Insomnia as a path to alcoholism: tolerance development and dose escalation

Sleep. 2018 Aug 1;41(8):zsy091. doi: 10.1093/sleep/zsy091.


Study objectives: To assess the risks associated with the use of alcohol as a "sleep aid," we evaluated tolerance development to pre-sleep ethanol's sedative-hypnotic effects, and subsequent ethanol dose escalation.

Methods: Volunteers, 21-55 years old, with insomnia in otherwise good medical and psychiatric health and no history of alcoholism or drug abuse participated. In experiment 1 (n = 24) 0.0, 0.3, or 0.6 g/kg (n = 8 per dose) ethanol was administered before sleep and 8-hour nocturnal polysomnograms (NPSGs) were collected. In experiment 2, after six nights pretreatment with ethanol 0.45 g/kg (n = 6) versus placebo (n = 6), choice of pre-sleep ethanol or placebo was assessed over seven choice nights.

Results: The 0.6 g/kg ethanol dose increased total sleep time and stage 3-4 sleep on night 2, but these effects were lost by night 6 (p < .05). Six nights of ethanol pretreatment produced on the choice nights more self-administered ethanol refills than the placebo pretreatment (p < .03).

Conclusions: These are the first data to explicitly show the risks associated with the use of alcohol as a "sleep aid" among people with insomnia. Initially, a moderate dose of ethanol improved NPSG sleep, which was lost by night 6. Tolerance was associated with enhanced self-administration of pre-sleep ethanol.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Alcoholism / etiology*
  • Drug Tolerance / physiology*
  • Ethanol / adverse effects
  • Ethanol / therapeutic use*
  • Female
  • Humans
  • Hypnotics and Sedatives / therapeutic use*
  • Male
  • Middle Aged
  • Polysomnography
  • Sleep / drug effects*
  • Sleep / physiology
  • Sleep Initiation and Maintenance Disorders / drug therapy*
  • Sleep Stages / drug effects*
  • Sleep Stages / physiology
  • Young Adult


  • Hypnotics and Sedatives
  • Ethanol