survey, 56% of 4,232 participants said their sleep quality was better by the end of the month.

Months to Years

A minority have lingering problems that may or may not be solely attributed to alcohol use. In studies that analyzed alcohol treatment, about a quarter of treated patients still had insomnia despite abstinence. Differences in sleep architecture were still measurable in people abstinent for up to 719 days after long-term heavy drinking.

A few things to remember . . .

It isn’t all or nothing. In studies, moderate drinking was associated with improved sleep, not only abstinence. Your sleep can move in the right direction before you reach zero.

Progress isn't a straight line. Expect good nights and bad nights. The direction over weeks matters more than any single night. If your sleep isn't improving after about a month, or it's getting worse, that's a concern worth raising with a clinician.

How to Overcome REM Sleep Problems After Reducing Alcohol Use

The goal isn't perfect sleep right away. That isn't a reasonable expectation. It's to protect your sleep while your brain readjusts, without reaching for a quick fix that backfires. Here is what the evidence supports, in order of how far each solution moves the needle.

Don't use alcohol to fix a bad night. It's the one thing most likely to make the initial phase longer. A large meta-analysis concluded that any benefit of alcohol for falling asleep is likely outweighed by the greater sleep disruption it causes.

Keep a steady schedule. Get up at the same time every day, even after a rough night. If you're lying awake for 20 minutes or so, get up, do something calm in low light and go back when you feel sleepy. These are core techniques of cognitive behavioral therapy for insomnia (CBT-I).

Watch caffeine intake, especially after bad nights. It's tempting to lean on extra coffee when you're tired, but in a small lab study of 12 healthy sleepers, 400 mg of caffeine (roughly two to three cups of coffee) taken six hours before bed cut total sleep time by more than an hour, and participants often didn't notice the effect. Cutting off coffee in the early afternoon can help prevent sleep problems later on.

Be careful with sleep aids. The American Academy of Sleep Medicine suggests against using diphenhydramine, the antihistamine in many over-the-counter sleep products. It makes the same suggestion for melatonin. Be sure to check with your prescriber before adding any sleep aid, particularly while you're adjusting to naltrexone.

If you're on naltrexone, work with your prescriber on the details. If nausea from naltrexone is keeping you up, taking the medication with food rather than on an empty stomach can help. If you think your dose is affecting your sleep, ask whether a change in timing makes sense for you. Some prescribers suggest taking naltrexone in the morning. Avoid stopping or changing your dose on your own, because early side effects often fade with time.

Healthy sleep habits, such as getting daylight and some movement earlier in the day and keeping a consistent bedtime routine, are also highly recommended.

Ready to get control over your drinking to get your health on track?

Take the online Alcohol Use Assessment for personalized recommendations and to see if naltrexone could be a good fit for you.

Related Reading

If you'd like to go deeper on any of the topics above, these Choose Your Horizon articles are a good next step.

Managing Sleep Changes on Naltrexone

• Naltrexone and Sleep: What to Expect and How to Manage It: why naltrexone can cause vivid dreams or insomnia in some people, how long it lasts, and what to adjust

• Getting Through Sleepless Nights When You Start Taking Naltrexone: practical steps for the first nights on the medication

• Naltrexone Side Effects in the First Week: what's normal early on versus what needs a call to your prescriber

• What to Expect in the First Month of Naltrexone: the full adjustment timeline

• Naltrexone and Fatigue: Does It Make You Tired?: why you might feel low on energy in the first weeks

How Alcohol Affects Your Sleep

• How Does Alcohol Affect Sleep?: why alcohol helps you fall asleep faster but hurts sleep quality later in the night

• Sleeping and Alcohol: What Really Happens to Your Night: a closer look at the nightcap myth, tolerance, and sleep apnea

• Insomnia After Quitting Alcohol: Why It Happens and How Long It Lasts: a deeper look at the early-recovery sleep timeline