This excerpt from Take Charge of Your Child's Sleep: The All-in-One Resource for Solving Sleep Problems in Kids and Teens was used with permission from Marlowe & Company, copyright 2005.

Mountain Dew to Starbuck's: The Caffeine Connection

It's everywhere – in the coffee and cocoa we sip, the chocolate bars we much, the soda we gulp, and in the tea we drink. It's there in huge amounts in those cleverly named "energy" beverages that are specifically marketed for kids and teens: Jolt, Red Bull, Monster, and Buzz Water. It's the main ingredient in Bawls, a carbonated drink sold over the Internet that boasts that's it's the most highly caffeinated beverage on the market and that it allows you to stay up all night and play computer games ("the perfect drink to make sure you don’t lag behind"). Caffeine is the most commonly used drug in America (and in the world).

Yes, that’s right, drug. Caffeine and its "sister" chemicals, theophylline and theobromine (which are also found in varying amounts in beverages like coffee, tea, colas, etc.), are central nervous system stimulants. This means they give you a "buzz" or a sense of increased alertness (theobromine is considerably weaker than caffeine and theophylline, having about one-tenth the stimulating effect of either). While theophylline and theobromine relax smooth muscle (that's how theophylline works as an asthma drug), they and caffeine are also cardiac stimulants (they increase your heart rate). They are also diuretics, which means they make your body produce more urine. All of these effects are related to the fact that caffeine inhibits a specific enzyme in the body (cyclic AMP phosphodiesterase, in case you wanted to know) that controls many body functions.

Caffeine is also addictive, in the sense that people develop a physical dependence upon it and have withdrawal symptoms if they stop. If you feel like you just can’t function without it and need to drink (or take) something with caffeine every day, then you are addicted to caffeine.

The Good (sort of) News: The potential benefits of caffeine are that it delays (but does not eliminate!) fatigue and provides a temporary boost of "energy." (All information about caffeine also applies to theophylline and theobromine as well.) Caffeine starts to work as soon as fifteen minutes after it is consumed. Its effects last about three to four hours. It’s often used by people (particularly by college students, truck drivers, and shift workers) to help them stay awake longer. Caffeine does work fairly well for a short time for this purpose, but it is not a substitute for sleep. Caffeine may help you stay awake and alert long enough to study, but it will not improve your performance on an exam the next day if you have not gotten enough sleep. Also, importantly, caffeine does not counteract the effects of alcohol. In other words, coffee does not make a drunk person sober or fit to drive.

CAFFEINE IS NOT A SUBSITITUTE FOR SLEEP!

One of the other touted benefits of caffeine is weight loss. Because it increases the metabolism of fatty acids, it has been used for years by runners and dieters. Caffeine is not an appetite suppressant, however, so its real usefulness as a diet aid is questionable. Despite that, over-the-counter diet aids, such as Dexatrim, typically have 200 milligrams of caffeine. You should be aware that herbal supplements for weight loss often contain substantial levels of caffeine as well. They may also contain guarana or ephedra (mahuang) – other central nervous stimulants.

And the Bad News: No matter what the potential benefits of caffeine may be, there's also a price to pay. First, once it is in the body, caffeine will stay around for hours. It takes about six hours for one-half of the caffeine to be eliminated from your body, but it can last much longer in some folks (like the elderly). Also, some people are clearly more sensitive to the effects of caffeine than others; some of this depends on how big you are and how much you weigh. Which is why caffeine, particularly later in the day, so often causes difficulty falling asleep and disrupts sleep.

Second, once you've become dependent on caffeine, stopping it is a big problem. Typical withdrawal symptoms associated with caffeine are headache, fatigue, and muscle pain. This headache, well known among coffee drinkers, usually lasts from one to five days. Often people who are reducing their caffeine intake, in addition to having a headache, are irritable or nervous, jumpy, and less able to concentrate. In some cases they get nauseous and vomit. These symptoms can occur as soon as twenty-four hours after the last dose of caffeine.

Other potential risks associated with caffeine include possible effects on the fetus in pregnant women. Although the effects in humans remain controversial, it is known that caffeine causes malformations in rats when ingested at extremely high rates. In any case, most doctors suggest that pregnant women avoid caffeine or at least consume it in moderation. In addition, theobromine is also highly toxic to dogs, and "chocolate poisoning" can be fatal. A few M&Ms won't hurt a dog, but a pound of chocolate could do a lot of damage. On the other hand, the suggested links between caffeine and cancer, heart disease (although it may cause temporary increases in blood pressure in sensitive people), osteoporosis, and breast (fibrocystic) disease have, for the most part, not been supported by research.

Coffee Talk: Coffee, probably the best-known source of caffeine, contains mostly caffeine and some theophylline. But all coffee is certainly not created equal when it comes to creating a buzz. For example, the amount of caffeine in dark roast coffees and espresso (because it uses significantly more ground coffee than regular drip coffee and is prepared using pressurized water, resulting in a higher percentage of caffeine) is generally higher. A cup of strongly brewed coffee (or tea) has more caffeine than a weakly brewed cup.

Tea, which many people think has a lot less in the way of caffeine effects, actually does contain theophylline and theobromine, which can have stimulating effects similar to caffeine (herbal tea that is specifically labeled "caffeine-free" does not). Similarly, although the amount of caffeine in cocoa is relatively small, its thebromine content (about seven times greater than caffeine) clearly makes it "stimulating" as well.

For the average teenager, however, other sources of caffeine are probably both more important and more socially acceptable (and also more likely to be in the average high-school vending machine) than coffee or tea. For parents who think of caffeine only when it comes to colas, some of these may be a surprise. There are also lots of beverages listed that parents may not even be aware of because such beverages enjoy a more "underground" distribution. For example, Thinkgeek.com ("over 441,466,395 milligrams of caffeine served by ThinkGeek to its loyal fans since 1999. Wowzers!") is just one of a number of popular Web sites that advertise many kinds of "super-caffeinated" beverages and syrups. Some carry the highly suspect endorsement of being "natural stimulants" (for "people from all walks of life who enjoy the clean, crisp taste of guarana along with a powerful rush of caffeine"). Perhaps more disturbingly, Thinkgeek also features a wide assortment of caffeine gum, caffeine candy, and caffeine mints (Black Black gum and candy, Bawls mints, Jolt gum, Buzz Bites Chocolate Chews, Penguin mints and gums), and caffeine pills ("pocket size caffeine delivery vehicles"). Are we the only ones that find it deeply disturbing that the Leaders of Tomorrow seem to need so badly to drug themselves to stay awake today?

Finally, you should be aware that many over-the-counter medications advertised for other purposes also contain substantial amounts of caffeine. Products like Umph Energy tablets, Enerjets, No-Doz Maximum Strength Caplets, and Vivarin are pretty clearly designed specifically for the three-o’clock-in-the-morning crowd. But the caffeine content in Anacin, Midol and Dristan, for example, might not be so obvious. The real problem here is that many unsuspecting folks (including perhaps your kids) are getting caffeine from multiple sources at the same time.

The other hard fact of modern life is that prescription stimulants (suc has Ritalin, Dexedrine, Concerta, and Adderall) are becoming more and more available as "street drugs." Most kids use them not so much to get high as to stay awake. It’s quite easy for any high-school student to "score" some stimulant medication from a friend with ADHD (and unfortunately, not impossible to get these drugs directly from an unsuspecting physician who is prescribing them for "attention problems" that are actually a direct result of lack of sleep). You need to be aware of the many ways a drug like caffeine can be and is (perfectly legally) consumed. You also need to be aware of potential risks for your child, and aware that your middle-schooler or adolescent may be using stimulants during the day to counteract the effects of not getting enough sleep at night.

What A Parent Can Do

• Know the numbers. Become familiar with the caffeine content of your child's favorite beverages. This is not typically listed in the ingredients, so you might have to play detective.
  
• Keep track. Figure out how much caffeine your child or teenager is consuming on a daily basis from all possible sources. Keep a careful record (and this will require your teenager's cooperation) of the amount and types of caffeine usually consumed in a typical week. You both may be surprised at how high the amounts are and where it's coming from (remember, 300 mg per day, the rough equivalent of three cups of coffee or three cans of Jolt cola, is considered "moderate" caffeine use).
  
• Ask questions. If your teenager seems to be consuming large amounts of caffeine on a daily basis, you need to figure out why. Maybe she's using it to help herself stay awake in class because she’s not getting the sleep she needs. Or maybe your son is downing Mountain Dews all evening so he can stay up and play computer games all night. Whatever the reason, tackling that first may eliminate the need for the caffeine in the first place.
  
• Cut down. Once you know what you're dealing with, make a plan with your child to eliminate caffeine or at least reduce it. There is really no reason for anyone to use caffeine, but there is particularly no rationale for children to have anything that contains it. There are plenty of healthier alternatives out there, such as caffeine-free soda, juice, and water.
  
• Go slow. The process known as "caffeine fading" is one way of beating the caffeine-withdrawal blues. Although you can always go "cold turkey," a more gradual reduction avoids potentially nasty withdrawal symptoms (especially the headache) and also gets the body used to functioning without the drug. Depending on where your child or teen starts out, reduce caffeine intake at a rate that feels comfortable. For example, cutting down at the rate of ½ cup of coffee (soda, Red Bull, whatever) works for some, while reducing caffeine intake in slower steps (two to five cups of coffee per week) is a more tolerable pace for others.
  
• Take a stand. Find out what your child's school vending machines have in them in the way of drinks. Make a pitch to the school to eliminate any caffeinated beverages. That goes for the lunch line as well (a local boarding school in one of the authors' hometowns recently added Starbuck's coffee to the cafeteria menu, supposedly for the faculty's benefit).
  
• Walk the walk. Maybe you don’t really need that double-shot espresso to get your engine started in the morning. Perhaps you wouldn’t feel quite so jittery or have quite as much of a headache by the end of the day if you cut down on your caffeine-of-choice. View this as yet another golden role model opportunity.

NEXT: Too many activities and too little time (for sleep, that is)