Better sleep is one of many benefits to alcohol abstinence

Key takeaways:

• Reducing alcohol intake can improve one’s sleep, immune function, mental health and more.
• Nearly 50% of a survey’s participants reported feeling more refreshed in the mornings when they stop drinking.

The popular trend of Dry January is coming to a close for the year, but it helped spark interest in the benefits of abstaining from alcohol, even for just a month.

‘Dry January’ originated as a public health campaign in the United Kingdom more than a decade ago, Elizabeth Salisbury-Afshar, MD, MPH, an associate professor of clinical health sciences at the University of Wisconsin-Madison, told Healio. Now, she said, it has “extended its influence to the U.S., progressively gaining traction.”

“In essence, it mirrors the spirit of New Year's resolutions, wherein individuals opt for a healthier choice,” Salisbury-Afshar said. “However, instead of committing for an extended period, many embrace a month-long abstinence from alcohol.”

Brian Black, DO, an osteopathic physician specializing in family medicine, said “the surge in interest in ‘Dry January’ this year prompts us to revisit the practice's implications,” particularly considering similar upcoming events like ‘Sober October.’

“‘Dry January’ provides an opportunity to discuss with patients the potential risks and benefits of alcohol and its connection to overall health with periodic or long-term cessation,” he said. “We can hope further open conversations about medication reduction, healthy eating, exercise, weight management and healthy lifestyle modifications may soon follow.”

Sleep

One of the most prominent areas of health that a period of alcohol abstinence like ‘Dry January’ affects is sleep.

Among 1,000 people who participated in a survey from the Sleep Foundation, 75% reported either considering or partaking in Dry January at some point and 58% said they lose sleep due to drinking alcohol. Of the 36% who said they gave up alcohol to sleep better, 84% reported it worked.

The impact that alcohol has on sleep “is intricate,” Black said.

“While it initially acts as a sedative for quick sleep onset, its overall influence disrupts sleep architecture, reducing deep sleep during the REM cycle,” he explained. “In regular or heavy drinkers, alcohol metabolism during sleep can lead to withdrawal symptoms, exacerbating a cycle of poor sleep and addiction.”

Of the survey participants who reported losing sleep to alcohol, 41% (the highest percentage) reported noticing an impact on their sleep after three or four drinks.

Salisbury-Afshar said “it's important to note that while alcohol acts as a nervous system depressant, inducing relaxation and facilitating initial sleep, it ultimately disrupts the sleep cycle and diminishes overall sleep quality.”

“Despite the perception of falling asleep easily after alcohol consumption, individuals often wake up the next morning feeling more tired and fatigued,” she said.

The survey’s respondents confirmed this: 30% reported falling asleep more quickly after drinking, but then having restless sleep; 21% reported waking up repeatedly throughout the night and 29% reported difficulty waking the morning after drinking.

However, when taking a break from alcohol, 42% felt less tired during the day, 48% felt more refreshed when waking and 50% said they slept more soundly.

Benefits and risks of abstinence

Of course, sleep is not the only aspect of health that alcohol affects.

Research has indicated that “a period of abstinence from alcohol” could also improve mood, reflux, liver function and skin hydration, Black said. For heavier drinkers, he said “cutting out alcohol can positively impact weight management, immune function, depression and lower the risk of certain cancers.”

However, cutting out alcohol entirely could be problematic for some. Salisbury-Afshar said “for daily or high-volume drinkers, abrupt abstinence may pose a risk of alcohol withdrawal.”

“Although severe cases are rare, they can be life-threatening,” she said. “It is crucial for physicians to discuss past withdrawal episodes with patients who report heavy daily drinking and recommend medical monitoring if necessary. For those who do not drink daily in large volumes, it is still beneficial to review mild withdrawal symptoms and advise on when to seek medical attention.”

Ultimately, how much a patient regularly drinks should decide whether they partake in a trend like ‘Dry January,’ Black said.

“Involving an experienced provider is crucial to prevent withdrawal symptoms both physical and mental in regular or heavy drinkers,” he said. “However, casual drinkers can easily cut back and stop use of alcohol for a break without fear of side effects.”

When maintained over the long term, Salisbury-Afshar said “diminishing alcohol consumption can yield various health benefits, and primary care clinicians are well placed to initiate discussions about reducing or abstaining from alcohol as a preventive health measure.”

“This holds true even for individuals who may not currently perceive any issues related to their alcohol use,” she said. “The evolving understanding of alcohol's impact on health underscores the importance of proactive conversations within the realm of preventive care.”

Everything in moderation?

There has long been a belief that moderate alcohol intake could offer some health benefits. For example, Black said that “a glass of red wine with dinner may offer cardiovascular benefits.” However, recent studies have presented “conflicting data and nuanced insights, thus challenging common public misconceptions.”

“Similar to advocating for minimal medication use to reduce side effects, I'm personally drawn to emphasizing the benefits of periods of abstinence, from both medications and alcohol, and advising on the risks of significant use in general,” Black said. “Often, I tell patients, ‘If you think you need to cut back, then you probably do.’”

Research suggests that alcohol consumption is associated with “various adverse health outcomes, including cardiovascular issues, multiple cancer types and liver disease,” Salisbury-Afshar said.

“Recent literature indicates that all forms of alcohol consumption carry some level of risk, and this risk is contingent on the amount consumed. The dose-response relationship emphasizes that even minimal alcohol intake poses potential risks,” she said. “In essence, contemporary findings emphasize that, when it comes to health, the mantra is ‘less alcohol is more.’”

Talking alcohol cessation

Many patients might not be aware of the U.S. Dietary Guidelines recommendations regarding alcohol use — a maximum of two drinks per day for men and one drink per day for women — Salisbury-Afshar said, “but these guidelines were established following a comprehensive review of available evidence concerning the adverse health effects linked to alcohol consumption.”

Although it is clear alcohol intake can pose health problems, talking about reducing consumption “can be uncomfortable for both the provider and the patients,” Clifford Stark, DO, an osteopathic physician specializing in family and sports medicine, said.

“There are various reasons why it may be uncomfortable or unpleasant to discuss this topic with patients,” he said. “I think that the more casual, comfortable and nonjudgmental the provider can be when discussing these topics, the more effective they will be in helping the patients cut down or quit.”

When talking to patients about the sensitive topic, Stark said he first asks about their drinking habits “in a very casual manner so that patients can comfortably answer accurately without feeling like they are being judged.”

“When obtaining information about amounts of alcohol patients consume, I think it is important to maintain a laid back response to what they report,” he said.

Salisbury-Afshar said that she first asks for permission to discuss alcohol’s connections with health.

“The extent of the discussion often depends on the amount of information already gathered,” she said. “At times, I inquire about the role alcohol plays in an individual's life and invite them to share their thoughts on how it may influence their health and overall well-being. This personalized and open approach allows for a more nuanced exploration of the individual's relationship with alcohol and its potential impact on their health.”

If a patient’s alcohol intake is deemed potentially problematic, Stark said “there are various methods that can be used for alcohol cessation, and I think the best is to tailor the approach to each individual patient's personality and preferences.”

For example, this might “include having the patient keep a diary and quantify how much alcohol they consume on a regular basis, having them set realistic goals (preferably in writing), reducing the amount of alcohol in the home, slowing down how quickly they drink alcohol, choosing alcohol free days, taking care to avoid social situations that might encourage them to drink alcohol and discussing costs associated with their amount of alcohol consumption (and how much they might save if not consuming alcohol, etc.),” he said.

When a patient expresses interest in discussing ways to reduce their intake, Salisbury-Afshar said she will “use motivational interviewing techniques to support them to make a plan that feels feasible and offer to check back in at a subsequent visit to see how things are going.”

“In instances of moderate or severe alcohol use disorder, where the individual aims for reduced use or abstinence, formal counseling and/or medications designed for alcohol use disorder can be beneficial,” she said. “For those with mild alcohol use disorder or who do not meet the criteria, establishing a specific goal becomes crucial.”

That goal could be as simple as limiting consumption to a maximum of one or two drinks in a single setting or not drinking for a specific period, like 1 week or 1 month.

“I typically encourage individuals to consider the settings where they usually drink and strategize how to manage these activities,” Salisbury-Afshar said. “This may involve finding alternative activities, opting for nonalcoholic beverages, and more. Additionally, informing friends and family about the goal and seeking their support in achieving it can be a valuable aspect of the process.”

Reference:

• Thinking about a Dry January? 61% say they sleep better for it. https://www.sleepfoundation.org/sleep-news/61-percent-sleep-better-when-they-take-a-break-from-drinking-alcohol. Published Dec. 28, 2023.