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.

Naps & Sleep Restriction: Could This Be a Happy Marriage?

Lesley Gale was a light sleeper who began to have insomnia about 8 years ago. She consulted doctors and tried the remedies they proposed, but nothing seemed to work. Investigating on her own, she came upon a treatment called sleep restriction therapy, or SRT.

“I had heard of SRT before,” Gale wrote in an e-mail, “having seen a couple of documentaries on TV about it, and then did further reading on the Internet. But for years I dismissed it instantly as being absolutely impossible for me.” Napping was off limits during SRT, and this was a deal breaker.

Sleep restriction for insomnia may be easier to comply with if insomniacs are allowed a brief afternoon napLesley Gale was a light sleeper who began to have insomnia about 8 years ago. She consulted doctors and tried the remedies they proposed, but nothing seemed to work. Investigating on her own, she came upon a treatment called sleep restriction therapy, or SRT.

“I had heard of SRT before,” Gale wrote in an e-mail, “having seen a couple of documentaries on TV about it, and then did further reading on the Internet. But for years I dismissed it instantly as being absolutely impossible for me, as I’m sure a lot of other people initially react.

“‘I need my 8 hours,’ I thought. I couldn’t possibly stay awake until the early hours of the morning—I’m a confirmed morning lark, not a night owl.” Having to stay up late was not the only problem Gale foresaw. Napping, too, was off limits during SRT, and for years, this was a deal breaker. “I can’t live without naps,” she said.

SRT and Naps

SRT, a behavioral treatment for insomnia, involves restricting time in bed for a while and then slowly adding time back in as sleep improves. Restricting time in bed is helpful because it enables a robust build-up of sleep drive during the day. The greater your sleep drive at bedtime, the more readily you’ll fall asleep and the more likely you are to sleep through the night. Anything that interferes with the build-up of sleep drive will retard your progress. So napping is generally discouraged.

But napping has never been strictly prohibited. In the first weeks of SRT, insomniacs tend to experience mild sleep deprivation, which can sometimes result in overwhelming sleepiness during the day. Sleepiness is dangerous if you’re driving a car or operating machinery. People are advised to avoid such dangers by taking a nap, but to keep the nap short. “No more than 30 minutes,” is the advice my sleep therapist gave me.

A New Perspective on Napping

Then a few months ago, I read about a study being conducted by Nicole Lovato, a postdoctoral research associate at Flinders University. The purpose of Lovato’s study is to find out if adding a 20-minute afternoon nap before 5 p.m. to the SRT protocol will not only keep from undermining the treatment but will actually increase its success.

“Even though we know this treatment [SRT] works very well,” Lovato said, quoted in Medical Express, “a lot of patients feel so sleepy that they find it difficult to adhere to their new bedtime, which is often much later than the time they normally go to bed. . . . We’re hoping that daytime napping will make it easier for patients to adhere to their bedtime and get through the day when they’re undertaking sleep restriction therapy.”

Unlike long naps, short naps are unlikely to interfere with the sleep restriction process. When you first fall asleep, you’re in the lighter stages of sleep, and hovering in the lighter stages will not diminish sleep drive. During long naps, on the other hand, you’re likely to descend into deep sleep. Deep sleep is the stuff that reverses sleep drive, and that is what you want to avoid.

A Testimonial

I wanted to have the results of Lovato’s study in hand before blogging about it. But I mentioned the study in the comment section of another blog, and Lesley Gale, whose desperation to find a solution to her insomnia had prompted her to start SRT despite her reservations, saw the comment and responded this way:

“I’m only 2 weeks into SRT, and I was so excited when I read . . . about naps maybe being OK with SRT,” Gale wrote. “Not being able to have naps has really put me off trying SRT before. But a ‘micro nap’ has worked wonders for me twice this week. About 10 minutes each time, I felt invigorated afterwards, and it didn’t affect my nighttime sleep at all.

“I can’t express what a massive relief it has been! Will keep this new favourite tool only for when I’m feeling really, really sleepy during the daytime. Just having that possibility in the back of my mind has made me feel so much more relaxed about making it through till bedtime.”

The Results Aren’t In Yet, but . . .

Reading Gale’s story has prompted me to go ahead and write about adding brief naps to SRT. People are sometimes desperate for ways to manage their insomnia, and if being allowed a 10- or 20-minute power nap in the afternoon before 5 p.m. might make SRT more palatable and easier to comply with, surely the benefits of mentioning it will outweigh the harm. If you try it out, though, make sure to set an alarm clock to keep your nap short and sweet.

Q & A: Insomnia and Polyphasic Sleep

I just read an interesting article about alternative sleep cycles. The writer says the idea that humans need to sleep a block of 8 hours at night is wrong. Other sleep patterns are just as good and may be more natural.

So are there any alternative sleep patterns worth trying out?

birds-sleepingCould polyphasic sleep be a solution to my insomnia? a reader wrote to Ask The Savvy Insomniac. I don’t sleep very well, and I have this overwhelming desire to nap in the afternoon.

I just read an interesting article about alternative sleep cycles. The writer says the idea that humans need to sleep a block of 8 hours at night is wrong. Other sleep patterns are just as good and may be more natural.

In a lot of traditional cultures it’s normal to sleep at night and then take a siesta in the afternoon. They’re not the ones with the sleep problems—WE ARE! She also talks about a schedule where you get a core chunk of sleep at night and take 3 short naps during the day. There’s another cycle where you take 6 short naps spaced evenly through the day. Are any of these alternative sleep patterns worth trying out?

Biphasic Sleep: A Maybe

The biphasic sleep pattern that occurs in places where the afternoon siesta survives has never been shown to create sleep problems or be harmful to health. On the contrary, napping can be highly beneficial (although it can create problems for people with insomnia—read my blog about naps), increasing alertness and improving memory. While napping may reduce your sleep time at night, afternoon naps may be a viable option for people inclined to take them.

(There’s also historical evidence of a different biphasic sleep pattern in humans before the advent of artificial lighting. See my blog about middle-of-the-night awakenings.)

But Polyphasic Sleep?

The other sleep patterns the writer mentions—involving several naps a day—strike me as improbable and likely to make insomnia worse! Early studies of the timing of human sleep suggest why.

In these older experiments, people lived for weeks and months in conditions where they were completely removed from cues about the time of day. (No clocks, no noise, no windows.) These subjects tended to sleep when their body temperatures were falling or at a low point. They were awake and alert when their temperature was on the upswing or high.

Our core body temperature typically rises and falls twice a day. The big drop occurs at night, the very lowest point occurring a few hours before wake-up time. A second temperature dip occurs mid-afternoon. So we feel sleepy at night, and many of us need a pick-me-up to counter the sleepy feeling we get mid-afternoon.

But trying to nap at any other time of day—when temperatures are rising or high—will be a losing proposition for most of us. We’re too aroused and alert to drift off then even though we may be feeling desperately sleep deprived.

A biphasic sleep pattern may work for some people. But the likelihood of thriving on multiple short sleep episodes daily is—well—for the birds (and cats).

Sleep Hygiene: Revisiting the Rules

A few weeks ago I blogged about managing insomnia by doing whatever works. It turns out that sleep experts (some of whom also struggle with insomnia) flaunt a few rules of good sleep hygiene themselves—regardless of recommendations they make to us.

exercise-nightA few weeks ago I blogged about managing insomnia by doing whatever works. It turns out that sleep experts (some of whom also struggle with insomnia) flaunt a few rules of good sleep hygiene themselves—regardless of recommendations they make to us.

You’ve heard that insomniacs are not supposed to read, eat, or watch TV in bed? Sleep expert David N. Neubauer has a qualified view on this.

“I think the ‘no reading in bed’ rule makes sense for chronic insomniacs,” Neubauer, associate professor at Johns Hopkins University School of Medicine, is quoted as saying in an article in Huffington Post, “but I find reading relaxing. I feel like I can put the book down when I get tired.”

Dr. W. Christopher Winter, medical director of the Martha Jefferson Hospital Sleep Medicine Center in Charlottesville, Virginia counsels his patients to work out early in the day. Yet he himself gets more of a benefit from exercising at 10 or 11 p.m. He also takes daytime naps—another thing insomniacs are routinely advised to avoid.

How Much Stock Should You Put in the Rules of Sleep Hygiene?

The suggestions you see in magazines and on the web exist for good reasons. Either they’re validated by scientific studies—such as the rule about going to bed and getting up at the same time every day—or based on observations made by clinicians, such as the advice to get up and do something when you can’t sleep rather lying in bed awake.

But each and every rule may not have value for all insomniacs. How could it be otherwise, when the sleepless are such a motley crew? Some of us have trouble getting to sleep; others, trouble staying asleep. Bad nights leave some insomniacs with short tempers; they leave others of us with brains that rattle along in second gear and never reach cruising speed.

Such a diverse array of symptoms implies to me that the causal mechanisms of our insomnias are probably different. So how could remedies proffered to the masses be uniformly beneficial to all?

Overall, I think we’re wise to pay attention to the rules of good sleep hygiene. But we’re also wise to experiment and find what works best for us.

Which rules of sleep hygiene are helpful to you, and which are not?