Q: Why can caffeine make sleeping difficult?
A: Caffeine is a stimulant found in coffee, tea, cocoa, and chocolate, and is an additive in many soft drinks and drugs. It keeps you alert and on the go. Some people are more sensitive to it than others. Caffeine blocks the action of adenosine and reduces its sleep-inducing effects in the brain. Caffeine reduces total sleep time and also reduces the amount of slow wave sleep.
Q: How can I cut down on my caffeine intake?
A: Caffeine enters the bloodstream within 15 minutes of ingestion (for example, drinking a cup of coffee) and shows peak blood levels between 30–60 minutes. To eliminate half the concentration of caffeine in blood takes about 3–5 hours. If you are having difficulty sleeping, cut down on your caffeine intake. Try not to drink any products containing caffeine 4–6 hours before going to bed.
Q: I’m a smoker. What effect does nicotine have on my ability to sleep?
A: Like caffeine, nicotine is a stimulant. Nicotine withdrawal can occur in heavy smokers once they have gone to bed, and may lead to sleep disruption and nightmares. Generally, it is best to smoke the last cigarette at least half an hour before going to bed to avoid the stimulating effect of nicotine.
Q: What effect does alcohol have on sleep?
A: Alcohol may make you feel sleepy initially. Larger quantities lead to increased slow wave sleep and suppression of REM sleep early in the night. Later on, a rebound increase in REM sleep can occur as well as more wakenings. This results in unrefreshing sleep. Try to restrict your last alcohol intake to your evening meal.

The effect of drugs on sleep

Many drugs affect the quality and quantity of sleep we experience, and it is important to be aware of those that are fairly commonly prescribed. Sleeping pills of the benzodiazepine class can suppress slow wave sleep. Many antidepressants can lead to a reduction in REM sleep and some may induce either insomnia or excessive sleepiness. Drug withdrawal can cause a rebound increase in the stage of sleep that was previously suppressed and lead to sleep disturbances. Marijuana in the immediate short term results in minimal sleep disruption with only a slight reduction in REM sleep. Chronic ingestion produces long-term suppression of slow wave sleep. Amphetamines, cocaine, and even drugs used in decongestant mixtures and “sinus relief” tablets, such as pseudoephedrine, can lead to insomnia and significant sleep disturbances.

DrugEffect on sleep
Alcohol Suppresses REM sleep; increases frequency of wakenings.
Beta-blockers Suppress REM sleep; can cause nightmares and increase daytime sleepiness.
Benzodiazepines Decrease slow wave sleep; can lead to daytime drowsiness, and memory and mood impairment.
Fluoxetine Affects REM sleep and can cause insomnia.
Phenytoin Suppresses REM sleep and increases sleepiness.
Pseudoephedrine Can cause insomnia and sleep disturbances.
Salbutamol Can cause insomnia; improves sleep if asthma is controlled.
Steroids Can cause sleep disruption and insomnia.
Simvastatin Can lead to insomnia.
Theophylline Increases light sleep; can result in sleep disturbances and insomnia.
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