Can Drinking Cure My Insomnia?

Question: A friend recommended I deal with my insomnia with a drink each night before bedtime. Is that a good idea?

Dr. Hibberd's Answer:

Many of us have difficulties with sleep from time to time and we often resort to some agent close at hand to get us to sleep. Used on an occasional basis, we generally are not looking at major harm to our health in the long term.

However, most sleep experts now emphasize good sleep habits in order to achieve healthy and restful sleep. Bedtime alcohol use is not regarded as a healthful habit. BEWARE.

Our central nervous system's ability to function, heal, and maintain itself depends upon adequate sleep quality and quantity. Chronic (long-term) alcohol use is not conducive to either. Insomnia (or difficulty sleeping) affects one third of adults on an intermittent basis and 10 percent of adults on a chronic (or long-term) basis.

Alcohol is a central nervous system (brain) depressant, and will adversely affect your quality of REM (rapid eye movement) sleep that we now recognize as associated with healthful and "invigorating" sleep so essential to our overall general health. Sleep disorders have been associated with decreased work productivity, serious job-related and motor vehicle accidents, and serious mental and physical consequences. Remember, by drinking each night you are conditioning your sleep habit to include regular alcohol intake.

Insomnia is divided into acute (sudden) and chronic (long-term) categories based on duration and triggers.

Acute insomnia (such as jet lag, emotional issues, environmental issues such as noise, light, or temperature) is usually caused by an identifiable trigger and lasts less than four weeks. Sleep aids may be appropriate here without the need for further investigation. Generally, you should prefer FDA approved sleep aids since these have been properly tested for safety and effectiveness. This eliminates almost all over the counter sleep aids. Ask your doctor if a prescription agent is appropriate for you.

Chronic insomnia should always be properly evaluated, preferably by a medical professional. Chronic insomnia refers to disturbed sleep for at least three nights per week for more than four weeks. Insomnia caused by no identifiable medical or psychiatric condition is called primary insomnia. Primary insomnia accounts for 12 percent to 15 percent of chronic insomnia and is a diagnosis of exclusion. That means that serious disorders must be first considered.

A full detailing is beyond the scope of this column, but suffice it to say, there are sometimes serious health issues behind the insomnia. Primary sleep disorder such as RLS (restless leg syndrome), circadian rhythm disorders (irregular sleep-wake rhythm, delayed or advanced sleep disorder, free running circadian rhythms), and parasomnias affect 10 percent of people with disturbed sleep.

In some cases, sleep disturbance may reflect an otherwise unrecognized serious underlying condition that may endanger your safety or even your life. Examples such as sleep apnea, congestive heart failure, and cardiac arrhythmias (irregular rhythms) are not uncommon. These conditions have specific treatments and sleep aid use may indeed be harmful.

I recommend you be properly evaluated by a medical professional who is trained to screen for serious causes of insomnia. Start with your primary care medical doctor. Don’t be afraid to ask for multi-specialty (cardiology, pulmonary, neurology, psychiatry, and possibly a sleep lab) referrals if your doctor is complacent with your complaint.