The Connection Between Alcohol and Sleep Apnea

As Anthony Burgess bluntly puts it: “Laugh and the world laughs with you, snore and you sleep alone.” Navigating the world of sleep can be tricky, and well, tiring, especially if you have sleep apnea, a pesky condition where breathing repeatedly stops and starts during sleep, potentially leading to a host of problems such as daytime fatigue, morning headaches, and even heart issues. 

In addition to causing snoring, sleep apnea can be uncomfortable and even scary. Imagine trying to rest with someone randomly pressing a “pause” button on your breathing! It’s like those annoying buffering moments while streaming your favorite show: you're immersed in the story and then — bam! — everything pauses. 

Research says that as much as over a quarter of the U.S. population suffers from sleep apnea as of 2023! Most are between the ages of 30 and 70, and as many as 40,000 die every year due to sleep apnea-related heart problems.

Adding alcohol to the mix can make things even more challenging. Let's explore the connection between alcohol and sleep apnea, and find ways to ensure that you get the best Zzz’s without those nightly interruptions.

The Science of Sleep Apnea

There are primarily two types of sleep apnea:

• Obstructive sleep apnea (OSA). This is the most common form of sleep apnea. OSA occurs when the muscles at the back of the throat fail to keep the airway open. It’s like trying to sip a thick shake through a straw that keeps collapsing.
• Central sleep apnea. Less common, this type of sleep apnea doesn't stem from a blocked airway. Instead, the brain fails to transmit the right signals to the muscles controlling your breathing. It’s a bit like forgetting to press the gas pedal while driving: everything's in place, but there’s just no action!

The “pauses” caused by sleep apnea can last from a few seconds to several minutes and might occur 30 times (or more) an hour, wreaking havoc on our sleep cycle. When your sleep is fragmented, we might wake up feeling like we've run a marathon, even if we’ve had a full night’s sleep. This can lead to irritability, difficulty concentrating, and a higher risk of accidents.

The aftermath isn't just waking up feeling groggy. Untreated sleep apnea is linked to a variety of health issues. Over time, it can contribute to hypertension, heart problems, type 2 diabetes, liver problems, and more.

Diagnosis and Treatment

If you or someone you know often feels extremely tired during the day, snores loudly, or wakes up with a choking sensation, it might be worth looking into sleep apnea. Getting a proper diagnosis is the first step to a solution! Potential treatments might be: 

• Continuous Positive Airway Pressure (CPAP) therapy. This is the most common treatment for moderate to severe obstructive sleep apnea. Patients wear a face or nasal mask, which is connected to a machine that delivers a continuous stream of air to keep the breathing passages open.
• Bilevel Positive Airway Pressure (BiPAP or BPAP) therapy. Unlike CPAP, which delivers steady, constant pressure, BiPAP delivers higher pressure when we inhale and lower pressure when we exhale.
• Oral appliances. These are devices that are designed to keep the throat open by bringing the jaw forward, which can sometimes relieve snoring and mild obstructive sleep apnea. They are often used as an alternative to CPAP for people with mild to moderate sleep apnea who cannot tolerate CPAP.
• Positional therapy. Some people experience sleep apnea primarily when sleeping on their back. In such cases, they might benefit from changes in sleep position, like sleeping on their side.
• Adaptive Servo-Ventilation (ASV). This device can store information about our normal breathing pattern and then uses pressure to normalize it, preventing pauses in breathing.
• Inspire therapy. This treatment uses a small pulse generator that’s implanted under the skin in the upper chest. The device monitors breathing signals during sleep and delivers mild stimulation to the airway muscles, keeping the airway open.
• Lifestyle changes. Weight loss, avoiding alcohol (more on this later), and sleeping in a different position can sometimes help those with milder forms of sleep apnea.
• Surgery. There are various surgical options, which might include uvulopalatopharyngoplasty (removing excess tissue from the throat), maxillomandibular advancement (moving the upper and lower part of the jaw forward to enlarge the space behind the tongue and soft palate), or genioglossus Advancement (moving the attachment for the tongue muscles forward).

Alcohol’s Role in the Mix

Now, let’s see how alcohol fits into this equation. Spoiler: it’s not a match made in dreamland!

Many have sworn by the "nightcap" — a drink before bedtime — believing it helps them nod off faster. And it's true: alcohol does have sedative properties. After we’ve had a drink, we might feel a wave of drowsiness inviting us to lie down and surrender to sleep.

But here's the twist: while alcohol can help us fall asleep faster, it doesn’t necessarily help us stay asleep or enjoy quality sleep, especially if sleep apnea is part of the mix. How? Here are four main ways booze can complicate the issue.

1: Muscle Relaxation

Alcohol acts as a muscle relaxant. While this might sound like a good thing — a relaxed body for relaxed sleep — this relaxation includes the muscles at the back of your throat. When these muscles get too relaxed, it makes it easier for the airway to become blocked, especially in those already predisposed to sleep apnea. The result? Disrupted breathing patterns and increased snoring.

Why does this happen? Alcohol is a central nervous system depressant, which means it slows down brain activity. As this slowing cascades through the system, muscles throughout the body get the memo to chill out: it’s why people might have a drink to "loosen up." However, when it comes to sleep, it's not all happiness and rainbows.

One key muscle group affected by this relaxation involves the muscles of the throat, especially the ones responsible for keeping our airway open. When these muscles relax too much, the airway can narrow or collapse entirely. This not only leads to an orchestra of snoring sounds but can also cause interruptions in breathing, which is a hallmark of sleep apnea.

Picture this: you're in a calm, gentle river on a float, but suddenly the water pathway narrows. It becomes harder to glide smoothly. This is similar to what happens when our throat muscles relax excessively: the "river" (or airway) narrows, making it tougher for air to flow smoothly.

For people already predisposed to conditions like sleep apnea, or for those who just naturally have a narrower airway, alcohol can accentuate the issue. But even for those without any predispositions, a heavy night of drinking can make sleep interruptions more frequent and pronounced.

2: Sleep Architecture Disruption

Our sleep follows a certain architecture, transitioning from light sleep to deep sleep and then REM (Rapid Eye Movement) sleep throughout the night. Each of these stages has its unique characteristics and plays a role in ensuring we wake up feeling rejuvenated.

• NREM Stage 1. During this initial stage, we’re just drifting off: it's light, and we can be easily awakened.
• NREM Stage 2. This stage is still relatively light, but it acts as a bridge to the deeper stages of sleep. Heart rate slows down, and body temperature drops.
• NREM Stage 3. This is deep sleep. If someone tried to wake us, they’d have a tough time. During this phase the body repairs muscles, strengthens the immune system, and performs other essential restoration tasks.
• REM sleep. This is where the magic happens. REM stands for Rapid Eye Movement, and it's the stage associated with vivid dreams. It’s also crucial for brain function and plays a role in memory, learning, and mood regulation.

Now, where does alcohol fit? Drinking, especially closer to bedtime, can propel us more rapidly into the deep sleep of NREM Stage 3. Sounds like a great shortcut, right? Well, the catch is that we spend more time in this stage early in the night and less time in REM sleep, which we would typically enter later. 

Missing out on that quality REM time, in turn, cuts our essential dream time short. In the long term, it can wreak havoc on our cognitive function and emotional health.

3: Frequent Bathroom Trips

We've all been there: waking up in the wee hours (pun intended) needing to make that groggy trek to the bathroom. If you've found that after a drink or two this calling seems to get louder and more frequent, you're not alone. Alcohol acts as a diuretic, increasing urine production and potentially causing dehydration. These middle-of-the-night wake-ups can interrupt the natural flow of our sleep cycle and make it harder to fall back asleep.

Alcohol inhibits the release of vasopressin, a hormone that helps our kidneys reabsorb water and reduce the amount of urine stored in the bladder. So when alcohol comes into play, less vasopressin is produced, leading to more fluid being directed to the bladder.

Here's the ripple effect in the pond of nighttime tranquility:

• Increased urine production. After consuming alcohol, we might find ourselves visiting the bathroom more often even before we hit the hay. 
• Interrupted sleep patterns. Once we’re asleep, the bladder fills up faster than usual. This means we might be pulled out of deep sleep or a dream-filled REM stage to dash to the restroom. In addition to breaking the rhythm of our sleep cycle, it makes it challenging to slide back into that restful state.
• Potential dehydration. With all this frequent urination, there's a chance we’re losing more fluids than we’re taking in. Dehydration can lead to a dry mouth, headaches, and can further undermine the quality of our sleep.

4: The Rebound Effect

Remember how alcohol puts us on the fast track to deep sleep and disrupts our sleep architecture? Well, another consequence of this disruption is the so-called "rebound effect,” which can lead to lighter, fragmented sleep in the second half of the night, causing us to wake up feeling less than refreshed.

The rebound effect has to do with the fact that alcohol interferes with the balance of neurotransmitters in the brain, initially suppressing the ones that keep us alert and active. However, as it gets metabolized and its effects diminish, there's a surge in these previously suppressed neurotransmitters. It's like holding a bouncy ball under water and then suddenly letting go. It shoots up with force! Similarly, as alcohol's effects wane, the brain becomes more active, leading to the "rebound" in wakefulness.

The most noticeable outcome of the rebound effect? Waking up feeling like we’ve been shortchanged in the sleep department. Even if we;ve clocked in a good 7-8 hours, the disrupted second half of your night can leave us feeling groggy, irritable, and less alert.

7 Action Steps to Improve Sleep

If you're looking to quit or cut back on alcohol, kudos to you! Here are some steps to help you on your journey and improve your sleep:

• Inform and educate. Awareness is the first step. Recognizing that the glass of wine or pint of beer might lead to trouble can help inform your drinking decisions, especially closer to bedtime. Maybe it's adjusting the timing, quantity, or simply ensuring you hydrate well with water in response.
• Set boundaries. Limit alcohol intake several hours before bedtime. This gives your body time to process the alcohol.
• Stay hydrated. Alcohol can be dehydrating. Ensure you drink plenty of water throughout the day to combat its effects.
• Opt for alternatives. If you fancy a drink, consider non-alcoholic beverages. There's a plethora of delicious mocktails waiting for you!
• Monitor your sleep. Consider using a sleep tracking app. This will help you see the direct effects of alcohol on your sleep patterns.
• Get professional advice. If you think you might have sleep apnea or any other sleep disorder, seek advice from a sleep specialist.
• Join a support group. There are tons of communities, both online and offline, where you can share your journey, learn from others, and get the motivation to continue.

Summing Up

When it comes to navigating sleep apnea, the more informed we are, the better. We all know how a restless night can spill over into our day, making us feel like we’re walking through molasses. And by understanding how alcohol interacts with our sleep patterns, we can make more informed decisions about our evening rituals. 

In conclusion, while alcohol might seem like your nighttime ally, it's worth pondering if it's doing more harm than good, especially when it comes to your sleep. A world of restful nights awaits you. So, why not take that first step? After all, the dreamy world of uninterrupted sleep is just around the corner!