What’s the Link Between Alcohol and Sleep Apnea?

Alcohol and sleep apnea have a complicated relationship. Drinking alcohol can worsen your snoring and increase your risk of sleep apnea.

That's because of the effects that alcohol has on your body, particularly your airway. Alcohol changes the amount of time you sleep, how long it takes you to fall asleep, and how you breathe while you're sleeping.

This article discusses how alcohol affects your body while you're asleep. It also explains how alcohol can contribute to sleep apnea and snoring.

The Connection Between Alcohol and Sleep Apnea

Drinking alcohol relaxes the muscles in your airway. At night, this can cause obstructions in your upper airway, leading to sleep apnea.

Sleep apnea is a sleep disorder that causes breathing to repeatedly stop and start while you sleep. It causes loud snoring with occasional gasping, choking, or snorting sounds. It can also lead to daytime sleepiness and low energy.

There are three kinds of sleep apnea:

• Obstructive sleep apnea (OSA): The most common type, OSA occurs when soft tissues in the back of the throat collapse, causing airway blockages while you sleep. The air passage narrows or closes, interrupting your natural breathing cycle and waking you up.
• Central sleep apnea: The brain fails to send the proper signals to the muscles that control breathing.
• Complex sleep apnea: Also known as treatment-emergent sleep apnea, it occurs when a person with OSA develops central sleep apnea from continuous positive airway pressure (CPAP) treatment.

Even people without OSA can experience symptoms of sleep apnea after drinking. Studies show moderate to heavy alcohol use can cause OSA episodes in people who don't otherwise have the condition.

In addition, research shows that people with alcohol use disorder have a higher risk of developing obstructive sleep apnea (OSA)—especially if they already snore.

Alcohol and Obstructive Sleep Apnea

For people with OSA, the effects of sleep apnea can become more serious when you add alcohol.

In addition to relaxing the airway, alcohol can also increase the time between when you stop breathing and "wake up" to breathe again. Alcohol can also cause nasal congestion, making it harder to breathe through your nose.

In other words, drinking alcohol can worsen OSA. This will make the drops in your blood's oxygen levels (desaturations) more severe. This can lead to increased carbon dioxide levels in your body (hypercapnia), which can be fatal if it's severe.

Alcohol and Central Sleep Apnea

Alcohol also worsens central sleep apnea, a central nervous system disorder. This is because alcohol slows the central nervous system and can cause more frequent apnea episodes.

Under normal circumstances, the brain signals respiratory muscles to inhale and exhale. However, in people with central sleep apnea, this automatic process glitches. Alcohol further reduces brain activity and leads to more frequent pauses in breathing.

Does Alcohol Cause Other Sleep Problems?

Drinking alcohol can affect your sleep in a number of ways. Research shows drinking alcohol disrupts the brain's normal electrical activity during sleep, altering your sleep cycle. This can lead to:

• Altered circadian rhythms
• Insomnia
• Shorter sleep duration

Heavy drinking—defined as five or more drinks per day on five or more days in the past month—is linked to chronic sleep problems. But even occasional moderate drinking can disrupt circadian rhythms and interfere with your sleep.

Does Alcohol Cause Snoring?

When you drink alcohol, the effects on your airways can also lead to an increase in snoring.

That's partly because alcohol decreases your drive to breathe. It slows your breathing and makes the breaths you take shallow.

In addition, alcohol can relax the muscles of your throat, which can allow your upper airway to collapse. This can cause vibrating of the soft tissues, leading to snoring.

Does Alcohol Cause Insomnia?

Drinking alcohol is linked to trouble falling asleep, staying asleep, or waking up too early, also known as insomnia.

Alcohol reduces both the quality of sleep and the amount of sleep you get at night. Even moderate moderate amounts of alcohol are associated with:

• Decreased REM sleep duration
• Increased wake after sleep onset time
• Longer time to fall asleep
• Lower percentage of time in bed spent sleeping

These effects are even more profound as we get older. Research in adults over age 50 found heavy drinkers have a 64% greater risk of insomnia, while less frequent binge drinkers are 35% more likely to develop insomnia than nondrinkers.

Even small amounts of drinking can affect your quality of sleep. One study found drinking fewer than two drinks for men or one drink for women caused a 9% decline in sleep quality.

Those figures increase the more you drink. Having two drinks for men or one drink for women caused a 23% decline while drinking in excess of that caused a 39% decline in sleep quality.

Should You Avoid Alcohol if You Have Sleep Apnea?

If you have sleep apnea, your provider will encourage you to avoid alcohol. At the very least, they will suggest that you do not consume alcohol a few hours before bedtime.

Drinking in the evening or before bed worsens sleep apnea making it more difficult to breathe. The more you drink, the worse effect it can have on your breathing and sleep.

Fortunately, CPAP treatment can reduce the effects of alcohol on OSA—but only if you remember to use it. Research shows people who drink alcohol frequently have lower rates of compliance with CPAP treatment.

It is also important to make sure that your CPAP machine is set up under typical sleeping conditions. If you normally drink alcohol most days but stop for your titration study, the pressure may not be enough to maintain your airway on nights you have been drinking.

Tell your healthcare provider if you drink frequently. An autoCPAP machine can adjust the pressures through the night, which may help to avoid this issue. 

Why You Need Enough Quality Sleep

Getting enough quality sleep at night is important to your overall health. You may want to consider the health benefits of sleep when you're considering whether to cut back or stop using alcohol.

Even though no one knows what the exact function of sleep is, research has shown that not getting enough of it can cause serious health problems.

Not getting enough quality sleep increases your risk of developing:

• Depression
• Poor metabolism
• Heart disease
• Insulin resistance (diabetes)

If you have a poor night's sleep, you'll feel tired the next day. Excessive daytime sleepiness caused by disturbances like breathing interruptions is associated with the following:

• Impaired function in social situations (e.g., at school or work)
• Trouble remembering things
• Car accidents
  

Tips for Living With Sleep Apnea

Sleep apnea can be managed with the following treatments and lifestyle changes:

• Avoid sleeping on your back
• Lose excess weight
• Use your CPAP machine every night
• Try a dental device to keep your jaw forward and the airway open while you sleep

In some cases, surgery to remove the tonsils, adenoids, or excess tissue at the back of the throat can treat sleep apnea. However, this may not cure OSA and could make it worse.

When to See a Healthcare Provider

If you suspect you may have sleep apnea, talk to your healthcare provider about getting a sleep study. Signs of sleep apnea include:

• Daytime sleepiness
• Fatigue
• Gasping for air in your sleep
• Snoring

If you have been diagnosed with OSA and your treatment doesn't seem to be working, tell your healthcare provider.

Summary

Consuming alcohol can affect your sleep and might increase your risk of sleep apnea. Alcohol can also lower your quality of sleep, make it harder to fall asleep or stay asleep, and cause snoring in people without OSA.

If you have sleep apnea, alcohol can cause you to experience more severe desaturation and could potentially increase your carbon dioxide to fatal levels. Ideally, people with OSA should refrain from drinking alcohol altogether. If you do drink, avoid drinking before bedtime, limit the amount you drink, and make sure you use your CPAP machine.

If you’re having sleep problems or symptoms of sleep apnea, talk to your provider. There are many steps you can take to try to prevent these conditions from getting worse, including reducing or stopping your alcohol consumption and sticking with your treatment plan if you have sleep apnea.