Alcohol and sleep Apnea: How drinking affects your sleep and breathing

Quick takeaways

• Alcohol can worsen sleep apnea because it’s a muscle relaxant,
  making breathing pauses more frequent and severe.¹
• Drinking alcohol before bed may weaken your brain’s response to
  low oxygen.² This means when you stop breathing during sleep,
  you stay in that pause longer before your brain wakes you
  up.³
• Drinking close to bedtime disrupts your night. You may experience
  a rebound of wakefulness, vivid dreams and fragmented
  sleep.⁴
• Alcohol can lead to dry mouth, nasal congestion, throat
  irritation and a higher likelihood of mask leaks.⁵ As such,
  avoiding drinking may help maintain more stable breathing during CPAP
  therapy at night.⁵

Some people believe a drink before bed helps them unwind, and it’s
true that alcohol initially acts as a sedative. You may fall asleep
faster,⁶ but your sleep quality drops fast as your body
processes the alcohol.^7,8 In many cases, alcohol can cause a
rebound effect later in the night, leading to frequent awakenings and
poor rest.

Because alcohol relaxes your throat muscles, your airway can collapse
more easily, leading to breathing pauses.² The following
guide explores the connection between alcohol and sleep apnea. We’ll
look at the science of why drinking relaxes your throat muscles and how
it may impact sleep apnea treatments. Keep reading to explore the
options and let us help you find the support you need for more restful
nights and fully energized days.

Understanding sleep apnea and its treatment

Let’s look at what happens in your body when you have sleep apnea and
how treatments like CPAP are designed to help.

What is sleep apnea?

Sleep apnea is a condition where breathing stops and restarts many
times throughout the night.⁹ These interruptions can make it
harder for your body to get enough oxygen.

Normally, blood oxygen levels while sleeping range from 96% to 100%.
For people with sleep apnea, these levels can drop significantly —
sometimes lower than 88%.¹⁰ Your heart, lungs and brain
require oxygen to function properly, and without it, tissue cells begin
to die. This lack of oxygen is why sleep apnea is linked to serious
health conditions, such as:¹¹

• Heart disease
• Diabetes
• Obesity
• Depression
• Stroke
• High blood pressure
• Kidney disease

Obstructive sleep apnea (OSA), is a condition where your upper airway
becomes blocked repeatedly during sleep, making it harder for air to
flow.⁹ These blockages can reduce or completely stop the flow
of air, causing your breathing to pause throughout the night.

Symptoms of OSA can include:⁹

• Excessive daytime sleepiness
• Morning headaches
• Feeling irritable or moody
• Difficulty concentrating, struggling to feel present during the
  day
• Snoring or gasping for air while you sleep

If left untreated, severe OSA can increase your risk of a heart
attack by 2.6 times, and people with severe sleep apnea have a 123%
higher risk of motor vehicle accidents.^12,13 Lack of quality
sleep can also lead to brain fog, trouble concentrating, lower
productivity at work and strained relationships with loved ones.

What is CPAP therapy?

Continuous positive airway pressure (CPAP) therapy is a sleep apnea
treatment that helps people breathe while they sleep.¹⁴ It
uses a small machine placed by your bed to gently deliver a steady flow
of air through a mask.

CPAP is a drug-free treatment with zero medication-related side
effects. A typical CPAP system includes three parts: a CPAP device, a
flexible tube and a mask that fits over your nose or over both your
nose and mouth. The gentle air pressure helps keep your airway open, so
you can breathe steadily throughout the night.

How alcohol affects sleep and breathing

Now, let’s bring alcohol into the picture. It’s important to
understand that alcohol is a substance that can affect your central
nervous system, your muscles and your sleep cycles.¹

How alcohol changes sleep

Some people may have a nightcap to help them drift off to sleep.
Alcohol acts as a sedative, slowing down brain activity and helping
people feel relaxed — making a drink before bed seem appealing. However,
while alcohol may make you feel sleepy at first, it can also relax the
tongue and soft tissue muscles, blocking the airways.¹ This
is why alcohol is considered a risk factor for obstructive sleep apnea
(OSA).

As your body breaks down the alcohol, the sleepy effect starts to
wear off.¹⁵ Brain activity can spike, causing you to wake up
frequently in the second half of the night.¹⁶ Plus, alcohol
can reduce time spent in rapid eye movement (REM) sleep, the stage
that’s vital for restoration, emotional processing and
memory.^7,17 Missing out on REM sleep can leave you feeling
groggy, unfocused and irritable the next day, regardless of how many
hours you spent in bed.

Why alcohol may worsen sleep apnea

Even for someone with a healthy airway, the muscle relaxation caused
by alcohol can make them snore when they don’t
usually.^6,18,19 For someone with obstructive sleep apnea
(OSA), the effects can be more severe.¹

Muscle relaxation and body structure

Alcohol can relax the muscles in your throat. This relaxation can
make your airway more likely to narrow or collapse while you sleep.

Delayed arousal response

A potentially serious effect alcohol can have on people with
obstructive sleep apnea is delayed arousal response.²⁰
Normally, when your airway closes, your brain signals your body to wake
up so you can breathe again. Alcohol acts as a central nervous system
depressant, reducing how quickly your body responds to low oxygen levels
during sleep.

Under normal circumstances, your brain quickly detects a drop in
oxygen and wakes you up to breathe. Alcohol slows this alarm system
down, meaning breathing interruptions can last longer than
usual.⁵ Longer breathing pauses may put increased strain on
the heart and can make symptoms like snoring or gasping more noticeable
as your body works harder to restore airflow.²¹

Alcohol’s impact on CPAP therapy

Continuous positive airway pressure (CPAP) therapy is designed to
help keep your airway open while you sleep. Alcohol may make it more
challenging to use CPAP therapy consistently.²² This can
create a cycle where the nights alcohol affects your sleep may also be
nights when using CPAP feels more difficult.⁵

How drinking interferes with treatment

Alcohol may cause several physical complications that make wearing a
CPAP mask uncomfortable.² Drinking before bed may cause nasal
congestion, dry mouth and throat irritation — all which may make it
harder to breathe through a nasal mask or nasal pillow.²

Inflammation caused by alcohol may force people to breathe through
their mouths, leading to dry mouth or compromising the seal of the
mask.²³ If your mouth falls open during sleep because your
nose is stuffed, the pressurized air from the CPAP machine may escape
through your mouth rather than keeping your airway open, which can make
the therapy less effective.

Tips for CPAP users

If you enjoy a drink now and then, it doesn’t mean you have to
sacrifice your sleep. In fact, using your CPAP machine may be especially
helpful on nights when alcohol affects your breathing, since your airway
can be more likely to narrow during sleep.²²

Here are a few tips to help:

• Try to avoid drinking alcohol 3–4 hours before bedtime.
• Stay hydrated while drinking.
• Keep your CPAP equipment clean and well-maintained.

Health risks of combining alcohol and sleep apnea

When we talk about alcohol and sleep apnea, the risks extend far
beyond a bad night’s sleep.

Cardiovascular
strain

Alcohol and untreated sleep apnea may increase the risk of high blood
pressure, stroke, arrhythmias and heart disease.²⁴ Severe
obstructive sleep apnea (OSA) is associated with a 2.65x increased risk
of a heart-related death.²⁵

When you stop breathing, oxygen levels drop. Typically, anything
lower than 90% is thought to be dangerous for your health.²⁶
Recovering from these drops requires your body to release a surge of
stress hormones like adrenaline. Such a surge can spike your blood
pressure and heart rate while you sleep — a time when your heart should
be resting. Over time, this repetitive stress can contribute to chronic
high blood pressure and atrial fibrillation (AFib)(irregular
heartbeat).^27,28

Mortality risks

Data indicates that severe obstructive sleep apnea (OSA) is linked to
nearly double the risk of death.²⁵ Alcohol can make airway
collapse worse — further increasing the risk of complications and even
death.

Metabolic health

Untreated OSA is linked to metabolic syndrome, a cluster of
conditions that impact how your body manages insulin and
cholesterol.²⁹ Severe obstructive sleep apnea (OSA) can make
it harder for your body to manage blood sugar levels.

This connection is common among people living with Type 2 diabetes.
In fact, 72% of people with Type 2 diabetes have some form of sleep
apnea.³⁰ Alcohol, which is often high in sugar and calories,
can further complicate blood sugar management and weight control. Weight
gain is a significant risk factor for sleep apnea.³¹ Excess
tissue in the neck can put more pressure on the airway and make it
harder to breathe.

Healthy habits for better sleep

Small adjustments to your alcohol use habits may impact how well you
sleep and how effective your treatment is.³²

Safer choices

Adjusting how you consume alcohol can help protect your sleep
quality:

• Limit alcohol, especially within a few hours of
  bedtime. Try to stick to moderate guidelines and avoid binge
  drinking. Stop drinking several hours before you plan to sleep to let
  your body process the alcohol.
• Choose your drinks wisely. Some people find that
  carbonated mixers can increase bloating and gas, which may push up on
  the diaphragm and make breathing more difficult.³³
• Avoid heavy meals or sedatives before sleep.
  Like alcohol, heavy meals can disrupt sleep, and other sedatives can
  relax throat muscles.
• Keep your sleep environment dark, quiet and
  cool. Such an environment helps promote deeper rest and can
  help counteract some of the restlessness caused by alcohol’s rebound
  effect.

Lifestyle changes that may help

Supporting your airway health involves more than just limiting
alcohol. Here are a few other healthy habits that can help you sleep
better:

• Stick to prescribed therapies such as continuous positive
  airway pressure (CPAP). Using your therapy consistently is an
  important part of getting the most benefit from it. Even if you have had
  a drink, try your best to use your device.
• Maintain a healthy weight. Managing weight can
  help reduce the severity of sleep apnea and improve overall
  health.³⁴
• Manage allergies or nasal congestion. Keeping
  your nose clear can help you breathe easier and may make CPAP more
  comfortable.
• Practice relaxation techniques. If you use
  alcohol to unwind, try swapping it for meditation, deep breathing
  exercises, regular cardio exercise or reading.^35,36 These can
  lower your heart rate and help prepare your body for sleep.
• Sleep on your side. Sleeping on your back
  (supine position) allows gravity to pull the soft tissues of your throat
  downward, making the airway collapse more likely. Sleeping on your side
  can help keep the airway open.

When to talk to your doctor

Consider scheduling an appointment with your doctor if:

• You notice snoring or gasping gets worse after drinking.
• You feel unusually tired, forgetful, anxious, or
  irritable.
• You drink more frequently.
• You find yourself using alcohol specifically to fall
  asleep.

Your doctor is here to help you reach your health goals. They can
adjust your treatment plan and connect you with support if needed. Being
open about your daily habits — including how much alcohol you drink —
can help your doctor create a treatment plan that fits your life.

Looking for tips for adjusting to CPAP? This guide can help.

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