Alcohol and Sleep Apnea: What a Drink Does to Your Breathing

Alcohol makes obstructive sleep apnea (OSA) worse for many people. It relaxes the muscles that keep your throat open and slows the brain's wake-up response, so breathing pauses can become more frequent and last longer, and oxygen levels drop further. The fix is simple to say: drink less, stop earlier in the evening, and keep using your CPAP every night.

How alcohol affects your airway

In OSA, the soft tissues of the throat relax during sleep and narrow or block the airway. Your brain then wakes you just enough to tighten those muscles and breathe again. Alcohol interferes with both steps.

• Relaxes throat muscles — alcohol is a muscle relaxant. The muscles that hold the airway open go slacker, so the throat collapses more easily.
• Blunts the wake-up signal — the brain is slower to notice a blocked airway, so each pause can last longer before you rouse to breathe.
• Lowers oxygen — longer pauses mean deeper drops in blood oxygen.
• Increases snoring — a floppier airway vibrates more, so snoring often gets louder after drinking.

What the research shows

A review that pooled 14 studies found that drinking alcohol raised the number of breathing pauses per hour of sleep (the apnea-hypopnea index, or AHI).^[1] The rise was small on average but larger in people who snore, and largest in people with sleep apnea: about 7 more events per hour.^[1] Breathing pauses also lasted longer and the lowest oxygen level of the night dropped further.^[1]

Over the long run, a separate review of 21 studies found that heavier drinking was linked to about a 25% higher risk of having sleep apnea.^[2] These studies show a link, not proof that alcohol alone causes it, but they point the same way. To learn what your AHI number means, see sleep study results and AHI explained.

If you snore but have never had a sleep study, this matters too. Alcohol can turn ordinary snoring into true breathing pauses on the nights you drink. If a bed partner notices that your snoring is much louder, or that you stop breathing, after a few drinks, that is a good reason to get checked.

Alcohol, sleep quality and REM sleep

Many people feel that a drink helps them sleep. Alcohol can help you fall asleep faster, but the rest of the night pays for it.^[3]

• Broken second half of the night — as your body clears the alcohol, sleep gets lighter and you wake more often.^[3]
• Less REM sleep — alcohol delays the first REM (dream) period and, at moderate and higher amounts, cuts total REM sleep.^[3]
• More tired the next day — add more breathing pauses on top of broken sleep, and daytime sleepiness can get worse.

Timing: why the hours before bed matter most

Alcohol affects your breathing while it is still in your body. The more you drink, and the closer to bedtime, the more alcohol is in your blood when you fall asleep and your airway is most relaxed.

• Stop earlier — finishing your last drink several hours before bed gives your body time to clear some of it. There is no single cutoff that is safe for everyone.
• Drink less — the effect on breathing grows with the amount you drink.
• Skip the nightcap — a drink right before bed is the worst timing for your airway.

Alcohol and CPAP

CPAP keeps your airway open with a gentle stream of air. In a small older study, CPAP at each person's correct pressure still kept the airway open after a moderate amount of alcohol.^[4] That is good news, but it does not cover heavy drinking.

• Use CPAP every night — nights you drink are the nights your airway needs it most.
• Watch for problems — after drinking, you may be more likely to pull the mask off in your sleep or sleep through leaks.
• Tell your sleep doctor — if you snore through your mask or feel worse after drinking nights, your settings or mask may need a check.

Safer habits if you drink

• Keep drinking light — less alcohol means less effect on your airway and your sleep.
• Don't mix alcohol with sleep aids — sleeping pills, opioid pain medicines and some anxiety medicines also slow breathing. Combining them with alcohol can be dangerous. Ask your doctor or pharmacist.
• Sleep on your side — for some people, apnea is worse on the back.
• Watch your weight — alcohol adds calories, and extra weight makes apnea worse. See weight loss and sleep apnea.
• Never drive drowsy — alcohol and untreated sleep apnea both make drowsy driving more likely.

When to see a sleep specialist

• Loud snoring, gasping or choking at night — especially if a bed partner has seen you stop breathing.
• Daytime sleepiness — dozing off while reading, watching TV or driving.
• Snoring that gets much worse after drinking — this can be a sign your airway collapses easily. Read more in why snoring may be dangerous.
• You use CPAP and still feel tired — your therapy may need adjusting.

More signs are listed in when to see a sleep specialist.

Sleep apnea care in Cedar Park

Dr. Minal Patel is board-certified in pediatrics and sleep medicine. Our practice offers in-lab and home sleep studies, CPAP and BiPAP therapy, snoring evaluation and Inspire evaluation. We are accepting new patients. Office hours are Monday through Friday, 8:30 to 5:00. We accept Medicaid and CHIP for sleep patients. We do not take walk-ins.