Caffeine-induced Sleep Disorder

Caffeine-induced Sleep Disorder

Definition

Psychoactive substances can produce sleep disorders distinct from the sleep disturbances associated with intoxication or with-drawal produced by that substance. It has long been recognized that caffeine-containing products can produce sleep disturbances, primarily in the form of insomnia. The primary feature of a sub-stance-induced sleep disorder is a sleep disturbance directly re-lated to a psychoactive substance (see DSM-IV-TR criteria). The form of the disorder can be insomnia, hypersomnia, parasom-nia, or mixed, although caffeine typically produces insomnia. In general, sleep disturbance can often be a feature of substance intoxication or withdrawal (although sleep disturbance does not typically occur with caffeine withdrawal), and caffeine-induced sleep disorder should be diagnosed in patients who are having caf-feine intoxication only if the symptoms of the sleep disturbance are excessive relative to what would typically be expected.

Etiology and Pathophysiology

Caffeine’s effects on sleep can depend on a variety of factors, such as the dose of caffeine ingested, the individual’s tolerance to caffeine, the time between caffeine ingestion and attempted sleep onset, and the ingestion of other psychoactive substances. The effects of caffeine on various measures of sleep quality are an increasing function of dose. Caffeine administered immediately prior to bedtime or throughout the day has been shown to delay onset of sleep and rapid eye movement sleep, reduce total sleep time, alter the normal stages of sleep and decrease the reported quality of sleep.

Assessment and Differential Diagnosis

The diagnosis of a caffeine-induced sleep disorder is based on evidence of a sleep disorder etiologically related to caffeine (see diagnostic decision tree for caffeine intoxication disorder, caffeine-induced anxiety disorder and caffeine-induced sleep disorder). Although caffeine consumption may decrease with age, the elderly commonly report increased sleeping problems which may be exacerbated by caffeine (Curless et al., 1993). Oc-cult caffeine consumption in the form of analgesic medication may produce sleep problems in the elderly (Brown et al. 1995).

Epidemiology, Comorbidity, Course and Treatment

There are no specific data on the prevalence, incidence, course, treatment, comorbidity or patterns of caffeine-induced sleep disorder. 

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision. Copyright 2000 American Psychiatric Association.