Alcohol and Sleep Apnea

Drinking alcohol is common, with roughly 55% of American adults Trusted Source National Institute on Alcohol Abuse and Alcoholism (NIAAA)A part of the National Institutes of Health, the NIAAA works to generate and disseminate fundamental knowledge about the effects of alcohol on health and well-being and apply that knowledge to improve diagnosis, prevention, and treatment of alcohol-related problems.View Source reporting that they’ve had a drink in the last month. Drinking alcohol close to bedtime can result in fragmented, lower-quality sleep. Alcohol may also contribute to sleep apnea, a condition marked by repeated breathing disruptions during sleep. 

Alcohol slows down the central nervous system Trusted Source Medline PlusMedlinePlus is an online health information resource for patients and their families and friends.View Source , which can worsen breathing in people with obstructive sleep apnea (OSA) and central sleep apnea (CSA). Untreated sleep apnea is linked to a number of potentially serious health complications, and alcohol consumption may heighten these health risks. 

If you have sleep apnea, it’s important to understand alcohol’s effects so that you can make informed choices that promote better, more restful sleep.

Start sleeping better with a Home Sleep Study

Take a one-night sleep study in your own bed, review results with a certified sleep expert, and get a personalized treatment plan.

Get Started

4.8

55,000+ patients

Can Alcohol Cause Sleep Apnea?

OSA affects 10% to 30% Trusted Source UpToDateMore than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights.View Source of adults in the United States. Alcohol consumption has been associated with a higher risk of having OSA, but more research is needed to determine if alcohol can actually cause OSA. Because many risk factors are associated with OSA, it can be difficult to identify a single cause for why OSA occurs in a specific person.

Observational studies in multiple countries have analyzed whether people who drink alcohol are more likely to have OSA. A meta-analysis of these studies found that OSA was around 25% more common in heavy drinkers compared to non-drinkers or light drinkers Trusted Source Journal of Sleep MedicineView Source . While this demonstrates a correlation, it does not necessarily prove that alcohol directly causes OSA.

OSA is characterized by upper airway collapse and breathing blockages. In people with OSA, the tongue, jaw, or soft palate obstructs their airway, which limits or interrupts breathing. Alcohol is a sedative that relaxes your throat muscles, making it harder for your airway to stay supported. 

Research to date has found that alcohol may contribute to the development of OSA and can also worsen symptoms and outcomes Trusted Source Sleep MedicineView Source in people who have already been diagnosed with the condition. In fact, one study shows that drinking alcohol can decrease your blood oxygen level and increase your apnea-hypopnea index (AHI), which is a measurement that shows how many times you pause or stop breathing in an hour of sleep Trusted Source National Library of Medicine, Biotech InformationThe National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information.View Source . Despite these findings, more research is needed to determine whether or not alcohol is a cause of sleep apnea.

Can Alcohol Cause Central Sleep Apnea?

In central sleep apnea, the brain and respiratory muscles fail to communicate and cannot properly regulate breathing. The root causes of CSA are harder to identify than OSA’s, and there are multiple types of CSA. There is more available research that shows the connection between alcohol and OSA, which isn’t surprising considering OSA is much more widely diagnosed than CSA. 

CSA can stem from breathing patterns, problems with altitude, and substance abuse. Often, opiates are the cause of substance-related CSA. However, alcohol can also impact CSA because it reduces activity in the brain and central nervous system. Because CSA is already characterized by a communication failure between the brain and respiratory system, the addition of alcohol can further complicate the symptoms of CSA and slow a person’s breathing.

Does Alcohol Make Sleep Apnea Worse?

After drinking alcohol, a person with OSA is prone to having more and longer-lasting breathing disruptions. Multiple studies have found that alcohol use increases a person’s AHI. Drinking alcohol has also been tied to reduced blood oxygen levels in people with OSA.

There are several reasons why alcohol use may make OSA worse.

• Higher arousal threshold: OSA-related breathing restriction and low oxygen levels cause people to partially awaken, allowing breathing to be restored. Alcohol raises the arousal threshold, meaning it becomes more difficult for a person to wake up. Therefore, breathing obstructions must be longer or more severe to cause an awakening.
• Relaxation of muscles around the airway: Drinking alcohol can make the muscles of the mouth and throat relax. This loss of muscle tone makes it more likely that loose tissue will block the upper airway.
• Increased nasal congestion: Alcohol consumption can induce changes in the nose’s blood vessels, which can contribute to congestion and make it harder to breathe through the nose. Nasal congestion can put more pressure on the upper airway and intensify breathing disruptions in people with OSA.
• Timing of alcohol consumption: Drinking alcohol in the evening or shortly before bed raises blood alcohol levels during sleep, increasing the effect on OSA. The impact on breathing may be higher during the first half of the night while the body is still metabolizing alcohol.
• Amount of alcohol consumed: Larger amounts of alcohol can heighten its effect on OSA. Studies have found that two to three standard drinks are associated with negative effects.
• Age: Some older people are more susceptible to alcohol’s effects, so those with OSA may make the condition worse if they drink before bed.

In addition to making symptoms worse, alcohol consumption may also compound health risks linked to OSA. For example, people with OSA have a greater risk of drowsy driving Trusted Source UpToDateMore than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights.View Source . Drinking alcohol can cause further impairment and make motor vehicle accidents more likely.By contributing to lower oxygen levels, alcohol use may also increase cardiovascular problems associated with untreated OSA.

Does CPAP Affect the Impact of Alcohol on Sleep Apnea?

While research so far is limited, studies suggest that using continuous positive airway pressure (CPAP) can reduce or eliminate the effects of alcohol consumption on OSA.

CPAP is a type of treatment for OSA that works by pumping air through a mask and directly into the sleeper’s airway. The pressurized stream of air helps hold the airway open while a person sleeps.

To date, only a few small studies have examined whether drinking alcohol makes OSA worse for people who use a CPAP machine. However, these studies have found that CPAP machines could prevent breathing disruptions in people with OSA who consumed alcohol, and that this did not require changing the pressure settings on the CPAP devices.More research will be needed to confirm these results. Meanwhile, people with OSA who use CPAP should remain aware of other possible effects of alcohol on sleep.

How Does Alcohol Affect Sleep?

The relationship between alcohol and sleep apnea is most clearly established in people with obstructive sleep apnea. But alcohol use is also linked to other types of sleep-related breathing disorders and snoring.

In addition to its potential impacts on breathing and sleep apnea, alcohol can interfere with sleep because of its effects on brain activity.

Although alcohol can make a person feel sleepy at bedtime, it throws off the normal process of sleep. As alcohol wears off during the night, a person is more likely to have shallower, lower-quality sleep and to awaken more frequently.

Drinking alcohol can interrupt a person’s sleep-wake cycle and may contribute to insomnia in people who rely on alcohol’s sedative effects to initially fall asleep.These sleep-disrupting consequences of alcohol consumption are most often found in people who have three or more drinks before sleeping. But even light drinking close to bedtime has the potential to interfere with sleep.

Does Alcohol Cause Snoring?

Drinking alcohol close to bedtime, drinking more than you typically do, and drinking heavily can all cause snoring. People who don’t typically snore may snore more loudly or intensely after drinking. However, snoring alone doesn’t mean they have sleep apnea. Alcohol causes the muscles in the mouth and throat to relax, which can cause tissues to flutter and make noise as the sleeper breathes in and out. 

While snoring is common in people with OSA, most people who snore do not have sleep apnea. In fact, most snoring does not interfere with breathing and is believed to be harmless. However, in people who typically snore, drinking alcohol may make snoring more severe.

Does Alcohol Cause Other Sleep-Related Breathing Disorders?

Some sleep-related breathing problems are linked to hypoventilation, a condition in which a person fails to get enough oxygen because their breathing is weak or slow. Drugs that depress the central nervous system, including alcohol, can worsen hypoventilation Trusted Source American Academy of Sleep Medicine (AASM)AASM sets standards and promotes excellence in sleep medicine health care, education, and research.View Source .

Doctors often recommend that people with a breathing disorder called obesity hypoventilation syndrome (OHS) avoid drinking alcohol because of its effects on respiration during sleep.

The effects of alcohol on hypoventilation may be even greater in people who already use medications with sedative effects.

Start Sleeping Better

Sign up to receive emails about the signs of sleep apnea,
as well as our comprehensive Better Sleep Guidebook.

Can Alcohol Cause Insomnia?

Alcohol is a sedative, so it’s understandable to think that it could help your sleep, but research shows that alcohol actually has a negative impact on sleep. Insomnia and alcohol are linked bi-directionally, so drinking can make insomnia worse, and insomnia can make people increase their alcohol intake Trusted Source Current Opinion in PhysiologyView Source . Drinking can impact sleep quality in both the short and long term. Insomnia affects between 31% and 91% of people with alcohol use disorder (AUD) compared to 10% of the general population. 

Your body feels a natural pressure to fall asleep, which is called homeostatic sleep drive Trusted Source Centers for Disease Control and Prevention (CDC)As the nation’s health protection agency, CDC saves lives and protects people from health threats.View Source . This pressure begins after you wake up and gradually increases throughout the day. Alcohol interrupts and weakens this drive, which makes it harder to fall asleep and stay asleep. Even moderate drinking can affect your circadian rhythm and sleep-wake cycle, as well as the quality and length of your sleep.

Tips for People Living With Sleep Apnea

Experts often suggest that people with sleep apnea avoid drinking alcohol. If abstaining from drinking completely is not realistic, it may be beneficial to reduce alcohol consumption and try to stop drinking at least a few hours before bedtime.

Regardless of whether they choose to drink alcohol, people with obstructive sleep apnea can potentially improve their sleep with the following strategies.

• Stick with the treatment plan: Standard treatment for OSA often involves CPAP or a similar device. To be effective, the CPAP must be used consistently, which may also lessen the effects of alcohol consumption on OSA. Concerns about comfort or other issues when using a CPAP should be shared with a doctor or sleep specialist.
• Consider lifestyle changes: For many people, losing weight, getting regular exercise, and avoiding back sleeping can reduce the severity of OSA.
• Practice good sleep hygiene: In addition to treating sleep apnea, taking steps to establish healthy sleep habits and design a sleep-friendly bedroom may help prevent unwanted interruptions during the night.

When to See a Doctor

Because it is not possible to determine if someone has sleep apnea based on symptoms alone, people with any of the following issues should see a doctor or sleep specialist:

• Gasping for air or making choking sounds during sleep
• Frequent snoring that is very loud
• Abnormal breathing patterns while asleep
• Significant daytime sleepiness
• Regular morning headaches
• Noticeable lack of focus or concentration during the day

It may help to ask a bed partner or roommate about snoring and other sleep-related breathing problems, since people with sleep apnea are not always aware of these issues.

When a person has one or more of these sleep apnea symptoms, a doctor can review their specific situation and determine whether to recommend sleep apnea testing, which is required to diagnose the condition.

People who have already been diagnosed with sleep apnea should talk with their doctor if their symptoms do not improve after starting treatment. A doctor can discuss alcohol habits and other lifestyle choices, as well as recommend steps to make treatment more effective.

It is also important for people to seek professional help if they show signs of alcohol abuse. For example, if consuming alcohol interferes with work, school, or personal relationships, it may be an indication of unhealthy drinking habits Trusted Source Centers for Disease Control and Prevention (CDC)As the nation’s health protection agency, CDC saves lives and protects people from health threats.View Source .

Still have questions? Ask our community!

Join our Sleep Care Community — a trusted hub of sleep health professionals, product specialists, and people just like you. Whether you need expert sleep advice for your insomnia or you’re searching for the perfect mattress, we’ve got you covered. Get personalized guidance from the experts who know sleep best.