How Booze Affects Your Snooze with Nancy Foldvary-Schaeffer, DO

Podcast Transcript

John Horton:

Hey there, and welcome to another Health Essentials podcast. I'm John Horton, your host. Many of us like to enjoy a beer or a glass of wine after a long day, but have you ever considered the effects of that nightcap when you go to bed? Because while alcohol might make you feel drowsy and even help you not off more quickly, it can be a real drag on the actual quality of your sleep. Today we're going to explore the relationship between alcohol and sleep with Dr. Nancy Foldvary-Schaefer, a sleep disorder specialist at Cleveland Clinic. She's one of the many experts who join us on our weekly podcast, to chat about ways to live healthier. So let's uncork the bottle on this topic, what's inside may help us sleep a little easier tonight.

Welcome back to the podcast, Dr. Foldvary-Schaefer. I have to tell you, you are the only guest we have where the goal is to put people to sleep with the conversation.

Dr. Nancy Foldvary-Schaefer:

I'm pretty good at that, I think. Thanks for having me.

John Horton:

Well, you always do seem to help. So today we're going to talk about alcohol and sleep. And after a tough day, it's just not unheard of for folks to unwind with a beer, a glass of wine, a cocktail. There's just something about a drink at night that just feels so relaxed. And given that, how does alcohol work against good sleep? It seems like it should help.

Dr. Nancy Foldvary-Schaefer:

That's a great question. For many of us a drink, alcoholic beverage here and there, does not seem to affect our sleep adversely. But in general, alcohol is not a friend of good sleep. In the United States, alcohol's probably the most common drug, so to speak, that Americans help themselves fall asleep. But once we fall asleep, alcohol is very destructive to the stages of sleep, particularly deep stages of sleep. And so it can lead to a chronic sleep problem, many chronic sleep problems, including insomnia.

John Horton:

Well, because alcohol, it has a sedative effect. Right? That's kind of, I guess the drug part of it that you're talking about.

Dr. Nancy Foldvary-Schaefer:

Right, right. It's initially a sedative, but once it wears off, and it really depends on our ability to metabolize alcohol, we all metabolize at different rates. Depends on the alcoholic content of what we were drinking, how many drinks we had. It even depends on gender because men can metabolize alcohol faster than women can. So there are many factors that are going to contribute to how quickly that alcohol is metabolized once we fall asleep. But as it gets metabolized, sleep quality becomes impaired, sleep becomes fragmented, and we tend to have a decline in REM sleep, REM sleep or rapid eye movement sleep. And this is a stage of sleep that predominates in the last one-third of the sleep period, and REM is critically important for brain health. It's critical for memory, learning, and even mood regulation. And so alcohol has the ability to chronically feed us REM sleep-deprived, which has significant brain adverse consequences.

John Horton:

Now, do we know how it does that? How does it interfere? Does it just put a little blockade up and it just doesn't let you reach that level of relaxation?

Dr. Nancy Foldvary-Schaefer:

I think it leads to so much fragmentation, and when our brain is waking up recurrently during the night, we then have to descend back into sleep and we do that through the light stages of non-REM. And so we normally will not immediately go into REM sleep and wake up and go back into REM sleep. Normally we'll have to transition through those lighter stages of non-REM sleep. So like some sleep disorders, for example sleep apnea and maybe other medications, use of alcohol is going to keep us chronically in those lighter stages so we can't achieve REM. And if we do achieve REM, we'll be waking up out of REM, so we will not attain the amount of REM sleep that we need for good brain health.

John Horton:

So it's almost like, from what you're saying, it sounds like alcohol makes it where you're waking up a little bit more at night. You don't even realize it, but it's just like your body's almost going into a little bit of an awake mode and then coming back into sleep, and it just never lets you get that full like, "I'm going deep into sleep."

Dr. Nancy Foldvary-Schaefer:

Yes, and most of it that's absolutely true, with the exception that I think most of us recognize it. Most of my patients recognize the difference in their sleep quality when they've had a drink or several drinks, versus when they're not drinking. Most of us do recognize that our sleep quality is better and deeper when we're alcohol-free.

John Horton:

It really is shocking. And I know you and I were talking ahead of this and I said, "I wear one of those smartwatches that tracks everything." And it is amazing if you have maybe a couple of drinks at night and you wake up the next day and look at your sleep, it's impacted. And you see that you didn't sleep quite as well. Like you said, you didn't have that deep sleep stage and it's surprising, but when you see it laid out for you like that, it really kind of drives it home.

Dr. Nancy Foldvary-Schaefer:

Yes, yes. And increasingly science is attempting to validate all the wearables that we have and validate them against a gold standard sleep study. But I think by and large, we recognize that there's a lot of accuracy to some of the wearables, particularly in terms of sleep fragmentation and probably in the assessment of deep sleep like REM sleep. And so certainly there's situations like use of alcohol where a wearable has the potential to be able to provide some direct feedback to the user, that sleep is different than a night after alcohol versus a night of being free alcohol.

John Horton:

Now, you had mentioned sleep apnea too. What's the connection that we see between alcohol consumption and sleep apnea?

Dr. Nancy Foldvary-Schaefer:

The specific connection with sleep apnea, and I might say that almost every category of sleep disorders can be adversely affected by alcohol use, specifically chronic alcohol use. There's a few ways in which alcohol can adversely affect sleep apnea. The first is that sleep apnea is also a condition where sleep can be fragmented. And so adding alcohol to the mix will lead to more fragmentation of sleep, less likelihood of achieving deep stages of sleep that again, we need to feel refreshed the next day and we need for good brain health.

But perhaps even more significantly is that obstructive sleep apnea, the most common form of sleep apnea, that affects maybe as many as 25% of men and 10% of women, 85% of which is probably not even diagnosed in the United States, is that alcohol is a depressant. So it reduces muscle tone in the nose and the upper airway in the throat, and that leads to the airway being more readily collapsible. And every time the airway collapses to a certain degree, we may consider that in the sleep laboratory an apnea episode. And so alcohol will make the airway more collapsible, make snoring louder, make apnea events potentially longer, and may even impair someone's ability to arouse after an apnea event.

John Horton:

Oh, wow.

Dr. Nancy Foldvary-Schaefer:

Which may lead to the oxygen level to be going even lower, which can go to a dangerously low level. And so there are physiological changes in upper airway tone that leads to a cascade of events that can make sleep apnea worse when alcohol's on board.

John Horton:

Wow. Well that really, yeah, that idea... Anyone's had that when you start losing that, your breathing gets compromised as you're laying there. That's scary. And it's hard to think that if you have enough alcohol, you're not even going to wake up during that.

Dr. Nancy Foldvary-Schaefer:

And eventually you'll wake up. But it may lead to a longer time of being apneic, being without oxygen at night, or being under the stress of having an apnea episode.

John Horton:

What are some other things that we sometimes see with alcohol affecting sleep? I've seen insomnia is one of them that seems to come up.

Dr. Nancy Foldvary-Schaefer:

Yes, insomnia is a big one. And it may sometimes even be the chicken or the egg. Is alcohol causing an insomnia disorder or is this somebody with a primary insomnia disorder? Which is common, 15% of adult Americans have chronic insomnia. And is it that chronic insomnia leads to substance use, including alcohol, because people are desperate to sleep? And in a way it might be easier to reach for a sleep aid, and alcohol might be the sleep aid of preference, rather than find a sleep provider who can help work through the tedious exercise of developing good sleep hygiene, which can take months to do with the right kind of healthcare provider. So insomnia is often intimately part of substance use in general, and that includes alcohol.

John Horton:

And it sounds like you actually hear of people, then they try to use alcohol almost to self-medicate, to try to beat insomnia, and really it's helping to fuel it.

Dr. Nancy Foldvary-Schaefer:

Yes. Yes, yes. And so, many people are recognized that it could be the alcohol that's interfering, but I've had many patients who came back to see me after curtailing alcohol use entirely, and their sleep disorder is resolved. Other times their insomnia is a little bit less problematic or their sleep apnea seems to be lesser. So alcohol use is a bad habit, and having bad sleep hygiene is also a chronic bad habit. And so these things tend to exacerbate one another when they coexist.

John Horton:

Now, it also seems like if you have a little bit to drink, there's times where you can get some just crazy dreams that follow that. I'm assuming that's not a coincidence.

Dr. Nancy Foldvary-Schaefer:

Yeah. So people may remember more dreams, especially when REM sleep is disrupted, and nightmares can happen, and just more active dreams can happen. Certainly in people with problems like PTSD who are prone to nightmares, they can feel significantly more symptomatic with the use of alcohol. And then there are sleep disorders like REM behavior disorder, which is a parasomnia. These are disorders of abnormal movements or behaviors surrounding sleep. So people with REM behavior disorder have the problem of being able to act out their dreams when normally our muscle tone is inhibited during sleep, so that while we're dreaming actively we're unable to move our body and act dreams out. But people with RBD, REM behavior disorder, can act out dreams, even in the absence of alcohol, can hurt themselves in their sleep by punching and kicking, falling out of bed. And alcohol certainly can exacerbate episodes in people with REM behavior disorder. So a whole spectrum of sleep disorders, including sleep timing, circadian disorders, can be impaired in the setting of chronic alcohol use.

John Horton:

I take it, would sleepwalking be in there too? Are you more apt to get up and start wandering around if you had a few drinks?

Dr. Nancy Foldvary-Schaefer:

Alcohol is known to be a trigger for sleepwalkers, as is chronic sleep deprivation. So people who chronically drink tend to become chronically sleep-deprived, and maybe chronically stressed. And those are the three main triggers for sleepwalkers.

John Horton:

I was going to say sleep deprivation, is a term that you hear, but it has some really just serious consequences, right?

Dr. Nancy Foldvary-Schaefer:

Absolutely. So sleep deprivation is usually classified as maybe something like acute sleep deprivation, where someone might be awake for 24 or 48 hours due to some life stressor, and then there's chronic sleep deprivation. So usually when we're seeing people in the sleep clinic and thinking about chronic alcohol use, we're talking about more chronic sleep loss. And so I would estimate that probably 35 to 40% of adult Americans are chronically sleep-deprived, meaning that they're sleeping less than seven hours on average, a chunk of those are sleeping less than six hours. And those people are at risk for adverse cardiovascular events, metabolic disorders, brain disorders. Let alone, for example, drowsy driving, 21% of fatal MVAs are attributed to drowsy driving. Drowsy drivers may just have been pulled a all-nighter, or they may be people who are chronically only sleeping five or six hours and think that's enough, and think they can get by. But it's just not enough sleep and at some point, our motor system as well as our cognitive systems are impaired by chronic sleep loss. Let alone adding maybe chronic alcohol use to that.

John Horton:

Yeah. Well, everything you laid out just sounds absolutely exhausting. So let's talk about how to avoid or limit these issues. Clearly not drinking any alcohol would be the obvious solution to these sort of problems, if they're brought on by alcohol. But if someone is going to enjoy a little, an adult beverage at night, what are the steps they can take to protect their sleep and maybe avoid some of these more serious issues?

Dr. Nancy Foldvary-Schaefer:

Yes. Yes. So generally, if you're going to consume alcohol, it should be probably within two to three hours of bedtime, maybe three hours of bedtime. So if you can drink a cocktail with an earlier dinner rather than a nightcap right before you're going to bed, chances are that alcohol is then metabolized and your sleep will not be as adversely affected. I think that's number one. Certainly lowering the amount of alcohol is important. Those are probably the most effective strategies. And I think if you're someone who is going to drink periodically, I think of this like when we prepare the kids to go back to school in the fall.

John Horton:

Yeah.

Dr. Nancy Foldvary-Schaefer:

Think about what effect that might have on how you function the next day, and maybe work in a little bit extra sleep the night before you go out to the wedding or wherever you're going to potentially drink. Because if you avoid being sleep-deprived going into a situation that might affect your sleep quality, you're going to recover faster than if you go into that already sleep-deprived.

John Horton:

That makes total sense. If you keep a good sleep schedule and everything's, your body's well rested, maybe you can have one night where you're putting it to the test a little bit more and you can rebound a little bit faster.

Dr. Nancy Foldvary-Schaefer:

Absolutely. The other tip would be that if you are drinking close to bedtime, I would sleep on my side rather than on your back. Because back sleeping has the tendency to further constrict the airway, and that can exacerbate sleep apnea. It can create a condition of sleep apnea, if you're drinking chronically right before bedtime, that might not even exist if you weren't drinking at all. So side sleeping is safer to protect the upper airway.

John Horton:

Well, and as you stated right at the start, the key is to drink responsibly on top of that. Moderation, we've mentioned that numerous times on this podcast when we've kind of touched on the issue of alcohol consumption. That is, first and foremost, the number one thing you need to do, if not just avoiding it entirely.

Dr. Nancy Foldvary-Schaefer:

Agreed.

John Horton:

So what are some signs that alcohol is seriously undermining your sleep? I'd imagine you're going to start noticing things or feeling certain things.

Dr. Nancy Foldvary-Schaefer:

Yes. People will notice that their sleep is lighter, that they're waking up maybe snoring or feeling like they're having apnea episodes, and very importantly that they're not refreshed in the morning like maybe they used to be before they were drinking alcohol. When we get sort of chronically sleep-deprived and have repeated nights of poor sleep, we feel it. Right? We're fatigued during the day, we're sleepy, we're yawning during the afternoon when we normally wouldn't be. And of course, when it gets to further stages, we may recognize that we're moody, others may recognize that we're irritable, we may have interpersonal conflicts because our mood has been adversely affected by losing REM sleep and by having fragmented sleep. And when it gets more and more severe, we start seeing cognitive changes that are chronic, poor judgment, poor decision making, and that gets people often behind the wheel where they're fatigued or sleepy and they're driving. And then when sleep deprivation really, really gets to an extreme degree, our motor reflexes, our reaction times can be impaired, and that can lead to devastating consequences behind the wheel or when using machinery at work, for example.

John Horton:

Yeah, and that's hard. You hear that, and I think everybody thinks, "Oh, I'm fine. You're a little tired, you're whatever." But it really slows down that much, I take it it's pretty noticeable?

Dr. Nancy Foldvary-Schaefer:

It is. And so alcohol has the effect of changing our sleep at night, and changing our sleep at night has the effect of how we function during the day. We sleep for a reason, sleep is foundational to health and wellness. And if we're setting ourselves up for bad nights of sleep, every organ system in our body potentially can be adversely affected the next day.

John Horton:

Wow. Well, this has been a pretty sobering conversation, Dr. Foldvary-Schaefer, and from the sound of it, that's a good thing. Before we say our goodbyes, do you have any other words of wisdom to share regarding alcohol and sleep quality, and just how we can all be a little more rested?

Dr. Nancy Foldvary-Schaefer:

Of course, minimizing alcohol or avoiding alcohol is one of many things we can do to promote good sleep health. And there is scientific evidence that tells us that poor sleep health is associated with cardiovascular consequences, metabolic disorders, obesity, for example, and cognitive decline. Now we know that people can develop Alzheimer's when they're chronically sleep-deprived over many years in their middle-aged years. And so I like to view sleep as something foundational to health and wellness, like exercise and diet. So just like when we're trying to follow a good diet, we're going to fall off the wagon once in a while, same will be with things like alcohol. But if we focus on most of the time trying to do the right thing for our sleep, we will benefit long-term. Our health and wellness will certainly benefit from that strategy.

John Horton:

And it makes sense. We should be spending about a third of our life asleep. So if you can get that good, you should be in a really great spot.

Dr. Nancy Foldvary-Schaefer:

That's right.

John Horton:

Well, Dr. Foldvary-Schaefer, thank you so much for coming in. I really appreciate you giving the time, and I look forward to having you back on.

Dr. Nancy Foldvary-Schaefer:

You're very welcome. Good to see you.

John Horton:

While drinking alcohol may initially make you feel relaxed or even drowsy, it can significantly compromise the quality of your sleep when you nod off, a reality you'll feel the next morning. So if you notice alcohol is interfering with your rest, think about making some changes. Might help put the good, in good night.

If you liked what you heard today, please hit the subscribe button, and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

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