When Napping & Caffeine Make Sense

Chronic insomniacs will have heard these messages before: “Don’t nap.” “Avoid caffeinated beverages later in the day.” These are good rules of thumb for most people with insomnia. If you catch yourself drifting off during the 6 o’clock news, it’s better to get up and walk around the block than drink coffee or indulge in a full-blown nap.

But some situations warrant breaking the rules.

sleep deprived insomniacs who must drive should have a nap & caffeineChronic insomniacs will have heard these messages before: “Don’t nap.” “Avoid caffeinated beverages later in the day.” These are good rules of thumb for most people with insomnia. If you catch yourself drifting off during the 6 o’clock news, it’s better to get up and walk around the block than drink coffee or indulge in a full-blown nap.

But some situations warrant breaking the rules. Say you end up pulling an all-nighter to study for a test and have to take a second test later the same day. Or say a family crisis triggers a couple bad nights and the next night you have to drive all the way to St. Paul. If you’ve got to be on your toes despite feeling seriously sleep deprived, then napping and well-timed use of caffeine make sense. Here’s what the research says.

Turning Low Energy into High

It’s normal to feel low energy when you’re short on sleep, and nerve-wracking when the situation calls instead for stamina and alertness. Your first impulse may be to reach for an energy drink. Energy drinks usually deliver what they promise: studies show that caffeine—a main ingredient—can improve attention, reaction speed, information processing, memory, mood, and aerobic performance.

Caffeine quickly moves from your gastrointestinal tract into your bloodstream. It’s at peak strength about 1 hour after you drink it. Caffeine blocks secretion of adenosine, in turn increasing the release of neurotransmitters that promote arousal. Fatigue falls away and your brain comes alive again.

When Caffeine Isn’t Enough

But under conditions of extreme sleep deprivation, caffeine by itself doesn’t work very well. Researchers at the University of Pennsylvania confirmed this and found out more when they conducted a double-blind study on sleep-deprived subjects to compare the effects of caffeine with and without periodic naps.

The participants, 58 healthy men (average age 29), underwent 3 nights of total sleep deprivation. Starting at hour 22, half of the men took a low-dose caffeine pill every hour on the hour, and the other half took a placebo. Half of the caffeine takers were also allowed to take a 2-hour nap every 12 hours and the other half were not. Likewise for the placebo takers.

The participants were tested repeatedly, and here’s what the investigators saw in the group taking only low-dose caffeine:

  • Compared with placebo, the caffeine significantly reduced declines in reaction time and lapses in attention associated with sleep loss, but this effect fell off as participants grew more and more sleep deprived.
  • Compared with placebo, caffeine did nothing to increase the amount of information the sleep-deprived participants could process or improve their working memory.

Adding Naps to Reduce Fatigue & Improve Performance

But taking low-dose caffeine and a 2-hour nap every 12 hours improved participants’ attention, ability to process information, and working memory. These effects held steady through all 3 days of the study. Adding caffeine to the naps also reduced the drowsiness participants felt on awakening from their naps.

The Penn researchers point out that “caffeine at any dose is not a chemical substitute for adequate healthy sleep.” But in situations where people must perform under conditions of sleep deprivation, “brief naps in combination with properly-dosed and well-timed energy products containing caffeine may provide the most benefit.”

Some people with insomnia don’t have an easy time napping, and I’m one of them. But when I’m truly suffering sleep loss—say, when I have jet lag on returning home from a trip—and I have to be up and alert, I turn on the coffee maker, nap if I can, and drink my coffee immediately on waking up.

But Note These Caveats

The effects of caffeine vary greatly from person to person largely due to genetic factors:

  • In this experiment, for example, the peak concentration of caffeine in the blood plasma of participants ranged from 2.0–9.4 mg/l. That’s a very wide range. It suggests that some participants’ behavior was much more impacted by caffeine than others’.
  • Also, some people metabolize caffeine more slowly than others. On average, caffeine has a half-life of 5–6 hours. But its half-life ranges from 2.5–10 hours (and the range is even wider in people who are pregnant, taking antidepressants, or have liver disease). A particular genetic polymorphism causes more women to metabolize caffeine more slowly than men, and more Asians and Africans to metabolize caffeine more slowly than Caucasians.

Insomnia: Holding Steady the Next Day

Will there ever be a morning-after pill prescribed for insomnia? Wouldn’t that be nice. Insomnia wouldn’t be half as bad if it weren’t so debilitating the next day. No fatigue to contend with, no brain fog, no low mood. White nights could even be enjoyable if we knew in the morning that we could resort to Plan B.

For now there’s no simple way to avoid insomnia symptoms that occur in the daytime. But there are ways to minimize their impact, whether the bad nights come often or just once in a while. Here are 6 habits I find useful and maybe you will, too.

Daytime affects of insomnia can be reduced by stretching and other activitiesWill there ever be a morning-after pill prescribed for insomnia? Wouldn’t that be nice. Insomnia wouldn’t be half as bad if it weren’t so debilitating the next day. No fatigue to contend with, no brain fog, no low mood. White nights could even be enjoyable if we knew in the morning that we could resort to Plan B.

For now there’s no simple way to avoid insomnia symptoms that occur in the daytime. But there are ways to minimize their impact, whether the bad nights come often or just once in a while. Here are 6 habits I find useful and maybe you will, too:

Eat a Healthy Breakfast

This might seem like a no-brainer, but with 18 percent of Americans older than age 2 regularly skipping breakfast, it’s worth a mention. Research suggests that eating a morning meal is beneficial in many ways: it lifts the mood and improves memory, and it makes you more active in the morning. Particularly when you’re feeling sluggish and sleep-deprived, a good breakfast is a must.

Make Judicious Use of Caffeine

It used to be that caffeinated beverages were on the “No Fly” list for people with insomnia. But expert opinion has changed. The thinking now is that while the caffeine-sensitive should avoid it within 8 hours of bedtime, it’s OK in moderation—and can even be helpful—as tolerated earlier in the day.

The trick is to discover what “as tolerated” means on days when you feel like drinking a whole pot of coffee. Caffeine has an average half-life of 5 to 6 hours (meaning that in 5 to 6 hours the amount of caffeine in the blood will have decreased by half). So most people can drink caffeinated beverages in the morning without fear of compromising sleep that night.

But many people experience a circadian slump somewhere in the middle of the afternoon. Particularly after a short night’s sleep, that’s when you really crave a pick-up. Is a 3 p.m. cappuccino going to set you up for another bad night?

Not necessarily, if you’re young or middle-aged. But it takes older adults longer to metabolize drugs. Keep this in mind as you decide when to drink that last cup of joe.

Drink Plenty of Water

Even mild dehydration can depress your mood, lower your ability to concentrate, and make tasks feel more difficult. It can also impair performance and short-term memory. So make a point of sipping often throughout the day. Keeping water on hand at your desk, or making frequent trips to the water cooler, could take the edge off a low mood and make it easier to accomplish what needs to be done.

Get Up and Move Around

Physical activity tends to elevate mood and alertness. New Zealand researchers found that subjects who reported higher levels of habitual physical activity also endorsed higher levels of interest, excitement, enthusiasm, and alertness—all qualities you may be short on if you’re short on sleep. Particularly if your work keeps you sedentary, make an effort to get up, move around a lot, and stretch at your desk. At lunchtime, take a walk.

Follow the Sun

Increasing your exposure to sunlight may also help to counteract symptoms of insomnia. Bright light tends to increase vitality and elevate mood. It’s also been shown to enhance alertness and cognitive performance. Even on cloudy days, daylight is 2 or 3 times brighter than normal office lighting. So make liberal use of it when you can. Particularly if you’re feeling sluggish, spend time outdoors or inside where there are plenty of windows.

Reorganize Your Day

You may not have much say in how you organize your day. Whatever tasks are on the schedule—make sales calls, teach a class, chair a meeting—you’ve just got to power through them, never mind that you’re exhausted when the day begins. But sometimes you can reset the agenda. After bad nights, juggle your tasks so you tackle the hard ones when you’re normally most alert and save the routine tasks for when you’re not.

Doing all these things may not have a big impact on your nights. But they may help you chart a steadier course during the day. That counts for something, don’t you think?

Late-Night Sweets and Your Sleep

Insomnia is big business these days, and not just for Big Pharma. Insomnia Cookies, the chain of late-night bakeries located in campus towns across the East and the Midwest, is opening up a new store every few months.

A sweet bedtime snack delivered right to the doorstep: now there’s a concept Dr. Atkins would have frowned on. But what effect would eating a late-night treat have on students’ sleep?

A high-carb diet may harm sleep, but an occasional treat near bedtime won't have much impactInsomnia is big business these days, and not just for Big Pharma. Insomnia Cookies, the chain of late-night bakeries located in campus towns across the East and the Midwest, is opening up a new store every few months.

I’ve wondered what’s behind the name of this store and its appeal. Are the cookies intended as a sort of high-octane fuel for students cramming for exams? Or are they supposed to assuage the food cravings of students who are anxious because they can’t sleep? Lots of things in life are not as complicated as I imagine them to be.

“It’s called Insomnia Cookies just because we stay open so late,” said Josh, second-in-command at a store near my house. “We’re open till 3 a.m. every day.”

I asked Josh if they get a lot of business late at night.

He nodded. “We get the bar-crawler crowd. And our last delivery goes out at 2:45.”

A sweet bedtime snack delivered right to the doorstep: now there’s a concept Dr. Atkins would have frowned on. But what effect would eating a late-night treat have on students’ sleep?

The Sugar High: Myth or Reality?

Despite continuing talk about the “sugar high” that afflicts kids who eat too much Halloween candy (a meta-analysis published 20 years ago found little evidence that the burst of energy kids seem to get after eating sweets is actually attributable to sugar), it’s unlikely that eating a cookie at bedtime will have much impact on your sleep. (Unless, that is, you eat the entire box of thin mints.)

Your body converts all carbohydrates—whether in the form of vegetables, grains or snacks–into glucose and then transports it via the bloodstream to cells throughout the body for use as energy. Most desserts are high in simple carbohydrates such as sugar and white flour, which the body metabolizes rapidly. So they may initially give you a burst of energy that would not be conducive to sleep.

But that burst of energy—if and when it occurs—is relatively short lived.

  • In one study of adults, eating a candy bar resulted in subjects reporting increased energy and reduced tiredness after 1 hour but greater tiredness and reduced energy after that.
  • In another, while 400 ml of fructose—the form of sugar found in fruit and honey—delayed the onset of extreme drowsiness in drowsy subjects by 20 to 30 minutes, 400 ml of glucose had no more effect on drowsy subjects than water.

I’ve combed the journals for other information about the acute effects of sugar on sleep but have come up empty handed. So it’s safe to assume that while a sweet treat is not exactly soporific, neither will it likely keep you up.

Chocolate and Sleep

What about desserts containing chocolate? Here, insomniacs are on shakier ground. If you crave a sweet at bedtime and you’re really caffeine sensitive, you’d be better off going with a snickerdoodle than a chocolate chip brownie.

But the amount of caffeine in chocolate is far less than the amount in coffee and popular energy drinks. While a 12-ounce cup of Starbucks coffee contains 260 grams of caffeine and an 8.4-ounce can of Red Bull contains 80 grams, a 1-ounce square of dark chocolate contains only 12 grams. Milk chocolate contains less caffeine, and white chocolate, much less.

A High-Carb Diet

An occasional late-night treat may not affect your sleep. But habitually indulging your sweet tooth is a risky business. Apart from the fact that eating lots of simple sugars may cause you to gain weight (and being overweight increases your risk of developing type 2 diabetes), a high-carb diet does not square with stable, high-quality sleep.

Two large studies that recently came out of Japan showed that

  • Women who ate few vegetables and lots of sweets and noodles were significantly more likely than others to report poor quality sleep, and
  • People whose diets were lowest in protein and highest in carbohydrates reported poor sleep-wake regularity.

A macadamia cookie at midnight is not going to hurt your sleep. But avoid making a habit of it if you love figure and your sleep.

If you get late-night food cravings, what do you eat?

Surviving Sleep Restriction

A new study confirms that in the early weeks of treatment, sleep restriction—a part of cognitive behavioral therapy (CBT) for insomnia—really is a cross to bear.

Seems like a no-brainer to me. But in research, quantification is important, and what these UK researchers have done is actually a good thing. (I’ll explain why later on.) Here are five tips for insomnia sufferers planning to undergo treatment.

sleep restriction often leads to mild sleep deprivationA new study confirms that in the early weeks of treatment, sleep restriction—a part of cognitive behavioral therapy (CBT) for insomnia—really is a cross to bear. Not only did the subjects in the study sleep significantly less than usual during the first three weeks of treatment. Sleep restriction also decreased their vigilance and reaction time on tests and made them sleepier in the daytime.

“Oh, please,” you may be thinking, “they had to do a study to figure that out? Wouldn’t sleep restriction by definition lead to sleep loss at night and sleepy days?”

Seems like a no-brainer to me. But in research, quantification is important, and what these UK researchers have done is actually a good thing. (I’ll explain why later on.) Here are five tips for insomnia sufferers planning to undergo treatment. (Sleep restriction has a pretty good track record, so it is worth trying, punishing though it may sound.)

Plan Ahead

  • When you go through treatment, expect to be off your game for at least a few weeks. Try to schedule therapy for a period when you’re not swamped with other commitments.
  • You’re going to have extra time on your hands for a few weeks—maybe even two or three hours a day. Don’t wait until the first night of sleep restriction to decide what you’re going to do with it. Before the short nights begin, come up with some activities that don’t require a lot of energy or concentration, but which are not so passive—watching TV, for example—that you find yourself drifting off. Hobbies, crafts, looking at photos or coffee table books, meal planning, and even light chores are all good choices.

During Treatment

  • This is the hard part: follow all the rules. If during the first week your sleep window is from 12 to 5 a.m., stay away from the bed at all other times. To do otherwise will lessen the effectiveness of the treatment and draw it out. Why suffer longer than necessary?
  • Make judicious use of caffeine if you feel logy or sleepy during the day. While caffeine may interfere with sleep at night when used later in the day, used sparingly in the morning or early afternoon, it can help you function better in the first weeks of treatment. If caffeine doesn’t agree with you, check with your physician about a short-term prescription for modafinil. This drug has been shown to cut down on daytime sleepiness in subjects undergoing sleep restriction.
  • Take special care when driving. Naps are generally off-limits when you’re going through CBT for insomnia, but drowsiness behind the wheel can be lethal. If you start to feel sleepy while driving, pull off the road and take a quick nap, or drink a cup of coffee.

The Benefits

The point of the pain associated with sleep restriction is to wind up with some gain: ease in falling asleep, fewer wake-ups, and sounder, more restorative sleep.

As for the benefits of the new study, it suggests that the current method for determining how much to restrict person’s sleep—based on sleep diaries—may be inadequate in some cases. Patients who report sleeping very little may be found in sleep studies to sleep more than they realize. When such a disparity exists, say the researchers, patients should start sleep restriction with a larger sleep window to avoid excessive daytime sleepiness.

Caffeine and Sleep: A Closer Look

A new study from Henry Ford Hospital shows that caffeine ingested 6 hours before bedtime has a disruptive effect on sleep and can cause insomnia.

For goodness sake, tell me something I don’t already know! Drinking coffee late in the day has always been a surefire summons to insomnia at my house.

But there’s a lot about caffeine I didn’t know—and that you might not know either—so I thought I’d pass along a few fascinating factoids.

Insomnia sufferers need not forego coffee completelyA new study from Henry Ford Hospital shows that caffeine ingested 6 hours before bedtime has a disruptive effect on sleep and can cause insomnia.

For goodness sake, tell me something I don’t already know! Drinking coffee late in the day has always been a surefire summons to insomnia at my house.

But there’s a lot about caffeine I didn’t know—and that you might not know either—so I thought I’d pass along a few fascinating factoids.

Who’s Sensitive, Who’s Not

When it comes to caffeine sensitivity, it’s all in the genes. Swiss researchers in 2007 published a paper linking self-rated caffeine sensitivity to differences in a particular adenosine receptor gene (adenosine is a neurochemical whose action is blocked by caffeine). The upshot is that some people can drink coffee after dinner with impunity; others can’t.

In 2012, Stanford researchers found that sensitivity to caffeine is also linked to chronotype—whether you’re a morning person or an evening person. In this study, caffeine had a strongly disruptive effect on the sleep of morning types, a moderately disruptive effect on the sleep of intermediate types, and virtually no effect at all on the sleep of night owls.

Does Caffeine Sensitivity Increase with Age?

Yes. In a paper published in April 2013, a group of Australian pharmacologists found that by the age of 65 or 70, adults experience a 33 percent decrease in the rate at which caffeine is metabolized and cleared from our bodies. This has practical implications for caffeine-sensitive baby boomers.

On average, caffeine has an elimination half-life of 5 to 6 hours. So 5 or 6 hours after you drink a cup of coffee, the amount of caffeine in your blood will have decreased by half. But as we age, our bodies take longer to clear most drugs, and caffeine is no exception. While at 35 we might have gotten away with an espresso at 3 p.m., at 55 we may need to fix the caffeine cut-off time just after lunch.

Beyond Timing

The other important factor to take into account is the amount of caffeine in your beverage of choice. You may be surprised at the caffeine content of some of these drinks:

Starbucks Venti 20 oz. 415 mg
Folgers Classic Roast Instant Coffee 12 oz. 148 mg
McDonald’s Coffee, large 16 oz. 133 mg
Black tea, brewed 3 minutes 8 oz. 30-80 mg
Snapple Lemon Tea 16 oz. 62 mg
Green tea, brewed 3 minutes 8 oz. 35-60 mg
Pepsi 12 oz. 38 mg
Coca-Cola, Coke Zero, or Diet Pepsi 12 oz. 35 mg
Jolt Energy Drink 23.5 oz. 280 mg
Red Bull 8.4 oz. 80 mg
Starbucks Hot Chocolate 16 oz. 25 mg

For a complete list of caffeinated beverages and the buzz they deliver, visit the Center for Science in the Public Interest.

Does caffeine affect your sleep? How? What’s your daily cut-off time?

Q & A: Be Your Own Sleep Scientist

“What good is keeping a sleep diary,” Lawrence wrote to Ask The Savvy Insomniac recently, “when all it’s going to do is confirm what I already know?”

It might seem pointless—and like a whole lot of bother—to keep a sleep diary when you’ve lived many years with insomnia and know its shape and contour like the back of your hands. But I think it’s a valuable investigative tool.

sleep scientistWhat good is keeping a sleep diary, Lawrence wrote to Ask The Savvy Insomniac recently, when all it’s going to do is confirm what I already know? Insomnia is my problem—I’m lucky if I get 5 hours a night. Exactly how am I going to benefit if I find out that Monday night I slept 4 hours and 45 minutes and Tuesday I slept 6 minutes less? A colossal waste of time that I can see. Besides, clock watching tends to make my insomnia worse.

It might seem pointless—and like a whole lot of bother—to keep a sleep diary when you’ve lived many years with insomnia and know its shape and contour like the back of your hands.

But I think it’s a valuable investigative tool. Not only can keeping a sleep diary give you a more realistic picture of how much and how soundly you sleep. It can also help you zero in on habits that may be interfering with—or helping—your sleep. You can then adjust your habits accordingly.

How a Sleep Diary Works

The American Academy of Sleep Medicine has a good sleep diary that you can download here. The task is to keep the diary for two weeks, noting every day when you do the following:

  • Go to bed (Don’t look at the clock after going to bed)
  • Sleep (Estimate the time you fall asleep), including time spent napping
  • Take medicine
  • Drink beverages with caffeine
  • Drink alcohol
  • Exercise.

You might also want to note how well rested you feel each morning.

Results

Tracking these variables over a two-week period may reveal quite a lot. In addition to discovering what your average total sleep time is (which may or may not be surprising), you might find that drinking a second cup of coffee at noon is OK, but a second cup at 2 p.m. tends to keep you up too late. Or you might discover that exercise helps you sleep more soundly. I did.

Now to be really scientific about this, you’d have to test these variables one at a time. One week, keep a sleep diary and vary the amount or timing of the caffeine you drink. The next week, vary the amount or timing of the alcohol. And so forth.

But for me personally, since I’m mostly a creature of habit, the amount and timing of the things I do doesn’t vary all that much from one day to the next. It’s the activities and habits that DO vary that may afford insight into how to avoid insomnia and improve your sleep.

Getting scientific about things can sometimes help.

Have you ever tried keeping a sleep diary? What, if anything, did you learn?

Coffee and Sleep: Are They Compatible?

I came of age when drinking caffeinated beverages was frowned on for people like me. Sleep experts exhorted people with insomnia to “stay away” from caffeine; a story in Working Woman stated that “the stimulant effect of coffee may last as long as 20 hours.”

Warnings like these made me feel guilty about indulging my java jones. Were my two cups of coffee, one at wake-up time and the other later in the morning, keeping me awake at night?

There’s nothing I love more in the morning than coffee. From the acrid smell of the grounds and the steam wafting upward with the first sip to the slightly bitter taste and the thrill of my world coming into sharper focus, no drink comes close to satisfying me like a piping hot café au lait.

But I came of age when drinking caffeinated beverages was frowned on for people like me. Sleep experts exhorted people with insomnia to “stay away” from caffeine; a story in Working Woman stated that “the stimulant effect of coffee may last as long as 20 hours.” Warnings like these made me feel guilty about indulging my java jones. Were my two cups of coffee, one at wake-up time and the other later in the morning, keeping me awake at night?

Unlikely, is the message I came away with from a sleep seminar I attended a year ago. “They’ve gone overboard on this one,” said behavioral sleep medicine specialist Michael Perlis, referring to the recommendation to steer clear of caffeine as part of good sleep hygiene. Studies where subjects have taken caffeine right before bedtime show that the drug interferes with the timing and quality of sleep. But used judiciously in the morning or even mid-afternoon, Perlis says, caffeine can reduce the daytime impairments associated with insomnia without harming sleep at night.

Moderate Use of Caffeine in the Morning

A recent study from the University of Pittsburgh School of Medicine bears this out. Researchers reviewed data collected from 65 insomniacs and 29 good sleepers with three questions in mind:

1)   how did the use of caffeine – and the plasma concentrations of its main metabolite, paraxanthine — compare between the two groups,

2)   was use of caffeine related to increased caffeine and paraxanthine plasma concentrations in the insomniacs compared to the good sleepers, and

3)   did caffeine consumption affect subjects’ sleep, and did the effect differ in insomniacs and good sleepers?

Researchers found no differences between the two groups in the amount of caffeine they consumed (no one drank more than 4 cups of coffee a day) or plasma concentrations of caffeine and paraxanthine. Nor did subjects differ in when they used caffeine, with most reporting use early in the day. And – here is the key finding – the caffeine had little if any impact on any of the subjects’ sleep, assessed both subjectively and objectively in a sleep lab.

“This study demonstrates that low to moderate caffeine use” (mainly in the morning) “did not have a powerful effect upon sleep in either good sleepers or primary insomniacs,” the authors conclude.

People differ in their sensitivity to caffeine and the speed at which their bodies metabolize it, so decisions about when and how much to use are individual matters. Me, I turn a deaf ear to caffeine purists these days. No way am I going to break off my steamy morning affair with Java Joe.