Caffeine-induced sleep disorder

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Caffeine-induced sleep disorder
Specialty Psychiatry

Caffeine-induced sleep disorder was a psychiatric disorder identified as resulting from overconsumption of the stimulant caffeine.

Contents

Caffeine is one of the most widely consumed psychoactive drugs: almost 90% of Americans in a survey consume some type of caffeine each day. [1] "When caffeine is consumed immediately before bedtime or .... throughout the day, sleep onset may be delayed, total sleep time reduced, normal stages of sleep altered, and the quality of sleep decreased." [2] Caffeine reduces slow-wave sleep in the early part of the sleep cycle and can reduce rapid eye movement sleep later in the cycle. Caffeine increases episodes of wakefulness, and high doses in the late evening can increase sleep onset latency. In elderly people, there is an association between use of medication containing caffeine and difficulty in falling asleep. [3]

Official recognition and past criteria

The latest Diagnostic and Statistical Manual of Mental Disorders, DSM-5, does not include caffeine-induced sleep disorder. It does have "Other Caffeine-Induced Disorders" and "Unspecified Caffeine-Related Disorder" which may have linkage with caffeine use. [4]

Previously DSM-4 included criteria for the disorder that there must be a significant inability to sleep which is caused entirely by the physiological effects of caffeine as proven by an examination; if sleeping issues can be accounted for due to a breathing-related sleep disorder, narcolepsy, a circadian rhythm sleep disorder or a mental disorder, then caffeine-induced sleep disorder was not the cause.[ citation needed ] This condition was seen as causing a notable impairment in functioning. [5]

Similarly the latest International Classification of Diseases, ICD-11, does not include a specific sleep-related caffeine disorder, but does include "sleep-wake disorders" under "Disorders due to use of caffeine, unspecified". [6]

Caffeine and age

Most studies [7] now, find that there is relatively no association between caffeine and its effects on sleep for infants. There was very little difference between mothers who had high caffeine consumption during pregnancy as opposed to mothers who did not have high consumption of caffeine during their pregnancy.[ citation needed ]

Caffeine in younger children has been found to shorten their sleep duration and increase daytime sleepiness. One study, which looked at children ages six to ten years of age, found that those who consistently consumed caffeine lost about 15 minutes of sleep each night. [7] In most cases where younger children are drinking high amounts of caffeine, parents usually buy their children soft drinks, iced tea, or energy drinks without realizing the amount of caffeine these drinks contain or the implications they have on their children. [8]

30% of adolescent adults in a survey were found to consume caffeine daily. [9] Individuals with higher caffeine consumption, tended to feel an increase in wakefulness after sleep onset, shorter sleep durations, and longer daytime sleep. Those who consumed high amounts of caffeine daily, were found to be 1.9 times more likely to have difficulty sleeping and 1.8 times more likely to feel sleepy in the morning compared to those who consume almost no caffeine. Individuals with higher caffeine consumption felt an increase in wakefulness after sleep onset, shorter sleep durations, and longer daytime sleep. The higher consumption time for adolescent adults tends to be on the weekends, while the lowest consumption is midweek. This is assumed to be from greater social opportunities among adolescence. [7]

Mechanism of caffeine

Caffeine is an adenosine receptor antagonist. This means that caffeine mainly works by occupying adenosine receptors in the brain, specifically, receptors that influence sleep, arousal, and cognition. [1] Once it is in the body, caffeine will persist for several hours, and takes about six hours for one half of the caffeine consumed to be eliminated. When caffeine reaches the brain, it increases the secretion of norepinephrine which is related to the "fight or flight" response. The rise in norepinephrine levels increases activity of neurons in areas of the brain and the symptoms resemble those of a panic attack. [10]

The half-life of caffeine is roughly 3–4 hours in healthy adults, however, it is dependent on a variety of variables such as age, liver function, medications, level of enzymes, pregnancy. [11] This short half-life has been found to help out daytime functioning, but increase the side effect of sleep problems. So, while caffeine has the potential to increase performance, it comes at a cost of sleep deprivation which in its own way can counter the main point of caffeine. Sleep deprivation alone can cause a variety of problems associated with cognitive control and functions. This can include reduced alertness, attention, vigilance, speed of motor functions. [1]

Though caffeine can be shown to decrease the quality of sleep, there is no evidence that caffeine affects all people the same way. In fact, some people report no sleep problems despite regularly consuming caffeine. Regular intake of caffeine may be normal for a person so it is understandable how they may still get satisfactory sleep. This finding shows that caffeine interferes with a modulatory mechanism in sleep regulation rather than a fundamental sleep regulatory brain circuit. [12] Ultimately, regular sleep habits are important in overall quality and timing of sleep.[ citation needed ]

Caffeine consumption

Overconsumption

Although the maximum daily consumption of caffeine varies with consideration of couple of aspects such as sex, age, race, physical activity and smoking, [13] excessive ingestion of caffeine can lead to a state of intoxication. This period of intoxication is characterized by restlessness, agitation, excitement, rambling thought or speech, and even insomnia. Even doses of caffeine relating to just one cup of coffee can increase sleep latency and decrease the quality of sleep especially in non-REM deep sleep. A dose of caffeine taken in the morning can have these effects the following night, so one of the main practices of sleep hygiene a person can do is to cease the consumption of caffeine. [14]

Moderation

Keeping in mind that caffeine content in beverages and food varies and that some individuals are more sensitive to caffeine consumption than others are, moderation of caffeine is key. Between 200 and 300 mg of caffeine is considered "moderate" for most adults. [11] While children can consume caffeine, it is advised to refrain children and adolescents from consuming caffeine due to their growing brains and to allow them to develop healthy sleep patterns. [15]

Consequences of sleep disruption

Normal healthy sleep is described as having sufficient duration, quality, timing, regulation, and the absence of sleep disturbances or disorders. Even though the suggested amounts of sleep is relatively well known, there are increasing high numbers in the lack of healthy and good quality sleep. [16]

Risk factors of sleep can range across many different arrays such as environmental, lifestyle, psychosocial, sleep disorders, or medical conditions. These are all circumstances which put individuals at risk for sleep disruption. Environmental risk factors for sleep disruption can include living in an area where there is excessive noise such as near an interstate, keeping an individual up later than normal. A lifestyle risk factor would include drinking alcohol, drug abuse, or a late shift at work. Psychosocial risk factors include being a caregiver for someone who needs constant attention, parents of young children, anxiety, worry, or stress, etc. [16]

Sleep plays an essential part in brain functions and has crucial implications across almost all body systems. Numerous studies have shown caffeine consumption to heavily disrupt sleep patterns. This can lead to other implications such as lengthening the onset of sleep latency and decrease the efficiency and duration of sleep. Disruption of sleep also affects pressure for sleep and lowers electroencephalogram power in the frontal, central, and parietal regions of the brain. [9] Short-term consequences of sleep disruption include: an increase in stress, emotional distress, mood and other mental health problems, cognition, memory, and performance deficits as well as an increase in behavioral problems in normally heathy individuals. Long-term consequences of sleep disruption include: cardiovascular problems such as cardiovascular disease, hypertension, higher concentration of fats in the body, weight issues such as metabolic syndrome, increased likelihood of cancer, and gastrointestinal disorders. [16]

Related Research Articles

<span class="mw-page-title-main">Caffeine</span> Central nervous system stimulant

Caffeine is a central nervous system (CNS) stimulant of the methylxanthine class and is the most commonly consumed psychoactive substance globally. It is mainly used for its eugeroic, ergogenic, or nootropic properties. Caffeine acts by blocking binding of adenosine at a number of adenosine receptor types, inhibiting the centrally depressant effects of adenosine and enhancing the release of acetylcholine. Caffeine has a three-dimensional structure similar to that of adenosine, which allows it to bind and block its receptors. Caffeine also increases cyclic AMP levels through nonselective inhibition of phosphodiesterase, increases calcium release from intracellular stores, and antagonises GABA receptors, although these mechanisms typically occur at concentrations beyond usual human consumption.

<span class="mw-page-title-main">Sleep</span> Naturally recurring resting state of mind and body

Sleep is a state of reduced mental and physical activity in which consciousness is altered and certain sensory activity is inhibited. During sleep, there is a marked decrease in muscle activity and interactions with the surrounding environment. While sleep differs from wakefulness in terms of the ability to react to stimuli, it still involves active brain patterns, making it more reactive than a coma or disorders of consciousness.

<span class="mw-page-title-main">Sleep disorder</span> Medical disorder of a persons sleep patterns

A sleep disorder, or somnipathy, is a medical disorder of an individual's sleep patterns. Some sleep disorders are severe enough to interfere with normal physical, mental, social and emotional functioning. Sleep disorders are frequent and can have serious consequences on patients' health and quality of life. Polysomnography and actigraphy are tests commonly ordered for diagnosing sleep disorders.

<span class="mw-page-title-main">Insomnia</span> Disorder causing trouble with sleeping

Insomnia, also known as sleeplessness, is a sleep disorder where people have trouble sleeping. They may have difficulty falling asleep, or staying asleep for as long as desired. Insomnia is typically followed by daytime sleepiness, low energy, irritability, and a depressed mood. It may result in an increased risk of accidents of all kinds as well as problems focusing and learning. Insomnia can be short term, lasting for days or weeks, or long term, lasting more than a month. The concept of the word insomnia has two possibilities: insomnia disorder (ID) and insomnia symptoms, and many abstracts of randomized controlled trials and systematic reviews often underreport on which of these two possibilities the word insomnia refers to.

<span class="mw-page-title-main">Stimulant</span> Drug that increases activity of central nervous system

Stimulants are a class of drugs that increase the activity of the brain. They are used for various purposes, such as enhancing alertness, attention, motivation, cognition, mood, and physical performance. Some of the most common stimulants are caffeine, nicotine, amphetamines, cocaine, methylphenidate, and modafinil.

<span class="mw-page-title-main">Alcohol abuse</span> Substance abuse of alcoholic beverages

Alcohol abuse encompasses a spectrum of alcohol-related substance abuse, ranging from the consumption of more than 2 drinks per day on average for men, or more than 1 drink per day on average for women, to binge drinking or alcohol use disorder.

Caffeinism is a state of intoxication caused by excessive consumption of caffeine. This intoxication covers a variety of unpleasant physical and mental symptoms associated with the consumption of excessive amounts of caffeine.

Hypersomnia is a neurological disorder of excessive time spent sleeping or excessive sleepiness. It can have many possible causes and can cause distress and problems with functioning. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), hypersomnolence, of which there are several subtypes, appears under sleep-wake disorders.

Sleep inertia is a physiological state of impaired cognitive and sensory-motor performance that is present immediately after awakening. It persists during the transition of sleep to wakefulness, where an individual will experience feelings of drowsiness, disorientation and a decline in motor dexterity. Impairment from sleep inertia may take several hours to dissipate. In the majority of cases, morning sleep inertia is experienced for 15 to 30 minutes after waking.

<span class="mw-page-title-main">Sleep hygiene</span> Set of practices around healthy sleeping

Sleep hygiene is a behavioral and environmental practice developed in the late 1970s as a method to help people with mild to moderate insomnia. Clinicians assess the sleep hygiene of people with insomnia and other conditions, such as depression, and offer recommendations based on the assessment. Sleep hygiene recommendations include: establishing a regular sleep schedule, using naps with care, not exercising physically too close to bedtime, limiting worry, limiting exposure to light in the hours before sleep, getting out of bed if sleep does not come, not using bed for anything but sleep and sex, avoiding alcohol in the hours before bedtime, and having a peaceful, comfortable and dark sleep environment.

<span class="mw-page-title-main">Caffeine dependence</span> Medical condition

Caffeine dependence is a condition characterized by a set of criteria, including tolerance, withdrawal symptoms, persistent desire or unsuccessful efforts to control use, and continued use despite knowledge of adverse consequences attributed to caffeine. It can appear in physical dependence or psychological dependence, or both. Caffeine is one of the most common additives in many consumer products, including pills and beverages such as caffeinated alcoholic beverages, energy drinks, pain reliever medications, and colas. Caffeine is found naturally in various plants such as coffee and tea. Studies have found that 89 percent of adults in the U.S. consume on average 200 mg of caffeine daily. One area of concern that has been presented is the relationship between pregnancy and caffeine consumption. Repeated caffeine doses of 100 mg appeared to result in smaller size at birth in newborns. When looking at birth weight however, caffeine consumption did not appear to make an impact.

The health effects of coffee include various possible health benefits and health risks.

Alcohol-related dementia (ARD) is a form of dementia caused by long-term, excessive consumption of alcohol, resulting in neurological damage and impaired cognitive function.

<span class="mw-page-title-main">Sleep deprivation</span> Condition of not having enough sleep

Sleep deprivation, also known as sleep insufficiency or sleeplessness, is the condition of not having adequate duration and/or quality of sleep to support decent alertness, performance, and health. It can be either chronic or acute and may vary widely in severity. All known animals sleep or exhibit some form of sleep behavior, and the importance of sleep is self-evident for humans, as nearly a third of a person's life is spent sleeping.

<span class="mw-page-title-main">Narcolepsy</span> Human sleep disorder

Narcolepsy is a chronic neurological disorder that impairs the ability to regulate sleep–wake cycles, and specifically impacts REM sleep. The pentad symptoms of narcolepsy include excessive daytime sleepiness (EDS), sleep related hallucinations, sleep paralysis, disturbed nocturnal sleep (DNS) and cataplexy. There are two recognized forms of narcolepsy, narcolepsy type 1 and type 2. Narcolepsy type 1 (NT1) can be clinically characterized by symptoms of EDS and cataplexy, and/or will have CSF orexin levels of less than 110 pg/ml. Cataplexy are transient episodes of aberrant tone, most typically loss of tone, that can be associated with strong emotion. In pediatric onset narcolepsy, active motor phenomena are not uncommon. Cataplexy may be mistaken for syncope, tic disorder or seizures. Narcolepsy type 2 (NT2) does not have features of cataplexy and CSF orexin levels are normal. Sleep related hallucinations, also known as hypnogogic and hypnopompic are vivid hallucinations that can be auditory, visual or tactile and may occur independent of or in combination with an inability to move. People with narcolepsy tend to sleep about the same number of hours per day as people without it, but the quality of sleep is typically compromised. Narcolepsy is a clinical syndrome of hypothalamic disorder, but the exact cause of narcolepsy is unknown, with potentially several causes. A leading consideration for the cause of narcolepsy type 1 is that it is an autoimmune disorder. Proposed pathophysiology as an autoimmune disease suggest antigen presentation by DQ0602 to specific CD4+ T cells resulting in CD8+ T-cell activation and consequent injury to orexin producing neurons. Familial trends of narcolepsy are suggested to be higher than previously appreciated. Familial risk of narcolepsy among first degree relatives is high. Relative risk for narcolepsy in a first degree relative has been reported to be 361.8. However, it is important to note that there is a spectrum of symptoms found in this study, including asymptomatic abnormal sleep test findings to significantly symptomatic.

<span class="mw-page-title-main">Nap</span> Short period of sleep during typical waking hours

A nap is a short period of sleep, typically taken during daytime hours as an adjunct to the usual nocturnal sleep period. Naps are most often taken as a response to drowsiness during waking hours. A nap is a form of biphasic or polyphasic sleep, where the latter terms also include longer periods of sleep in addition to one period. For years, scientists have been investigating the benefits of napping, including the 30-minute nap as well as sleep durations of 1–2 hours. Performance across a wide range of cognitive processes has been tested.

Idiopathic hypersomnia(IH) is a neurological disorder which is characterized primarily by excessive sleep and excessive daytime sleepiness (EDS). Idiopathic hypersomnia was first described by Bedrich Roth in 1976, and it can be divided into two forms: polysymptomatic and monosymptomatic. The condition typically becomes evident in early adulthood and most patients diagnosed with IH will have had the disorder for many years prior to their diagnosis. As of August 2021, an FDA-approved medication exists for IH called Xywav, which is oral solution of calcium, magnesium, potassium, and sodium oxybates; in addition to several off-label treatments (primarily FDA-approved narcolepsy medications).

Caffeine-induced anxiety disorder is a subclass of the DSM-5 diagnosis of substance/medication-induced anxiety disorder.

Stimulant use disorder is a type of substance use disorder where the use of stimulants caused clinically significant impairment or distress. It is defined in the DSM-5 as "the continued use of amphetamine-type substances, cocaine, or other stimulants leading to clinically significant impairment or distress, from mild to severe". These psychoactive drugs, known as stimulants, are among the most widely used drugs in the world today, although not all stimulants can induce addiction. As of 1993, Approximately 200 million Americans have used some type of stimulant in the past year alone.

<span class="mw-page-title-main">Sleep deprivation in higher education</span> Health issue in students

Sleep deprivation – the condition of not having enough sleep – is a common health issue for students in higher education. This issue has several underlying and negative consequences, but there are a few helpful improvements that students can make to reduce its frequency and severity.

References

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  2. ↑ "Sleep and Caffeine" (PDF). Johns Hopkins University School of Medicine. Archived from the original (PDF) on 16 June 2015. Retrieved 2 November 2015.
  3. ↑ Winston, Anthony P.; Hardwick, Elizabeth; Jaberi, Neema (2005). "Neuropsychiatric effects of caffeine". Advances in Psychiatric Treatment. 11 (6). Anthony P. Winston, Elizabeth Hardwick, Neema Jaberi: 432–439. doi: 10.1192/apt.11.6.432 .
  4. ↑ https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-5-Contents.pdf
  5. ↑ R. Gregory Lande (2005-07-07). "Caffeine-Related Psychiatric Disorders". eMedicine. Retrieved 2007-05-05.
  6. ↑ "ICD-11 for Mortality and Morbidity Statistics".
  7. 1 2 3 Clark, Ian; Landolt, Hans Peter (February 2017). "Coffee, caffeine, and sleep: A systematic review of epidemiological studies and randomized controlled trials". Sleep Medicine Reviews. 31: 70–78. doi: 10.1016/j.smrv.2016.01.006 . ISSN   1087-0792. PMID   26899133.
  8. ↑ Torres-Ugalde, Yeyetzi C.; Romero-Palencia, Angélica; Román-Gutiérrez, Alma D.; Ojeda-Ramírez, Deyanira; Guzmán-Saldaña, Rebeca M. E. (April 5, 2020). "Caffeine Consumption in Children: Innocuous or Deleterious? A Systematic Review". International Journal of Environmental Research and Public Health. 17 (7): 2489. doi: 10.3390/ijerph17072489 . ISSN   1661-7827. PMC   7177467 . PMID   32260589.
  9. 1 2 Calamaro, Christina J.; Yang, Kyeongra; Ratcliffe, Sarah; Chasens, Eileen R. (July 2012). "Wired at a Young Age: The Effect of Caffeine and Technology on Sleep Duration and Body Mass Index in School-Aged Children". Journal of Pediatric Health Care. 26 (4): 276–282. doi:10.1016/j.pedhc.2010.12.002. ISSN   0891-5245. PMID   22726712.
  10. ↑ "Home". Sleep Foundation. March 3, 2023.
  11. 1 2 Torres, F.M. (April 2009). "Caffeine-Induced psychiatric disorders". Continuing Education: 75.
  12. ↑ "Actions of Caffeine in the Brain with Special Reference to Factors That Contribute to Its Widespread Use".
  13. ↑ Tucker, Larry (2017). "Caffeine Consumption and Telomere Length in Men and Women of the National Health and Nutrition Examination Survey (NHANES)". Nutrition & Metabolism. 14: 10. doi: 10.1186/s12986-017-0162-x . PMC   5465534 . PMID   28603543.
  14. ↑ Olini, N.; Kurth, S.; Huber, R. (2013). "The Effects of Caffeine on Sleep and Maturational Markers in the Rat". PLOS ONE. 8 (9): e72539. Bibcode:2013PLoSO...872539O. doi: 10.1371/journal.pone.0072539 . PMC   3762801 . PMID   24023748.
  15. ↑ "Caffeine: How much is too much?". Mayo Clinic. Retrieved 2020-12-03.
  16. 1 2 3 Medic, Goran; Wille, Micheline; Hemels, Michiel EH (2017). "Short- and long-term health consequences of sleep disruption". Nature and Science of Sleep. 9: 151–161. doi: 10.2147/NSS.S134864 . PMC   5449130 . PMID   28579842.

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