Interview with Farrah M. Thomas, PsyD

Do people with epilepsy drink too many caffeinated beverages? And if so -- why? Farrah M. Thomas, PsyD, Cleveland Clinic, and colleagues studied caffeine use among people with epilepsy to determine overall usage and to see if excessive ingestion was related to taking medication that causes sleepiness or was simply a bad habit tied to other unhealthy behaviors. Dr. Thomas reported the findings at the recent American Epilepsy Society annual meeting.

Study methods and results

Three hundred and one adults with medically intractable epilepsy participated in a health psychology evaluation for epilepsy surgery that included demographic, health, and disease status, clinical interview concerning current and past psychological status, and self-report measures of mood, fatigue, and daytime sleepiness.

Just less than half of the 301 participants were male. Nearly one in five of the participants drank no caffeine, 31% drank less than 24 ounces per day, 45% drank between 24 and 96 ounces per day, and 3% drank 100 ounces or more per day. The researchers found that caffeine ingestion was not associated with gender, hours of nighttime sleep, level of fatigue or degree of daytime sleepiness. On the other hand, caffeine consumption was associated with regular use of nicotine and alcohol, and lack of exercise, and being employed.

Conclusions

In an interview, Dr. Thomas told epilepsy.com that "Patients with epilepsy experience various types of sleep difficulties. Lack of sleep contributes to excessive daytime sleepiness, which can be attributed to factors such as the effects of seizures or the patient's antiepileptic drug medication." However, in any case, she pointed out that while "previous studies have shown a clear link between lack of sleep and quality of life, the results of our study suggest the relationship between caffeine and epilepsy is not as straightforward as we would expect."

"Our results did not support previous findings that persons with epilepsy consume excessive amounts of caffeine to counteract side-effects of anti-epileptic drugs," said Dr. Thomas, "but we did find consistency with the literature regarding unhealthy behavior among men. We argue for a more complex model explaining caffeine use in epilepsy."

Therefore Dr. Thomas is making certain recommendations. "It is important to directly ask patients how much caffeine they are consuming and why they are consuming it, in order to make appropriate recommendations about caffeine use."

"For example, for people who must drink coffee, we might suggest half decaf and half regular. We as providers want to improve the overall health of our patients so it is important to ask specific questions about health-related behaviors. We know caffeine can interfere with sleep – it can keep you up or stimulate your bladder so you have to wake up multiple times during the night to use the restroom – and that some epilepsy patients identify inadequate sleep and fatigue/tiredness as triggers for seizures. Therefore it makes sense to reduce caffeine intake, especially in the late afternoon and evening," she said.

Based on the study, Dr. Thomas added, "It appears that excessive caffeine consumption is a bad habit connected to other unhealthy behaviors but the reason may not be as simple as we previously thought. So many of the men, in particular, will say to us, 'I have to start my morning with my coffee, a cigarette, and the paper.'"

The researchers are suggesting a lifestyle change. "Even though we did not find a relationship between sleep/fatigue and caffeine use, we want to educate people to understand the importance of good sleep because for many, lack of sleep can trigger a seizure," said Dr. Thomas. "Future research that compares caffeine use among patients with various chronic illnesses where fatigue is a symptom … may help us to better understand the unique reasons and consequences of caffeine use in epilepsy," she concluded.

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This interview was based on the study, Caffeine Use in Refractory Epilepsy, conducted by ¹Farrah M. Thomas, ²Noah Webster, ¹Peggy Crawford, and ¹Nancy Foldvary at the following institutions, ¹Neurology, Cleveland Clinic, Cleveland, OH; and ²Sociology, Case Western Reserve University, Cleveland, OH

Authored By: 
Rita Watson MPH
Farrah M. Thomas PsyD
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Authored Date: 
12/2006