When you've started drinking to fall asleep

What follows combines several patients' visits into one composite story. It is not about any one person, and anything that could identify someone has been removed.

⚠️ Something to be clear about first

Difficulty quitting alcohol is itself a matter for psychiatry and addiction counseling. We do not claim to offer treatment that makes you quit drinking.

If you feel you can't control it on your own, or if your hands shake, you break into a cold sweat, or you can't sleep at all when you stop, please see those specialists first. We recommend getting that checked.

This article is about what state your body is in when you've come to need a drink to fall asleep.

How do patients usually come to us?

Patients tell us that when they lie down, their heart pounds and they feel heat rising, so they can't fall asleep. They dream a lot, and the dreams are unsettling.

Then they discover that a drink helps them fall asleep, and it repeats every night. Many reach the point where nights without a drink are even harder.

They eat about as much as anyone else, yet they've actually lost weight, and they say they're always tired.

Why does the body keep wearing out?

It's close to being switched on all the time with nowhere to put the energy. We compare it to leaving the heater running with the windows open.

If tension doesn't let go during the day, the body can't shift into rest mode at night. Even lying down, the daytime state continues, so the heart races and heat rises.

Alcohol doesn't undo this state. It only makes it look like you're asleep, so the next day you're more worn out, and you need it again.

What do we look at?

We gently press on the belly. We check whether the front of the belly is hard and tense, and whether it hurts when we press along the center line.

We also look at the color of the tongue and the lower eyelids. A dry mouth and a thick coating on the tongue we read as the body being dried out with heat circulating inside.

We ask about digestion too. Many people have acid reflux, frequent indigestion, or hard stools.

How do we treat it?

We aim to calm the part that's switched on and restore digestive strength. We don't start by telling you to quit drinking.

Once your body can shift into rest mode at night, nights when you fall asleep without a drink begin to appear, little by little. We track the increase in those nights as progress.

Settling the stomach goes in the same direction. When acid reflux and indigestion ease, nights become less uncomfortable.

What are the limits of this approach?

What we do goes only as far as helping your body become able to sleep. We can't do the work of quitting alcohol for you.

If you're already at the point where it's hard to control, we'll guide you to see psychiatry and addiction counseling as well. You can continue our treatment while receiving that care.

To people with the same worry

1. If you feel you can't control it, psychiatry and addiction counseling come first.
2. Alcohol only makes it look like you're asleep; it doesn't undo the exhaustion.
3. If tension doesn't let go during the day, the body can't shift into rest at night.
4. We don't start by telling you to quit drinking.
5. We track the increase in nights you fall asleep without a drink as progress.

We start by sorting out what kind of insomnia it is. Trouble falling asleep and waking up during the night point to different places to look.

If sleep problems are wrecking your days, come see us once. We start by sorting out whether you can't fall asleep or keep waking up. Each points to a different place to look.

There are many possible causes, so the same treatment can lead to different courses for each person.