A couple of days ago I went to a picnic celebrating the Fourth of July and a friend’s daughter’s graduation. While socializing with people of various ages I had the delightful opportunity to speak with the graduate’s grandmother.
“If I could only sleep better, I’d be happy,” she said. She was saying how well she felt otherwise, but needed to find a solution to sleep better.
Insomnia, or difficulty falling/staying asleep, was a relatively frequent complaint from some of my patients. Most ofter they sought a “sleeping pill” to solve the problem, but oftentimes that wasn’t necessary. Insomnia was also a challenge to students in my Smoke-Stoppers classes. The stress of stopping smoking would seem to bring insomnia to the forefront and hence it was common to discuss it.
The physician-patient discussion would then focus around the characteristics of the insomnia. Was it difficulty falling asleep or staying asleep? Most often it was “staying” asleep or sleep maintenance. My next question was whether they were taking anything that would tend to keep them awake. Some antidepressant medications can do that as well as nasal congestion meds as in nasal sprays and tablets. Phenylephrine and pseudoephedrine are available over the counter (although you have to show your driver’s license due to their potential abuse). When these meds are present in “Sustained Release” tablets their effect can last quite a while.
But the most common non-medication cause of insomnia was caffeine. I’ve had a number of stories of patients who seem to “suddenly” become caffeine sensitive. And that’s not too surprising. Our tolerance to caffeine often changes as we mature. Three cups of large coffee daily as a “twenty-something” changes to caffeine scrutiny of all drink labels when we’re older. Remember, our body is a work in progress and we have to adapt appropriately.
According to what I’ve read, caffeine is metabolized to its breakdown products within 12 hours. However, those products can still affect your sleep! Characteristically caffeine and its by-products won’t keep you from falling asleep, however you won’t sleep as deeply, and you’ll have a harder time going back to sleep if you wake up for some reason.Such reasons include waking up to go to the bathroom,anxiety, hearing a noise, or even having “something on your mind.”
I recommend caffeine withdrawal in a gradual fashion, even from only one cup of coffee a day. People have had severe withdrawal headaches from going one cup per day to “cold turkey.” I suggest one half cup caffeine per day for 3 to 7 days before stopping. Some coffee shops may even offer “half & half” caffeine for those days, then decaffeinated thereafter. Remember, decaf is really low-caf. Decaffeinated coffee has one-sixth to one-tenth the amount of caffeine as regular coffee, depending on the brand. It’s extremely rewarding to have the patient come back, off caffeine, sleeping soundly, on no new meds, and feeling great.
Caffeine traditionally has had a role to help our generally sleep-deprived population wake up each morning. There were also some studies that have claimed some anti-(pancreatic?) cancer effects, and delaying manifestations of Alzheimer’s disease. Although this may be true and work for some people, caffeine can be a problem.
Caffeine can cause gastroesophageal reflux (acid from the stomach shoots into the lower esophagus)during digestion. On a long term basis this can predispose to cancer in that area. On a short term basis it can cause discomfort of “acid indigestion,” or trigger asthma symptoms. Approximately half of all asthma patients have this potential sensitivity which explains why they breathe better when they watch what, how, and when they eat! (I’ll make a note for my self to talk more about this in a future posting). Palpitations can be caused by caffeine and this can alter the effectiveness of some cardiac medications.
The acid indigestion segues into another hidden cause of insomnia. The earlier stages of reflux may not be perceived. But if one realizes that they ate just before going to bed, or had a fatty meal, or tomato-based food, or alcohol, then taking a Tums tablet may neutralize the acidity and allow sleep! Tums contain calcium and should be used cautiously by patients who have difficulty handling it. Check with your doctor if you have any questions about it!
One final note is where caffeine can be found. We all know that it is in the cola sodas. However, watch for it also in Mountain Dew, A&W Cream soda, Sunkist Orange,Moxie soda and Barq’s Root Beer. Watch for it in the teas, especially the Iced Teas which we frequently drinks on these hot, summer days!
The grandmother with whom I was speaking drank one cup of caffeinated coffee daily and will consider switching to decaf.
Watching the amount of caffeine you consume should help with insomnia, palpitations, anxiety, gastroesophageal reflux, and asthma symptoms.
Dr. Mike Taz 