Trait-like differences in cognitive performance after sleep loss put some individuals more at risk than others, the basis of such disparities remaining largely unknown. Similarly, interindividual differences in impairment in response to alcohol intake have been observed. We tested whether performance impairments due to either acute or chronic sleep loss can be predicted by an individual's vulnerability to acute alcohol intake. Also, we used positron emission tomography (PET) to test whether acute alcohol infusion results in an up-regulation of cerebral A adenosine receptors (AARs), similar to the changes previously observed following sleep deprivation. Sustained attention in the psychomotor vigilance task (PVT) was tested in 49 healthy volunteers (26 ± 5 SD years; 15 females) () under baseline conditions: () after ethanol intake, and after either () total sleep deprivation (TSD; 35 hours awake; = 35) or () partial sleep deprivation (PSD; four nights with 5 hours scheduled sleep; = 14). Ethanol- versus placebo-induced changes in cerebral AAR availability were measured in 10 healthy male volunteers (31 ± 9 years) with [F]8-cyclopentyl-3-(3-fluoropropyl)-1-propylxanthine (CPFPX) PET. Highly significant correlations between the performance impairments induced by ethanol and sleep deprivation were found for various PVT parameters, including mean speed (TSD, = 0.62; PSD, = 0.84). AAR availability increased up to 26% in several brain regions with ethanol infusion. Our studies revealed individual trait characteristics for being either vulnerable or resilient to both alcohol and to sleep deprivation. Both interventions induce gradual increases in cerebral AAR availability, pointing to a potential common molecular response mechanism.