Coffee and Early Morning Awakenings

  1. Dear Dr Sleep,

I have a very strange response to coffee: after the second cup I feel increasingly sleepy and have a problem driving. My friends make a lot of jokes about it, because everyone uses coffee to stay awake except me. I have noticed this problem since the last year when my blood pressure increased during my divorce proceedings.

Is it a disorder? If it is, what I should do?

Jonathan N.
New York.

A. Dear Jonathan,

Coffee is a very well known biological stimulant and intensive research about its good and potentially negative side effects has been underway for many years.

Coffee’s fans are very enthusiastic about data suggesting increased attention, alertness and memory after drinking coffee. At a recent conference of radiologists in Chicago, researchers from Florida found a direct correlation between the amount of coffee intake and memory improvement. Scientists from Innsbruck (Austria) showed increased activity in the frontal areas of the brain, which is damaged in patients with Alzheimer’s disease. According to Finnish researchers, the probability of acquiring type II diabetes drinking 3-4 caps of coffee a day decreased 29% in women and 27% in men. If they drink ten or more (!) cups a day, the risk of diabetes decreased 80% in women and 55% in men. In spite of this, the more careful scientists advise to exercise caution when drinking coffee.

Although it is true that coffee is a stimulant, too much coffee or even small amounts in sensitized people could produce many unwanted side effects: increase stimuli for frequent and urgent urinations and/or defecations, induced hand tremor, blurred vision, heart palpitations, irritability and lapses in coordination.

For patients with hypertension or those under stress, a large amount of coffee could further increase blood pressure, which typically produces a heavy head and sleepiness.

It looks like this might be your problem, Jonathan, because you mentioned an association of sleepiness from coffee with stress and increased blood pressure.

Consult your doctor for treatment of hypertension and decrease your coffee intake, at least for now.

Be well.

Early Morning Awakenings. Why?

Q. Dear Dr Sleep,

I wake up almost exactly at 3 am every night. Some times I can go right back to sleep, but sometimes it takes me a few hours. Please, explain what other problems I might get besides fatigue in the morning. I am a 43-year-old mother of two. I have stable type II diabetes but am not on insulin, although moderately obese. Otherwise, I am fine. I am working in a consulting firm and am a frequent traveler but my sleep schedule is normal. What are your comments and advice?

Gloria L. Washington DC

A. Dear Gloria,

Midnight awakenings might be a good or bad thing, depending on the situation and your medical condition. In diabetes, even in stable diabetes, blood glucose levels usually drops at a maximum during sleep between 2 and 4 am. This is due to the specifics of the glucose metabolism. In diabetes, too low a glucose level produces turbulence in the body, such as heart rate instability and restless motor activity. This usually causes arousals, which have a compensatory function to “offset” the wrong sleep associated with heart arrhythmias. In this case, awakening is good. In more severe cases of diabetes, the early morning awakening is especially good because it allows the patient to wake up and check the glucose level. In depression and other conditions, early morning awakenings are also positive phenomena.

Negative effects of prolonged or frequent midnight awakenings include next day sleepiness, fatigue, loss of concentration, and lapses in judgment. Physically, it may cause muscle spasms (fibromyalgia), blood pressure swings, headaches, and deterioration of existing problems.

It is very important to avoid self-treatment. Please, consult your doctor or a sleep specialist who has tools to differentiate “good” and “bad” awakenings.

Have a healthy sleep and Happy Holidays.