Why Hangovers Get Worse With Age

At 23 you could drink until two, sleep until ten and be fine by lunch. Now three glasses of wine on a Friday cost you most of Saturday, and Sunday isn't great either. It's easy to conclude that hangovers get worse with age.

There are good reasons to expect that, and they're worth knowing. There's also a twist. When researchers ask people of different ages about their hangovers, older drinkers report fewer and milder ones. Here's how both can be true, and what it means for your weekends.

Your body holds less water

Alcohol spreads through the water in your body, so the less water you carry, the more concentrated it gets. The US National Institute on Alcohol Abuse and Alcoholism (NIAAA) explains that muscle mass and body water tend to fall as people age. As a result, some older adults reach a higher blood alcohol level than younger people after drinking the same amount.

NIAAA also says older people are more sensitive to alcohol's sedative effects and to its effects on balance, coordination and attention. The same three glasses can land harder at 55 than they did at 25.

You may clear alcohol more slowly

Your body breaks alcohol down into acetaldehyde, a toxic by-product, and then breaks that down in turn. A review on ageing and alcohol metabolism describes the enzymes that handle both steps becoming less active with age. Together with the drop in body water, that pushes blood alcohol higher from the same drinks. Acetaldehyde exposure is one of the causes of hangover symptoms that NIAAA lists.

One caveat: most of this research looks at people over 65. How much it matters at 40 is less clear.

Sleep gets more fragile

Alcohol helps you fall asleep and then breaks up the second half of the night. Disrupted sleep is one of the main contributors to a hangover, according to NIAAA. At the same time, NIAAA notes that many adults have more trouble with how long and how well they sleep as they get older.

Put those together and the same drinks cost you more sleep, on a night when you had less to spare. Some people start using a drink to help them nod off, and NIAAA warns that drinking to cope with poor sleep can make sleep problems worse.

Medicines change the picture

The US National Institute on Aging notes that many older people take medicines every day, which makes interactions a bigger concern. NIAAA lists common medicines that interact badly with alcohol. Sedating drugs for sleep, anxiety, allergies or pain can add to alcohol's effects. Alcohol can also change how some blood pressure medicines and antibiotics work. Aspirin plus alcohol raises the risk of stomach or intestinal bleeding.

If you take anything regularly, ask your doctor or pharmacist how it mixes with alcohol.

The day after costs more

NIAAA notes that during a hangover your attention and decision-making can be impaired, along with your ability to do important tasks such as caring for others. MedlinePlus adds that even when you feel fine the morning after heavy drinking, the lasting effects of alcohol reduce your ability to perform at your best. At 22, a lost Saturday might have meant a long lie-in. At 42 it might mean a child's football match, a work deadline and a parent who needs a call. Even an identical hangover would land on a fuller day.

The catch: the research points the other way

When researchers ask people about their hangovers, older drinkers report fewer and milder ones.

• A Danish study of 51,645 adults found that severe hangovers after binge drinking were far more common in younger people. Men aged 18 to 29 had nearly seven times the odds of men aged 60 and over. The gap wasn't explained by how much people usually drank, how often they binged, or whether they drank with meals.
• A Dutch survey of 761 drinkers aged 18 to 94 found that hangovers became less frequent and less severe with age, even after accounting for estimated blood alcohol levels.

Part of the difference is that younger people drink more per occasion. That doesn't explain all of it. The Dutch researchers found older drinkers felt less drunk at the same estimated blood alcohol level, and they suggest a lower sensitivity to pain with age may also play a part.

These studies have limits. Both relied on people recalling and rating their own hangovers, and both compared different people of different ages at one point in time. Neither followed the same drinkers from 30 to 60, so neither can tell you how your own hangovers have changed.

What that means for you

Averages describe groups. If your own mornings have got worse, the reasons above are plausible, and you don't need a study to confirm how a Saturday felt. For a clearer view of your own pattern, jot down for a few weeks how many drinks you had and how you felt the next day. On one point the research and your experience agree: the dose matters. NIAAA says that in general, the more alcohol you drink, the worse the hangover.

That makes the fix practical. The NHS suggests setting a limit before you start, choosing smaller or lower-strength drinks, eating first, alternating with water or soft drinks, and having several drink-free days each week. Knowing what counts as one drink makes a limit easier to keep. For the morning itself, see what helps a hangover, and what doesn't, and if the bad mornings come with a wave of worry, hangxiety explains why.

One safety note if you decide to stop altogether: if you drink heavily every day, stopping suddenly can be dangerous. Talk to a doctor first.