John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Persons with insomnia often suffer from fatigue as a
result of sleep deprivation. Stimulant products are
frequently used in an attempt to offset fatigue and other
unpleasant side effects that can accompany a lack of sleep.
(These products are also used by persons who need to stay
awake for longer periods of time than is normal for them,
such as school examinations or long distance driving.)
However, the use of stimulant products can also cause
insomnia, leading to a counterproductive effort to deal
with sleep deprivation.
Caffeine
Caffeine (for example,
NoDoz, Caffedrine) is the sole active
ingredient in most non-prescription stimulants. It is the
only drug approved by the FDA for this purpose. Caffeine is
used for improving alertness and for staying awake.
Caffeine is a powerful stimulant, but tolerance (the need
to use increasing amounts) can be developed. Caffeine also
is present in medications for menstrual cramps, headaches,
and colds. Additionally, caffeine is found in coffee, tea,
soft drinks, and chocolate.
Caffeine increases alertness by stimulating the nerves
in the brain and spinal cord. It decreases muscle fatigue
by stimulating muscle contraction. Caffeine also increases
the heart rate and the force of contraction of the heart.
The effect of caffeine varies among individuals and some
people are only affected minimally.
Pregnancy and lactation: Studies have shown that
moderate caffeine intake does not cause low birth weights,
miscarriages, or premature births. However, there are
reports of birth problems in women who consume more than
300 milligrams per day of caffeine. Therefore, daily
caffeine intake should probably be limited to less than 300
milligrams during pregnancy.
Caffeine is secreted into breast milk. The concentration
of caffeine in breast milk is approximately one-percent of the
amount in the mother's blood. A lack of sleep and
irritation may occur in breastfed infants whose mothers
consume more than 600 milligrams of caffeine per day. No
adverse effects have been noted in breastfed infants whose
mothers consume between 200-336 milligrams per day of
caffeine. A mother can limit the amount of caffeine her
infant receives by limiting the amount of her caffeine
intake and ingesting the caffeine after nursing.
Children: Caffeine is not recommended for children less
than 12 years of age.
Elderly: Older persons may be more sensitive to the effects of caffeine,
and it may incrase the excretion of calcium from the body. In limited amounts,
it is generally considered safe.
Drug interactions:Cimetidine (Tagamet),
norfloxacin
(Noroxin), ciprofloxacin (Cipro), and the estrogens in
oral
contraceptives block the break-down and elimination of
caffeine from the body. Use of caffeine with these drugs
could lead to increased levels of caffeine in the body and,
therefore, a higher likelihood of side effects.
Caffeine decreases the absorption of iron tablets. Iron
should be administered one hour before or two hours after the
consumption of caffeine.
Caffeine decreases the effects of sedatives, and
sedatives decrease the restlessness, alertness, and arousal
that is caused by caffeine.
Adverse effects: The most common adverse effects of
caffeine are insomnia, nervousness, excitement, headaches,
vomiting, diarrhea, and stomach pain. Caffeine also causes
abnormal heartbeats and increases heart rate.
Dependence can occur from the regular use of caffeine.
If caffeine intake is stopped suddenly, a withdrawal
reaction that consists of fatigue, headaches, anxiety,
vomiting, and restlessness may occur. Symptoms of
withdrawal start 12-24 hours after the last consumption of
caffeine and may last for a week.
REFERENCES:
American Insomnia Association. Medications for Insomnia.
FDA.gov. Medication Guide Intermezzo.
FDA.gov. Sleeping Pills and Sleep Medications for Insomnia.
MedicalGuide.org. FDA Requests Label Change for All Sleep Disorder Drug Products.
Night sweats are severe hot flashes that occur at night and result in a drenching sweat. In order to distinguish night sweats that arise from medical causes from those that occur because one's surroundings are too warm, doctors generally refer to true night sweats as severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment.
Restless leg syndrome (RLS or restless legs syndrome) is a common cause for painful legs that typically eases with motion, and becomes worse and more noticeable at rest. This characteristic nighttime worsening can frequently lead to insomnia. Treatment of the symptoms of restless leg syndrome is generally with medication as well as treating any underlying condition causing restless leg syndrome.
A number of vital tasks carried out during sleep help maintain good health and enable people to function at their best. Sleep needs vary from individual to individual and change throughout your life. Not getting enough sleep can hurt memory performance, health, and your mood.
Insomnia is the perception or complaint of inadequate or poor-quality sleep because of difficulty falling asleep; waking up frequently during the night with difficulty returning to sleep; waking up too early in the morning; or unrefreshing sleep. Secondary insomnia is the most common type of insomnia. Treatment for insomnia include lifestyle changes, cognitive behavioral therapy, and medication.
Narcolepsy, a chronic disease of the central nervous system causes have not been fully determined. Some theories include abnormalities in hypocretin neurons in the brain or an autoimmune disorder. Symptoms of narcolepsy include excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, sleep paralysis, disturbed nocturnal sleep, and automatic behavior. Diagnosis of narcolepsy is based on a clinical evaluation, specific questionnaires, sleep logs or diaries, and the results of sleep laboratory tests. Treatments of narcolepsy symptoms include medication and lifestyle changes.
Sleepwalking is a condition in which an individual walks or does other activities while asleep. Factors associated with sleepwalking include genetic, environmental, and physiological. Episodes of sleepwalking may include quiet walking to agitated running. Conditions that may have similar symptoms of sleepwalking, but are not include night terrors, confusional arousals, and nocturnal seizures. Treatment of sleepwalking generally include preventative measures. Medication may be prescribed if necessary.
Hypersomnia is a condition where a person has excessive daytime sleepiness and trouble staying awake during the day. Treatment for hypersomnia includes medication, CPAP machines, and lifestyle changes.
Caring for a loved one or patient with Alzheimer's can become a difficult and overwhelming task at times. This guide helps caregivers of individual's with Alzheimer's deal with communicating, bathing, and dressing; as well as problem solving with incontinence, sleeping, wandering; and coping with difficulties Alzheimer's patients present.
Periodic limb movement disorder (PLMD) is a sleep disorder characterized by rhythmic movements of the limbs during sleep. The movements typically involve the legs, but upper extremity movements may also occur. Movements occur periodically throughout the night and can fluctuate in severity from one night to the next. They tend to cluster in episodes that last anywhere from a few minutes to several hours. These movements are very different from the normal spasms, called hypnic myoclonia, that we often experience initially while trying to fall asleep.
When sleepiness interferes with daily routines and activities, or reduces the ability to function, it is called "problem sleepiness." A person can have problem sleepiness without realizing it. Symptoms of problem sleepiness include: consistently don't get enough sleep, or poor quality sleep, fall asleep while driving, struggle to stay awake when inactive (like watching TV or reading), have difficulty paying attention or concentrating at work, school, or home, have poor performance problems at work or school, have difficulty remembering things, have slowed responses, have difficulty controlling your emotions, and/or if you have to take naps on most days.
Sleep needs in children and teenagers depends on the age of the child. Sleep disorders in children such as sleep apnea, parasomnias, confusional arousals, night terrors, nightmares, narcolepsy, and sleepwalking can effect a child's or teen's sleep. Healthy sleep habits and good sleep hygiene can help your infant, toddler, preschooler, tween, or teenager get a good night's sleep.
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