The suitability of a caffeinated energy drink for night-shift workers. The effects of caffeine on simulated night-shift work and subsequent daytime sleep. Laboratory and field studies of naps and caffeine as practical countermeasures for sleep-wake problems associated with night work. Enhanced mood and psychomotor performance by a caffeine-containing energy capsule in fatigued individuals. Low-dose repeated caffeine administration for circadian-phase-dependent performance degradation during extended wakefulness. Cognitive performance during sustained wakefulness: A low dose of caffeine is equally effective as modafinil in alleviating the nocturnal decline. Caffeinated tube food effect on pilot performance during a 9-hour, simulated nighttime U-2 mission. Single-dose bright light and/or caffeine effect on nocturnal performance. The effects of chewing versus caffeine on alertness, cognitive performance and cardiac autonomic activity during sleep deprivation. Caffeine for Apnea of Prematurity trial: benefits may vary in subgroups. The effects of coffee and napping on nighttime highway driving: a randomized trial. High-dose caffeine suppresses postoperative apnea in former preterm infants.
Past research has indicated that caffeinated 'functional energy drinks' (FEDs) are effective in counteracting sleepiness. It is not known however, what impact FEDs have on sleep itself. FEDs contain several active ingredients, including caffeine. They may therefore impact negatively on sleep and hence subsequent performance, deeming their use counterproductive. In a randomised cross-over design, 15 young adults participated in a simulated first night-shift protocol with 2 conditions, Functional Energy Drink (FED) and Non Functional Energy Drink (NonFED). Both involved a period of extended wakefulness (0700-0730 h-24.5 h) followed by an 8-h daytime 'recovery' sleep (0730-1530 h). During the FED condition, a commercially available FED was administered twice during the night. Sleepiness was assessed during the period of extended wakefulness and for a further 6h after waking. Sleep periods were recorded using a standard 5 channel polysomnogram. Comparison of the sleep periods showed that sleep onset latency remained unchanged as did stage 2 and slow wave sleep. Total sleep time however, was 29.1 min shorter (p<.05) in the FED condition. Sleep efficiency was also significantly reduced from 91.8+/-.9% to 84.7+/-2.7% (p<.05). It is evident that the residual effects of the FED's active ingredients impact on some aspects of daytime sleep following a simulated night-shift. Subsequent performance however was unaffected. The results deem FEDs to be effective for a single night-shift and warrant investigation into their use over successive night-shifts. Thirty healthy volunteers were randomly assigned to either a caffeine or a placebo group to investigate the alerting effects of caffeine at night. Subjects adhered to a simulated night-shift schedule for 5 consecutive nights. On the first 3 nights, 2 mg/kg caffeine was added to decaffeinated coffee at 2220 and 0120 hours for the caffeine group. On nights 4 and 5 both groups received placebo. Each night, subjects completed five 60-minute sessions of a computerized simulated assembly line performance task (SALT), a multiple sleep latency test (MSLT) and questionnaires. Daytime sleep was recorded in the laboratory between 0900 and 1700 hours each day following nighttime testing. Caffeine decreased physiological sleep tendency on the night shift compared with placebo; however, the two groups performed at equivalent levels on the SALT. On nights 4 and 5, when both groups received placebo, there were no differences between the groups on the MSLT, suggesting the absence of a discontinuation effect. There were no differences on daytime polysomnograms between the groups. To evaluate the effects of napping, caffeine, and napping plus caffeine on performance and alertness in both laboratory and field settings.
                (1) Laboratory Study: parallel-groups design with random assignment to 1 of 4 experimental conditions. (2) Field Study: crossover design.
                Sleep laboratory and field settings.
                (1) Laboratory Study: 68 healthy individuals; (2) Field Study: 53 shiftworkers who worked nights or rotating shifts.
                (1) Laboratory Study: an evening nap opportunity before the first 2 of 4 consecutive simulated night shifts plus placebo taken all 4 nights, caffeine taken nightly, the combination of the nap and caffeine conditions, or placebo. (2) Field Study: an evening nap on the first 2 of 4 consecutive night shifts plus caffeine taken nightly versus placebo taken nightly without naps.
                (1) Laboratory Study: Napping, caffeine, and their combination all improved alertness and performance as measured by Maintenance of Wakefulness Test and Psychomotor Vigilance Task, but the combination of napping and caffeine was best in improving alertness. (2) Field Study: Napping plus caffeine improved performance as measured by Psychomotor Vigilance Test and decreased subjective sleepiness in individuals working the night shift.
                Napping plus caffeine helps improve performance and alertness of night-shift workers. Caffeine produces mild psychostimulant effects that may be particularly evident in individuals whose mood or performance is impaired by sleep restriction or caffeine withdrawal. Caffeinated energy drinks have been shown to improve energy and cognition but expectancy effects cannot be ruled out in these studies. Very few studies have examined the effects of caffeine-containing energy capsules upon behavioral and subjective measures. This study compared the effects of a caffeine-containing (200 mg) supplement (CAF) or placebo in capsule form after prolonged wakefulness, in participants who varied in their level of habitual caffeine use. Thirty-five healthy volunteers (16 male, 19 female) participated in two experimental sessions in which they remained awake between 5 p.m. and 5 a.m. At 3:30 a.m. they consumed CAF or placebo in random order under double-blind conditions. Participants completed subjective effects questionnaires and performed computerized attention tasks before and after consuming capsules. Heart rate and blood pressure were monitored at regular intervals. Compared to measures at 5 p.m., participants reported more tiredness and mood disturbance at 3 a.m., and exhibited longer reaction times and more attentional lapses. Heavier caffeine consumers exhibited the greatest decreases in Profile of Mood States (POMS) Vigor. CAF produced stimulant-like effects and significantly improved mood and reaction times upon the tasks. These effects did not vary with level of habitual caffeine consumption. These findings indicate that consumption of a caffeine-containing food supplement improves subjective state and cognitive performance in fatigued individuals that is likely a result of its caffeine content.
                2008 APA To investigate whether the effectiveness of a novel high-frequency low-dose caffeine regimen in counteracting the deterioration of performance during extended wakefulness is related to its interaction with homeostatic or circadian signals modulating performance and sleep propensity.
                Double-blind, placebo-controlled, parallel-group design in a 29-day forced desynchrony paradigm in which the period of the sleep-wake cycle was scheduled to be 42.85 hours, i.e., far removed from the circadian range. This design allowed for separate estimation of the sleep homeostatic, circadian, and caffeine contributions to performance deficits or improvements.
                Private suite of a general clinical research center, in the absence of time of day information.
                Sixteen healthy normal-sleeping men (aged 18-30 years)
                Caffeine (0.3 mg per kg per hour) or placebo was administered hourly during the 28.57-hour wake episodes.
                Plasma caffeine concentrations rose in an exponential saturating manner during wakefulness. Rising caffeine levels markedly attenuated wake-dependent deterioration of a number of measures of cognitive performance, particularly at the circadian performance nadir. Moreover, caffeine enhanced the ability of subjects to remain consistently awake for extended periods, holding subjects back from completing the full transition to sleep, but at the expense of increasing subjective sleepiness.
                High-frequency low-dose caffeine administration is effective in countering the detrimental performance effects of extended wakefulness. These data are in accordance with the hypothesis that adenosine is a mediator of performance decrements associated with extended wakefulness and may lead to new strategies to use caffeine in situations in which neurobehavioral functioning is affected by sleep loss. Cognitive performance at night exhibits a substantial drop, typically before dawn. One of the means of dealing with this phenomenon, as well as with the accompanying sleepiness during sustained wakefulness, is the administration of stimulants. The most widely used and well-documented stimulants are caffeine, amphetamines, and modafinil. Of these, amphetamines are the least recommended, as they may severely affect behavior. Caffeine and modafinil seem to produce relatively milder side effects and usually only at high doses. Previous comparison studies have revealed equal efficacy of both the stimulants in maintaining alertness and performance during sustained wakefulness. However, these studies used relatively high, and thus not completely safe, doses of these drugs (600 mg caffeine and 400 mg modafinil). Therefore, the aim of the present study was to assess the efficacy of a low and medically safe dose of caffeine (200 mg) and modafinil (200 mg) in maintaining cognitive performance during sustained wakefulness. A flight simulation task was chosen for the assessment of the stimulants in a counter-balanced, within-subject design under four different conditions: baseline (no drugs), placebo, caffeine (200 mg), and modafinil (200 mg). The equal effectiveness of both drugs in abolishing the nocturnal drop in cognitive performance, as well as of oral temperature and blood pressure, supported the use of low doses of caffeine and modafinil for the maintenance of alertness in healthy subjects during sustained wakefulness. Interventions to maintain performance are necessary to meet demanding mission requirements during sustained and surge aviation operations. Tube foods are the only foods that can be consumed during a U-2 mission due to the confining and encapsulating nature of required support equipment. Caffeine is a safe and effective strategy to enhance cognitive performance and is an ingredient in some tube foods. The objective of this study was to determine whether moderate doses of caffeinated tube foods would enhance performance in a simulated U-2 mission.
                Volunteers were 12 healthy USAF male pilots. The study used a double blind, placebo-controlled, two-factor, repeated-measures (five iterations per night) design. Caffeinated (200 mg each) or placebo tube food was consumed at 00:00 and 04:00. Dependent measures assessed included standardized tests of cognitive performance, vigilance, and mood designed to simulate the demands of a nighttime U-2 mission.
                Statistically significant (p < 0.05) improvements in performance due to caffeine administration compared with placebo were present in all five cognitive tasks either as main effects, interactions, or absence of significant degradation in the caffeine treatment condition compared with the placebo condition. A majority of sleep deprivation-induced performance decrements were attenuated by 200 mg of caffeine in tube food consumed every 4 h, and in some cases, performance was improved beyond baseline levels.
                Caffeinated tube food maintained cognitive performance representative of U-2 long-duration mission tasks at or near baseline levels for a 9-h overnight period in qualified USAF pilots. Side effects were minor and did not differ between placebo and caffeine conditions. The impact of the separate and combined effects of a 1-h exposure to bright light (approximately 3000 lx) and a 200-mg dose of caffeine on nocturnal performance was studied during a simulated shift-work schedule beginning 1730 in the evening and ending 1000 the next morning.
                Light and caffeine exposure were expected to improve nocturnal fatigue degradation.
                There were 11 subjects tested under 4 treatment conditions: 1) 1 h Dim Light-Placebo; 2) 1 h Bright Light-Placebo; 3) 1 h Dim Light-Caffeine; 4) 1 h Bright Light-Caffeine. Exposure to the light occurred between 0130 and 0230 hours. Caffeine or placebo was administered at 0140 hours.
                Choice Reaction Time (RT) recorded during the four post-treatment sessions were shorter for the Bright Light-Caffeine, Bright Light-Placebo, and Dim Light-Caffeine conditions than for the Dim Light-Placebo condition. During the sessions beginning 0430 and 0830 hours, the shortest RT was recorded for the Bright Light-Caffeine treatment. The largest number of trials without false alarms per session for the working memory task (letter cancellation) was found for the Bright Light-Caffeine condition. Exposure for 1 h to 3000 lx reduced melatonin concentration between 42-47% from 0230 to 0410 hours. A 200-mg dose of caffeine also reduced melatonin levels, although to a lesser degree than 1 h exposure to 3000 lx.
                Although 1 h exposure to bright light at 0130 hours combined with a 200-mg dose of caffeine maintains performance throughout the remainder of the night/early morning, a 1-h exposure to bright light without the caffeine may actually degrade performance. Chewing has been shown to alleviate feelings of sleepiness and improve cognitive performance during the day. This study investigated the effect of chewing on alertness and cognitive performance across one night without sleep as well as the possible mediating role of cardiac autonomic activity. Fourteen adults participated in a randomized, counterbalanced protocol employing a chewing, placebo and caffeine condition. Participants completed tasks assessing psychomotor vigilance, tracking, grammatical reasoning, alertness and sleepiness each hour across the night. All participants received either placebo or caffeine (200 mg), while the chewing condition also chewed on a tasteless and odorless substance for 15 min each hour. Heart rate (HR), root mean square of the successive differences in R-R intervals on the ECG (RMSSD), and preejection period (PEP) were simultaneously recorded. Alertness and cognitive performance amongst the chewing condition did not differ or were in fact worse when compared with placebo. Similarly, measures of HR and RMSSD remained the same between these two conditions; however, PEP was reduced in the later part of the night in the chewing condition compared with a relative increase for placebo. Caffeine led to improved speed and accuracy on cognitive tasks and increased alertness when compared with chewing. Relative increases in RMSSD and reductions in HR were demonstrated following caffeine; however, no change in PEP was seen. Strong associations between cardiac parasympathetic activity and complex cognitive tasks, as well as between subjective alertness and simpler cognitive tasks, suggest a differential process mediating complex versus simple cognitive performance during sleep deprivation. To determine whether the benefits of caffeine vary in three subgroups of 2006 participants in the Caffeine for Apnea of Prematurity (CAP) trial.
                Post-hoc subgroup analyses were performed on the basis of: (1) indication for commencement of study drug: treat apnea, prevent apnea, or facilitate extubation; (2) positive pressure ventilation (PPV) at randomization: endotracheal tube (ETT), noninvasive ventilation, or none; and (3) timing of commencement of study drug: early or late (< or =3 versus >3 days). Outcomes assessed were those showing treatment effects in the original analyses. We investigated the consistency of caffeine effects by using regression models that incorporated treatment/subgroup factor interactions.
                There was little evidence of a differential treatment effect of caffeine in subgroups defined by the clinical indication for starting study drug. The size and direction of the caffeine effect on death or disability differed depending on PPV at randomization (P = .03). Odds ratios (95% CI) were: no support, 1.32 (0.81-2.14); noninvasive support, 0.73 (0.52-1.03); and ETT, 0.73 (0.57-0.94). Adjustment for baseline factors strengthened this effect (P = .02). Starting caffeine early resulted in larger reductions in days of respiratory support. Postmenstrual age at time of discontinuing PPV was shorter with earlier treatment (P = .01). Mean differences (95% CI) were: early, 1.35 weeks (0.90-1.81); and late 0.55 weeks (-0.11-0.99). Adjustment for baseline factors weakened this effect (P = .03).
                There is evidence of variable beneficial effects of caffeine. Infants receiving respiratory support appeared to derive more neurodevelopmental benefits from caffeine than infants not receiving support. Earlier initiation of caffeine may be associated with a greater reduction in time on ventilation.
                Copyright 2010 Mosby, Inc. All rights reserved. Sleep-related accidents often involve healthy young persons who are driving at night. Coffee and napping restore alertness, but no study has compared their effects on real nighttime driving performances.
                To test the effects of 125 mL of coffee (half a cup) containing 200 mg of caffeine, placebo (decaffeinated coffee containing 15 mg of caffeine), or a 30-minute nap (at 1:00 a.m.) in a car on nighttime driving performance.
                Double-blind, randomized, crossover study.
                Sleep laboratory and open highway.
                12 young men (mean age, 21.3 years [SD, 1.8]).
                Self-rated fatigue and sleepiness, inappropriate line crossings from video recordings during highway driving, and polysomnographic recordings during the nap and subsequent sleep.
                Participants drove 200 km (125 miles) between 6:00 p.m. and 7:30 p.m. (daytime reference condition) or between 2:00 a.m. and 3:30 a.m. (coffee, decaffeinated coffee, or nap condition). After intervention, participants returned to the laboratory to sleep.
                Nighttime driving performance was similar to daytime performance (0 to 1 line crossing) for 75% of participants after coffee (0 or 1 line crossing), for 66% after the nap (P = 0.66 vs. coffee), and for only 13% after placebo (P = 0.041 vs. nap; P = 0.014 vs. coffee). The incidence rate ratios for having a line crossing after placebo were 3.7 (95% CI, 1.2 to 11.0; P = 0.001) compared with coffee and 2.9 (CI, 1.7 to 5.1; P = 0.021) compared with nap. A statistically significant interindividual variability was observed in response to sleep deprivation and countermeasures. Sleep latencies and efficiency during sleep after nighttime driving were similar in the 3 conditions.
                Only 1 dose of coffee and 1 nap duration were tested. Effects may differ in other patient or age groups.
                Drinking coffee or napping at night statistically significantly reduces driving impairment without altering subsequent sleep. Thirty-two former preterm infants (less than or equal to 44 weeks postconceptual age) undergoing inguinal hernia repair were prospectively studied. General inhalational anesthesia with neuromuscular blockade was used. No barbiturates or opioids were given. Infants were randomly divided into two groups. Group 1 received iv caffeine 10 mg/kg immediately after induction of anesthesia. Group 2 received iv saline. Respiratory pattern, heart rate, and SpO2 were monitored using an impedance pneumograph and a pulse oximeter, respectively, for at least 12 h postoperatively. Tracings were analyzed for evidence of apnea, periodic breathing, and/or bradycardia by a pulmonologist unaware of the drug given. None of the patients who received caffeine developed postoperative bradycardia, prolonged apnea, or periodic breathing, and none had postoperative SpO2 less than 90%. In the control group 13 (81%) developed prolonged apnea 4-6 h postoperatively. Fifty percent of the patients had SpO2 less than 90% at the time. This study shows that iv caffeine 10 mg/kg is effective in the control of apnea in otherwise healthy expremature infants between 37 and 44 weeks of postconceptual age. It is still recommended, however, that all infants at risk be monitored for at least 12 h for apnea and bradycardia following general anesthesia.
Caffeine may be an effective intervention for improving performance in shift workers however, there are no trials from which we can assess its effect on injuries. The results largely originate from studies involving young participants under simulated conditions, and the extent to which the findings are generalisable to older workers and real world shift work is unclear. Based on the current evidence, there is no reason for healthy individuals who already use caffeine within recommended levels to improve their alertness to stop doing so. The assessment of the relative effects of caffeine to other potential countermeasures should be a focus of future research.