The Whitworths of Arizona, bringing science to you in everyday language.

Thursday, August 9, 2012

Alcohol and Lewy

Judy asks, “Matt loves his after-dinner drink of wine. Is there any problem if that’s all he has?"

Maybe not. It might even be good for him. In the last decade, many studies have shown a positive association between moderate alcohol consumption, especially wine, and reduced risk of dementia and better cognitive function. And any negative results will be temporary and so, once Judy knows what to look for, allowing Matt a single glass of wine might be just fine. But first, let’s look at a few facts about alcohol and the normal, healthy body during sleep.

Normal sleep occurs in cycles of 75% deep sleep and 25% lighter, REM sleep, which is when dreams occur. Each cycle takes about 90 minutes and so you may have several dreams each night but no one dream lasts very long.

Let’s say that Brian, a man with no health problems, has a couple of after-dinner drinks while he watches TV. He says it relaxes him helps him fall sleep easier. Alcohol is a sedative and so it probably does.It will also cause him to sleep more deeply with fewer dreams—for the first half of the night. Then, however, he is likely to be sleep poorly for the rest of the night.

That’s because the body is all about balance. Brian’s drinks lower the functioning of his whole system—blood pressure, everything.  In an effort to compensate, his body secretes chemicals that direct its organs to work harder. Two to four hours into the night, the effects of the alcohol will be gone but the last of his body’s chemicals, secreted while there was still some alcohol in the system, will still be circulating, causing a rebound effect. Brian will be more restless and may find himself waking up. 

Studies have shown that a moderate dose of alcohol (2 glasses of wine) consumed even several hours before bedtime can increase wakefulness during the second half of the night. Further, in an effort to restore the ratio of deep sleep to REM sleep, Brian’s whole night’s quota of dreams will now be crowded into the last half of the night, resulting in more restlessness, and even nightmares.

Now, let’s add Matt’s LBD. First, LBD already slows everything down and so the alcohol has a greater effect. Therefore, Matt may respond to his single drink as though it were much more—putting him in at least, the “moderate drink” category. Next, it may take Matt a longer time to metabolize the drink. Thus, even though he has his drink earlier in the day, it may still have a similar nighttime sedation/rebound effect.
And then, there’s alcohol’s effect on RBD—active dreams. Matt already has active dreams now and then. But with all of his REM sleep crowded into the last half of his night, his active dreams will be longer and probably more disturbing. Nightmares were reported in the literature for people without RBD—certainly, we might expect the same or worse for Matt.

However, all of these effects are temporary. They last only as long as the chemicals do. And so, first Judy and Matt need to do some research.  Go ahead—have the drink. Then Judy needs to watch Matt’s sleep pattern carefully. Is there more restlessness during the last part of the night than during the first part? Is it serious enough to worry about? If not, they are home free. Of course, LBD is a constantly changing disorder and so Judy should continue to be alert for increased wakefulness or increased active dreams.

If Judy does see evidence of a rebound effect, all is not lost. Try the drink earlier in the day and see what happens. If there is still restlessness, consider a wine spitzer, with half, or even less alcohol. Again, first after dinner and then, earlier in the day. If that doesn’t work, consider warm milk or herbal tea, or my personal favorite, a cup of nice hot water.

Go to the links shown in this blog for more information on this subject.  Reminder: We are not doctors and cannot make specific recommendations. We offer our own opinions based on caregiver experiences and information gleaned from current literature. You should consult a physician for your specific issues.

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