Alcohol, Nicotine, Melatonin, and Drugs That Can Affect Your Sleep

Alcohol

Though many use alcohol to help initiate sleep, alcohol has a pervasive negative impact that ultimately makes this practice counterproductive. Even small amounts of alcohol leads to greater sleep fragmentation and awakenings in the early morning hours, reducing total sleep time. Alcohol also causes changes to sleep architecture. Rapid eye movement (REM) sleep is reduced at all doses of alcohol. REM sleep is most commonly known for it’s role in memory and is also critical for a number of other biological processes. Chronic alcohol users often report extremely vivid dreams once they are able to resume sleeping normally - these vivid dreams are a result of the rebound in REM sleep after prolonged REM sleep deprivation. Alcohol use has also been associated with insomnia and worsening of obstructive sleep apnea symptoms. We recommend limiting alcohol consumption to one to two drinks per day, or less, and to avoid drinking within three hours of bedtime.

Melatonin and other sleep aids

The hormone melatonin is naturally secreted approximately 1 hour prior to your habitual bedtime. The secretion of melatonin marks the biological night. Supplemental melatonin can be purchased over-the-counter in drug stores or ordered online through sites such as Amazon. Melatonin may help to facilitate sleep onset or to sleep at an adverse circadian phase. This may make it useful for shiftworkers attempting to sleep during the day or for travelers attempting to adjust to a new timezone. While it is generally safe as a supplement, it is commonly sold in much higher doses than is naturally secreted by your body. Avoid doses exceeding 3mg and seek out sources of melatonin that have been tested for purity and concentration.

Railroaders have reported using other sleep aids, including medications labeled as PM for use at night, allergy medications, and others. Many of these medications use similar ingredients that have a side effect of drowsiness. A consequence of these medications is often a hangover-type effect, where detrimental effects of the medications are observed upon waking. We do not advise the use of these drugs to facilitate sleep.

Please talk to your doctor about any issues with your sleep. Most doctors do not ask about sleep and most patients do not discuss sleep issues with their physician. As a result, many sleep issues persist despite effective treatment options being readily available.

Nicotine

Nicotine is a powerful stimulant that is now available in a variety of forms and concentrations through smoking, vaping, chewing tobacco, using nicotine pouches, patches, lozenges, and other original products. Railroaders and public safety personnel commonly report using nicotine to maintain alertness. Nicotine has a significant impact on sleep. Its use is associated with decreased sleep duration, sleep quality, and slow wave sleep; as well increased sleep latency and sleep fragmentation. Thus, users of nicotine tend to take longer to fall asleep and experience more nighttime awakenings. As a result, users of nicotine often have shorter sleep duration and report that their sleep is not as restorative in comparison to those who do not use nicotine. We recommend avoiding nicotine in the hours prior to bed.

Stimulants and other wake-promoting drugs

Medicines prescribed for attention-deficit disorders or shiftwork disorder should never be taken unless they are prescribed by your doctor and used as directed. This class of medications can make it hard to fall asleep and can cause other side effects, such as a racing heartbeat, high blood pressure, and depressed mood. Overdoses of these medicines can cause very serious health problems, including an irregular heartbeat, hallucinations, and even coma.