by Неизвестный
Source: A. La Voie, “Sleepless in Seattle, and All Around the Globe,” Medical Tribune News Service, June 27, 1997.
As you may know, a night’s sleep is divided into roughly ninety-minute cycles in which brain activity changes dramatically. In Illustration 3, you can see that during each cycle, the brain goes through four stages, from S1 (shallow sleep) to S4 (deep sleep). Most people are familiar with Si because that is when we dream and have rapid eye movement (REM). But in reality, each stage provides the body and brain with essential repair, rejuvenate, and rebuild
benefits. Dreams, for example, are absolutely critical for maintaining mental and emotional health. We don’t know why, but if you prevent a person from dreaming for just a few nights, that individual will start to experience clear signs of psychosis. It was once thought that caffeine enhanced dream sleep, or at least lengthened the S1 phase of the sleep cycle. But recent research shows that caffeine (and numerous other drugs) can disrupt this crucial function.32
As important as dreams are to the mind, deep sleep (S4) is essential for the health of the body. Interestingly, scientists have learned a great deal about deep sleep from studying coma patients. The purpose of coma, you see, is to deactivate all nonessential functions of the body and brain in order to devote every possible ounce of energy to the task of healing. Likewise, the body uses deep sleep to mobilize all available resources for healing and rejuvenation.
During S4 sleep, there is a massive creation of new cells throughout the body.
Every tissue benefits, but most activity is centered on building immunity and restoring the nervous system. We all know how wonderful we feel after a good night’s sleep. That’s because deep sleep provides a level of rest that cannot be obtained in any other way. In a very restful night, you may experience deep sleep at two and possibly three phases. But when there’s caffeine (or its metabolites) in your bloodstream, you are unlikely to experience deep sleep at all.
Illustration 3
A Normal Sleep Cycle
Caffeine has been found to shorten total sleep time, increase the duration of Stage 2, shorten Stage 3, and often eliminate Stage 4 (deep sleep).
Sources: S. H. Onen, F. Onen, D. Bailly et al., “Prevention and Treatment of Sleep Disorders through Regulation of Sleeping Habits,” Presse Medicale, 1994;12;23(10):485-89; and M. H. Bonnet and D. L. Arand, “Metabolic Rate and Restorative Function of Sleep,” Physiology and Behavior, April-May 1996;59(4-5):777-82.
Those who promote caffeine as a harmless drug like to cite research showing that coffee and soft drink users become tolerant to the stimulant effects and no longer experience insomnia. You must understand that insomnia is not the issue.
Insomnia (the inability to fall asleep) deals only with the quantity of sleep. The real issue here is sleep quality. Caffeine tolerance may allow you to fall asleep,
real issue here is sleep quality. Caffeine tolerance may allow you to fall asleep, but if S4 sleep is disrupted, you will wake up feeling tired instead of renewed.
Research shows that people who consume more than 250 milligrams of caffeine per day tend to have poor sleep quality.33,34 What’s more, they are generally unaware of this critical problem. In one study, habitual coffee drinkers were allowed to drink coffee until midday (in order to prevent withdrawal).
Later in the day, they were given either caffeine or placebo, and on days when they received placebo, their sleep quality improved significantly.35 As a result, they felt much better the following day. But for millions of Americans, caffeineinduced sleep disorders remain hidden and undiagnosed. These people drag themselves out of bed and remain tired through the day.
I don’t think it is being overly cynical to suggest that this is precisely what the caffeine industry wants. After all, if you’re groggy in the morning, you’ll reach for their product. By midmorning, that first cup will wear off, so you’ll reach for another. You’ll have a caffeine beverage with lunch and most likely another in midafternoon—all because your body really didn’t rest. You fell asleep but never got to experience the depth of sleep that you need most. Is the problem widespread? Recent surveys suggest that 25 percent of U.S. adults have trouble falling asleep, 23 percent awaken frequently, 25 percent wake up too early, nearly half of all Americans are dissatisfied with the quality of their sleep, and one out of every ten is taking some medication to help them sleep.
While this certainly qualifies as an epidemic, I believe those numbers don’t come close to identifying the magnitude of the sleep problem. That’s because we have limited information. In a sleep laboratory, we’d be hooked up to a monitor that would record every stage of sleep on a device called an electroencephalogram (EEG). The scientist conducting the study could tell us, “You never made it into S4 sleep last night. Better cut back on the caffeine.” But in real life, most of us simply look at the clock, wonder why we feel exhausted, and then stumble into the kitchen to make a pot of coffee.
Take another look at Illustration 3. Did you notice that this normal sleep cycle takes place over a span of eight hours? Do you normally get a full eight hours of sleep? I didn’t think so. In fact, few American adults devote enough time to this critical repair and rebuild cycle, and we suffer greatly for it.
CASE STUDY
Amy came to my office with a five-year history of fibromyalgia. During the interview, she was surprised at how interested I was to know her caffeine
interview, she was surprised at how interested I was to know her caffeine history. In fact, no one had ever explained to her the connection between caffeine and her painful disorder.
Now I believe that if you give a person enough time, he or she will usually tell you the cause of their illness. Amy’s story was classic. She was a “one cup in the morning” woman with a low-stress job in Thousand Oaks, California, a town about twenty-five miles north of Los Angeles. Life changed dramatically for her when she landed the “job of her dreams” in LA. The commute was an hour and a half on a good day, and to assure that she would not be late, Amy started leaving the house at 6 A.M. That meant she had to get up at 5 A.M. sharp. Her usual bedtime (before the LA job) was 11:30 or midnight, which gave her about seven hours of sleep, “barely enough” as she described it.
But to get the same amount of sleep on her new schedule would mean going to bed at 10 P.M. and she was just not tired at ten. In fact, if she went to bed at ten, she just tossed and turned until midnight anyway, so she gave up and assumed that she could “catch up” on her sleep over the weekends.
Unfortunately, it doesn’t work that way. It is possible to “make up” for one bad night’s sleep, and maybe even two nights. But according to most sleep experts, after two consecutive nights of poor sleep, the damage starts to accumulate. You’ll learn exactly how that damage contributes to fibromyalgia in Chapter 5, but right now I want to tell you why Amy couldn’t fall asleep before midnight. Actually, you probably already know.
Getting two hours’ less sleep made Amy tired, but she had to be “up” for her new job, so she started drinking coffee while driving to LA. She bought a special “commuter mug” and didn’t notice that it held twenty ounces, about twice what she normally drank. What’s more, she seldom had time for her usual breakfast, and so this coffee was invariably consumed on an empty stomach. As the weeks went by, she started having another mug of coffee at midmorning and one or two cola beverages in the afternoon. It wasn’t long before she started having shoulder and neck pain. Her friends at work were quick to suggest that she get a better chair and elevate her wrists when using the computer. She bought special back supports for the car seat and desk chair, and tried stretching exercises twice a day, but the pain only got worse. That’s because none of these measures dealt with the cause of her problem.
The trap that Amy was caught in is extremely common. You probably know someone with the same story, and right now, it’s easy to see the elements of that cycle: reduced sleep led to increased caffeine consumption, caffeine disrupted what little sleep Amy was a
ble to get, and the loss of sleep quantity and sleep
what little sleep Amy was able to get, and the loss of sleep quantity and sleep quality contributed to her fibromyalgia, the primary symptoms of which are pain and fatigue.
Illustration 4
The Caffeine-Sleep-Disease Cycle
Coffee and Sleep: Debunking More Myths
Time of Day
There is a popular notion that coffee before 3 P.M. can’t disturb your sleep. In fact, caffeine at any time of the day can cause sleep problems, especially if you are under stress. Researchers at the Institute of Pharmacology in Zurich, Switzerland, gave a moderate amount of caffeine (200 milligrams) to healthy subjects at 7 A.M. By 11 P.M. blood levels of caffeine had fallen more than 80
percent and still the subjects experienced significant sleep disturbance, especially in the S4 stage.36 This may be due to the stimulation of cortisol, or to some unidentified brain-body dysfunction created by caffeine earlier in the day.
WHO’s MOST AT RISK?
We also tend to think that caffeine-related problems are mostly experienced by people in the workforce. In reality, those hardest hit appear to be the elderly.
Even though seniors tend to cut back on coffee, the caffeine they do ingest is detoxified much more slowly and their nervous systems are much more sensitive than those of younger people. Research is now showing that sleep disturbance among the elderly is a major factor not only in age-related physical degeneration but in mental degeneration as well.37, 38Investigators from the National Institute on Aging have identified another culprit: hidden caffeine. Their 1995 report showed that those taking any caffeinecontaining medications were nearly twice as likely to have sleep problems compared to agematched controls.39 Avoiding these medications is not an easy task. Today, more than 2,000 OTC and prescription medications contain caffeine.
Critical Point #10: Your Fatigue Quotient
While the connection between poor sleep and fatigue is obvious, caffeine contributes to fatigue in at least three other ways. Adrenal exhaustion results in profound tiredness, as can blood sugar abnormalities associated with caffeine use. And we’ve already seen in Chapter 2 (Test #4) that the muscle tension resulting from stress can use up tremendous amounts of energy.
How ironic that the very substance people turn to for energy is a major cause of their fatigue. It gets worse, of course, when you understand that the
cumulative effect of fatigue and poor sleep is more serious illness. In fact, fatigue is one of the top three reasons why Americans seek medical help.40 In 1994, there were over 15 million doctor visits for this problem. The tragedy is that, for the most part, physicians are unaware of the caffeine connection.
Surveys show that fewer than 10 percent of patients receive advice from their doctor to reduce caffeine. Even with heavy coffee drinkers, the percentage is less than 15 percent.41
The popular press, however, may be catching on. A while ago, U.S. News &
World Report ran a feature article on the growing epidemic of fatigue in America.42 Boxed out on page one of the article was a list of “the most common causes of prolonged fatigue.” Caffeine addiction was number two on the list, and, overall, caffeine was a factor in five of the seven points listed.
THE BLOOD SUGAR ROLLER COASTER
Hypoglycemia results when blood sugar levels fall below normal. Since blood sugar (or glucose) is the fuel that runs our muscles and brain, hypoglycemia typically produces fatigue, depression, and anxiety. There is no single cause of hypoglycemia. It is an imbalance in the complex process of energy metabolism involving the liver, pancreas, and adrenal glands.
Caffeine plays a major role because it stimulates the fightor-flight stress response described earlier. As part of this response, the liver rapidly raises blood sugar levels. This is felt as a “lift” by the person who drank the coffee (especially if the coffee contained added sugar) but the body must then deal with the metabolic emergency of hyperglycemia (elevated blood sugar). This is accomplished by the pancreas, which secrets insulin, driving the blood-sugar level down.
In some individuals, however, blood sugar may decrease to levels below normal, resulting in hypoglycemia and the all-too-familiar “letdown” feeling a few hours after the coffee lift. Of course, many people simply reach for another cup of coffee, which starts the roller-coaster cycle all over.
Although this model of “caffeinism” is well understood, it is not clear why some people are more sensitive than others. Experts believe this has to do with the individual’s age, weight, body composition, overall health, and other factors.
CASE STUDY
Jeff had a promising career as an architect. He worked in a huge Los Angeles firm, and competition for advancement was fierce. When he came to see me, Jeff had been at the company for five years, but his position was anything but secure.
At any moment, he knew he could be replaced by an ambitious and energetic intern. There were only two ways Jeff could demonstrate his value to the firm: work harder and work longer. I was not surprised when he told me that he drank about twelve cups of coffee a day.
At the age of thirty-four, Jeff was feeling old. He remembered a time, not so many years back, when he would bounce out of bed in the morning, work hard, and still have energy to play softball in the evening. As he sat talking to me, however, his manner was anything but bouncy. The dark circles under his eyes told me that he was sleeping poorly. And although he had been a collegiate AllAmerican, I could tell that Jeff was out of shape and about twenty-five pounds overweight. At his last physical, his doctor listened to his complaints, announced, “You’re depressed,” and handed him a prescription for an antidepressant.
But Jeff was smart enough to know that his depression was not the cause of his fatigue. It was the other way around. He was even aware that caffeine was part of the problem, but he didn’t think there was any alternative. Everyone at work was a caffeine addict. It was part of the culture.
The first thing I did with Jeff was to create an agreement. If he would follow my Off the Bean program step by step without fail, I would guarantee that in sixty days, he’d feel better and have more energy. It was a no-lose proposition for Jeff. After all, if I was wrong, he could always go back to the coffee. We measured his blood pressure, heart rate, and weight. He filled out a questionnaire like the one in Appendix C, and we took a photograph. That kind of documentation is extremely valuable in charting one’s progress.
I have no doubt that if I had simply told Jeff to cut out coffee, he would have left my office and never come back. But the program made sense to him, and in just two weeks, he was able to reduce his caffeine intake by 50 percent with no headache or fatigue. He called a few days later to tell me that for the first time in years, he had awakened before the alarm clock went off. By the end of the month, he was down to one cup of coffee in the morning and a cup of tea in the afternoon.
During the next thirty days, Jeff experienced remarkable improvements in his energy level. Before, his days had been like a roller coaster, with peaks of creativity and alertness alternating with mental fog and profound fatigue. Now he was sailing through the day with consistent energy and clarity. Even the
he was sailing through the day with consistent energy and clarity. Even the dreaded three-o’clock slump had disappeared. His appearance had improved and he’d lost weight, but the most important benefit for him was his attitude. Jeff felt like himself again: optimistic, energetic—and happy!
Now the Hollywood ending would be Jeff becoming a partner in the firm, but that’s not what happened. The experience of near burnout convinced Jeff that the price of success in that arena was much too high. So he took his renewed energy and went to work for a smaller company. At his new job, he didn’t have to watch his back constantly, so he was able to spend more time in creative pursuits. A year later, he was doing quite well and enjoying life immensely, along with a few cups of caffeine-free herbal tea every day.
Critical Point #11: Malnutrition
> Malnutrition is one of the most welldefined effects of habitual caffeine intake. It contributes in a very logical way to a host of disorders that we will explore in Chapter 5. Caffeine, and possibly other ingredients in coffee and tea, causes an increased loss of thiamin and other B vitamins in the urine.43–44, 45 There is evidence that caffeic acid also decreases the bioavailability of thiamin so that less of this vital nutrient is absorbed from food46. Since the B vitamin status of many Americans is borderline to begin with, regular consumption of coffee and soft drinks can contribute to deficiency and a raft of symptoms, including neurological damage.47
Then there is the loss of calcium and other minerals. Researchers at Washington State University’s Department of Food Science and Human Nutrition found that as little as 150 milligrams of caffeine caused increased loss of calcium, magnesium, sodium, and chloride in the urine.48 The losses were far greater when the caffeine intake was raised to 300 milligrams. Research just published in the Annals of Nutrition and Metabolism found that caffeine increased potassium loss by nearly one-third.49 To make matters worse, such mineral loss appears to be accelerated when caffeine is mixed with sugar.50