Caffeine Intervention

Caffeine:  The typical cup of coffee has about 80 to 100 mg of caffeine in it.  A single shot of espresso has about 63 mg of caffeine, so if you have 2, you have consumed 126 mg of caffeine.  So called energy drinks typically contain 80-150 mg of caffeine per 8-ounce drink.  By contrast, a cup of green tea has between 25 and 45 mg of caffeine.  Caffeine reaches its peak concentration in the blood stream about 1-2 hours after it is consumed.  It declines until 50% is gone between 4 and 6 hours, this is called the half-life, but some people with a slower metabolism take as long as 8 to 9 hours to reach that level.  This is important because most caffeine is consumed in the morning but increasingly energy drinks and caffeinated sodas are consumed at lunch or in the early afternoon.  Caffeine creates a strong wakefulness signal and if any caffeine at all is present in the blood stream at the time when you are trying to go to bed it will have an effect.  We often see patients who say that caffeine does not affect them, and they can go right to sleep after a cup of caffeinated coffee or several caffeinated beverages with dinner.  While falling asleep, might be possible in some cases with a very strong sleep drive at the time you go to bed, that sleep will typically be very restless and of low quality.  For all of these reasons, if you have any issues latency or restlessness, we recommend a trail of complete abstinence from caffeine for at least 7-14 days.  If you are consuming a very large dose of caffeine every day, the equivalent of more than 2-3 cups of coffee per day, then you should wean down your caffeine over a few days so as to avoid a caffeine withdrawal headache.

Record, your latency, restlessness and Epworth Sleepiness scale in the sleep experiment forms at the end of the chapter.  Then wean down your caffeine intake until you are completely off caffeine all together.  Do this for not less than 7-10 days and then record the same values again.  If you see improvements, then work toward maintain abstinence or substantially reducing your caffeine intake moving forward.