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Scot: Getting up at 5:00 in the morning and then grinding into the night to get things done, that's a badge of honor. "I'm not lazy. I'm getting it done. I'll just get a couple energy drinks and do it again tomorrow." Probably heard the saying, "I'll sleep when I'm dead." That feels pretty manly to say, by the way.

Regardless, if it makes you feel good to tell people how little you sleep, or there are other reasons you're not getting sleep, sleep has proven health benefits and not getting enough can have similar downsides as not getting enough activity or good food.

You could have the other three core four dialed in and if you're not getting enough sleep, it could sabotage at all. That's how important sleep is.

So today, on the "Core Four: Back to Basics" series, we're going to talk about sleep, how good sleep improves your life and how to get better sleep.

My name is Scot Singpiel. I bring the BS to the proceedings here, and the MD to my BS is Dr. Troy Madsen. And before you say hi, I want you to say, "I'm Dr. Troy Madsen, and I'll sleep when I'm dead," in your manliest voice.

Troy: I'm Dr. Troy Madsen, and I'll sleep when I'm dead.

Scot: Also we've got Mitch Sears in the mix. Same thing.

Mitch: I'm Mitch Sears, and I'll sleep when I'm dead.

Troy: Sounded like you were thinking about it. You're like, "I'll sleep tonight."

Scot: We have one opportunity for our manliness to be saved here, and that's Thunder Jalili.

Thunder: I'm Thunder Jalili, and I will sleep when I'm dead.

Scot: There you go. All right. So, today, we are going to talk about the benefits of good sleep. And for some reason, I think society kind of undervalues sleep. What do you guys think of that? When we think about being healthy, it's pretty common to come to nutrition or exercise, but sleep is just as crucial as we're going to learn in a couple of seconds. Is it just me, or does society kind of devalue it? And why do you think that is?

Thunder: I think actually American society maybe does devalue sleep. I think it's part of our work hard work ethic, get it all in and don't be a wimp, and get your stuff done, because other cultures around the world aren't like ours. The Spanish, they value sleep. They have a nap built into the day. We're not like that.

Troy: Yeah, I agree. I think we definitely undervalue it and it certainly is a badge of honor for a lot of people. And as someone who works in the healthcare profession, I can say it is absolutely a badge of honor. If you can talk about how little you sleep or let's say you say, "I just came off a night shift and I didn't go home and sleep, and now I'm here in the office working all day," that's a badge of honor. It's not like, "Wow. That's stupid." Yeah, no question about it.

Mitch: I remember when I was working in broadcast, you would come in and the night shift would be coming off and they would have their pile of energy drinks and they would just be very proud of how much caffeine they were functioning off of and "still getting a good job done." That was always very like, "What are we doing?"

Scot: Dr. Madsen or anybody, do you think that people just don't realize the benefit of sleep? Because a lot of times it's the first thing to get jettisoned, right? When things get tight in your life, that's where you'll cheat, either getting up early or staying up late to get things done. Do you think it's just because people don't realize what that tradeoff is actually costing them?

Troy: Yeah, it may just be that we don't quite realize the magnitude of the effect. I think we recognize, "Yeah, there's some detrimental effect, but those effects are more immediate. I'm tired, but I can use caffeine. I can drink some caffeine or whatever, and that will eliminate that short-term effect." But I do think we definitely undervalue the long-term effects.

Thunder: Yeah, I agree with that. I think cutting sleep is an easy thing to do in the short-term to get things done, and there are ways to get around it, like Troy said, with caffeine. So I agree with him completely.

Scot: All right. I think that's a good segue into talking about the benefits of getting enough sleep and how it can impact your health. Thunder, go ahead and kick us off on that.

Thunder: So there are many benefits to getting good sleep. I'll just share a couple with you. One is sleep is actually tied into maintaining healthy body weight. And I know that's a big focus of what we've talked about on this show in the past. We talk a lot about the exercise and the nutrition component, but getting enough sleep is also a valuable contributor to healthy body weight.

The other thing that's great about sleep is it helps you keep your stress levels low and it helps improve your mood. If you think about it, think about the nights that you haven't gotten a good night's sleep and you wake up the next day and you're just kind of a little grumpy or a little off and things are bothering you. That's something everyone has experienced, and that's really that function of not getting enough sleep.

So having that regular sleep schedule can definitely improve with that. It gives your mind a chance to reset at night and reduce your stress level.

Troy: Yeah. Thanks, Thunder. And the other thing too that I've definitely seen plenty of studies that have shown that sleep lowers your risk for diseases like diabetes and heart disease and cancer as well, like long-term studies.

It's a little scary because I've often seen these studies done with shift workers like myself, which is kind of depressing, but it is one of those things. They do find those who don't sleep well do have higher risk of diabetes, heart disease.

I think the obvious thing we've talked about already is it does help you to think more clearly. But this is something that's been quantified in multiple studies. They've kept people awake for 18 to 24 hours and just noted their ability to perform tasks just declines over time to the point where . . . At 18 to 24 hours, you're at a point where your technical skills, and your focus, and your attention are on par with if you were legally intoxicated. So definitely effects there.

I think we all know we've had those experiences when we don't sleep well, we get sick. Sleeping well helps us to stay healthier, get sick left less often, and helps us look better too. We look better. We look healthier. Our appearance is improved when we sleep well, when we're well-rested. So that's a big thing as well.

Thunder: Don't have those bags under your eyes.

Troy: Exactly. Get rid of the bags.

Scot: I'm noticing the last two episodes that that's been Troy's thing, appearance. So do you want to talk about something?

Troy: I'm feeling self-conscious about my appearance and I need to sleep more. Maybe that's it.

Scot: You look wonderful.

Troy: Thanks, Scot.

Scot: We're going to hit up here some of our sleep struggles and then what we've done to try to work through those or not work through those.

But first, Mitch, let's talk about, like we have in past episodes, the basics. These are kind of the rules that you want to try to incorporate when you're talking about sleep.

Mitch: Yeah. And these are the ones that have been kind of tried and proven from research and studies, etc. So these are kind of the things that have the most evidence behind them.

The first thing that you want to do with your sleep is to prioritize it. And it's important to realize that when you prioritize sleep, it also means that it's not just quality of sleep. It's also quantity of sleep.

So what they're saying is that you need to get at least a minimum of seven hours and that you can't really just make it up. You can't sleep four hours one night and nine the next and expect it to be as healthy as if you were to get seven hours each night.

The other thing is that in order to get a better quality sleep, try to go to bed at about the same time every night and wake up at the same time every morning, which is something that we've kind of talked about before with Kelly Baron on a previous episode about everything from your sleep hygiene to making sure that you're going to bed and waking up at the same time every morning.

Now, the other thing you want to make sure to do is to not underestimate how things you do during the day can impact your sleep. A lot of things you do throughout the day can really impact not only the quality, but the quantity of sleep that you're actually getting. So make sure that exercise, nutrition, and mental health are all big factors that go into your sleep.

Stress, anxiety, depression can all impact how well you sleep every night. Activity, exercise during the day is good, but not less than two hours before bedtime. They've shown that that can kind of interrupt your sleep cycle, if you work out too close to going to bed. And finally, caffeine, alcohol, and nicotine four to six hours before bedtime and big meals before bed can impact your quality of sleep.

So you just want to make sure that you're not working out too close to bed, but you should be working out through the day, and to kind of avoid some of these different chemicals that can really impact the quality of your sleep.

The other thing is that sleep environment needs to be dark, quiet, and a comfortable to temperature. By making sure all of those things are kind of in place, it will really improve the quality of your sleep.

And make sure that you are not doing things that engage your brain like screens, TVs, games, radio, talking on the phone. If you do those things too close to sleep, it can also impact the quality of sleep that you get.

And finally, if you've tried everything else and you are still having trouble with sleep, go talk to a doctor and rule out that you don't have a sleeping disorder.

Scot: Some good basics there. So let's hit the sleep struggles. I want to start with Troy because you work in the ER, you work crazy shifts, you might be working during the day for a few days and then you do an overnight shift. What is one of your sleep struggles?

Troy: My sleep struggles are so plentiful, it's difficult to choose from them. But like you said, Scot, I do shift work, so I end up working nights, evenings. And for me, evening means I get to bed at like 2:00 or 3:00 in the morning. Night means I get to bed at like maybe 9:00 or 10:00 in the morning.

Scot: Wow.

Troy: Yeah. And so I'm trying to do that and then turn around double back and do a 7:00 a.m. shift the next day and do a 10-hour day on that.

So I have no doubt, and I think talking to Kelly Baron, it was very clear I do suffer from shift work sleep disorder. It's not something I really had prior to doing shifts when I started my residency training.

I have plenty of times where I think I don't struggle so much to get to sleep. I generally fall asleep once I get back into my regular routine, but then I will often find that I'm awake four hours later and just lying there and not sleeping. So that's probably the biggest for me.

I feel like I can get to sleep, I can fall asleep, but then I'm often awake a few hours later and not sleeping at that point. So that's definitely a struggle and I think not an uncommon struggle, definitely for people who do shift work, but I think a lot of people I've talked to have that issue as well.

Scot: Yeah. I look forward to hearing if you have some things that you've figured out of work around that. I mean, you can't totally fix it, right? The best you can do is kind of make the best out of a worse situation.

Troy: Yeah.

Scot: Thunder, how about you? Do you have any sleep struggles or you do all right?

Thunder: In general, I do all right. But my sleep struggle that does come up from time to time, believe it or not, is temperature. If it's too warm, I have trouble sleeping. So I have to be aware of that. Most of the time it's fine, especially in my own house, but when I travel, sometimes you're out of your comfort zone and you're someplace where the temperature may not be right.

So I try to do what I can, make sure I'm not putting too many covers on the bed because if it's too warm, it's tough. Hopefully I can adjust the temperature in a room, things like that. But that's my main challenge.

Scot: I'm pretty fortunate that I haven't had a lot of struggles. I have a job that allows me to have a pretty regimented sleep schedule. And for the most part, I fall asleep. For the most part, I sleep through the night. And then for the most part, I'm able to wake up in the morning when I need to. So I am pretty fortunate.

I think my biggest challenge, though, is I'm always thinking. My brain is always going, and sometimes I'll just lay in bed and I can't quite shut it all off. And part of it might be my fault. Maybe I was doing something too close to bedtime, but that's kind of mainly the struggle that I have.

How about you, Mitch?

Mitch: So I guess I have a slightly different story here. I have always struggled with waking up feeling refreshed. Every single night, it just feels like I haven't gotten any sleep the night prior and it's day after day after day, month after month.

I've been working with my doctor for the last year to try to figure out what I should be doing. And from stuff that we've talked about on the show, I've made sure that I go to bed at the same time every night. I'm waking up at the same time in the morning. I've played around with using a little bit of melatonin sometimes before bed. I've tried making sure not to look at screens or anything beforehand, and it doesn't seem to help.

And it was just recently after trying all of these things, my doctor had me do an at-home sleep study and they think they have found that I have sleep apnea. So I am waiting to go to do a formal sleep study in the next month or so and kind of figure out what's going on.

The struggle I've been having is I try everything and I still feel so tired. And when it comes to the Core Four, I'm working on my nutrition, I'm working out, I'm doing all the mental health things I can, but sleep has been one that's been really troublesome. And it eventually led me to talk to the doctor and we might be able to actually fix it now that we can find what's going on.

Troy: That's great you did that, though, Mitch. You talked to them and you went and looked for help. Yeah, that's a common story I hear from people where they say exactly that. They feel like they're getting plenty of hours of sleep, but they are just awake and they are not refreshed.

And I'm guessing they talked to you about in your sleep study, or in the sleep study you'll do, if they do see that, you wake up so many times at night due the sleep apnea that you're really not sleeping a whole lot, or at least good, deep REM sleep.

Mitch: Yeah. And that's kind of what they've explained. It's like, "Hey, if you have a sleep disorder, whether it be apnea or . . ." They talked about some restless leg syndrome. They talked about all these different kinds of things that can keep you up through the night. It doesn't matter what you're doing. It doesn't matter how often you're going to bed. It doesn't matter how healthy you are with your sleep hygiene and your hours and everything. If your body has something a little messed up that is waking you up all night, it doesn't matter. So that's where I'm at.

Troy: You're going the right direction. That's good. That's good to hear.

Scot: Mitch, do you find that impacts you, any of your other Core Four, like your nutrition, your . . .

Mitch: Oh, yeah.

Scot: How so?

Mitch: So I find that on days where I have not had any restful sleep and it's been day, after day, after day, when your energy level is so low, the idea of cooking a meal goes right out the window, right? In my sleep deprived state, all I want is a Big Mac. You go straight to the fast food whenever you can.

When I'm tired, I find that I can't work out the way I'm supposed to. When I go out for a jog or something like that, I can't go nearly as far as I think I need to. The whole process is really kind of frustrating and your heart rate gets up higher than it's supposed to, etc.

And mental health-wise, things . . . We're living in a very stressful time right now and I find that on the days where I don't get enough sleep or I'm not able to sneak off and take a nap in the middle of the day, I get really stressed and my anxiety gets high and I'm quicker to be frustrated and all sorts of things.

And it's been really surprising, ever since starting working on this podcast, that I'm focusing so much on all aspects of my health, but sleep was the last one. Sleep was the one that was like, "Eh, that one will figure itself out." But here I am learning that maybe I have something else going on. And hopefully, by working with my doctor and finding out a treatment plan, maybe in the next little while I can start seeing better results elsewhere.

Scot: That's a great point about how "maybe it'll just work itself out," right? This notion of "something might fix itself," I think that can be kind of dangerous, and I think a lot of us guys have that.

Mitch: And that was kind of the thing that was interesting when I first started speaking with my doctor. He was like, "Well, yeah, if you're having trouble sleeping, you might be having mental health stuff. Why don't you go talk to someone about that?" and, "Oh, when you start getting more activity, I'm sure you'll feel tired by the end of the day," and, "Oh, if you improve your nutrition and drink less caffeine, I'm sure your sleep will kind of fall into place."

And so, for the last year, I've really been working under that assumption that sleep is easy, sleep is going to just happen if I do all these right things. But if you're out there and you've been trying everything, maybe it's time to talk to a doctor.

Scot: All right. Let's go ahead and talk about maybe three struggles or three things that we've learned and what we've done to overcome those. And again, the hope is that if somebody else is struggling with something similar, this might be a new, fresh idea for them.

So I'm going to kick things off with this notion of a dedicated bedtime, being sure that you get to bed at the time that you've decided to get to bed. For me, it was 10:00. And it was challenging because if it was 9:15 or 9:30 and my wife and I were up and we were hanging out and she wanted to start a show, I'm like, "Well, it's going to be 52 minutes. I can't do that. That's going to put me past my bedtime."

Or sometimes I feel like I don't have enough time in the day to get things done. And I'm sure that's something that a lot of men deal with. And so, as a result, you push into the night, or what I've learned is you kind of have to prioritize what's important or ask for help to get all the things done that you need to get done. You can let go of some of those things.

So a dedicated bedtime has really, really helped me, and it helps me wake up a lot more refreshed, but it is challenging for those reasons and other reasons as well.

Troy: Scot, I'm going to jump right on that, and I'm going to say also a dedicated wake-up time. That's been big for me. We talked about that also with Kelly and just saying, "I'm going to get up every day." For me, it's, "I'm going to get up every day by 7:00 a.m. regardless."

And certainly, I have shifts where I have to get up early. I don't care if it's the weekend, whatever. Granted, I did mention there those times I'm getting to bed at like 3:00 or 4:00 in the morning, so I might sleep in a little after that. But once I'm in my regular routine, I'm up at 7:00, and I know I'm going to get up at 7:00.

Just knowing that, it kind of helps mentally, because before, I would kind of give myself this nebulous wake-up time. If I didn't have a shift or if I didn't have something going on early, I'd be like, "Well, I'll just get up when I wake up, because I have to make up for my missed sleep."

And then during my night sleeping, I would just lie there and I wouldn't really fall back asleep and I would just be like, "Well, I don't really have to get up. Okay. Maybe 9:00. Maybe it'll be 10:00." Kind of this mental thing where I just kept putting it off in my mind.

But I think knowing, "Hey, I'm going to be up at 7:00," something about that mentally just lets me know, "This is my sleep time, and I'm going to take advantage of it and I'm not going to sleep past that, so don't think I'm going to be able to make up what I'm missing now by sleeping in until 9:00."

Thunder: So I'm going to jump on the regular schedule bandwagon as well. I'm also all about that, going to bed about the same time and waking up about the same time.

I will add one thing about the waking. I usually wake up around 6:30, give or take a little bit, and I never have to set an alarm because I'm used to waking up at 6:30. So all the things that you have to do in life that you have to wake up early for and you need to set an alarm for, I never do that, and I find it cuts down on my stress level the night before. You're not thinking, "Oh, I've got to wake up extra early," or, "My alarm is going to go off," or something. You just wake up at your normal time.

The new thing I'll add to that is I have a bit of a relaxation routine that I engage in almost every night, and that is I read a little bit before bed. And for me, that works. I'm talking reading out of an actual book, or a magazine, or sometimes I'll read on my Kindle with a black screen.

So that kind of helps my mind disconnect from whatever was going on during the day and get lost in something else for a little bit. And I don't last too long reading. Maybe I can do like 10 minutes to 30 minutes, depending on what it is. So that's part of my routine, that little relaxation moment.

Scot: All right. Mitch, you're up.

Mitch: So the thing that it really helped me out is I'm the worst millennial. I am on my phone up until . . . I used to be, at least. I was on my phone up until the moment of my bedtime. What I have found is that regardless of your phone, most modern phones, whether it be an iPhone or an Android, they have digital wellbeing settings. And if you can go into there and turn them on and respect them, it has really helped me make sure that I'm not doing too much screen time before bed.

On my phone, at least, I set in my bedtime. I'm like, "Hey, I want to start winding down. I want to stop using my screen for an hour before bed. Here's when I want it." And when the phone hits that time period, it turns off all my notifications, it turns super-duper dim, and black and white.

And it seems kind of dumb because it's like, "Well, I can still use the phone." But for some reason, the lack of color, the fact it's super dim, the fact that you can't hear anything, it really helps just kind of disconnect and set it aside before I go to bed.

Scot: That was a big thing for me too. Up until recently, I would go to bed and I'd get out my iPad and I'd scroll social media, and then I'd find something that enraged me and then I couldn't stop thinking. Somebody would make some comment and then I would spend the next hour coming up with what my comment would be back to them, right? So, for me, getting rid of that social media has been absolutely crucial.

And the other thing that I struggled with too, and, Mitch, tell me if you did this, are the Instagram Reels, which are like TikTok videos, right?

Mitch: Oh, yeah.

Scot: I'd watch those. And even if I'd quit an hour before bedtime, then I'd have one of those stupid songs playing in my head and I couldn't get it out and fall asleep.

Mitch: Well, it's so easy to just get sucked into that hole too. You're just scrolling, and swiping, and swiping, and swiping and the next thing you know, it's like, "Oh, man, I've been doing this for two hours."

Troy: And how much of our life do we waste just thinking about snarky replies to other people's snarky replies?

Scot: Right?

Troy: I totally hear you on that. It's like, "What am I going to say to this?"

Scot: That I would never ever actually enter in, but I'll spend a lot of time thinking about what it's going to be.

Troy: Yep. I'm going to think about it, and it's going to be good. It's going to keep me up all night.

Scot: All right. Number two for me. Now, I don't know if this is a type of meditation or what, but it's a little exercise I do. It could be considered maybe a form accounting sheep or whatever. But if I'm struggling falling asleep, I will pick a color. That kind of tends to be my go-to. So I'll pick the color green, for example, and then I'll just let my mind go and think about things in my life that are green or in my past that have been green.

Troy: Oh, wow.

Scot: It takes me down this kind of memory lane. My parents' first car that I remember was this big green Plymouth from the 1970s. And then I'll think, "Oh, I had a toy box. It was a frog, and it was green." I just kind of let my mind go where it wants to with whatever color I've picked, and I find that after a few minutes of that, I feel kind of tired or I might just fall right asleep. So it's a little weird, but it's worked for me.

Thunder: So it's so boring that it puts you to sleep?

Troy: I guess so. I just feel like that would be too engaging. You would really be thinking way back into your childhood and trying to come up with all different things. I don't know. That's interesting. You just kind of let your mind wander and somehow that puts you to . . . I've never heard of people doing that, but whatever works.

Scot: Yeah. I mean, I get the engaging part because I have caught myself in the trap where I'm engaging and thinking about it too much. I think, for me, the trick really is just to let your mind wander through your past and just those things that were green. So anyway, that's mine.

Thunder: It almost sounds like a type of meditation. You pick one thing and you just kind of reflect on it and just let your mind go on it.

Scot: I don't know why it works, but it works. Who's next?

Thunder: Another thing that works to me for me is related to . . . We talked a little bit about temperature of the room is important. So we have this Nest thermostat in our home and it's programmed to start reducing temperature around 9:00. And it's great in a winter because by the time I want to go to bed around 10-ish, the temperature of the bedroom is probably like around 65 degrees, which for me is a good temperature.

So it's kind of good. It's automated, so I don't have to do it. It just happens every evening, and that is part of what helps with my sleep schedule.

Troy: Well, kind of along the lines of making sure you're addressing external factors, for me, it's about white noise and sleep mask.

Six years ago, I reached a point where I said, "I'm going to do everything I can to try and optimize my sleep and do what I can to optimize it and control what I can in terms of environment." For me, that meant white noise.

And for me, white noise means I actually have earbuds I sleep with that are made for sleeping. They're comfortable. They're soft. And then I just have a white noise thing I play that I listen to there, just kind of a sound of a fan or something. And I wear a sleep mask.

For me, that's made a big difference just being able to have that, control what I can, trying to eliminate the light, and noise, and all those sorts of things.

Mitch: And even for people who aren't doing shift work where you might be trying to sleep during the daytime, there are a lot of little itty bitty lights that are turned on in every room, in my house at least, whether it be a little power indicator light, or whether it be the light on a fan, whatever. And it has been night and day since I've gotten my sleep mask how quickly I'm able to fall asleep and stay asleep.

Scot: Tell me more about these earbuds that you have in because I've seen Bose advertise these sleep-only earbuds, but they're super expensive, right?

Troy: Yeah, crazy expensive.

Scot: Yeah. So did you find a cheaper alternative, and how do they work?

Scot: Mine are super, super cheap. It's like $10. They're designed to be ergonomic flat. They're noise-blocking. So they're just earbuds. They're soft. It did take about a couple weeks to get really used to them and comfortable with them.

Thunder: Hey, Troy, have you ever tried just foam earplugs?

Troy: Yes, I have.

Thunder: I've done that on occasion when I'm somewhere where there's a lot of ambient noise.

Troy: Trust me, Thunder, I've tried everything. And once again, I'm probably going to admit things here that are very embarrassing, but I not only have tried foam earplugs, I've tried foam earplugs with construction-type . . . like those noise blockers, those big headphone things that construction workers wear.

Mitch: Oh, my.

Troy: I'm a side sleeper, so I actually took an old pillow and I actually hollowed out a little spot in the pillow.

Scot: Oh, my.

Mitch: Oh, wow.

Troy: I was that desperate to try and block noise that I tried it. And I actually used that for a couple months. I took a lot of heat from Laura, from my wife, making fun of me, that I was that desperate that I tried that.

Finally, just these ergonomic things, these earbuds with just white noise going through it, that's what worked for me. So trust me, I've tried it.

Scot: Mitch, what do you have?

Mitch: So one of the things that is a constant struggle for me is I'm a list maker, like, "What is my to-do list? What am I doing next?" And when I try to fall asleep, for the longest time, it would just be, "Okay. What do I have to do tomorrow? I'm waking up, I'm doing this, I'm doing this, I'm doing this."

And what I found is that I keep my day planner . . . When I'm going to bed, as part of my ritual, I take the day planner, I climb into bed, I take my little pen out, and I write everything down that I'm going to be doing the next day. And for me, at least, that has really helped cut down the anxious thinking about the next day that typically happens when I try to fall asleep.

Troy: Yeah. I've heard of people doing that. And just doing a notepad, not typing it on your phone because you don't want the blue eye to mess you up. You just have a notepad, something is on your mind, write it down, deal with it later. That's a great idea.

Scot: My last one is another weird one. It works for me. I don't know if it'd work for anybody else. But sometimes when I have a hard time falling asleep . . . I'm a side sleeper, but I will lay on my back with my knees bent. Can you kind of picture what that looks like? What? Why are you laughing?

Mitch: You're just curled up and thinking about colors, and that's . . .

Troy: That's called a fetal position, Scot. You're doing it on your back.

Scot: No, I'm not on my side in the fetal position. I'm on my back and I've bent my knees, right? So if you were to come in the room, you would see this big bump of where my knees are in the comforter, right?

Troy: Yeah.

Scot: So I will lay on my back with my knees up. I mean, 99% of the time, if I can't fall asleep within five minutes, if I do that, I will fall asleep.

Troy: Wow.

Scot: I don't necessarily fall asleep on my back, but I get so tired from that position that I will turn over to my side and I can fall asleep. I don't know why it works. I don't know how I discovered it, but there it is.

Troy: I just want to be a fly on the wall in your house, Scot, and just see this, just see you lying there and sleeping with your knees brought up to your chest.

Mitch: And then talking about snakes and cars.

Scot: No, it's not all way up to my chest. I'm not that flexible. It's just like a 45 . . . Yeah, it's like a 45- or 90-degree of your knees.

Troy: I'm trying to think of the physiology of this, how this might work. I will tell you there are certain things called vagal maneuvers that basically increase the blood flow to the head and slow the heart down.

If someone comes in with a very rapid heart rate in the ER and something called super ventricular tachycardia, we will do a procedure where we lay the head of their bed down and lift their legs up at the same time to increase that blood flow. And that sort of has a calming effect on the heart rate.

So I'm trying to think of this physiologically, Scot. I don't know if there's anything to that, but it's interesting you do that and you found that works. Maybe there's something to it.

Scot: Thunder, you're up next.

Thunder: Well, this last one may be kind of old fashioned, and it doesn't actually pertain to me exactly. But I think having a television in the bedroom, a lot of people have that. I think that could actually interfere with sleep. I've never done that, but similar to being on the phone, being on a tablet, laptop, whatever, I think having a TV on when you're in bed trying to go to sleep . . . Again, it's something to engage your mind and keep you active. So that's something I think we should consider.

Scot: And Kelly Baron, when she was on the show, talked about the bedroom is for two things. It's not to watch TV. It's to sleep and to . . . I guess we're going to go to Troy next.

Troy: And to make sweet love. Is that what you want me to say, Scot? Anyway, Scot, moving on from that, this third thing I'm going to say is something I am going to try. And I will tell you I recently celebrated a birthday. For this birthday, I received a gift, and my sister was so excited to send me this gift. She said, "This is something I heard about on the podcast." The gift I received was a toilet light. So Mitch suggested this. This is one of the gifts Mitch suggested getting.

Mitch: Yes.

Troy: And I have now been using it for about a week. It's awesome. It's got a motion sensor, Mitch. It's everything you described. You come in . . .

Mitch: I told you.

Troy: Yeah, it's so cool. It's like a joke kind of gift, but I've used it and I'm like, "I love it." You come in and it just . . . I've got it on this very dim, purple light. It just hangs over into the toilet. It just lights up the bowl like this little beacon in the night, like, "Oh, there it is." I don't have to flip on lights. I'm not struggling to find the toilet. It's great.

I think it definitely helps you to avoid those interruptions in your REM sleep where you're flipping on lights and you're too focused on the task at hand, so to speak. Instead, you've got the toilet light, great, in and out, go back to sleep.

Mitch: I love that. A couple of my friends also purchased. So I don't know how much reach we have in this podcast, but some toilet lights were bought this Christmas season because of what we were saying. And I cannot be more delighted because everyone has been saying, "This is ridiculous. I can't believe I spent $10 on this." And then the next day they're like, "It's wonderful. This is the best thing. I don't have to wake up. I don't have to turn on the lights."

Thunder: Yeah. Add me to the list. I also have a toilet light.

Scot: What?

Mitch: Yes!

Thunder: Yeah. And it is, it's awesome. The only thing that I don't like about the toilet light is it . . . or maybe it's just the one we have. When the batteries start to go low, it flashes red like a police siren.

Troy: Oh, no.

Mitch: Yeah.

Thunder: So that's the one thing. You walk in there and batteries are always like, "Flash, flash, flash." It's like, "Oh, my gosh." It's very bright red. But love it.

Mitch: It's interesting you thought police siren. I thought poltergeist the first time I woke up in the middle of the night and there was a flashing light in my bathroom. I was like, "My house is haunted. I've got to go figure this out."

Troy: Your toilet. Something is going to emerge from the toilet.

Mitch: Yeah.

Thunder: But all in all, it is really a great invention.

Troy: Well, we've got three believers here, Scot. I think you're next.

Scot: Yeah, I guess.

Troy: Now I know what I'm going to get you for your graduation.

Scot: Oh. Yeah.

Troy: Because we know that's coming up soon.

Scot: Oh. Mitch, you're taking us out with number three.

Mitch: So the last one is actually a tip for my partner, Jonathan, and it's kind of this same thing. If you have difficulty sleeping and it has something to do with not being able to turn your brain off or not being able to just let go of the anxieties of the day, the thing that he does every night as part of his sleeper team that he's come up with is he has a series of positive affirmations and mantras that he tells himself.

At the start, again, I think there's a touch of toxic masculinity where I'm just like, "You're doing what? You're positive self-talking before bed?" I don't know. I need to be better about that. But he has seen a significant . . .

Scot: Go ahead and incorporate that into your self-talking.

Mitch: Right. I've got to bring that in to me, right? But he's found a lot of real benefit from it. And I've been trying it out recently where it's just . . . If you are someone who's struggling with any sort of negative self-talk or any sort of . . . if you go to bed and you replay the bad moments that happened through the day, if that's you, this has been really helpful.

And it sounds cheesy and it feels ridiculous. You're looking in the mirror telling yourself something, but it works for him. And since I've been doing it, I've been finding myself able to go to sleep faster.

Thunder: Mitch, I think that's awesome because I think we're good at being hard on ourselves about different things and replaying those in our mind, but we're not good at the opposite, patting ourselves on the back when we need to.

Scot: This turned out to be a far more entertaining show than I could have expected.

Mitch: Not the snooze fest?

Scot: Yeah, not the snooze fest I thought it was going to be. I was like, "What are we going to talk about?" But I think we've learned a lot about each other.

Troy: And I'm so glad you shared, Scot. I'm so intrigued by your sleep techniques. Anyway, it's definitely been entertaining.

Scot: Yes. It's been a good show. So I think the takeaway is that the Core Four . . . Sleep is one of them. And a lot of times, if you get your activity, and your nutrition, and your mental health right, the sleep will take care of itself. But sometimes it doesn't. Sometimes maybe the sleep is the first thing that you need to tackle.

The Core Four don't live in isolation. They all impact each other. And like Mitch explained to us, how sleep impacts those other three for him is absolutely huge.

So hopefully you got some good tips here. Hopefully you have a better understanding of the importance of sleep, and thanks for listening.

We are going to talk about next week, in our "Back to Basics: Core Four" series, mental health. So that'll be next.

If you have a technique that you would like to share, you can get a hold of us. It's so easy.

Troy: Yeah. You can reach out to us, hello@thescoperadio.com. We're on Facebook, facebook.com/whocaresmenshealth. Call our listener line, 601-55SCOPE. I would love to hear who is going to try Scot's elevation of the knee technique tonight when they can't sleep and tell us if it worked. I'm going to try it, Scot. If I can't sleep, I'm trying it, and I'm going to give feedback.

Scot: All right. I look forward to that.

Thunder: I'm going to try the color technique.

Mitch: Oh, yeah.

Troy: The color technique. I'm going to start with color and then I'm going to move on to knees. That's my strategy.

Scot: I'm glad I had an influence on you guys today.

Troy: You did.

Scot: As always, it's awesome. Thanks for listening and thanks for caring about men's health.

Interviewer: For men who have been diagnosed with an enlarged prostate, there are a lot of treatment options, but it can be a little overwhelming. And some men fear about the side effects of those treatment options. We're going to sort through that today.

Dr. Stephen Summers is a urologist at University of Utah Health, and he's going to help us better understand the treatment options available for an enlarged prostate and, more importantly, understand what you would want to weigh as a patient when you're having a discussion with your physician or urologist about those different treatment options. So you were telling me that sometimes men put off treating an enlarged prostate because of the fear of side effects. So let's start there. Treatment options have side effects. Do they all have side effects?

Dr. Summers: Unfortunately, any treatment option will have side effects. So the first one, I guess, that has the fewest side effects is lifestyle modification. So if you can lose weight and improve your diet, cut out caffeine, you may have some benefit. But once we start talking about medications and surgical treatment, it's a matter of weighing the side effect with the benefit that you expect to see.

Interviewer: Okay. So can you talk us through that a little bit? So, if I understand, the hierarchy is lifestyle changes first. And you've given us a great reason to want to do that to avoid the side effects of medication. But then it would be medication next. So talk us through, what are some of the options there?

Dr. Summers: Yeah. There are three categories of medications. But primarily, we start with alpha blockers. And the most common medication used is a medication called Flomax or tamsulosin. It works to open up the prostate and the bladder neck to allow the urine to flow through a little bit easier. For the most part, it's well tolerated, but the side effects that bother men with taking that medication can be dizziness. And so you get up all of a sudden, you may have some lightheadedness or a possibility of fainting. And the other one is something called retrograde ejaculation or a sexual side effect. And that is when a man orgasms, instead of having the semen come forward out the end of the penis, it goes backwards into the bladder. And that certainly can be concerning to a lot of men and is one of the main side effects of a lot of different treatments for prostate enlargement.

Interviewer: Is that something I should be concerned about?

Dr. Summers: No. It is a concern if you're planning to father more kids. Obviously, that is an important part of reproduction. But in terms of your overall health, it doesn't make a big difference. It doesn't impact the sensation of orgasm too much, but it's highly individual. In some men, that can be a real bother.

Interviewer: Yeah. Sure. Like I would imagine a lot of these side effects are going to be very individual.

Dr. Summers: Sure. Yeah. The other medications that we use, there is a medication that falls into a class called 5α-reductase inhibitors. There's a medication called finasteride or Proscar or Avodart or dutasteride,. These medications get at the effect of testosterone on the prostate. So they block the effect of testosterone on the prostate growth and over time can cause some shrinkage of the prostate. They are very slow medications to work, and you have to continue on those medications for life once you start them if you're going to experience the benefit of the treatment for them. The main side effects with those can be erectile dysfunction, problems with mood, energy level. It can cause occasional breast enlargement in men. And it does have the side effect of causing hair regrowth. So the medication that was commonly prescribed called Propecia is in this class of drugs. But there are more substantial sexual side effects, I will say.

Interviewer: Why would a man choose this particular treatment then over maybe the first one?

Dr. Summers: No. That's a good question. So, oftentimes, they're combined. So we will use both medications. There's pretty good data out there to suggest that both of them work almost synergistically together than using either one alone. The other advantage with the finasteride, that we were just talking about, is it does reduce the progression of symptoms and severity of the disease, and so you can reduce the risk of progression to the point where one might need surgery by about half. And so there are clear benefit with that.

Interviewer: And you said the one that you have to take for life, say I started, at six months later, I'm like, "Ah, these side effects, I can't live with these." Am I able to then take a different treatment option?

Dr. Summers: Sure. You can always change the treatment option. There is some controversy though, and I think it's important for men to know that there have been some men that have had persistent side effects even after stopping that medication.

Interviewer: Okay.

Dr. Summers: So some of those sexual side effects have lasted even once they've come off of it. Now, that's a very small percentage of men, but certainly, if you're one of those patients, that's going to be a concern for you.

Interviewer: Yeah. And then there's a third category of drugs as well?

Dr. Summers: Yeah. The other category of drugs works primarily on the bladder. It relaxes the bladder, so it treats the symptoms of the disease, but does nothing really to the prostate. And so you're really putting a Band-Aid on treating the symptom, the frequency, the urgency, the getting up at night, but you're not really addressing the problem. So a lot of times we'll use those medications in combination with these other drugs to help lessen or minimize the symptoms as we're focusing on the problem of the prostate itself.

Interviewer: All right. So it sounds like that, you know, you need to have a conversation with your physician about the risks and benefits of the medication. At that point, if that doesn't work or is it possible that a man just might not choose to do the medications because of the side effects that they would move on to surgery. Let's talk about that as a treatment option.

Dr. Summers: You bring up a great point. Sometimes we consider surgery even before medications when you're trying to minimize some of those side effects. So there are a couple of new or recently developed treatments that I think are important to highlight here. And I highlight them specifically because they do not have those sexual side effects that are so common with the medications. And we call them minimally invasive surgical treatments. They're done in the office with a local anesthetic. So it's a very quick recovery with little downtime or little missed work.

The first of those treatments is something called a UroLift. That is a device that is implanted in the prostate that holds back that prostate obstructing tissue and opens up the channel to allow the urine to flow through easier. The advantage with it is it's done relatively quickly in the office. A lot of men do not even have to have a catheter following that procedure, and it doesn't have any of the sexual side effects. So there's no risk of erectile dysfunction, there's no risk of retrograde ejaculation, and there's no risk of urinary incontinence following that procedure. Unfortunately, not all men are candidates for that procedure. It depends a little bit on prostate size and anatomy. But it can be a great option for a lot of men.

Interviewer: And are there other surgical options that you discuss with your patients?

Dr. Summers: Sure. I think it's important to really know all of the options, and so I like to review everything with my patients prior to entertaining any one of them. Another office-based procedure that we do is something called Rezūm. Rezūm uses steam or water vapor therapy in an effort to shrink or ablate and remove prostate tissue. And so, similarly, it's done in the office under a local anesthetic and with some mild sedation. We go in and I inject the prostate with the steam. And depending on the size of the prostate, you may get anywhere from 4 to 10 or even higher injections. And that steam destroys the prostate tissue, shrinks it down and opens up the urinary channel. Men following that procedure do have to have a catheter for a few days. The recovery can be a little bit longer, but there are no restrictions. You're able to go back to work as soon as you're able to tolerate things. It similarly does not have any risk of sexual side effects, including erectile dysfunction or retrograde ejaculation, and no risk of incontinence.

Interviewer: Is this one a little bit more of an option for men than the previous one? Because you said the previous one, you know, some men would not necessarily be a good candidate for it.

Dr. Summers: Yeah. So it has the ability to tailor the treatment a little bit more to a broader range of prostate anatomy, so different prostate sizes and three-dimensional constructs of the prostate. But both of them are, you know, often used interchangeably, and both are good options for a lot of men that are hopeful to avoid some of the bigger surgeries.

Interviewer: Is there a reason why a man might pick one surgery over the other if they were eligible for either one?

Dr. Summers: A lot of times it comes down to the recovery. It comes down to experience, provider preference too, and duration, you know, how long we've been doing those treatments and what's the long-term data and retreatment rates for each of those. So, you know, it gets into a little bit more in-depth discussion that I try to tailor to the individual. When they come seeking one of those treatments, we kind of look at the data and say, you know, "This is what I have that's published based on this treatment. And how does that fit with kind of your expectations and the symptoms that we're looking to treat?"

Interviewer: Getting close to wrapping this up, are there other options that we haven't covered yet that we should?

Dr. Summers: You know, I think one of the common questions I get in surgical treatments that a lot of men that talk about it is the TURP, and that stands for transurethral resection of the prostate. For some reason, men affectionately call it the rotor-rooter. It's an older treatment -- it's better around, you know, almost 100 years -- where urologists go in and using a resection knife in the operating room, with the patient asleep, we hollow out the prostate. It's still a commonly practiced procedure. Most urologists do a lot of them. It still has its place. And technology, of course, has improved as have the side effects. So we've, you know, gotten better at that procedure. But I think a lot of men come thinking that is their only option. And, unfortunately, they have, you know, all had a friend that has had this done and has had maybe a complication, and they fear and procrastinate putting off treatment because of some of the side effects of this older treatment option.

Interviewer: So did I miss something there? I guess I assumed that the surgeries would remove the prostate. And I don't know that I heard any of the things you talked about actually explicitly say removing the prostate.

Dr. Summers: Yeah. That's a common question we get too, and it's a bit confusing when you look at pictures of the prostate. So most of the treatment for benign prostate disease does not remove the entire prostate. We're removing the inside glandular portion of the prostate that's obstructing the urine flow. That is contrasted and much different than an operation that we do for prostate cancer. So if a man has prostate cancer, most of the time that cancer is on the outside of the prostate, and we have to remove the entire prostate. Whereas with benign prostate disease or BPH, that growth or enlargement is on the inner part of the prostate that's obstructing and pushing on the urethra.

Interviewer: And then does that affect the function of the prostate? Is it no longer functional at that point?

Dr. Summers: Once you remove the whole prostate, yeah. Certainly, it's no longer functional. In terms of removing a portion of it, you do lose some function. The function of the prostate is to secrete supporting fluid in your semen for sperm. And so, for most men that were treating prostate enlargement, that is less of an issue. But certainly, if you're a younger patient still planning on fertility or have fertility concerns, then we need to weigh that in with what treatment options we're considering.

Interviewer: Final question. How can a man go into this meeting with their urologist, armed and ready to have this conversation, other than listening to this great interview, of course?

Dr. Summers: Yeah. I think just being open and honest about what your symptoms are, kind of what your priority is, knowing that there are side effects and risks with any of these treatments, what's important for you. Is it that we're treating your nighttime symptoms? Are we improving your flow or your frequency? If you can identify what really bothers you the most, then I can tailor the treatment to fix or improve that symptom. It's really hard to certainly change things and reverse things to make it a 100% better, but if you can tell me what bothers you most, then I can highlight that and incorporate that into our treatment.

Interviewer: Energy drinks, accidental overdose, and who is most at risk. That's next on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier, healthier life. You're listening to The Scope.

Interviewer: We're talking with Dr. Barbara Crouch, the Medical Director of the Utah Poison Control Center today. She also happens to be an expert on energy drinks. Tell us a little bit about energy drinks, Dr. Crouch.

Dr. Barbara Crouch: Well energy drinks have just exploded on the market in the last decade, and they are very popular, especially among teens. And energy drinks contain a lot of caffeine, and caffeine in a variety of sources. So I think one of the issues with energy drinks is that we tend to add a lot more caffeine into our diet every day in addition to maybe other sources of caffeine. So it's important to be aware of the fact that energy drinks contain a lot of caffeine, so that as we balance the rest of our diet we can take that into consideration and avoid any adverse consequences.

Interviewer: Because there's some real danger from caffeine overdoses, isn't there?

Dr. Barbara Crouch: Yes there is, and caffeine is the most common psychoactive substance in the world. Almost all of us consume some sort of caffeine on a regular basis, whether that is in coffee, or tea, or in a soft drink, or even chocolate. So it is common, and we use caffeine as a pick me up to avoid sleeping, and normally we tolerate it fairly well.

Now we have an explosion of other sources of caffeine, and I think vulnerable teens may not recognize that they are adding so much more caffeine into their diet. There are so many energy drinks; they are marketed to toward young adults. Their marketing is sort of edgy, and they have lots and lots of caffeine, even more caffeine than you might find in a very large cup of coffee from Starbucks.

So if you were to look at the label of an energy drink you might see a variety of natural substances listed. It may also list caffeine itself, and you don't really know how much caffeine you're consuming, because there is synthetic caffeine, and then there might be a variety of natural sources. So the total amount of caffeine isn't clear.

And then we have other natural stimulants, and so a lot of the energy drinks have boosted their products by adding additional stimulants, like ginseng, and synephrine, taurine, and a variety of other things that sort of add to and contribute to that stimulant load, if you will. So it's hard to know exactly how much you're ingesting.

Some of the products, if you were to look at the cans, you'll look at the serving size; they will tell you that you open up a can and it contains two servings. I don't know about you, but I don't open a can of something and not finish it. So again, there's this sort of almost deception as to how much caffeine may be included in a product.

Interviewer: It sounds like with energy drinks the risk for caffeine overdose increases.

Dr. Barbara Crouch: Yes, caffeine is a stimulant, and as a stimulant it can exert a lot of adverse effects. In toxicology we like to say that the dose makes the poison. So the more we take the more likely we are to experience an adverse effect, or even a toxic effect. As a stimulant, you know, the first thing that you might feel if you drank too much caffeine is you might feel a little jittery. You might be shaky. You might have a tremor. And as you increase that load your heart starts to beat fast, and it may be very irregular. So somebody who has an underlying heart problem is at risk. And then in very high doses you can seize. So again, it's sort of the dose.

When I drink a cup of coffee I might have a strong cup of coffee, but it's a warm beverage that I am sipping over a period of time. And as I'm ingesting the caffeine, my body is metabolizing the caffeine. What happens with the energy drinks is a lot of them, especially again with the young adults, they tend to drink them fast, and they may have more than one. So all of a sudden the amount of caffeine being consumed and absorbed into the body is much higher over a shorter period of time.

So then you have to think about it, that that's the energy drink. What other sources of stimulants are you taking in? Have they had a cup of coffee or tea or a soft drink that has caffeine? Are they taking any over-the-counter medications? You can buy caffeine as an over-the-counter drug and take it as a stay-awake drug. And a lot of kids in school do, to stay up to study for exams. There are now food products that have caffeine in them, like Cracker Jack'D that has 100 milligrams of caffeine in a packet.

And then we have stimulants, or medications that are stimulants, that can add to and contribute to adverse effects, and those include a lot of our ADHD drugs. So if you have a teenager who has ADHD and is on an ADHD drug, and they add a bunch of caffeine, they are more likely to have an adverse effect than somebody who isn't on those medications. So there are a lot of factors that play into somebody's risk for having an adverse effect.

Interviewer: The adverse effects have real consequences on a person's health, but you mentioned toxic effects earlier. At what point do adverse effects become toxic effects?

Dr. Barbara Crouch: Well that's a good question. And there is no good answer to that. I think we have an idea of certain amounts of caffeine if ingested all at once can be a problem. But it's going to depend on each individual. It's going to depend on whether they are on other medications. It's going to depend on how much total caffeine they are ingesting. And it's going to depend on their underlying health. So I know of at least one report out there of a teenager who died. They have suggested that it was due to an energy drink, and it turned out that the teenager had an undiagnosed heart problem. That probably contributed to her death, potentially. So I think underlying health is also an important component.

Interviewer: So obviously there are going to be certain people and groups of people that are going to be more vulnerable to caffeine overdose. You mentioned teenagers; you mentioned people who might be taking a stimulant drug for a medical condition, or people with heart conditions. Are there any other vulnerable populations or people that you can think of?

Dr. Barbara Crouch: Well certainly very young children. We don't typically give our children coffee or soft drinks at a young age. But you can imagine if you have an attractive container that's out and about in the house, that a toddler when they're exploring their environment might find that attractive and drink that. And so again, a fair amount of caffeine that might way too much for that small child.

Interviewer: I appreciate you visiting with us today, Dr. Crouch. Do you have any final thoughts that you'd like to share with us about caffeine?

Dr. Barbara Crouch: Well I think the most important thing is people need to be aware of the fact that it is a stimulant, and that it has the potential to cause adverse effects when ingested in large amounts.

Interviewer: And of course if you are worried about somebody that may have had a caffeine overdose, whether it be a child or adult, you can always call the Utah Poison Control Center. The number is universal and works in whatever state you are in, and the number is 800-222-1222.

Dr. Barbara Crouch: Great, yes, absolutely.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.

There is caffeine everywhere right now, but it is wise to keep caffeine to a minimum for kids. While the United States hasn't developed guidelines for caffeine intake in kids, Canada has, and they recommend preschoolers don't get more than 45 mg of caffeine a day. That's the equivalent amount of caffeine in a 12 oz. can of soda.

Caffeine is actually defined as a drug because it stimulates the central nervous system. At lower levels, it can make people feel alert and energetic, but when kids get too much caffeine, same with adults, you can feel jittery and nervous. It can make your stomach upset. Kids can get headaches. They can have a hard time concentrating. Instead of feeling more alert, kids are actually so wired that they can't focus. It definitely decreases their ability to sleep. It also increases the heart rate, and it really does a number on blood pressure. It raises blood pressure.

It doesn't take a lot of caffeine to produce these effects in kids. Adults, you need more, but in kids, not so much. If your child has been drinking a lot of soda and caffeine, abruptly stopping it can cause withdrawal symptoms. Again, it's a drug. You can get withdrawal from it. We talked about the headache, they can also get muscle aches, feel temporarily depressed actually because they just feel really slow and down and sluggish, and kids who also abruptly stop caffeine can be very irritable.

Someone who is cutting back from caffeine is going to feel tired. And the best way to get over that tired hump is to get some sleep. Don't reach for a soda or more caffeine; you're just going to set yourself backward. What your body is doing is it's saying, "Hey, I know you're cutting back on the caffeine. I need some more rest." Don't worry; the energy levels that you are looking for, they'll return back to normal in a few days once your body gets the caffeine out of your system.

How do you get your kids to cut back on caffeine? It's not easy. Instead of offering sodas, things like that, offer milk, water, fruit juice in small amounts. I usually say about one juice box a day. You could also make sure that everything that you're serving for the kids is convenient. It's really easy to pick up a bottle of soda, twist the top, or pop the lid open and drink something. Well, have water and things like that in squeeze bottles, make it fun for them.

The bottom line is, as with everything, moderation is the key to keeping your kid's caffeine consumption under control.

updated: February 28, 2022
originally published: September 15, 2014