Alcohol and apnea: a risky mix

Alcohol and apnea: a risky mix

Alcohol and sleep make for strange bedfellows at the best of times.

While having a drink (or three) before bed can relax your muscles and indeed lead to falling asleep faster, in reality your body is not achieving restorative sleep when you’ve been drinking.

Even if we aren’t talking about enough alcohol to land you with a head-ringing hangover the next day, your nighttime celebration alters your sleeping brain wave patterns,1 so even if you’re in bed “sleeping” for several hours, you’ll likely feel tired the next morning. Add Obstructive Sleep Apnea to the mix, and you are going to pay a heavier price than you may have bargained for when you accepted that last round at the end of the night.

How does alcohol make us snore?

Alcohol is a depressant that causes muscle relaxation. While you sleep, the muscles of your throat relax, your tongue falls backward, and your throat becomes narrow.  What you hear as snoring is simply the vibration of the throat tissues as you breathe. The narrower your airway becomes, the greater the vibration and the louder your snoring.  For this reason, even people who don’t suffer from OSA are likely to saw logs during sleep.

man sleeping with his mouth open

Faster sleep doesn’t mean better sleep

Using a CPAP machine can help sufferers of OSA get a much better night’s sleep, but sometimes settling down at bedtime can be a problem for anyone. When you drink alcohol, you may fall asleep hard and fast, but alcohol will only exacerbate your sleep apnea, essentially doubling down on your sleep disruption.  Drinking alcohol can actually increase the apnea events and their duration, and you’re likely to feel the symptoms in the morning.

As mentioned above, one  of the effects of alcohol is to cause muscle relaxation. If you remember what they told you when you first sought treatment for OSA, it all begins with relaxation of the muscles of the soft palate, which then descends to block your airway and cause repeated micro-waking events throughout the night.

You don’t usually notice it, but you’re actually being robbed of restorative REM sleep and that’s why you awaken feeling as though you were up half the night. Muscle relaxation caused by alcohol has the same effect, even on people without OSA,2 so combining the two means you’re in for a rough morning.

how alcohol affects your sleep 1

Apnea never sleeps

If you regularly use a CPAP machine, having had a few drinks is no reason to take a “night off” and flop into your bed with the mask hanging beside you like an awkward wallflower at a party. For most patients who have adapted to sleeping with a CPAP machine, the restfulness it brings makes it a cherished companion they wouldn’t want to do without. For some though, early struggles to get used to the machine may leave a lingering resistance, even if they know that regular use is better for them. That’s completely normal.

The trouble with “tying one on” is that it can lead to questionable decision making, and the decision to leave the mask hanging after you’ve had a few is definitely not a good one. You can take a break from treatment, but your apnea won’t – so if you’ve already impaired your sleep cycle with drinking, do yourself a favour and at least make sure you’re getting the assistance of your CPAP while you sleep it off.

dame dort avec son masque CPAP à côté d'elle

Limit your intake

Numerous studies, going back to the 1980s, have clearly established the ways that alcohol can worsen sleep apnea.3

Even without the science, ever since the stone age humans discovered that drinking the funny-tasting grape juice made them feel good, we’ve known that there’s a price to pay for drinking. If you’re planning a night that might include alcoholic beverages, consider planning to cut yourself off after a fixed number so you don’t over-indulge.

deux hommes habillés en lutins dorment dans un bar

Allowing time for alcohol to wear off before bed

It takes time for your body to metabolise alcohol so it’s best to Quit while you’re ahead. There’s really no way around it. Even one or two drinks before bed are enough to throw off your sleep cycle, so the tradition of the nightcap was clearly invented by someone who didn’t understand the value of a good night’s sleep.

To avoid disruption, consider giving yourself a “last call” a few hours before you hit the sack. It varies based on weight and gender, but as a general rule it takes about an hour to process one unit of alcohol (it doesn’t matter if that means a beer, a glass of wine, or a shot of tequila) so try to give yourself 2-3 hours between your last drink and bedtime.4 You’ll be thanking yourself in the morning.

dame endormi avec un verre de vin vide dans les mains

Tempering alcohol with water

There’s an old expression about mixing types of alcohol that goes something like, “beer then liquor, makes you sicker, liquor then beer in the clear.”

While that might have some merit with regards to impulse control and the temptation to drink faster if you’re piling on shots at the end of the night, it doesn’t really help when it comes to your ability to get restorative sleep. Alcohol is alcohol as far as your brain and body are concerned. One trick is to alternate water or some other (non-sugary or caffeinated) drink between each alcoholic one. Call it, “water between booze, helps you snooze.”

It’ll not only help you stay at the party without embarrassing yourself, but it will also mean that your overall consumption is lowered so you’ll be better off when you call it a night. Just be careful not think you can carry this trick to the extreme and balance out a bender with a giant jug of water – that much consumption of any liquid before bed is likely to mean you’re waking up for a different reason.

de l'eau qui se fait verser dans un verre

Balance is key

There’s nothing wrong with having a few drinks with friends from time to time. The trouble with alcohol is it can easily fool you into thinking that you’re sleeping better because you fall asleep faster, when in fact the opposite is true. Because of the allure of falling asleep quickly when you’re regularly tired, many people succumb to the trap of “self medicating” with a drink or two before bedtime, which in the long term will not only rob you of rest but can also lead to alcohol dependence.

If you choose to drink that’s fine, but doing so in moderation, stopping early, and making sure to always use your CPAP will greatly improve your quality of sleep. And remember that if you’re struggling with sleep habits or the use of your CPAP machine, the team at Apnée Santé is always there to help.

drinking with friends

If you are a habitual drinker with OSA, consider using Auto-CPAP

Probably the most important thing you can do after drinking a few glasses is to use an Auto-CPAP machine. Why is this? As your muscle tissue relaxes, an increase in pressure may be needed to keep your airway open. An auto CPAP machine can detect variations in airflow and self-adjust as need be so that you get optimal air pressure throughout the night. If you’re in a fixed pressure, your CPAP is set to a constant pressure that reflects a typical night’s sleep and not a night affected by alcohol.

You should also keep in mind the importance of setting up your continuous positive airway pressure (CPAP) under typical sleeping conditions. Therefore, if you drink alcohol daily but abstain prior to your sleep study, the pressure may not be adequate to maintain your airway when you drink.

To maximize your response to therapy, let us check verify that your CPAP is delivering the right pressure for your needs.

un verre et une bouteille de vin sur une table de nuit à côté d'une machine CPAP