Sunday, December 2, 2007

Seriously, There's a Point . . .

I watched an entire marathon of ‘What Not to Wear’ while continuously combing the cat I agreed to ‘sit’ while my friend was out of town. I made threadbare the one good coat the cat was wearing while I promised to no one in particular that if I could just make it to the store in these sweats without ending up on the next episode, I’d sacrifice them to the slob gods as soon I got home. And borrowing most of the cat’s coat thanks to the mindlessly excessive maintenance I subjected it to wasn’t making either of us look any more chic. On an up note, I always thought my tragic fashion sense would some day qualify me for handicap plates in a neighborhood with no legal parking. I never guessed that a crippling social disorder would ultimately win pole position in that race.

The disorder became obvious just last week while on a mission of mercy. Michael asked me to get him beans at Vivace - the best coffee in my neighborhood and everybody else’s’. Since my days are always perfumed with the brew, I understood the urgency. If any independent coffee house in Seattle appreciated that people only breeze in at 5:30 a.m. when they have someplace to be, I’d be spoiled with exceptional coffee but since they all act as if I have all the time in the world while they busy themselves making sweet love to the beans, I go instead to the corporate colossus of coffee. I stood in line and savored the pretense that I was the kind of person who sauntered into Vivace because the world can wait for me to caffeinate and still I worried that I stank of a lowbrow grind.

As I stood in line, the man in front of me turned around and then turned again. I pondered whether it impressed him that I was in line at Vivace before I remembered that so was he. We chatted like northwesterners while I beat down the instinctive northeasterner suspicions that pushed me to data dodge by way of bullshit. I was a confident, successful business woman having a casual conversation until he asked if I wanted to join him for coffee. Immediately I became a nervous ninth-grader still holding tightly to my mother’s warnings about strangers. My eyes went wide, I jammed my hands into my pockets and mumbled something about having to go home and go to bed. For the love of God please tell me I didn’t just tell a grown man that I couldn’t stay out because it was past my bedtime!

So I understand that as a segue to a conversation about sleep, this was terrible but, as my sister points out, I write this blog because I amuse the heck out of myself and the fact that I can spar with a man but sharing coffee with one scares the bejeebers out of me – well, that’s just laugh-out-loud funny. Or tragic – depending on whether or not you’re my ovaries.

I’ve been collecting data about sleep since I asked Dr. Singh about napping. I was looking for solutions to my sleep deprivation and he told me that naps longer than twenty minutes can cause sleep inertia. Ah, yes. I nodded knowingly. What I knew, however, is that I had no real idea what he was talking about so I looked it up. Following are studies that I compiled in my quest, but first, a definition of sorts:

Sleep inertia

Sleep inertia is a transitional state of lowered arousal occurring immediately after awakening from sleep and producing a temporary decrement in subsequent performance. Many factors are involved in the characteristics of sleep inertia. The duration of prior sleep can influence the severity of subsequent sleep inertia.

Although most studies have focused on sleep inertia after short naps, its effects can be shown after a normal 8-h sleep period. One of the most critical factors is the sleep stage prior to awakening. Abrupt awakening during a slow wave sleep (SWS) episode produces more sleep inertia than awakening in stage 1 or 2, REM sleep being intermediate. Therefore, prior sleep deprivation usually enhances sleep inertia since it increases SWS. There is no direct evidence that sleep inertia exhibits a circadian rhythm. However, it seems that sleep inertia is more intense when awakening occurs near the trough of the core body temperature as compared to its circadian peak.

A more controversial issue concerns the time course of sleep inertia. Depending on the studies, it can last from 1 min to 4 h. However, in the absence of major sleep deprivation, the duration of sleep inertia rarely exceeds 30 min. But all these results should be analysed as a function of type of task and dependent variables. Different cognitive functions are probably not sensitive to the same degree to sleep inertia and special attention should be provided to dependent variables as a result of the cognitive processes under review. Finally, sleep disorders represent risk factors which deserve new insight in treatment strategies to counteract the adverse effects of sleep inertia.

H SAYS: For all of those folks who dozed half way through that you should pause to marvel all the evil implications. Four hours of sub-par function behind your desk equals low productivity which then means later hours to catch up. Plus, as Dr. McCleary points out, lack of sleep actually shrinks the hippocampus which means you'll never remember that I told you how dangerous sleep deprivation can be because that's what the hippocampus is supposed to do. Spending the first couple of hours at work trying to remember where you're supposed to be, what you're supposed to be doing and where you put you're coffee mug isn't getting you promoted during this review period (that should keep you up at night). Just saying.

Effects Of Sleep Inertia As Bad Or Worse Than Being Legally Drunk, Say Researchers

A new University of Colorado at Boulder study shows that people who awaken after eight hours of sound sleep have more impaired thinking and memory skills than they do after being deprived of sleep for more than 24 hours.

The study showed test subjects had diminished short-term memory, counting skills and cognitive abilities during the groggy period upon awakening known as sleep inertia, said CU-Boulder Assistant Professor Kenneth Wright, lead study author. The new study has implications for medical, safety and transportation workers who are often called upon to perform critical tasks immediately after waking, since cognitive deficiencies following 24 hours of sleep deprivation have previously been shown to be comparable to the effects of alcohol intoxication, he said.

The study appears in the Jan. 11 issue of the Journal of the American Medical Association. Study authors included Wright and Adam Wertz of CU-Boulder's integrative physiology department and Joseph Ronda and Charles Czeisler of Brigham and Women's Hospital in Boston, which is affiliated with Harvard Medical School.

"This is the first time anyone has quantified the effects of sleep inertia," Wright said. "We found the cognitive skills of test subjects were worse upon awakening than after extended sleep deprivation. For a short period, at least, the effects of sleep inertia may be as bad as or worse than being legally drunk."

Following six nights of monitored sleep lasting eight hours per night, the study participants were given a performance test that involved adding randomly generated, two-digit numbers, said Wright. Based on the results, the researchers concluded the subjects exhibited the most severe impairments from sleep inertia within the first three minutes after awakening, he said.

The most severe effects of sleep inertia generally dissipated within the first 10 minutes, although its effects are often detectable for up to two hours, according to the study authors.

Studies conducted by Dr. Thomas Balkin and colleagues at the Walter Reed Army Institute of Research in Washington, D.C., have shown cortical areas of the brain like the prefrontal cortex take longer to come "on-line" following sleep than other areas of the brain, Wright said. The prefrontal cortex is thought to be responsible for problem solving, emotion and complex thought.

The CU-Boulder study has implications for medical professionals who are often called on to tend patients in crisis on a moment's notice, often at odd hours, Wright said. Medical residents, for example, who may work 80 hours or more per week and who "catnap" at times, could be prone to make simple math mistakes when calculating dosages of medicine during bouts of sleep inertia, he said.

The results also have implications for emergency medical technicians and firefighters who may be hastily awakened and called upon to drive a vehicle to an emergency scene, putting themselves and others at risk, said Wright. The study also has implications for commercial truck drivers, who frequently pause for quick naps in their vehicles' sleeping berths during cross-country excursions, he said.

Wright and his colleagues said further studies are needed to measure the effects of nap interruption and "recovery sleep" in on-call, sleep-deprived individuals.

The study also illuminates the challenges faced by everyday people who are forced to make crucial decisions following abrupt awakening. "If a person is awakened suddenly by a fire alarm, for example, motivation alone may be insufficient to overcome the effects of sleep inertia," he said.

The paid study volunteers, nine of whom were included in the sleep inertia study, slept eight hours per night during the month leading up to the study, had no medical, psychiatric or sleep disorders and were free of medication including alcohol, nicotine, recreational drugs and caffeine. The subjects also spent several hours each day during their six-day, in-patient stay practicing the math test used to quantify sleep inertia.

"These were very healthy people who had performed the test hundreds of times, making the results even more profound," said Wright. Located at Boston's Brigham and Women's Hospital, the sleep lab used in the study contained infrared video cameras, audio equipment and physiological recorders that monitored sleep patterns of participants through the night, he said.

The More You Sleep, The Longer You Live

Dr. Keith Humphreys
Sunday, September 2, 2007

It's done in bed, it feels great and most Americans don't get enough of it. It's sleep, of course, the most undervalued contributor to optimum health and performance.

Did you know that sleep had anything to do with success in sticking to a diet? Get to know leptin and ghrelin. They sound like a Hungarian comedy act, but they are hormones that regulate appetite. Ghrelin is produced in the stomach and signals the brain when it's time to eat. Leptin is secreted by adipose tissue (i.e., fat) and has the reverse effect, telling your brain when you are full. Chronic lack of sleep increases ghrelin and decreases leptin, leading you to feel hungry when you don't really need to eat and to keep eating after you have gotten the calories you need.

Hitting the weights at the gym? Good sleep will bring you the results you want more quickly. The body repairs itself, including rebuilding your sore biceps, during the deepest phase of sleep. That's why a good night's sleep will not only make your workouts more productive but will also boost your immune system in general.

Despite these and other benefits, including greater mental alertness, improved concentration, better mood - even lower risk of car accidents - sleep remains underrated when it comes to health promotion. Maybe people can't believe that something as mundane as consistently getting seven or eight hours of sleep a night can have such a positive impact on their health. Or maybe, in a culture of double cappuccinos and Ambien, sleep deprivation goes unrecognized in the first place.

If you get stuck in a period of weeks or even months where sleep is hard to come by (e.g., new baby, a big work deadline), pay off your sleep debt with extra sleep as soon as you can and you should suffer no long-term ill effects. But don't make sleep deprivation a lifelong habit. A study of almost 7,000 Alameda County residents, over a nine-year period, found that people who routinely slept six or fewer hours a night had about 70 percent higher risk of dying than did people of similar age who slept seven or eight hours a night.

H SAYS: Again, dying - not a good strategy for promotion during this review cycle.

There are many common sense ways to make it easier to get to sleep, including keeping to a consistent schedule and avoiding big meals, caffeine and intense exercise just before bed. A full list of strategies is available from the National Institutes of Health.

The Institute's strategies for better sleep are useful, but they work only if you make sleep a priority, which many people in the compulsively busy Bay Area do not. If you think you don't have time to sleep enough, remember that survey research shows that most people grossly underestimate how much time gets away from them in the evenings when they are idly surfing the Net or half-watching TV. If you feel tired, turn off the machines and go to bed. And if you believe you absolutely must see the next episode of "Big Brother" or a rerun of "Gilligan's Island," remember that TiVo and VCRs were invented so that we can watch such programs later, when we are rested enough to appreciate their nuanced messages and enduring contributions to our culture.

Keith Humphreys is a professor of psychiatry at Stanford University. He does research in addiction treatment and national mental health and drug policy. He has written for the New York Times and other publications.