Effects of visual art therapy on depressive symptoms in adults: a systematic review and meta-analysis.

The deleterious effects of co-consuming caffeine (including energy drinks) and alcohol are well-established. Yet, an alternate understudied pattern of temporally mediated co-use, perhaps aimed at arousal (rather than broader mood) regulation and with unclear impacts, is the “Edge-On Edge-Off” (EO-EO) cycle. In this cycle, poor sleep quality leads to low daytime arousal, which individuals may combat with caffeine use later in the day (i.e., Edge-On). Greater caffeine use then leads to higher arousal in the evening, which individuals may take advantage of (to prepare for socializing) or even combat (in the case of hyperarousal or jitteriness) by drinking alcohol (i.e., Edge-Off). Heavy drinking, in turn, is posited to disrupt sleep (potentially adding hangover effects to daytime fatigue) and continues the cycle, particularly in the absence of structural barriers to drinking (e.g., potential consequences of unmet social or work obligations). Derivable hypotheses based on this cycle test the posited behavioral pattern, the arousal mechanism, and potential consequences or benefits. The current analyses test within-person associations concerning the behavioral pattern involving daily associations between sleep, caffeine use, and alcohol use across a ten-day sampling period in a college sample. We also extend the model to test whether the sleep-alcohol use cycle is broken by napping. This EO-EO cycle may be particularly relevant for college students, who not only have high rates of intense and extreme drinking patterns, but also report highly variable sleep schedules, poor sleep quality, and prioritizing other activities over sleep (e.g., academic and social obligations. These factors may be compounded as heavy drinking students with poor sleep quality report more alcohol-related consequences than their peers. Moreover, longer weekend than weekday sleep patterns may contribute to perceptions of poor sleep quality, with daytime fatigue being a major problem reported by nearly half of all college students. Cross-sectional findings suggest that heavy drinking college students show greater rates of insomnia, sleep disorders, and negative sleep-health outcomes relative to those who drink less– though mechanism and directionality are difficult to establish in these findings. Young adults are also heavy consumers of caffeine; 64% of 18–29-year-olds have consumed caffeine in the last year, with an average of 228 mg of caffeine consumed per day among caffeine users. Some studies suggest that college students show even higher rates of use (e.g., 92% of college students have consumed caffeine in the last year, with the average college caffeine consumer intaking 173 mg/day. The role of caffeine use in linking alcohol use and sleep in a reciprocal pattern over time remains unclear in the current literature. Lab-based alcohol challenge studies generally show biphasic effects on arousal linked to the blood alcohol curve (BAC) and rate of consumption. In these studies, a rising BAC is linked to stimulatory effects or increased arousal, whereas descending BAC (or in some studies surpassing some ‘high’ BAC level) is linked to sedative effects or decreased arousal. This pattern indicates that although individuals may enter a drinking episode motivated by stimulatory effects, experienced drinkers may also anticipate that after particularly high levels of drinking, arousal dampening effects can occur. Complicating findings of such acute biphasic effects are individual differences in sensitivity to either the excitatory or dampening effects of alcohol use (or both).