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Substances and Sleep: How Alcohol, Prescription Drugs, and Stimulants Disrupt Your Sleep

Produced by the National Council of Aging

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Nov 28, 2023

Fact Checked

Understanding how substances like alcohol, prescription and over-the counter

drugs, and stimulants, affect your sleep can help you discover ways for a

more restful night’s sleep.

Written by: Steven Marshall, DNP, MSN, BSN, RN

Medical Reviewer: Chester Wu, MD

Reviewed by: Kathleen Cameron, BSPharm, MPH


Key Takeaways

● Contrary to common belief, the adult sleep requirement of seven to nine

hours does not decrease as we age.

● On average, 25.5% of women and 22.6% of men 65 and older sleep

less than seven hours per night.

● Poor sleep can increase your risk of accidents and injury and is

associated with chronic diseases and health-related issues, like high

blood pressure, stroke, and memory loss.

● Alcohol, prescription and over-the-counter (OTC) medications, sugar,

caffeine, and other substances can impact sleep quality and quantity.


All adults require an average of seven to nine hours of sleep each night, but a

common misconception is that we need less sleep as we age. [1]

Getting adequate sleep is vital for maintaining your overall health. Not only

does sleep regulate hormones that tell your body when you’re hungry or full,

but not getting enough sleep can make daily stressors harder to handle,

increase your risk of depression, [2]

and reduce the effectiveness of your immune system. [3]


Since sleep is so important, it’s important to understand that substances like

alcohol, marijuana, medication, food, and dietary supplements can negatively

impact sleep. [4]


This guide discusses how certain substances can impact sleep quality and

provides tips on getting the rest your body needs.


The importance of sleep as we age


With its restorative powers and ability to boost the immune system, sleep is a

critical component of our overall health. While the recommended amount of

sleep for adults is between seven and nine hours per night, [5]

25.5% of women and 22.6% of men 65 and older sleep less than seven hours

per night. It’s important to consider the substances we expose ourselves to

daily, as many of these can negatively impact our sleep.


Ryan Sultan, MD, a board-certified psychiatrist, substance use disorder

therapist, and assistant professor at Columbia University, shared, “The

significance of sleep and its multifaceted relationship with various substances,

especially in older adults, is a growing concern and interest. The twilight years

can be fraught with sleep disturbances, often exacerbated by substances, like

alcohol, medications, and dietary supplements.”


Sleep often gets worse with age


As we age, our sleep patterns change, resulting in difficulty falling or staying

asleep and decreased periods of deep restorative sleep. In addition, chronic

illnesses and issues, like heartburn, diabetes, pain, and hypertension, can

interfere with sleep, as can changes in our social life. [6]

Habits, like consuming caffeine too late in the day, can also disrupt sleep.


Poor sleep negatively impacts your health


Insomnia, which is trouble falling and staying asleep, is the most common

sleep problem for adults 60 and older. [7]

Sleep apnea, a disorder characterized by halted breathing for short periods

while you sleep, may lead to high blood pressure, stroke, or memory loss.

Other common sleep disorders involve involuntary body movements, including

restless leg syndrome, periodic limb movement disorder, and rapid eye

movement (REM) sleep behavior disorder.


“Poor sleep patterns have been linked to cognitive impairments, exacerbating

memory issues and potentially accelerating conditions, like Alzheimer’s

disease,” said Sultan.


Lack of sleep can be a hazard during the daytime


Excessive daytime sleepiness (EDS) is common as we age, with roughly 15%

of adults 60 and older affected. [8]

EDS is associated with depression, cognitive deficits, and doubling falls risks.

Lack of sleep can lead to problems with balance, coordination, and attention,

and it also increases the risk of falls, accidents, and injury. [9]


How alcohol affects sleep


Alcohol use is common across many ages, but roughly 65% of people age 65

and older exceed daily guidelines for consumption. [10]

Some people may use alcohol to help with insomnia, but it can actually have

the reverse effect. While studies have shown [11]

that alcohol can increase sleepiness, chronic use results in less quality sleep.

[12]


Alcohol and your sleep cycles


When we sleep, our brain goes through natural activity cycles. [13]

Cycles last approximately 90 minutes and repeat throughout the night.

Short-term alcohol use can reduce the time it takes to fall asleep. In contrast,

chronic use increases this time, resulting in difficulty falling asleep. [14]


Alcohol-disrupted sleep


Research has shown a link between the chronic use of alcohol and sleep

disorders, like snoring and obstructive sleep apnea. For example, heavy

drinkers are at an increased risk for sleep apnea, heart attack, stroke, and

sudden death. [15]

And ongoing sleep cycle disruption can result in daytime sleepiness. Other

potential impacts on daytime functioning include difficulty concentrating,

drowsiness, fatigue, and sluggishness. Poor sleep quality can also increase

risks for falls, as well as motor vehicle- and work-related accidents. [16]


Adjusting alcohol habits for better sleep


As we age, we may feel the effects of alcohol quickly, so moderation is

essential for health. The Dietary Guidelines for Americans describe drinking in

moderation as no more than two drinks per day or less for men and one or

less per day for women.


To minimize the impact of alcohol on your sleep, here are some tips to

consider:

● Reduce your total daily alcohol intake. Alcohol has a cumulative

effect—the more you consume, the more likely you are to have

problems with your sleep.

● Avoid alcohol within at least three hours of bedtime or more. [17]

● Set a cutoff time for drinking alcohol and be consistent.

● Keep a sleep diary. Track your alcohol intake with your sleep patterns to

help you identify ways to improve your sleep.

● Keep your bedroom for sleep, sex, and when you’re sick (avoid drinking

alcohol, eating, or watching television in your bedroom).

● Set the lighting and temperature in your bedroom to levels that will help

you fall asleep and stay asleep throughout the night.


How medicine can impact sleep


Common medicines that affect sleep

Many medications impact the central nervous system and can affect your

sleep. Drowsiness is one of the most reported side effects of these

medications. Medication classes commonly associated with daytime

sleepiness and other side effects that negatively affect sleep include: [16]

● Alpha-adrenergic blocking agents (e.g., Cardura, Minipress): Often

used to treat blood pressure or prostate problems, these medications

can decrease REM sleep.

● Anticonvulsants (e.g., Clonazepam, Gabapentin): This class of

medication is used to treat epilepsy (seizures) and can negatively

impact the sleep-wake cycle.

● Antidepressants (e.g., Celexa, Prozac): Many of these medications

impact serotonin, dopamine, and norepinephrine, which can worsen

sleep in some people.

● Antidiarrheal agents (e.g., Imodium): Many diarrhea medications slow

down the muscle contractions in the gastrointestinal system and

commonly cause drowsiness.

● Antiemetics (e.g., Phenergan, Zofran): Medications for nausea and

vomiting can impact serotonin and dopamine, resulting in dizziness or

drowsiness.

● Antihistamines (e.g., Benadryl): Unless these medications contain a

non-drowsy label, they can cause drowsiness and potentially serve as

sleep aids.

● Antipsychotics (e.g., Seroquel): Due to the sedating effects of these

medications, off-label brands have served as a treatment for insomnia.

● Antitussives (e.g., Codeine, Dextromethorphan): Cough

suppressants may affect the central nervous system, resulting in

sedation and drowsiness.

● Benzodiazepines and sedative-hypnotics (e.g., Valium, Xanax): This

class of medication affects your central nervous system, leading to

calming and sedating effects. Studies have suggested these are not

good medications for treating insomnia due to daytime drowsiness,

increased risk for falls, and memory issues. [18]

● Beta-adrenergic blocking agents (e.g., Metoprolol, Propranolol):

These medications can negatively affect your melatonin levels,

impacting your sleep-wake cycle.

● Decongestants (e.g., Phenylephrine, Pseudoephedrine): Many

decongestants are alpha- and beta-agonists and can cause heart

palpitations and anxiety, adversely affecting the quantity or quality of

sleep. Pseudoephedrine is also a stimulant and can impact sleep if

taken around bedtime. It should be taken several hours before bedtime.

Phenylephrine is no longer available due to FDA removal because of

ineffectiveness, but some people may still have it in their medicine

cabinets.

● Diuretics (e.g., Lasix, Spironolactone): Commonly referred to as fluid

or water pills, taking these medications too close to bedtime can lead to

frequent nighttime urination.

● Nicotine (e.g., cigarettes, cigars, patches, gum): Nicotine acts on the

neurotransmitter systems and can impact sleep by causing insomnia,

increasing sleep onset time, and daytime sleepiness.

● Supplements (e.g., St. John’s wort): Supplements marketed as sleep

aids, like St. John’s wort, have been shown to increase REM sleep.

Marijuana and cannabidiol (CBD): Medicinal marijuana and CBD

product use may improve sleep quality and reduce the use of

prescription sleep medications. But chronic use may lead to less REM

sleep, so moderation and guidance from a health professional is

essential. [19]


Download our PDF Common Medicines and How They Impact Sleep below.


Understanding medications and side effects


When taking prescription or OTC medications, it’s crucial to understand

potential side effects and interactions. [20]

Side effects are undesirable effects caused by medication. For instance,

nausea, vomiting, and diarrhea are common side effects of many medications.

Medicine can also have more severe side effects, like heart palpitations or

shortness of breath. Anytime you experience side effects, you should consult

your health provider to see if they advise continuing the medication.


Drug interactions occur when medicines are taken with other medicines,

supplements, or food and can have different and potentially undesirable

effects on you. For example, taking prescription blood thinners, like Coumadin

and over-the-counter aspirin, can increase your chances of bleeding. Eating

grapefruit can interact with certain statin cholesterol medications, like Zocor.

Many supplements also have interactions with medications. An example of

this would be taking St. John’s wort with heart or lung medications, like digoxin

and theophylline, which can decrease the effectiveness of these medicines.


Medications that impact your central nervous system and cause drowsiness

can have an increased impact on sleep when combined with alcohol, pain

medications, antidepressants, or antihistamines. Your primary care provider or

pharmacist can help you determine if the combination of your prescription and

over-the-counter medications can impact your sleep. You can also do your

research online. Consider using MedlinePlus as a free resource available

through the National Library of Medicine. [20]


Managing medication for better sleep


As we grow older, we may experience increased difficulty sleeping due to

medical issues or hormonal changes, which include insomnia, pain, sleep

apnea, or menopause for women. These coexisting factors make treating

sleep disorders more challenging.


Additionally, the body changes as we age, and we may absorb medications

less quickly and effectively. [21]

It may also take the body longer to eliminate medication, prolonging its

intended effects. As many medications impact sleep, it can be challenging to

identify which medication may be causing your sleep problems. Monitoring

and adjusting your medications over time can help you ensure they are

effective and avoid potential adverse effects. Be sure to discuss any sleep

problems with your health care provider and review your medications and any

supplements you take with them at each visit.


Download our PDF Sleep Diary and Substance Tracker below to track your

sleep.


Dietary stimulants that affect sleep


Proper nutrition is critical to maintaining overall health and well-being. In fact,

nutrition has a significant impact on quality of sleep and daytime alertness. [4]

Eating too little protein can impact sleep quality, and eating too much can

result in difficulty staying asleep.


Sugar and caffeine


Studies show a significant relationship between consuming added sugars in

your diet and poor sleep quality. [22]

High sugar consumption can lead to blood sugar spikes, which may wake you

up at night. After the spike, you can experience a blood sugar crash that will

cause you to wake up feeling hungry or thirsty. Sugar also stimulates brain

activity and can impair your ability to fall and stay asleep. Studies have related

high-sugar diets with decreased restorative and dream (REM) sleep phases.

[4]

Caffeine is a stimulant in coffee, tea, chocolate, energy, and soft drinks. It’s

commonly used to relieve tiredness and fatigue but can actually harm sleep.

Once consumed, caffeine can continue to impact your body for up to 10 or

more hours. Caffeine affects the central nervous system and can cause

shortened or poor-quality sleep and daytime sleepiness.


Other ingredients that may affect you at night


Foods high in tryptophan, melatonin, and serotonin can make you sleepy.

Some over-the-counter supplements with these ingredients are marketed as

sleep aids. On the other hand, food with high glycemic indexes, like refined

grains and starches, can increase the risk of insomnia. Furthermore, food

additives, like dyes and preservatives, might impact sleep quality, and some

believe there is a link between food additives and hyperactivity in children.

[23]


Adjusting your diet for better sleep


Choosing foods that promote better sleep and avoiding those that impair sleep

can help you meet your rest goals. Here are some diet tips for better sleep:

● Avoid eating foods high in sugar late in the day.

● Stop your caffeine intake at least six hours before going to bed. Some

people may need to stop around noon if they experience the effects of

caffeine for longer periods.

● Choose snacks that are high in melatonin, like walnuts or kiwis.

● Drink chamomile tea before bed. Antioxidants in this tea can help

promote sleepiness.

● Dairy products, like milk, contain tryptophan, which can help you sleep

better.


Lindsey DeSoto, RDN, LD, a renal dietitian at Fresenius Medical Care North

America in Waltham, Massachusetts, added, “Studies have shown that diets

low in saturated fat and high in fiber, fruit, vegetables, and seafood seem to be

beneficial for improving sleep. A balanced diet can also help you achieve and

maintain a moderate weight, which can also help improve sleep quality.”


Tips for healthy sleep among older adults


Getting a good night’s sleep is an important goal. Take action to get a better

night’s sleep by following these tips:

● Establish and maintain a bedtime routine. Go to bed and get up at the

same time every day, including weekends.

● Find ways to relax before bed. Do something calming before you head

to bed. Reading, taking a warm shower or bath, deep breathing, or

drinking chamomile tea (which has antioxidants that promote

sleepiness) can help you fall asleep.

● Keep cellphone, computer, and television use out of the bedroom.

● Exercise daily, but ensure it’s at least three hours before bedtime.

● Limit naps to 30 minutes or less and not late in the day.

● Keep your bedroom quiet and comfortable by eliminating background

noise and adjusting your thermostat.

● Avoid substances that may negatively impact your sleep or use only in

moderation.

● Consult your health care provider, pharmacist, or sleep specialist if

you’re consistently having difficulty sleeping.

● Explore relaxation techniques such as meditation.

● Consider cognitive behavior therapy (CBT), specifically for insomnia, to

help treat prolonged sleep problems.


“Sleep is not just a restorative process for the body; it’s a cornerstone for

overall well-being,” said Sultan. “Adequate sleep aids in memory

consolidation, physical restoration, and emotional well-being. There are a

number of things that can be done to achieve quality sleep, such as keeping a

consistent schedule by going to bed and waking up at the same time daily” to

help set a regular sleep rhythm. He added that you can also “ensure the

bedroom is dark, quiet, and cool. Consider using earplugs, eye shades, or

white noise machines if needed.”


Why you should avoid OTC sleep aids


Many older adults may turn to over-the-counter substances such as Tylenol

PM, Excedrin PM, or ZzzQuil to help them fall asleep and stay asleep.

Although these products are available without a prescription, they should be

avoided or used with great caution. Speaking with a doctor or pharmacist

about side effects and other concerns before taking these medications is

sound advice.


Many OTC sleep aids contain diphenhydramine, an antihistamine and active

ingredient in Benadryl. Diphenhydramine should be avoided by older adults

because as we age, our metabolism slows down, which increases the amount

of the medication that stays in our bodies, prolonging the medication’s effects.


Diphenhydramine causes many side effects in older adults like dizziness,

daytime drowsiness (even when taken at bedtime), confusion, constipation,

low blood pressure, blurry vision, and increased risk of falls. People with

Alzheimer’s disease or other types of dementia should not take

diphenhydramine because it can make symptoms of dementia worse.


Download our PDF Healthy Sleep Hygiene Tracker below to track your sleep.


Bottom line


Sleep is a critical component of our overall health, and many substances can

impact our quality or quantity of sleep. Understanding how various substances

may affect sleep is important to achieving the best sleep quality. Start by

considering the potential downsides of consuming substances, like alcohol,

prescription and OTC medications, stimulants, and supplements. Then, talk to

your doctor about the changes you can make on a daily basis to improve your

sleep quality. While there’s no one-size-fits-all solution to achieving optimal

sleep, an individualized approach may include adjustments to medication,

supplements, daily routines, and sleep hygiene. By following this approach,

you may be able to help improve your sleep quality and overall well-being.


Have questions about this review? Email us at reviewsteam@ncoa.org.

Sources


1. National Institute on Aging. 10 Myths About Aging. June 23, 2020.

Found on the internet at

2. Columbia University Department of Psychiatry. How Sleep Deprivation

Impacts Mental Health. March 16, 2022. Found on the internet at

mental-health

3. Communications Biology. Role of Sleep Deprivation in Immune-Related

Disease Risk and Outcomes. Nov. 18, 2021. Found on the internet at

4. Sejbuk, Monika. Nutrients. Sleep Quality: A Narrative Review on

Nutrition, Stimulants, and Physical Activity as Important Factors. May 2,

2022. Found on the internet at

5. Adjaye-Gbewonyo, Dzifa, et al. Mortality Weekly Report. QuickStats:

Percentage of Adults Aged ≥18 Years Who Sleep <7 Hours on

Average in a 24-Hour Period, by Sex and Age Group — National Health

Interview Survey, United States, 2020. March 11, 2022. Found on the

6. Koyanagi, Ai, et al. Chronic Conditions and Sleep Problems Among

Adults Aged 50 Years or Over in Nine Countries: A Multi-Country Study.

PLOS ONE. Dec. 5, 2014. Found on the internet at

2

7. National Institute on Aging. A Good Night’s Sleep. Nov. 3, 2020. Found

8. Hayley, Amie C, et al. . Excessive Daytime Sleepiness and Falls Among

Older Men and Women: Cross-Sectional Examination of a

Population-Based Sample. BMC Geriatrics. July 5, 2015. Found on the

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-2#ref-CR1

9. Morelhão, Priscila K, et al. Can Sleep Problems Have a Negative

Impact on Falls in Older People? Journal of Clinical Sleep Medicine.

Oct. 15, 2018. Found on the internet at

10. National Institute on Drug Abuse. Substance Use in Older Adults.

July 2020. Found on the internet at

-drugfacts

11.Zheng, Dandan, et al. Alcohol Consumption and Sleep Quality: A

Community-Based Study. Public Health Nutrition. Nov. 13, 2020. Found

on the internet at

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D7730877B32FA1CAA47116D619

12. Park, Soon-Yeob, et al. The Effects of Alcohol on Quality of Sleep.

Korean Journal of Family Medicine. Nov. 20, 2015. Found on the

13. ScienceDaily. Reviewing Alcohol’s Effects on Normal Sleep. Jan. 22,

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14. Martindale, Sarah L., et al. Chronic Alcohol Use and Sleep

Homeostasis


 

Steve Marshall has more than 35 years of clinical and leadership experience in health care. He has worked in various settings, including emergency departments, intensive care units, air and ground transport, oncology, infectious disease, and infusion services.  He founded See Doc Nurse Write LLC in 2023 to expand the reach of his clinical knowledge and expertise.

Chester WuMedical Reviewer

Dr. Chester Wu is board certified in Psychiatry and Sleep Medicine, training at Baylor College of Medicine and Stanford University School of Medicine, respectively. He has since established his own private practice in Houston, TX where he provides psychiatric and sleep medicine services.

Kathleen CameronReviewer

Kathleen Cameron, BSPharm, MPH, has more than 25 years of experience in the health care field as a pharmacist, researcher, and program director focusing on falls prevention, geriatric pharmacotherapy, mental health, long-term services and supports, and caregiving. Cameron is Senior Director of the NCOA Center for Healthy Aging, where she provides subject matter expertise on health care programmatic and policy related issues and oversees the Modernizing Senior Center Resource Center.


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