How caffeine disrupts your sleep

New research looks into the specifics of how late-in-the-day caffeine can disrupt your sleep at night.

You hear it all the time when it comes to sleep: Don't drink caffeine too late in the day. It's among the most common sleep tips -- and it's a good one. Caffeine, with its stimulant effects, is disruptive to good sleep. And these days, with the popularity of energy drinks and other caffeine-laden beverages and snacks, it's not difficult to wind up consuming caffeine throughout the day, even if you've set your coffee cup aside. The negative health consequences of too much caffeine also extend beyond sleep problems. Research shows that caffeine may contribute to cardiovascular problems. A recent large-scale study also suggeststhat heavy caffeine consumption -- more than four 8-ounce cups of coffee per day on a daily basis -- is linked to higher mortality rates in men and women.

But how late in the day is too late in the day to be consuming caffeine? Despite consensus about caffeine's sleep-disrupting effects, recommendations about the timing of caffeine consumption -- and when it's best to stop for the day -- can vary widely. Though an abundance of research has been conducted to establish caffeine's negative effects on sleep, very little attention has been paid to the specific timing of caffeine consumption relative to bedtime.

A new study attempts to fill in some of these important specifics about the effects of late-afternoon and early-evening caffeine consumption on nightly sleep. Researchers at Michigan's Henry Ford Hospital's Sleep Disorders & Research Center and Wayne State College of Medicine analyzed the sleep-disruptive effects of caffeine consumption at different lengths of time before bedtime. They found that caffeine consumed even six hours before bedtime resulted in significantly diminished sleep quality and sleep quantity. This is believed to be the first study to investigate directly the effects of caffeine at specific times before nightly sleep.

The study included 12 adult men and women, all of whom were healthy and were normal sleepers who in their regular lives were moderate consumers of caffeine. During the study period volunteers kept up their normal sleep routines, which included bedtimes between 9 p.m. and 1 a.m. and wake times between 6 a.m. and 9 a.m. Participants' total nightly sleep duration fell somewhere in the range of 6.5 to 9 hours per night, with no regular habit of napping during the day. Throughout the study researchers tracked sleep by having participants keep sleep diaries and by using at-home sleep monitors. Participants were given doses of caffeine in pill form as well as placebo pills, on a schedule that enabled researchers to measure the sleep-disruptive effects of caffeine taken at three different points: at bedtime, three hours before bedtime, and six hours before bed. They found significant disruptions to sleep as a result of caffeine taken at all three points:

• Caffeine consumed zero, three, and six hours before bedtime significantly reduced total sleep time. Even caffeine consumed six hours before bed reduced total nightly sleep amounts by more than one hour.
• Caffeine consumed at all three points diminished sleep quality. Caffeine taken three and six hours before bedtime, as well as caffeine consumed at bedtime, significantly increased the amount of time spent awake during the night.
• Disruptions to sleep as a result of caffeine were perceived by volunteers (as recorded in sleep diaries) for caffeine consumed at bedtime and three hours before bed, but were not reported for caffeine taken six hours before bed. However, sleep monitors measuring total sleep time, and sleep efficiency (time spent sleeping relative to total time spent in bed) showed that caffeine consumed six hours before bedtime had significant detrimental effects to both.

This last finding is especially important, because it suggests that people can't -- and shouldn't -- rely entirely on their own perceptions of how much or little caffeine affects their sleep, especially caffeine consumed in the afternoon. Even if you don't feel that late-afternoon cup of coffee has a negative impact on your sleep, this study suggests that it is likely to be interfering nonetheless. This is one reason that I have long recommended a 2 p.m. cut off time for caffeine consumption.

Remember, limiting caffeine doesn't mean removing it entirely from your daily routine. A moderate amount of caffeine, consumed at the right times, can be useful and evenhealthful, stimulating alertness and energy. These new findings provide us with some really important specifics about just how significantly late-in-the-day caffeine can undermine a good night's sleep. Want to enjoy your coffee without wrecking your sleep? Follow these basic suggestions for consuming caffeine in a sleep-friendly way:

Stick to a 2 o'clock cut off. As this current study shows, late-afternoon caffeine can cause problems for your sleep, even if you aren't aware of it. To avoid sleep disruption, restrict your caffeine consumption primarily to the morning hours. If you do have a midday cup of coffee, make sure to drink it before 2 p.m.

Taper caffeine as the day progresses. Start your day with your most highly caffeinated beverage and ease up on the caffeine as the morning goes on. First thing in the morning is likely when you'll crave caffeine the most, and when it can do you the most good in terms of boosting energy and shaking off the effects of a night's sleep. Switch over to tea or decaffeinated coffee as the morning continues, to keep overall daily caffeine amounts moderate and be comfortably caffeine-free by mid-afternoon.

Avoid jumbo drinks. These days, everything seems to be "super-sized" -- and caffeinated drinks are no exception. From a 20-plus-ounce latte or soda to a caffeine-packed energy drink, a lot of caffeine products deliver way more of the stimulant than is healthful. Stick to something much closer to the old-fashioned 8-ounce cup, and savor it.

Don't ignore your sleep problems. Being tired makes us more likely to feel the need for caffeine, and that extra consumption can in turn make sleep problems worse. Avoid this sleep-disruptive cycle by making sleep a daily priority. Practice good sleep hygiene and talk to your doctor about how you are sleeping, particularly about any problems that arise.

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Why sleep changes as we age

This article discusses why a person's sleep changes as he or she ages and what can be done about it.

As we age, sleep quality can decrease, partly because of normal changes and partly as a consequence of disease, poor habits, and medications.

That's not to say disrupted sleep or insomnia is OK; any problem sleeping should be discussed with your physician or a sleep specialist.

But there are differences between the natural changes we have in our sleep patterns as we age and changes caused by underlying issues that need to be addressed.

It is a normal part of aging, for example, to have an earlier bedtime and have difficulty staying asleep as long as we used to. It also may be normal to have less deep sleep and more awakenings toward the end of sleep. In addition, the diseases we accumulate as we age affect the quality of sleep. And pain from these illnesses and the medications we're taking for them can affect sleep significantly.

But it is not necessarily normal to snore, have pauses in your breathing (apnea), wake up with a headache, sleep fewer than six to seven hours, or have dream-related behaviors (movements that act out your dream). And excessive sleepiness during the daytime, increased irritability, worsened memory, and frequent awakenings or fragmented sleep may all be signs of a sleep disorder and should not be ignored.

In the case of obstructive sleep apnea, which occurs as frequently in the elderly as in the general population, signs may be different and snoring may be less pronounced. Snoring is rarely benign, and when coupled with increased sleepiness during the day or fragmented sleep, may indicate sleep disordered breathing.

In addition, the presence of dream enactment behaviors may increase with aging and can be associated with neurological disease and dementia, such as Parkinson's disease. The movements may seem small and infrequent but they can increase in frequency and may cause injury to you or your bed partner. The emergence of movement during dream sleep, and particularly mimicking the dream, should also be evaluated by your primary physician or a specialist.

Disordered sleeping of any kind, especially in the elderly, can lead to a worsened quality of life, impaired thinking, and exacerbate depression and anxiety.

Of all sleeping problems, insomnia is by far the most common complaint and it is typically not difficulty falling asleep but staying asleep. Changes in the body's natural clock and rhythm tend to cause this and include dampening of the signal and advancing phase, which helps keep us asleep. The result is typically an earlier bedtime with an earlier wake-up time and increasing difficulty staying asleep in the early morning hours.

As with all age groups, there are steps you can take to help make falling asleep and staying asleep easier:

Maintain a regular bedtime and wake time.

Remain active and get exercise every day.

Do not lie in bed trying to fall asleep; if you aren't asleep within 15 minutes, get out of bed and do something quiet and relaxing and try again when sleepy.

Avoid napping during the day.

Limit alcohol and caffeine late in the day.

Limit fluid intake before bedtime.

Keep the bedroom cool, dark, and quiet.

Know how your medications affect sleep.

Seek care if warning signs are present or sleep disturbance persists

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Sleep and Emotional Health

Sleep can have a large impact on a person's emotional health and vice versa.

The relationship between disordered sleep and emotional health is an intricate one, as each can influence the other for better and worse. Stress and worry, as well as mental illnesses such as depression and anxiety can interfere with sleep. And an abundance of research indicates that people who experience disrupted sleep, including obstructive sleep apnea and insomnia, are at dramatically elevated risk for depression and other psychiatric disorders. Insomnia is an important risk factor for depression, and has also been linked to a sharply increased risk of suicide among people who suffer from depression. Despite all that we know about this complicated relationship, scientists are still working to understand the underlying mechanics and root causes of sleep disorders and mood disorders when both are present.

A new study provides some important new information about how disrupted, insufficient sleep may contribute to the onset of emotional difficulties as well as the development of depression and other psychiatric problems. Researchers at the University of Pittsburgh School of Medicine investigated emotional responses in the brains of people with insomnia and found dysfunctional activity in an area of the brain that regulates and processes emotions. Their findings may provide an explanation for the mechanism by which disrupted sleep influences depression and other psychiatric conditions.

Researchers included 44 adults in their study. Of these, 14 had chronic insomnia, and no other primary psychiatric disorders. The remaining 30 participants were people who had no insomnia and who slept well. All of the study subjects participated in the same exercise, a task involving voluntary emotional regulation. First, participants were shown a series of images containing both negative and neutral emotional content. They were asked to view the series of images passively, without trying to control or influence their emotional responses. When they were shown the images a second time, participants were asked to decrease their emotional response using a voluntary emotional regulation technique called cognitive reappraisal. Cognitive reappraisal involves the deliberate attempt to change your emotional response to a stimulus. In this case, participants were asked to intentionally decrease their negative emotional responses to the images shown to them. Researchers’ analysis showed:

• A distinct difference in the brain activity of those with insomnia compared to those with normal sleep patterns. Specifically, researchers found a dramatic difference in the activity of the amygdala, a cluster of neurons within the temporal lobe that plays a critical role in processing and regulating emotion.
• Amygdala activity was significantly greater for those with insomnia during the period when they were asked to decrease their negative responses to images using cognitive reappraisal, compared to those without the sleep disorder.
• There was no significant difference between insomnia and non-insomnia participants during their passive viewing of the images.

Previous research has shown that cognitive reappraisal decreases amygdala activity.These results, which show the opposite, suggest that insomnia may impair the brain’s ability to successfully process negative emotions, a finding that could help to explain the mechanics of how sleep contributes to depression and other psychiatric disorders.

Other recent research has demonstrated evidence of neural changes and emotional regulation difficulties among people with disordered, insufficient sleep:

• The ability to accurately judge emotion in human faces is compromised by sleep deprivation, according to research conducted at the University of California, Berkeley. Researchers measured the ability to read emotions in faces by people who were sleep deprived in a laboratory setting, and found significant impairment to their assessment of certain emotions, including anger and sadness. The impairment was particularly significant among women. The decrease in this ability was alleviated after a night of recovery sleep.
• Researchers in the United Kingdom examined how sleep deprivation affects inhibition and impulse control. They found a night of sleep deprivation lowered inhibition and increased impulsivity to negative stimuli.
• In responding to a series of images categorized as pleasant, neutral, or unpleasant, people who were sleep deprived perceived the neutral images more negatively than those who were not sleep deprived. Those who were sleep deprived also demonstrated more negative moods.
• Sleep deprived patients were more highly reactive to both negative and positive stimuli, showing greater levels of activity in the limbic regions of the brain, where much of the work of emotional regulation and processing occurs.

The latest research findings add to the growing body of scientific knowledge indicating that sleep problems cause dysfunction in the brain that may contribute to emotional difficulties and psychiatric conditions. This is an exciting and important area of research, as scientists continue to explore the biological roots of both sleep disorders and psychiatric disorders.

All of us who’ve experienced insufficient, disrupted sleep know first-hand how being sleep deprived can negatively affect our emotional equilibrium. When we’re tired, we’re more likely to be short-tempered, impatient, and moody. Research such as this brings us closer to understanding the mechanics that may underlie a broad range of emotional disturbance and dysfunction.

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Technology hurting your sleep

Light from phones, tablets and computers can interfere with a person's natural melatonin production and interfere with sleep.

Smartphones and tablets can make for sleep-disrupting bedfellows. One cause is believed to be the bright light-emitting diodes that allow the use of mobile devices in dimly lit rooms; the light exposure can interfere with melatonin, a hormone that helps control the natural sleep-wake cycle. But there may be a way to check your mobile device in bed and still get a good night's sleep. A Mayo Clinic study suggests dimming the smartphone or tablet brightness settings and holding the device at least 14 inches from your face while using it will reduce its potential to interfere with melatonin and impede sleep.

The research was among Mayo Clinic studies being presented at SLEEP 2013, the Associated Professional Sleep Societies annual meeting in Baltimore.

"In the old days people would go to bed and read a book. Well, much more commonly people go to bed and they have their tablet on which they read a book or they read a newspaper or they're looking at material. The problem is it's a lit device, and how problematic is the light source from the mobile device?" says co-author Lois Krahn, M.D., a psychiatrist and sleep expert at Mayo Clinic in Scottsdale, Ariz.

"There's a lot of concern about using mobile devices and that prompted me to wonder, are they always a negative factor for sleep?" Dr. Krahn says. "We found that only at the highest setting was the light over a conservative threshold that might affect melatonin levels. If it's at the mid setting or at a low setting it's bright enough to use."

In the study, researchers experimented with two tablets and a smartphone in a dark room, using a meter on its most sensitive setting to measure the light the devices emitted at various settings when held various distances from a person's face. They discovered that when brightness settings were lowered and the devices were held just over a foot from a user's face, it reduced the risk that the light would be bright enough to suppress melatonin secretion and disrupt sleep.

Other Mayo research presented at the conference includes the finding that some sleep apnea patients may not need annual follow-up visits. Patients with obstructive sleep apnea being treated with positive airway pressure are less likely to need a yearly check-up.

The researchers suggest developing a screening tool to assess which of these patients need annual follow-up visits.

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Overcoming Sleep Disturbances in Children

Helping children get over their sleep issues requires finding the source of the issue according to the following article.

Annie was having a tough time. While her five-year-old son Paul would sleep through the night, her two-year-old daughter Nina would wake every few hours, meaning Annie was exhausted. “My little girl had extremely interrupted sleep patterns and would rarely sleep for more than three hours at a time,’’ says Annie, a Dubai HR officer. “She’d wake up crying as if she’d had a nightmare and it would take a lot of comforting before she’d go back to sleep.’’

Her husband Mathew helped her to soothe Nina and put her back to bed, and the lack of sleep was taking its toll on both parents. “I was finding it difficult to concentrate at work and my husband said that he once even dozed off at the wheel,’’ says Annie. “I realised then I needed to do something before a disaster happened. The lack of sleep was becoming dangerous.”

She took the toddler to her doctor for a check-up, but there was nothing physically wrong with her. “We tried all kinds of things like rubbing her back, cuddling her and putting her to bed at fixed times,” says Annie. “It took nearly a year before she fell into a regular sleep pattern.’’ Annie’s not sure what caused the problems, but suspects it was a stage her daughter eventually grew out of.

Nothing that can’t be tackled

Battling through months of disturbed sleep is to be expected when you’ve got a new baby. But when your child is older and still not sleeping through the night, it can be a huge family problem. However, there are very few issues that can’t be tackled, promises Dr Richard Ferber, director of the Centre for Pediatric Sleep Disorders at Boston Children’s Hospital.

He stresses that while children’s sleep problems vary widely (common issues include being unable to fall asleep without help, getting up repeatedly during the night, waking early, being hard to wake up, bed-wetting and sleep apnoea) they are rarely the result of poor parenting.

A revised version of Dr Ferber’s book, Solve Your Child’s Sleep Problems, was published recently, and he hopes parents of children of any age will read it to help them understand sleep so they can prevent problems occurring. “Pretty much all children have the ability to sleep fairly normally,” he says. “But there are many ways sleep patterns can be disrupted and that’s when it’s worth trying to sort it out.”

Stop it at the source

Dr Ferber says that one of the most common problems is children not being able to go to sleep easily or stay asleep. This is often due to schedules (the timing of sleep and how it’s controlled) and habits related to sleep (what they’re used to doing before sleep) such as feeding. As a child gets older, there may be issues around limit setting (sticking to strict rules on sleep-delaying tactics), and night-time fears may also cause problems.

He explains that solutions will differ depending on the child, and says that while trying something such as controlled crying – where babies older than six months are left to cry but checked regularly and reassured without being picked up – may help in particular situations, it’s often not appropriate.

It shouldn’t be used if children are in pain or discomfort, if their sleep schedule isn’t correct (if parents think the child should be sleeping for longer than he or she is capable) or if they’re frightened. If a child has night-time fears, it’s important to identify the source of the fears and deal with it so the problem can be resolved. “The first question is ‘why is a child crying?’” stresses Dr Ferber.

He says that it’s to do with some sort of association, for example if they have to have their back rubbed to fall asleep, then if they wake up in the middle of the night, which is a normal part of the sleep cycle, someone can’t be there to rub their back all night. “If they learn how to go to sleep without back rubbing, there’s no problem, so withdrawing it is appropriate,” says Dr Ferber. “If the child is upset, you may want to check them at increasing intervals to show you haven’t disappeared, but without reinstating the back rubbing or the habit related to them getting to sleep.”

According to Dubai-based Dr Onita Nakra, educational psychologist and counsellor, American School of Dubai, poor sleep can impact a child negatively. “The child’s health, safety, development, learning and behaviour can be affected,” she has said. “A common complaint is difficulty concentrating or poor retention at school. A tired child also has difficulties focusing in the classroom.”

Dr Ferber points out that children often have a combination of more than one sleep problem, and parents need to be aware that if they deal with one problem such as a sleep association and the child still has sleep difficulties, it may be because there’s an another issue. This may be an incorrect sleep schedule. “Parents may come to the conclusion that their child is just a bad sleeper, but if they fix the schedule as well, they may find the child’s actually a great sleeper,” he says.

Another sleep problem is a child not getting enough sleep. While Ferber stresses there’s no way of telling from numbers alone, a general guide for how much children should be getting is around 14-18 hours for a baby, around 12-14 hours for a toddler and around 11-13 hours for primary school-aged children.

A bedtime routine is very important. A child put to bed straight after watching TV without any transition period can cause problems. “Establishing a routine the child looks forward to, such as a song or a story, makes the process more pleasurable,” says Dr Ferber. “It’s also a chance for parents to get away from other distractions and interact with their child. It can be as special a time for parents as it is for children. We’re not talking about much time, but it’s time well spent.”

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Chronic Fatigue Syndrome and How It Affects Sleep

This article discusses what chronic fatigue syndrome is, its negative effect on sleep, and research that is being done on this syndrome.

For people with chronic fatigue syndrome, sleep problems are common. Sleep disorders and disruptive and non-refreshing sleep are some of the most frequent complaints from people suffering from chronic fatigue. Chronic fatigue syndrome is a debilitating medical condition. It's also a mysterious -- and historically controversial -- illness.

The basic characteristics of chronic fatigue syndrome include ongoing fatigue that interferes with daily activities, problems with memory and concentration, muscle pain and headaches, and other physical symptoms such as sore throat and tender lymph nodes. People with chronic fatigue also experience feelings of malaise after periods of mental and physical exertion.

The causes of chronic fatigue are unknown. There is no test to determine the presence of the illness. Physicians make a diagnosis based on the presence of a cluster of symptoms over an extended period of time, at least six months, and by ruling out other conditions. For many years, chronic fatigue was considered with skepticism by some in the medical community. There were those who questioned whether chronic fatigue was an illness at all, rather than the consequence of a sleep disorder or a mental health issue. Over the past two decades, chronic fatigue syndrome has won acceptance by the medical establishment. But much about the disorder -- its causes, its mechanisms in the body -- remain largely unknown.

Disrupted sleep is a hallmark of chronic fatigue syndrome. Chronic fatigue is associated with a range of sleep problems, including:

• Excessive daytime sleepiness
• Non-restorative sleep (waking feeling tired even after sufficient or prolonged periods of rest)
• Difficulty falling asleep and staying asleep
• Sleep disorders such as obstructive sleep apnea, insomnia, and narcolepsy

Despite the frequency with which people with chronic fatigue syndrome experience sleep disturbances, the connection between sleep and chronic fatigue -- like so much else about the disorder -- is not well understood.

Researchers at Australia's Victoria University have conducted a review of research related to sleep and chronic fatigue. Their analysis sheds some light on possible reasons for poor sleep among patients with chronic fatigue.

Sleep complaints are common among chronic fatigue patients, but there is no single or typical sleep experience for people with this disorder. For the past two decades, research has shown high levels of sleep disorders among adults with this condition:

• Several studies, including this one, have found that more than half of chronic fatigue patients have some type of sleep disorder.
• This study showed chronic fatigue patients experience greater levels of disrupted sleep than patients with multiple sclerosis.
• More than 50 percent of chronic fatigue patients in this study had obstructive sleep apnea or sleep-related movement disorders, such as restless leg syndrome.
• A similar study showed 46 percent of chronic fatigue patients suffered from obstructive sleep apnea
• This large, population-based study showed nearly 80 percent of chronic fatigue patients experienced un-refreshing sleep, and 20 percent had obstructive sleep apnea or narcolepsy.

An important area of research into the connection between sleep and chronic fatigue looks at the role of pain. The physical pain associated with chronic fatigue may be a significant factor in the sleep problems experienced by people with chronic fatigue. We know that pain and sleep influence each other in multiple ways. Pain can make sleep difficult to achieve and sustain. Lack of sleep, in turn, can make us more sensitive to pain. Studies like this one have shown that pain causes chronic fatigue patients to wake more often throughout the night than either healthy people or those with depression. And one study found that disruption to slow wave sleep in healthy people triggered physical pain and fatigue similar to people with chronic fatigue syndrome. As researchers themselves note, the role of muscle pain in sleep disorders among chronic fatigue sufferers is an area of research that warrants more attention and further study.

There's another body of research that suggests that people with chronic fatigue experience changes to their sleep cycles that could result in less restorative sleep. Studies have shown that people with chronic fatigue may spend less time in slow wave sleep than healthy people. Slow wave sleep occurs during the sleep stages three and four and is the most restorative sleep we can experience. Studies have shown that chronic fatigue patients spend a reduced amount of time in slow wave sleep and in REM sleep than healthy people. To date, there is less evidence for the reduction in REM sleep than in slow wave sleep. The cause of this disturbance to sleep cycles is unclear. However, there is evidence of a possible link between systematic inflammation and disruptions to sleep cycles, particularly to time spent in slow wave sleep. Systemic inflammation in the body is common among chronic fatigue patients and may play a role in the persistent problem of non-refreshing sleep.

Still another area of study suggests that changes to the body's nervous system activity may play a role in the sleep disruptions experienced by people with chronic fatigue. Chronic fatigue patients experience alterations to the functioning of their nervous systems during waking hours, and these can continue during sleep. Several studies have shown that chronic fatigue patients are more likely to experience disruptions to normal nervous system activity during sleep, and this may be affecting the quality of sleep they experience.

There are so many questions that remain unanswered about the relationship between sleep and chronic fatigue syndrome. Why and how does non-restorative sleep occur so frequently? What is the cause -- or effect -- of sleep disorders such as obstructive sleep apnea and restless leg syndrome among people with chronic fatigue? Do the standard measurements of sleep quality work accurately for this group of people?

Here's one thing we do know: Sleep disruptions are a critical component of chronic fatigue syndrome. Answering these and other questions about the role that sleep plays in chronic fatigue could provide some much needed insight into this debilitating illness.

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