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Sleep Aids And Stimulants (cont.)

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What stimulant products are available OTC?

People with insomnia often suffer from fatigue as a result of sleep deprivation. Stimulant products are frequently used in an attempt to offset fatigue and other unpleasant side effects that can accompany a lack of sleep. (These products are also used by people who need to stay awake for longer periods of time than is normal for them, such as for school examinations or long distance driving.) However, the use of stimulant products can also cause insomnia, leading to a counterproductive effort to deal with sleep deprivation.


Caffeine (for example, NoDoz, Caffedrine) is the sole active ingredient in most non-prescription stimulants. It is the only drug approved by the FDA for this purpose. Caffeine is used for improving alertness and for staying awake. Caffeine is a powerful stimulant, but tolerance (the need to use increasing amounts) can be developed. Caffeine also is present in medications for menstrual cramps, headaches, and colds. Additionally, caffeine is found in coffee, tea, soft drinks, and chocolate.

Caffeine increases alertness by stimulating the nerves in the brain and spinal cord. It decreases muscle fatigue by stimulating muscle contraction. Caffeine also increases the heart rate and the force of contraction of the heart. The effect of caffeine varies among individuals and some people are only affected minimally.

Pregnancy and lactation: Studies have shown that moderate caffeine intake does not cause low birth weights, miscarriages, or premature births. However, there are reports of birth problems in women who consume more than 300 milligrams per day of caffeine. Daily caffeine intake should probably be limited to less than 300 milligrams during pregnancy.

Caffeine passes into breast milk. The concentration of caffeine in breast milk is approximately one-percent of the amount in the mother's blood. A lack of sleep and irritation may occur in breastfed infants whose mothers consume more than 600 milligrams of caffeine per day. No adverse effects have been noted in breastfed infants whose mothers consume between 200-336 milligrams per day of caffeine. A mother can limit the amount of caffeine her infant receives by limiting the amount of her caffeine intake and ingesting the caffeine after nursing.

Children: Caffeine is not recommended for children less than 12 years of age.

Elderly: Older persons may be more sensitive to the effects of caffeine, and it may incrase the excretion of calcium from the body. In limited amounts, it is generally considered safe.

Drug interactions: Cimetidine (Tagamet), norfloxacin Noroxin, ciprofloxacin (Cipro), and the estrogens in oral contraceptives block the break-down and elimination of caffeine from the body. Use of caffeine with these drugs could lead to increased levels of caffeine in the body and, therefore, a higher likelihood of side effects.

Caffeine decreases the absorption of iron tablets. Iron should be administered one hour before or two hours after the consumption of caffeine.

Caffeine decreases the effects of sedatives, and sedatives decrease the restlessness, alertness, and arousal caused by caffeine.

Adverse effects: The most common adverse effects of caffeine are insomnia, nervousness, excitement, headaches, vomiting, diarrhea, and stomach pain. Caffeine also causes abnormal heartbeats and increases heart rate.

Dependence can occur from the regular use of caffeine. If caffeine intake is stopped suddenly, a withdrawal reaction that consists of fatigue, headaches, anxiety, vomiting, and restlessness may occur. Symptoms of withdrawal start 12-24 hours after the last consumption of caffeine and may last for a week.

Medically reviewed by Peter O’Connor, MD; American Board of Otolaryngology with subspecialty in Sleep Medicine


American Insomnia Association. Medications for Insomnia.

American Academy of Sleep Medicine. Insomnia. Medication Guide Intermezzo. Sleeping Pills and Sleep Medications for Insomnia. FDA Requests Label Change for All Sleep Disorder Drug Products. Doxepin. Caffeine and the elderly. Insomnia and Sleep.

UpToDate. Medical disorders resulting in problem sleeplessness in children.

UpToDate. Treatment of Insomnia.

Last Editorial Review: 11/20/2015


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