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Is there a scientific term for when you fall asleep because you can't handle something?

Is there a scientific term for when you fall asleep because you can't handle something?



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I'm wondering if there is a scientific term that describes when you fall asleep or pass out after some traumatic event?

This effect happens when people witness something gruesome (a friend being killed, for instance), have some major upheaval in their life, or experience some other trauma (eg. a bad breakup, losing a job, etc.). When the mind can't cope it simply shuts off and they fall asleep or pass out. A decent example I just though of can be seen in the first Matrix movie (not the first place I would have thought of to look for an example) when Neo finds out about the matrix and promptly vomits and passes out for a few hours.

The closest term I'm aware of is a dissociative fugue or fugue state, though I'm unsure if that's related (possibly it's simply a more extreme version of the effect I tried to describe above).


The specific event you mention (my paraphrasing: loss of consciousness and motor control leading to a sleep/coma-like state due to acute circumstantial stress) might best be classified according to @Monacraft's excellent answer. To build on that somewhat, we've discussed in chat that there might be important distinctions among various levels of consciousness, such that, per your example, "sleep" might be usefully different from "passed out." I've noted my own vague familiarity with theories of consciousness that model it in terms of discrete levels of awareness. My off-the-cuff proposal for such a model was as follows: $$ ext{fully alert > calm}ge ext{trance}ge ext{drowsy} ext{> REM sleep > deep sleep > "KO'd" unconscious} ext{> deep coma}ge ext{Near-death experience}ge ext{vegetative > kaput}$$ I see that Wikipedia has its own page about levels of consciousness as well, which lists the following levels as a summary (using GRE-level vocab), for which it cites Porth (2007):

$$ ext{conscious > confused > delirious > somnolent > obtunded > stuporous > comatose}$$

The above Wikipedia page even mentions and links to a separate page about the Glasgow Coma Scale (cf. Gill, Reiley, & Green, 2004), which is one of apparently many scales in medical use for measuring differences among unconscious states, so it seems one could take an even finer-grained or fully continuous approach to modeling individual differences in degree of conscious awareness. A Google image search for "levels of consciousness" also leads to a lot of rather suspicious-looking diagrams of levels of consciousness above sleep, so a continuous dimensional model would probably help reduce a lot of this theoretical mess if theorists could somehow be made to agree with it unanimously. Then again, one strong counterargument would be the often sudden loss of muscle tension that can occur in rapid transitions from awake to unconscious. That might better support a model with at least one such discrete state change.

Anyway, this reminds me of general adaptation syndrome (GAS), which describes normative stress response in terms of a curvilinear model of resistance as a continuous dependent variable changing over time: Thus another conceivable, more general answer might simply be "exhaustion", as above. One source on GAS that I was able to find online just now mentions "passing out" explicitly in association with the exhaustion stage, so this at least tentatively supports the interpretation of exhaustion as potentially leading to unconscious, sleep-like levels of consciousness, though maybe more authoritative references than this could be found to provide such support (please comment or edit if you find any). Another parallel worth drawing here is between "resistance to stress" and emotional arousal, the vertical axis on the circumplex model of emotion I mentioned in another answer here. Given a stressful circumstance, we'd of course be looking at the left side of that diagram, and reinterpreting the rise and fall of resistance as the transition from neutral, to nervous, to gloomy, and finally sluggish or tired. This might help explain why depression is a related issue. Long-term depression (such as in people suffering a major depressive episode) naturally leaves a person exhausted, and maybe more likely to just pass out when overwhelmed by stress, because such a person is probably closer to "overwhelmed" from the outset.

In our chat, we've discussed some other complexities on the diathesis side of the stress response model; I think some of that is worth re-posting here. First, a handy (if simplistic) diagram from Wikipedia on the diathesis-stress model:
To apply this here, let's define thenegative outcomeas that described in the OP; thepositive outcomeas simply retaining consciousness, self-control, and effective coping capability; thenegative environment/experienceas the class of traumatic events described in the OP; thepositive environment/experienceas ordinary experience; theresilient individualas the subpopulation of people who would score at least one standard deviation (SD) above average on measures of protective characteristics and one SD below average on diathesis-exacerbating characteristics; thevulnerable individualas the opposite subpopulation; and both lines as oversimplified predictions of average tendencies subject to probabilistic error. This allows us to accommodate a potentially endless list of individual differences that could moderate the normative tendency to change one's level of conscious awareness in response to extremely shocking, traumatic stress. For now, I'll limit myself to mentioning only two, particularly relevant differences:

  • Hardiness is the prototypical stress-resistance trait; you'd expect a resilient individual to have lots.
  • Neuroticism, the opposite of emotional stability, characterizes individuals with tendencies toward negative emotionality and stronger stress response. This would make an individual more reactive, likely to experience depression, and thus more likely to suffer chronic exhaustion and be vulnerable.
    • It relates to psychiatric illness in general, which relates to syncope (Oh & Kapoor, 1997).
    • It's negatively related to hardiness, but partially distinct (Sinclair & Tetrick, 2000), so a neurotic person who also lacks hardiness would be especially vulnerable, and vice versa.

References

Gill, M. R., Reiley, D. G., & Green, S. M. (2004). Interrater reliability of Glasgow Coma Scale scores in the emergency department. Annals of Emergency Medicine, 43(2), 215-223.

Oh, J. H., & Kapoor, W. N. (1997). Psychiatric illness and syncope. Cardiology Clinics, 15(2), 269-275.

Porth, C. (2007). Essentials of pathophysiology: Concepts of altered health states, pp. 835. Hagerstown, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7087-4. Retrieved July 3, 2008.

Sinclair, R. R., & Tetrick, L. E. (2000). Implications of item wording for hardiness structure, relation with neuroticism, and stress buffering. Journal of Research in Personality, 34(1), 1-25.


I'm not completely sure, but you may be referring to Syncope, a medical term which describes events such as fainting or passing out which occurs upon low blood flow to the brain. As a result it can occur when under shock or trauma or a post-effect of stress.

Obviously, one would expect the opposite to happen in half the events, such as after vomiting, however when you said

have some major upheaval in their life, or experience some other trauma (e.g., a bad breakup, losing a job, etc.). When the mind can't cope it simply shuts off and they fall asleep or pass out.

I realised you may be relating to someone feeling a depressed, in which case lowering of blood pressure is possible and thus he or she could suffer from syncope.

In all honesty it is simply a technical term for fainting, and is more commonly used for people who suffer a disorder which will cause them to faint often.


Timing Is Everything

When a sleeping brain hears a word proved to be an important component in sleep learning. During slow wave sleep our brains alternate between “up states” and “down states” every half-second. During up states, the brain is highly active and interconnected — prime for learning.

“We looked how often we managed to hit these up-states with our word presentation, and what we found was that there is a clear dose-response curve: the more often you hit an up-state, the better the memory.”

In other words, people were more likely to correctly classify the words they heard during slow-wave peaks than the ones they heard during less-optimal periods of brain activity. To see what was happening inside the brain, a subgroup of participants performed the post-sleep memory test while being imaged with fMRI. As participants classified the new words they learned while sleeping, fMRI imaging showed that the language areas of the brain and hippocampus were activated.

It’s an indication that these structures allow for memory formation whether we’re awake or asleep, according to Züst.


"Guga" means elephant: Learning languages during sleep?

Andrillon and his colleagues have found that learning in sleep can go beyond simple conditioning. In their 2017 study published in the journal Nature Communications, subjects were able to pick out complex sound patterns that they had heard during sleep.

Learning abilities in sleep may extend to the learning of words. In a study published in the journal Current Biology in January, researchers played pairs of made-up words and their supposed meanings, like that "guga" means elephant, to sleeping participants. After this, when awake, the people performed better than chance when they had to pick the right translation of made-up words in a multichoice test.

What all these studies have in common is that they show an implicit form of memory. "It's not some knowledge they'll be able to use spontaneously, because they don't know this knowledge is even there," Andrillion said. "The question is, 'Where do we go from there?'"

Learning a new language involves many different layers: recognizing the sounds, learning the vocabulary and mastering the grammar. So far, research suggests it may be possible to get familiarized with the tone and accent of a language or even the meaning of words while sleeping, but to a weaker level than what we already do all the time during the day without noticing. [Why Don't We Remember Being Babies?]

And then you have to consider the cost, Andrillion said. Stimulating the sleeping brain with new information likely disrupts the functions of sleep, negatively affecting the pruning and strengthening of what we have learned over the previous day, he said.

While losing quality sleep to potentially learn a few words is not a smart trade-off, researchers continue to study sleep learning because the compromise may be worth it in special cases. For example, sleep learning could be useful when people need to change a habit or alter stubborn disturbing memories in cases of phobias and post-traumatic stress disorder.

And some forms of implicit learning that may help in those situation may occur more strongly during sleep. The conditioning that happened in the smoking and rotten egg study, for example, doesn't work well when done during wakefulness. If you smoke every day near a garbage bin, you know the two are unrelated, so you don't link them. We are not easily tricked when awake.

"But the sleeping brain is not so smart, and we can manipulate it for our own good," Andrillion said. "It sounds a lot like the 'Eternal Sunshine' [movie], and this is still ongoing work, but the possibility is there."

Until then, remember that a good night's sleep is already sleep learning at its best.


What are the Benefits of Listening to Music Before You Sleep?

Many people struggle with getting to sleep at night, and the benefit of listening to music is that it can help you get into the sleep zone by relaxing you.

Although we all have a different response to music, listening to familiar much-loved music can improve mood and feelings of wellbeing.

According to studies, listening to music can increase sleep-inducing hormones serotonin and oxytocin.

Physical benefits of listening to music while you go to sleep are that it can reduce heart rate and blood pressure and help you relax muscles.


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Make a to-do list

&ldquoWorries keep people awake, and they don&rsquot have to be negative worries,&rdquo says Findley. &ldquoIt could also be something positive you&rsquore planning, like a trip or a big event with a lot of things you have to remember.&rdquo Spending time during the day or earlier in the evening to sit and address those concerns may help, he says&mdashbut if it&rsquos too late for that, grab a notebook and try physically writing them down in a list for the next day.

A recent study found that writing out a to-do list of future tasks helped people fall asleep nine minutes faster than people who wrote about tasks they&rsquod already accomplished that day. (The longer and more detailed the participants&rsquo lists, the faster they fell asleep.) It may seem counterintuitive that focusing on tomorrow&rsquos responsibilities would lead to faster sleep, but researchers think the act of getting them down on paper helps clear the mind and stop rumination, at least temporarily.


Why You Dream

As you sleep, your brain cycles through multiple stages of brain activity. The first three stages of sleep are called non-rapid eye movement (non-REM) sleep, and they progress from light sleep (Stage 1) to deeper sleep (Stage 3) as your body relaxes. In the final stage you experience rapid eye movement (REM) sleep, which occurs when your thalamus (the part of the brain that relays sensory information) kicks into high gear. This is when most of your dreaming occurs. You typically spend about two hours dreaming each night, even if you don’t remember those dreams in the morning.

Experts still don’t know exactly why we dream, but there’s an undeniable connection between dreams and the real-life things we’re dealing with. “I like to say that dreams are just thinking in a very different brain state,” says Barrett. “We continue to think and worry about our fears, our hopes and aspirations, and our emotional and interpersonal life.” The difference is that our typical environment (the world around us) isn’t present in our dreams. Think of your sleeping mind like a blank state for your thoughts to play around in.


Why Falling Asleep When Driving Happens and How to Handle It

Falling asleep while you're driving can be dangerous, both for you and others on the road. Feeling drowsy behind the wheel is a very common phenomenon, but becoming so tired that you fall asleep at the wheel can be a sign that you may be suffering from a serious sleep problem that will need to be addressed. Nodding off for as little as three seconds while you are driving can cause a fatal accident. Even driving while drowsy can slow your reaction time enough to increase your risk of serious accidents on the road.

Causes of Falling Asleep While Driving

Sleep loss is one of the most common causes of drowsy driving. Many conditions can cause the patient to suffer from sleep deprivation. Personal demands, stress or lifestyle choices can cause people to miss the 7-9 hours of sleep they need. Troubled sleep may also fail to provide adequate rest, causing the patient to feel drowsy throughout the day.

Sleep Disorders

Undiagnosed sleep disorders or sleep disorders that are not being treated properly can cause you to feel drowsy throughout the day. These symptoms can be worsened when performing repetitive activities such as driving. Noting your other symptoms and working with your doctor can help you learn if you have sleep disorders such as restless leg syndrome, narcolepsy or obstructive sleep apnea that could be affecting your ability to perform tasks like driving safely.

  • Narcolepsy- Narcolepsy is a chronic condition that affects your ability to properly regulate your sleep schedule. Narcolepsy is caused by environmental triggers that induce your brain to rapidly release the chemicals which lead you to fall asleep. This can cause sudden loss of muscle control, strong emotions or severe daytime fatigue. You may also notice nighttime wakefulness, sleep paralysis, rapid entry to REM sleep or hallucinations. Your doctor can perform a spinal fluid analysis, nocturnal polysomnogram or multiple sleep latency tests to determine if you suffer from narcolepsy.
  • Obstructive sleep apnea- This condition causes the patient to stop breathing while you are asleep. This can be caused by the airway becoming blocked or conditions that cause the airways to become floppy or narrowed because the body relaxes to the point where the muscles that regulate your breathing do not function properly. Sleep apnea can cause patients to become forgetful, grumpy, impatient or suffer from headaches. They may fall asleep during daily activities because they are not getting the rest they need at night. Doctors will perform an ECG, echocardiogram or an examination of thyroid function and arterial blood gasses to check for sleep apnea.
  • Restless leg syndrome and periodic limb movement disorder- Restless leg syndrome or periodic limb movement disorder commonly coexist in patients. In combination, these conditions can cause insomnia, excessive daytime sleepiness and daytime fatigue. It can also cause difficulty when you try to move your limbs, which can result in you losing control when performing activities such as driving. Patients that seem to be showing signs of limb movement disorders can go over these concerns with their doctor to determine if they have a condition that requires treatment. Medication can often be prescribed to help avoid falling asleep while driving in such cases.

Disruption of Biological Clock

The circadian pacemaker or biological clock is the body's natural mechanism that tells it when it is time to sleep. This mechanism sends the signals to the brain and tells it to get sleep in the mid-afternoon and at night. If you are working a job at this time or performing stressful tasks you can become susceptible to falling asleep during these activities.

Medications and Alcohol

Alcohol is a depressant which will increase feelings of sleepiness or fatigue that are present. Some medications also list fatigue as a side effect. Ingesting these substances, such as antidepressant, antihistaminic, benzodiazepine and antipsychotic before driving can be dangerous. If you are taking a medication for the first time, avoid performing activities like driving until you know how they will affect you.

Poor Sleeping Habit or Sleep Loss

In order to maintain optimum health, people should get between 7-9 hours of sleep per night. But activities such as working late, worrying about personal issues or choosing to stay up late to socialize can interrupt this natural sleep schedule. Consistently interrupting your sleep schedule or failing to get an adequate amount of sleep per night will cause you to become drowsy during the day. If this condition is not addressed you can find yourself falling asleep while you try to function throughout the day, which may include falling asleep behind the wheel.

Tips to Avoid Falling Asleep While Driving

Tips for Getting Enough Sleep

One of the most important tips to avoid sleepiness while driving it so make sure you get enough sleep every night. Make a point of setting your schedule so you can get 7-8 hours of sleep each night. Try to go bed around the same time every night and get up around the same time every day to allow your body to become used to this schedule.

Getting restful sleep is also a key to avoiding fatigue during the day. Avoid eating big meals before bed and avoid consuming alcohol for at least three hours before going to bed. Avoid substances like caffeine for at least six hours before you try to sleep. If you have trouble sleeping, make sure you have a comfortable room to sleep in that is not disrupted by uncomfortable temperature, excessive light or noise.

Tips for Driving on the Road

Since falling asleep while driving is so dangerous, you should know these tips to keep you on the safe side. Try to avoid driving when you are feeling drowsy. If you will be driving for a long period of time, avoid using the cruise control setting. Staying actively involved with your driving can help you stay alert. If you find yourself becoming drowsy or distracted, keep the car cool to help promote alertness. Listen to music or get involved with an active conversation to help relieve the monotony associated with driving.

Avoid driving for long periods at night or driving for long distances alone. If you must travel long distances, make a point of stopping at a rest area every 1-2 hours to exercise and increase your energy level. If necessary, stop in a rest area to take a 15-20 minute nap to avoid falling asleep behind the wheel. Once you begin driving again, make a point of sitting up straight. Slouching down in the seat can promote sleepiness, particularly if you are driving at night.


Contents

Insomnia Edit

Insomnia, one of the six types of dyssomnia, affects 21–37% of the adult population. [7] [8] Many of its symptoms are easily recognizable, including excessive daytime sleepiness frustration or worry about sleep problems with attention, concentration, or memory extreme mood changes or irritability lack of energy or motivation poor performance at school or work and tension headaches or stomach aches.

Insomnia can be grouped into primary and secondary, or comorbid, insomnia. [9] [10] [11]

Primary insomnia is a sleep disorder not attributable to a medical, psychiatric, or environmental cause. [12] There are three main types of primary insomnia. These include: psychophysiological, idiopathic insomnia, and sleep state misperception (paradoxical insomnia). [9] Psychophysiological insomnia is anxiety-induced. Idiopathic insomnia generally begins in childhood and lasts the rest of a person's life. It's suggested that idiopathic insomnia is a neurochemical problem in a part of the brain that controls the sleep-wake cycle, resulting in either under-active sleep signals or over-active wake signals. Sleep state misperception is diagnosed when people get enough sleep but inaccurately perceive that their sleep is insufficient. [13] [ citation needed ]

Secondary insomnia, or comorbid insomnia, occurs concurrently with other medical, neurological, psychological and psychiatric conditions. Causation is not necessarily implied. [14]

Sleep is known to be cumulative. This means that the fatigue and sleep one lost as a result, for example, staying awake all night, would be carried over to the following day. Not getting enough sleep a couple days cumulatively builds up a deficiency and that's when all the symptoms of sleep deprivation come in. When one is well rested and healthy, the body naturally spends not as much time in the REM stage of sleep. The more time one's body spends in REM sleep, causes one to be exhausted, less time in that stage will promote more energy when awakened. [15]

Sleep apnea Edit

Obstructive sleep apnea is often caused by collapse of the upper airway during sleep, which reduces airflow to the lungs. Those who suffer from sleep apnea may experience symptoms such as awakening gasping or choking, restless sleep, morning headaches, morning confusion or irritability and restlessness. This disorder affects between 1 and 10 percent of Americans. [16] It has many serious health outcomes if untreated. Positive airway pressure therapy using a CPAP (Continuous positive airway pressure), APAP or BPAP devices is considered to be the first line treatment option for sleep apnea. [17] Mandibular displacement devices in some cases can reposition the jaw and tongue to prevent the airway from collapsing. For some patients supplemental oxygen therapy may be indicated. Nasal problems such as a deviated septum will shut down the airway and increase swelling in the mucus lining and nasal turbinates. Corrective surgery (septoplasty) in some cases may be an appropriate choice of treatment.

Central sleep apnea is caused by a failure of the central nervous system to signal the body to breathe during sleep. Treatments similar to obstructive sleep apnea may be used as well as other treatments such as Adaptive Servo Ventilation and certain medications. Some medications such as opioids may contribute to or cause central sleep apnea. [18]

Voluntary Edit

Sleep deprivation can sometimes be self-imposed due to a lack of desire to sleep or the habitual use of stimulant drugs. Sleep deprivation is also self-imposed to achieve personal fame in the context of record-breaking stunts.

Mental illness Edit

The specific causal relationships between sleep loss and effects on psychiatric disorders have been most extensively studied in patients with mood disorders. [ medical citation needed ] Shifts into mania in bipolar patients are often preceded by periods of insomnia, [19] and sleep deprivation has been shown to induce a manic state in about 30% of patients. [20] Sleep deprivation may represent a final common pathway in the genesis of mania, [21] and manic patients usually have a continuous reduced need for sleep. [22]

The symptoms of sleep deprivation and those of schizophrenia are paralleled, including those of positive and cognitive symptoms. [23]

School Edit

The National Sleep Foundation cites a 1996 paper showing that college/university-aged students got an average of less than 6 hours of sleep each night. [24] A 2018 study highlights the need for a good night's sleep for students finding that college students who averaged eight hours of sleep for the five nights of finals week scored higher on their final exams than those who didn't. [25]

In the study, 70.6% of students reported obtaining less than 8 hours of sleep, and up to 27% of students may be at risk for at least one sleep disorder. [26] Sleep deprivation is common in first year college students as they adjust to the stress and social activities of college life.

A study performed by the Department of Psychology at the National Chung Cheng University in Taiwan concluded that freshmen received the least amount of sleep during the week. [27]

Studies of later start times in schools have consistently reported benefits to adolescent sleep, health and learning using a wide variety of methodological approaches. In contrast, there are no studies showing that early start times have any positive impact on sleep, health or learning. [28] "Astronomical" data from international studies demonstrate that "synchronised" start times for adolescents are far later than the start times in the overwhelming majority of educational institutions. [29] In 1997, University of Minnesota research compared students who started school at 7:15 am with those who started at 8:40 am. They found that students who started at 8:40 got higher grades and more sleep on weekday nights than those who started earlier. [30] One in four U.S. high school students admits to falling asleep in class at least once a week. [31]

It is known that during human adolescence, circadian rhythms and therefore sleep patterns typically undergo marked changes. Electroencephalogram (EEG) studies indicate a 50% reduction of deep (stage 4) sleep and a 75% reduction in the peak amplitude of delta waves during NREM sleep in adolescence. School schedules are often incompatible with a corresponding delay in sleep offset, leading to a less than optimal amount of sleep for the majority of adolescents. [32]

Hospital stay Edit

A study performed nationwide in the Netherlands found that general ward patients staying at the hospital experienced shorter total sleep (83 min. less), more night-time awakenings, and earlier awakenings compared to sleeping at home. Over 70% experienced being woken up by external causes, such as hospital staff (35.8%). Sleep disturbing factors included noise of other patients, medical devices, pain, and toilet visits. [33] Sleep deprivation is even more severe in ICU patients, where the naturally occurring nocturnal peak of melatonin secretion was found to be absent, possibly causing the disruption in the normal sleep-wake cycle. [34] However, as the personal characteristics and the clinical picture of hospital patients are so diverse, the possible solutions to improve sleep and circadian rhythmicity should be tailored to the individual and within the possibilities of the hospital ward. Multiple interventions could be considered to aid patient characteristics, improve hospital routines, or the hospital environment. [35]

Internet Edit

Study published in the Journal of Economic Behavior and Organisation found out that the broadband internet connection was associated with sleep deprivation. The study concluded that the people with a broadband connection tend to sleep 25 minutes less than those without the broadband connection, hence they are less likely to get the scientifically recommended 7–9 hours of sleep. [36] According to another study published by 9 out of 10 people use their smartphones, browsing the Internet before bedtime and this affects their sleep quality poorly. [37]

Brain Edit

One study suggested, based on neuroimaging, that 35 hours of total sleep deprivation in healthy controls negatively affected the brain's ability to put an emotional event into the proper perspective and make a controlled, suitable response to the event. [38]

The negative effects of sleep deprivation on alertness and cognitive performance suggest decreases in brain activity and function. These changes primarily occur in two regions: the thalamus, a structure involved in alertness and attention and the prefrontal cortex, a region sub-serving alertness, attention, and higher-order cognitive processes. [39] This was the finding of an American study in 2000. Seventeen men in their 20s were tested. Sleep deprivation was progressive with measurements of glucose (absolute regional CMRglu), cognitive performance, alertness, mood, and subjective experiences collected after 0, 24, 48, and 72 hours of sleep deprivation. Additional measures of alertness, cognitive performance, and mood were collected at fixed intervals. PET scans were used and attention was paid to the circadian rhythm of cognitive performance. [39]

A noted 2002 University of California animal study indicated that non-rapid eye movement sleep (NREM) is necessary for turning off neurotransmitters and allowing their receptors to "rest" and regain sensitivity which allows monoamines (norepinephrine, serotonin and histamine) to be effective at naturally produced levels. This leads to improved regulation of mood and increased learning ability. The study also found that rapid eye movement sleep (REM) deprivation may alleviate clinical depression because it mimics selective serotonin reuptake inhibitors (SSRIs). This is because the natural decrease in monoamines during REM is not allowed to occur, which causes the concentration of neurotransmitters in the brain, that are depleted in clinically depressed persons, to increase. Sleep outside of the REM phase may allow enzymes to repair brain cell damage caused by free radicals. High metabolic activity while awake damages the enzymes themselves preventing efficient repair. This study observed the first evidence of brain damage in rats as a direct result of sleep deprivation. [40]

Animal studies suggest that sleep deprivation increases levels of stress hormones, which may reduce new cell production in adult brains. [41]

Attention and working memory Edit

Among the possible physical consequences of sleep deprivation, deficits in attention and working memory are perhaps the most important [2] such lapses in mundane routines can lead to unfortunate results, from forgetting ingredients while cooking to missing a sentence while taking notes. Performing tasks that require attention appears to be correlated with number of hours of sleep received each night, declining as a function of hours of sleep deprivation. [42] Working memory is tested by methods such as choice-reaction time tasks. [2]

The attentional lapses also extend into more critical domains in which the consequences can be life-or-death car crashes and industrial disasters can result from inattentiveness attributable to sleep deprivation. To empirically measure the magnitude of attention deficits, researchers typically employ the psychomotor vigilance task (PVT) which requires the subject to press a button in response to a light at random intervals. Failure to press the button in response to the stimulus (light) is recorded as an error, attributable to the microsleeps that occur as a product of sleep deprivation. [43]

Crucially, individuals' subjective evaluations of their fatigue often do not predict actual performance on the PVT. While totally sleep-deprived individuals are usually aware of the degree of their impairment, lapses from chronic (lesser) sleep deprivation can build up over time so that they are equal in number and severity to the lapses occurring from total (acute) sleep deprivation. Chronically sleep-deprived people, however, continue to rate themselves considerably less impaired than totally sleep-deprived participants. [44] Since people usually evaluate their capability on tasks like driving subjectively, their evaluations may lead them to the false conclusion that they can perform tasks that require constant attention when their abilities are in fact impaired.

Mood Edit

Many people already know that sleep affects mood. Staying up all night or taking an unexpected night shift can make one feel irritable. Once one catches up on sleep, one's mood will often return to baseline or normal. Even partial sleep deprivation can have a significant impact on mood. In one study, subjects reported increased sleepiness, fatigue, confusion, tension, and total mood disturbance, which all recovered to their baseline after one to two full nights of sleep. [45] [46]

Depression and sleep are in a bidirectional relationship. Poor sleep can lead to development of depression and depression can cause insomnia, hypersomnia, or obstructive sleep apnea. [47] [48] About 75% of adult patients with depression can present with insomnia. [49] Sleep deprivation, whether total or not, can induce significant anxiety and longer sleep deprivations tend to result in increased level of anxiety. [50]

Interestingly, sleep deprivation has also shown some positive effects on mood. Sleep deprivation can be used to treat depression. [4] Also, chronotype can affect how sleep deprivation influences mood. Those with morningness (advanced sleep period or "lark") preference become more depressed after sleep deprivation while those with eveningness (delayed sleep period or "owl") preference show an improvement in mood. [51]

Mood and mental states can affect sleep as well. Increased agitation and arousal from anxiety can keep you awake and stress can make you more aroused, awake, and alert. [45]

Driving ability Edit

The dangers of sleep deprivation are apparent on the road the American Academy of Sleep Medicine (AASM) reports that one in every five serious motor vehicle injuries is related to driver fatigue, with 80,000 drivers falling asleep behind the wheel every day and 250,000 accidents every year related to sleep, [52] though the National Highway Traffic Safety Administration suggests the figure for traffic accidents may be closer to 100,000. [30] The AASM recommends pulling off the road and taking a 15- or 20-minute nap to alleviate drowsiness. [52]

According to a 2000 study published in the British Medical Journal, researchers in Australia and New Zealand reported that sleep deprivation can have some of the same hazardous effects as being drunk. [53] People who drove after being awake for 17–19 hours performed worse than those with a blood alcohol level of 0.05 percent, which is the legal limit for drunk driving in most western European countries and Australia. Another study suggested that performance begins to degrade after 16 hours awake, and 21 hours awake was equivalent to a blood alcohol content of 0.08 percent, which is the blood alcohol limit for drunk driving in Canada, the U.S., and the U.K. [54]

Fatigue of drivers of goods trucks and passenger vehicles have come to the attention of authorities in many countries, where specific laws have been introduced with the aim of reducing the risk of traffic accidents due to driver fatigue. Rules concerning minimum break lengths, maximum shift lengths and minimum time between shifts are common in the driving regulations used in different countries and regions, such as the drivers' working hours regulations in the European Union and hours of service regulations in the United States.

The Exxon Valdez Oil Spill was the second largest oil spill in the United States. This accident occurred when an Exxon oil tanker struck a reef at the Prince William Sound in Alaska. Approximately 10.8 million gallons of oil spilled into the sea. The accident caused great environmental damage including the death of hundreds of thousands of birds and sea creatures. Fatigue and sleep deprivation were the major contributors to the accident. The captain of the ship was asleep after a night of heavy drinking he was severely fatigued and had been awake for 18 hours. The entire crew was suffering from fatigue and inadequate sleep. [55]

Sleep transition Edit

Sleep propensity (SP) can be defined as the readiness to transit from wakefulness to sleep, or the ability to stay asleep if already sleeping. [56] Sleep deprivation increases this propensity, which can be measured by polysomnography (PSG), as a reduction in sleep latency (the time needed to fall asleep). [57] An indicator of sleep propensity can also be seen in the shortening of transition from light stages of non-REM sleep to deeper slow-waves oscillations can also be measured as indicator of sleep propensity. [57]

On average, the latency in healthy adults decreases by a few minutes after a night without sleep, and the latency from sleep onset to slow-wave sleep is halved. [57] Sleep latency is generally measured with the multiple sleep latency test (MSLT). In contrast, the maintenance of wakefulness test (MWT) also uses sleep latency, but this time as a measure of the capacity of the participants to stay awake (when asked to) instead of falling asleep. [57]

Sleep-wake cycle Edit

Research studying sleep deprivation shows its impact on mood, cognitive and motor functioning, due to dysregulation of the sleep-wake cycle and augmented sleep propensity. [57] Multiple studies that identified the role of the hypothalamus and multiple neural systems controlling circadian rhythms and homeostasis have been helpful in understanding sleep deprivation better. [57] [58] To describe the temporal course of the sleep-wake cycle, the two-process model of sleep regulation can be mentioned. [57]

This model proposes a homeostatic process (Process S) and a circadian process (Process C) that interact to define the time and intensity of sleep. [59] Process S represents the drive for sleep, increasing during wakefulness and decreasing during sleep, until a defined threshold level, while Process C is the oscillator responsible for these levels. When being sleep deprived, homeostatic pressure accumulates to the point that waking functions will be degraded even at the highest circadian drive for wakefulness. [57] [59]

Microsleeps Edit

Microsleeps occur when a person has a significant sleep deprivation. Microsleeps usually last for a few seconds and happen most frequently when a person is trying to stay awake when they are feeling sleepy. [60] The person usually falls into microsleep while doing a monotonous task like driving, reading a book, or staring at a computer. [61] Microsleeps are similar to blackouts and a person experiencing them is not consciously aware that they are occurring.

An even lighter type of sleep has been seen in rats that have been kept awake for long periods of time. In a process known as local sleep, specific localized brain regions went into periods of short (

40/min) NREM-like states. Despite the on and off periods where neurons shut off, the rats appeared to be awake, although they performed poorly at tests. [62]

Cardiovascular morbidity Edit

Decreased sleep duration is associated with many adverse cardiovascular consequences. [63] [64] [65] [66] The American Heart Association has stated that sleep restriction is a risk factor for adverse cardiometabolic profiles and outcomes. The organization recommends healthy sleep habits for ideal cardiac health along with other well known factors like blood pressure, cholesterol, diet, glucose, weight, smoking, and physical activity. [67] The Centers for Disease Control and Prevention has noted that adults who sleep less than 7 hours per day are more likely to have chronic health conditions including heart attack, coronary heart disease, and stroke compared to those with adequate amount of sleep. [68]

In a study that followed over 160,000 healthy, non-obese adults, the subjects who self-reported sleep duration less than 6 hours a day were at an increased risk for developing multiple cardiometabolic risk factors. They presented with increased central obesity, elevated fasting glucose, hypertension, low high-density lipoprotein, hypertriglyceridemia, and metabolic syndrome. The presence or lack of insomnia symptoms did not modify the effects of sleep duration in this study. [69]

The United Kingdom Biobank studied nearly 500,000 adults who had no cardiovascular disease, and the subjects who slept less than 6 hours a day were associated with a 20 percent increase in the risk of developing myocardial infarction (MI) over 7 years of follow-up period. Interestingly, long sleep duration of more than 9 hours a night was also a risk factor. [70]

Immunosuppression Edit

Among the myriad of health consequences that sleep deprivation can cause, disruption of immune system is one of them. While it is not clearly understood yet, researchers believe that sleep is essential to provide sufficient energy for immune system to work and allow inflammation to take place during sleep. Also, just like sleep can reinforce memory in our brain, it can help consolidate the memory of immune system or adaptive immunity. [71] [72]

An adequate amount of sleep improves effects of vaccines that utilize adaptive immunity. When vaccines expose the body to a weakened or deactivated antigen, the body initiates an immune response. The immune system learns to recognize that antigen and attacks it when exposed again in the future. Studies have found that people who don't sleep the night after getting a vaccine were less likely to develop a proper immune response to the vaccine and sometimes even required a second dose. People who are sleep deprived in general also do not provide their bodies with sufficient time for an adequate immunological memory to form, and thus, can fail to benefit from vaccination. [71]

People who sleep less than 6 hours a night are more prone to infection and are more likely to catch a cold or flu. A lack of sleep can also prolong the recovery time in patients in intensive care unit (ICU). [71] [73] [74]

Weight gain Edit

A lack of sleep can cause an imbalance in several hormones that are critical in weight gain. Sleep deprivation increases the level of ghrelin (hunger hormone) and decreases the level of leptin (fullness hormone), resulting in an increased feeling of hunger and desire for high-calorie foods. [75] [76] [77] Sleep loss is also associated with decreased growth hormone and elevated cortisol levels, which are connected to obesity. People who do not get sufficient sleep can also feel sleepy and fatigued during the day and get less exercise. Obesity can cause poor sleep quality as well. Individuals who are overweight or obese can experience obstructive sleep apnea, gastroesophageal reflux disease (GERD), depression, asthma, and osteoarthritis which all can disrupt a good night's sleep. [78]

In rats, prolonged, complete sleep deprivation increased both food intake and energy expenditure with a net effect of weight loss and ultimately death. [79] This study hypothesizes that the moderate chronic sleep debt associated with habitual short sleep is associated with increased appetite and energy expenditure with the equation tipped towards food intake rather than expenditure in societies where high-calorie food is freely available. [80]

Type 2 diabetes Edit

It has been suggested that people experiencing short-term sleep restrictions process glucose more slowly than individuals receiving a full 8 hours of sleep, increasing the likelihood of developing type 2 diabetes. [81] Poor sleep quality is linked to high blood sugar levels in diabetic and prediabetic patients but the causal relationship is not clearly understood. Researchers suspect that sleep deprivation affects insulin, cortisol, and oxidative stress, which subsequently influence blood sugar levels. Sleep deprivation can increase the level of ghrelin and decrease the level of leptin. People who get insufficient amount of sleep are more likely to crave food in order to compensate for the lack of energy. This habit can raise blood sugar and put them at risk of obesity and diabetes. [82]

In 2005, a study of over 1400 participants showed that participants who habitually slept few hours were more likely to have associations with type 2 diabetes. [83] However, because this study was merely correlational, the direction of cause and effect between little sleep and diabetes is uncertain. The authors point to an earlier study which showed that experimental rather than habitual restriction of sleep resulted in impaired glucose tolerance (IGT). [84]

Other effects Edit

The National Sleep Foundation identifies several warning signs that a driver is dangerously fatigued. These include rolling down the window, turning up the radio, trouble keeping eyes open, head-nodding, drifting out of their lane, and daydreaming. At particular risk are lone drivers between midnight and 6:00am. [85]

Sleep deprivation can negatively impact overall performance, and has led to major fatal accidents. Due largely to the February 2009 crash of Colgan Air Flight 3407, which killed 50 people and was partially attributed to pilot fatigue, the FAA reviewed its procedures to ensure that pilots are sufficiently rested. Air traffic controllers were under scrutiny when in 2010 there were 10 incidents of controllers falling asleep while on shift. The common practice of turn-around shifts caused sleep deprivation and was a contributing factor to all air traffic control incidents. The FAA reviewed its practices of shift changes and the findings saw that controllers were not well rested. [86] A 2004 study also found medical residents with less than four hours of sleep a night made more than twice as many errors as the 11% of surveyed residents who slept for more than seven hours a night. [87]

Twenty-four hours of continuous sleep deprivation results in the choice of less difficult math tasks without decreases in subjective reports of effort applied to the task. Naturally caused sleep loss affects the choice of everyday tasks such that low effort tasks are mostly commonly selected. Adolescents who experience less sleep show a decreased willingness to engage in sports activities that require effort through fine motor coordination and attention to detail. [88] [89]

Great sleep deprivation mimics psychosis: distorted perceptions can lead to inappropriate emotional and behavioral responses. [90]

Astronauts have reported performance errors and decreased cognitive ability during periods of extended working hours and wakefulness as well as due to sleep loss caused by circadian rhythm disruption and environmental factors. [91]

One study has found that a single night of sleep deprivation may cause tachycardia (in the following day). [92]

Generally, sleep deprivation may facilitate or intensify: [93]

  • aching muscles [94] , memory lapses or loss [95][95]
  • development of false memory and hypnopompichallucinations during falling asleep and waking, which are entirely normal [96]
  • hand tremor[97] , commonly known as "bags under eyes" or eye bags
  • increased blood pressure[98]
  • increased stress hormone levels [98]
  • increased risk of Type 2 diabetes[98]
  • lowering of immunity, increased susceptibility to illness [99]
  • increased risk of fibromyalgia[100][93] (rapid involuntary rhythmic eye movement) [101][98][102] in children [93]
  • violent behavior [103][93][104][105]
  • symptoms similar to:
      (ADHD) [93][96][106][107][108]
  • Patients suffering from sleep deprivation may present with complaints of symptoms and signs of insufficient sleep such as fatigue, sleepiness, drowsy driving, and cognitive difficulties. Sleep insufficiency can easily go unrecognized and undiagnosed unless patients are specifically asked about it by their clinicians. [109]

    Several questions are critical in evaluating sleep duration and quality, as well as the cause of sleep deprivation. Sleep patterns (typical bed time or rise time on weekdays and weekends), shift work, and frequency of naps can reveal the direct cause of poor sleep, and quality of sleep should be discussed to rule out any diseases such as obstructive sleep apnea and restless leg syndrome. [109]

    Sleep diaries are useful in providing detailed information about sleep patterns. They are inexpensive, readily available, and easy to use. The diaries can be as simple as a 24-hour log to note the time of being asleep or can be detailed to include other relevant information. [110] [111] Sleep questionnaires such as the Sleep Timing Questionnaire (STQ) can be used instead of sleep diaries if there is any concern for patient adherence. [112]

    Actigraphy is a useful, objective wrist-worn tool if the validity of self-reported sleep diaries or questionnaires is questionable. Actigraphy works by recording movements and using computerized algorithms to estimate total sleep time, sleep onset latency, the amount of wake after sleep onset, and sleep efficiency. Some devices have light sensors to detect light exposure. [113] [114] [115] [116]

    Although there are numerous causes of sleep deprivation, there are some fundamental measures that promote quality sleep as suggested by organizations such as Centers for Disease Control and Prevention, the National Institute of Health, the National Institute of Aging, and the American Academy of Family Physicians. The key is to implement healthier sleep habits, also known as sleep hygiene. [117] Sleep hygiene recommendations include setting a fixed sleep schedule, taking naps with caution, maintaining a sleep environment that promotes sleep (cool temperature, limited exposure to light and noise, comfortable mattress and pillows), exercising daily, avoiding alcohol, cigarettes, caffeine, and heavy meals in the evening, winding down and avoiding electronic use or physical activities close to bedtime, and getting out of bed if unable to fall asleep. [118]

    For long term involuntary sleep deprivation, cognitive behavioral therapy for Insomnia (CBT-i) is commonly recommended as a first-line treatment, after exclusion of physical diagnosis (f.e. sleep apnea). CBT-i contains five different components: cognitive therapy, stimulus control, sleep restriction, sleep hygiene, and relaxation. These components together have shown to be effective in adults, with clinical meaningful effect sizes. As this approach has minimal adverse effects, and long-term benefits, it is often preferred to (chronic) drug therapy. [119]

    There are several strategies that help increase alertness and counteract the effects of sleep deprivation. Caffeine is often used over short periods to boost wakefulness when acute sleep deprivation is experienced however, caffeine is less effective if taken routinely. [120] Other strategies recommended by the American Academy of Sleep Medicine include prophylactic sleep before deprivation, naps, other stimulants, and combinations thereof. However, the only sure and safe way to combat sleep deprivation is to increase nightly sleep time. [121]

    To facilitate abusive control Edit

    Sleep deprivation can be used to disorientate abuse victims to help set them up for abusive control. [122] [123]

    Interrogation Edit

    Sleep deprivation can be used as a means of interrogation, which has resulted in court trials over whether or not the technique is a form of torture. [124]

    Under one interrogation technique, a subject might be kept awake for several days and when finally allowed to fall asleep, suddenly awakened and questioned. Menachem Begin, the Prime Minister of Israel from 1977 to 1983, described his experience of sleep deprivation as a prisoner of the NKVD in Soviet Union as follows:

    In the head of the interrogated prisoner, a haze begins to form. His spirit is wearied to death, his legs are unsteady, and he has one sole desire: to sleep. Anyone who has experienced this desire knows that not even hunger and thirst are comparable with it. [125]

    Sleep deprivation was one of the five techniques used by the British government in the 1970s. The European Court of Human Rights ruled that the five techniques "did not occasion suffering of the particular intensity and cruelty implied by the word torture . [but] amounted to a practice of inhuman and degrading treatment", in breach of the European Convention on Human Rights. [126]

    The United States Justice Department released four memos in August 2002 describing interrogation techniques used by the Central Intelligence Agency. They first described 10 techniques used in the interrogation of Abu Zubaydah, described as a terrorist logistics specialist, including sleep deprivation. Memos signed by Steven G. Bradbury in May 2005 claimed that forced sleep deprivation for up to 180 hours ( 7 + 1 ⁄ 2 days) [127] [128] by shackling a diapered prisoner to the ceiling did not constitute torture, [129] nor did the combination of multiple interrogation methods (including sleep deprivation) constitute torture under United States law. [130] [131] These memoranda were repudiated and withdrawn during the first months of the Obama administration. [127]

    The question of extreme use of sleep deprivation as torture has advocates on both sides of the issue. In 2006, Australian Federal Attorney-General Philip Ruddock argued that sleep deprivation does not constitute torture. [132] Nicole Bieske, a spokeswoman for Amnesty International Australia, has stated the opinion of her organization thus: "At the very least, sleep deprivation is cruel, inhumane and degrading. If used for prolonged periods of time it is torture." [133]

    Treating depression Edit

    Studies show that sleep restriction has some potential in treating depression. [4] Those who suffer from depression tend to have earlier occurrences of REM sleep with an increased number of rapid eye movements therefore, monitoring patients' EEG and awakening them during occurrences of REM sleep appear to have a therapeutic effect, alleviating depressive symptoms. [134] This kind of treatment is known as wake therapy. Although as many as 60% of patients show an immediate recovery when sleep-deprived, most patients relapse the following night. The effect has been shown to be linked to an increase in the brain-derived neurotrophic factor (BDNF). [135] A comprehensive evaluation of the human metabolome in sleep deprivation in 2014 found that 27 metabolites are increased after 24 waking hours and suggested serotonin, tryptophan, and taurine may contribute to the antidepressive effect. [136]

    The incidence of relapse can be decreased by combining sleep deprivation with medication or a combination of light therapy and phase advance (going to bed substantially earlier than one's normal time). [137] [138] Many tricyclic antidepressants suppress REM sleep, providing an additional evidence for a link between mood and sleep. [139] Similarly, tranylcypromine has been shown to completely suppress REM sleep at adequate doses.

    Treating insomnia Edit

    Sleep deprivation can be implemented for a short period of time in the treatment of insomnia. Some common sleep disorders have been shown to respond to cognitive behavioral therapy for insomnia. One of the components is a controlled regime of "sleep restriction" in order to restore the homeostatic drive to sleep and encourage normal "sleep efficiency". [140] The main goal of stimulus control and sleep restriction therapy is to create an association between bed and sleep. Although sleep restriction therapy shows efficacy when applied as an element of cognitive-behavioral therapy, its efficacy is yet to be proven when used alone. [141] [119]

    National Geographic Magazine has reported that the demands of work, social activities, and the availability of 24-hour home entertainment and Internet access have caused people to sleep less now than in premodern times. [142] USA Today reported in 2007 that most adults in the USA get about an hour less than the average sleep time 40 years ago. [143]

    Other researchers have questioned these claims. A 2004 editorial in the journal Sleep stated that according to the available data, the average number of hours of sleep in a 24-hour period has not changed significantly in recent decades among adults. Furthermore, the editorial suggests that there is a range of normal sleep time required by healthy adults, and many indicators used to suggest chronic sleepiness among the population as a whole do not stand up to scientific scrutiny. [144]

    A comparison of data collected from the Bureau of Labor Statistics' American Time Use Survey from 1965–1985 and 1998–2001 has been used to show that the median amount of sleep, napping, and resting done by the average adult American has changed by less than 0.7%, from a median of 482 minutes per day from 1965 through 1985, to 479 minutes per day from 1998 through 2001. [145] [146]

    Randy Gardner holds the scientifically documented record for the longest period of time a human being has intentionally gone without sleep not using stimulants of any kind. Gardner stayed awake for 264 hours (11 days), breaking the previous record of 260 hours held by Tom Rounds of Honolulu. [90] LCDR John J. Ross of the U.S. Navy Medical Neuropsychiatric Research Unit later published an account of this event, which became well known among sleep-deprivation researchers. [90] [147] [148]

    The Guinness World Record stands at 449 hours (18 days, 17 hours), held by Maureen Weston, of Peterborough, Cambridgeshire in April 1977, in a rocking-chair marathon. [147]

    Claims of total sleep deprivation lasting years have been made several times, [149] [150] [151] but none are scientifically verified. [152] Claims of partial sleep deprivation are better documented. For example, Rhett Lamb of St. Petersburg, Florida was initially reported to not sleep at all, but actually had a rare condition permitting him to sleep only one to two hours per day in the first three years of his life. He had a rare abnormality called an Arnold–Chiari malformation where brain tissue protrudes into the spinal canal and the skull puts pressure on the protruding part of the brain. The boy was operated on at All Children's Hospital in St. Petersburg in May 2008. Two days after surgery he slept through the night. [153] [154]

    French sleep expert Michel Jouvet and his team reported the case of a patient who was quasi-sleep-deprived for four months, as confirmed by repeated polygraphic recordings showing less than 30 minutes (of stage-1 sleep) per night, a condition they named "agrypnia". The 27-year-old man was suffering from Morvan's fibrillary chorea, a rare disease that leads to involuntary movements, and in this particular case, extreme insomnia. The researchers found that treatment with 5-HTP restored almost normal sleep stages. However some months after this recovery the patient died during a relapse which was unresponsive to 5-HTP. The cause of death was pulmonary edema. Despite the extreme insomnia, psychological investigation showed no sign of cognitive deficits, except for some hallucinations. [155]

    Fatal insomnia is a neurodegenerative disease eventually resulting in a complete inability to go past stage 1 of NREM sleep. In addition to insomnia, patients may experience panic attacks, paranoia, phobias, hallucinations, rapid weight loss, and dementia. Death usually occurs between 7 and 36 months from onset.


    How to Fall Asleep Easier As a Teen

    This article was co-authored by Alex Dimitriu, MD. Alex Dimitriu, MD is the Owner of Menlo Park Psychiatry and Sleep Medicine, a clinic based in the San Francisco Bay Area with expertise in psychiatry, sleep, and transformational therapy. Alex earned his Doctor of Medicine from Stony Brook University in 2005 and graduated from the Stanford University School of Medicine's Sleep Medicine Residency Program in 2010. Professionally, Alex has dual board certification in psychiatry and sleep medicine.

    There are 21 references cited in this article, which can be found at the bottom of the page.

    wikiHow marks an article as reader-approved once it receives enough positive feedback. This article received 13 testimonials and 82% of readers who voted found it helpful, earning it our reader-approved status.

    This article has been viewed 1,130,263 times.

    Balancing school, activities, and homework makes it hard for teens to get the recommended amount of sleep each night. That balancing act is even tougher to manage if you’re up late tossing and turning. Try to relax and clear your mind if you have trouble falling asleep. To prevent insomnia, make your bedroom as sleep-friendly as possible, and work on developing a relaxing nightly routine.


    Blacking Out

    People say they black out all the time: at parties, during arguments, while taking tests, and under distress in general. Some blame alcohol. Others claim to be overcome by something they cannot quite pin down. Either way, it raises the question: What really happens?

    For your reference, here’s a picture of the human brain. We’ll be talking quite a bit about it, so make sure you familiarize yourself with it.

    As you can see from all the arrows, Latin nomenclature, and tubular stuff, this organ is no picnic. Once this is clear, it should come as no surprise that any meaningful answer about this system requires a very precise question. In other words, we need to be perfectly clear about what we are asking.

    Personally, I had to learn this the hard way: last week, I emailed a dozen neurologists asking them to define unconsciousness for me. While those who got back to me brimmed with enthusiasm about the topic, everyone seemed to tread lightly, citing a limited scientific consensus. Put simply, unconsciousness is the temporary or permanent absence of consciousness — and without a clear definition of consciousness, we can’t really talk about either in a meaningful way.


    New study says that it’s okay to let babies cry at night

    ARCHIVED CONTENT: As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date each article was posted or last reviewed. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

    When my eldest was a baby, I remember feeling so torn when she cried during the night. Our pediatrician and my mother both said that it was okay to let her cry for a while and let her learn to go back to sleep. But as I listened to her cry, I wondered: Will this make her too stressed? Will it damage her emotionally? Will it ruin our relationship?

    The answer to all of those questions, according to a new study published in the journal Pediatrics, is no. Not only that, if I’d done it (I didn’t, I was too worried), my daughter and I might have gotten a bunch more sleep.

    Researchers from Australia worked with families who said that their babies (ages 6-16 months) had a sleep problem. They divided the families into three groups. One was told to do “graduated extinction,” during which they let the baby cry first just for a minute before going in and interacting with them, and then gradually increased the amount of time they let them cry. Another group did something called “bedtime fading,” where they told the parents to delay bedtime so that the babies were more tired. The last group was the “control” group and got education on babies and sleep, but nothing else.

    To measure the effects on the babies, the researchers did something interesting: they measured the level of cortisol, a stress hormone, in the babies’ saliva. They also asked the mothers about their levels of stress. Twelve months later, they looked for any emotional or behavioral problems in the babies, and they also did testing to see how attached the babies were to their mothers.

    Here’s what they found. The babies in the graduated extinction group and the bedtime fading group both fell asleep faster and had less stress than the control group — and not only that, their mothers were less stressed than the control group mothers. Of the three groups, the extinction group babies were less likely to wake up again during the night. And when it came to emotional or behavioral problems, or attachment, all three groups were the same.

    This means that it’s okay to let your baby cry a little. It’s not only okay, it may lead to more sleep all around. Which makes everyone happier.

    In another study published about four years ago, researchers looked even further out than a year. They compared families who did sleep training and families who didn’t and followed them for six years. There was no difference between the two groups. Whether parents let babies cry or got up all night to hold them, the kids turned out the same.

    We can get sleep and still have well-adjusted kids who love us. How great is that?

    Just to be clear, “graduated extinction” doesn’t mean letting your kid cry all night. It just means that you slowly but surely help your baby learn to soothe himself when he wakes up at night, instead of always relying on you to do it. (Dr. Richard Ferber has a great book called Solve Your Child’s Sleep Problems that explains all of this and is very helpful.)

    It’s a natural instinct to want to stop your baby from crying. But sometimes, milestones in life involve some crying — whether it’s learning to fall back to sleep, learning to walk (there’s always a tumble), starting daycare or school (leaving parents is hard), making friends (kids can be mean), playing sports (you don’t always win), or learning to drive (oh, wait, it’s the parents who cry with that one). Never letting our children cry doesn’t help them in fact, it can end up hurting them.

    And let’s face it: getting sleep helps us be better parents.

    If your baby is waking up crying at night, talk to your doctor. There are lots of reasons babies cry at night. But if your doctor tells you that everything is okay, don’t feel that you have to respond to every single cry.


    Why You Dream

    As you sleep, your brain cycles through multiple stages of brain activity. The first three stages of sleep are called non-rapid eye movement (non-REM) sleep, and they progress from light sleep (Stage 1) to deeper sleep (Stage 3) as your body relaxes. In the final stage you experience rapid eye movement (REM) sleep, which occurs when your thalamus (the part of the brain that relays sensory information) kicks into high gear. This is when most of your dreaming occurs. You typically spend about two hours dreaming each night, even if you don’t remember those dreams in the morning.

    Experts still don’t know exactly why we dream, but there’s an undeniable connection between dreams and the real-life things we’re dealing with. “I like to say that dreams are just thinking in a very different brain state,” says Barrett. “We continue to think and worry about our fears, our hopes and aspirations, and our emotional and interpersonal life.” The difference is that our typical environment (the world around us) isn’t present in our dreams. Think of your sleeping mind like a blank state for your thoughts to play around in.


    What are the Benefits of Listening to Music Before You Sleep?

    Many people struggle with getting to sleep at night, and the benefit of listening to music is that it can help you get into the sleep zone by relaxing you.

    Although we all have a different response to music, listening to familiar much-loved music can improve mood and feelings of wellbeing.

    According to studies, listening to music can increase sleep-inducing hormones serotonin and oxytocin.

    Physical benefits of listening to music while you go to sleep are that it can reduce heart rate and blood pressure and help you relax muscles.


    Why Falling Asleep When Driving Happens and How to Handle It

    Falling asleep while you're driving can be dangerous, both for you and others on the road. Feeling drowsy behind the wheel is a very common phenomenon, but becoming so tired that you fall asleep at the wheel can be a sign that you may be suffering from a serious sleep problem that will need to be addressed. Nodding off for as little as three seconds while you are driving can cause a fatal accident. Even driving while drowsy can slow your reaction time enough to increase your risk of serious accidents on the road.

    Causes of Falling Asleep While Driving

    Sleep loss is one of the most common causes of drowsy driving. Many conditions can cause the patient to suffer from sleep deprivation. Personal demands, stress or lifestyle choices can cause people to miss the 7-9 hours of sleep they need. Troubled sleep may also fail to provide adequate rest, causing the patient to feel drowsy throughout the day.

    Sleep Disorders

    Undiagnosed sleep disorders or sleep disorders that are not being treated properly can cause you to feel drowsy throughout the day. These symptoms can be worsened when performing repetitive activities such as driving. Noting your other symptoms and working with your doctor can help you learn if you have sleep disorders such as restless leg syndrome, narcolepsy or obstructive sleep apnea that could be affecting your ability to perform tasks like driving safely.

    • Narcolepsy- Narcolepsy is a chronic condition that affects your ability to properly regulate your sleep schedule. Narcolepsy is caused by environmental triggers that induce your brain to rapidly release the chemicals which lead you to fall asleep. This can cause sudden loss of muscle control, strong emotions or severe daytime fatigue. You may also notice nighttime wakefulness, sleep paralysis, rapid entry to REM sleep or hallucinations. Your doctor can perform a spinal fluid analysis, nocturnal polysomnogram or multiple sleep latency tests to determine if you suffer from narcolepsy.
    • Obstructive sleep apnea- This condition causes the patient to stop breathing while you are asleep. This can be caused by the airway becoming blocked or conditions that cause the airways to become floppy or narrowed because the body relaxes to the point where the muscles that regulate your breathing do not function properly. Sleep apnea can cause patients to become forgetful, grumpy, impatient or suffer from headaches. They may fall asleep during daily activities because they are not getting the rest they need at night. Doctors will perform an ECG, echocardiogram or an examination of thyroid function and arterial blood gasses to check for sleep apnea.
    • Restless leg syndrome and periodic limb movement disorder- Restless leg syndrome or periodic limb movement disorder commonly coexist in patients. In combination, these conditions can cause insomnia, excessive daytime sleepiness and daytime fatigue. It can also cause difficulty when you try to move your limbs, which can result in you losing control when performing activities such as driving. Patients that seem to be showing signs of limb movement disorders can go over these concerns with their doctor to determine if they have a condition that requires treatment. Medication can often be prescribed to help avoid falling asleep while driving in such cases.

    Disruption of Biological Clock

    The circadian pacemaker or biological clock is the body's natural mechanism that tells it when it is time to sleep. This mechanism sends the signals to the brain and tells it to get sleep in the mid-afternoon and at night. If you are working a job at this time or performing stressful tasks you can become susceptible to falling asleep during these activities.

    Medications and Alcohol

    Alcohol is a depressant which will increase feelings of sleepiness or fatigue that are present. Some medications also list fatigue as a side effect. Ingesting these substances, such as antidepressant, antihistaminic, benzodiazepine and antipsychotic before driving can be dangerous. If you are taking a medication for the first time, avoid performing activities like driving until you know how they will affect you.

    Poor Sleeping Habit or Sleep Loss

    In order to maintain optimum health, people should get between 7-9 hours of sleep per night. But activities such as working late, worrying about personal issues or choosing to stay up late to socialize can interrupt this natural sleep schedule. Consistently interrupting your sleep schedule or failing to get an adequate amount of sleep per night will cause you to become drowsy during the day. If this condition is not addressed you can find yourself falling asleep while you try to function throughout the day, which may include falling asleep behind the wheel.

    Tips to Avoid Falling Asleep While Driving

    Tips for Getting Enough Sleep

    One of the most important tips to avoid sleepiness while driving it so make sure you get enough sleep every night. Make a point of setting your schedule so you can get 7-8 hours of sleep each night. Try to go bed around the same time every night and get up around the same time every day to allow your body to become used to this schedule.

    Getting restful sleep is also a key to avoiding fatigue during the day. Avoid eating big meals before bed and avoid consuming alcohol for at least three hours before going to bed. Avoid substances like caffeine for at least six hours before you try to sleep. If you have trouble sleeping, make sure you have a comfortable room to sleep in that is not disrupted by uncomfortable temperature, excessive light or noise.

    Tips for Driving on the Road

    Since falling asleep while driving is so dangerous, you should know these tips to keep you on the safe side. Try to avoid driving when you are feeling drowsy. If you will be driving for a long period of time, avoid using the cruise control setting. Staying actively involved with your driving can help you stay alert. If you find yourself becoming drowsy or distracted, keep the car cool to help promote alertness. Listen to music or get involved with an active conversation to help relieve the monotony associated with driving.

    Avoid driving for long periods at night or driving for long distances alone. If you must travel long distances, make a point of stopping at a rest area every 1-2 hours to exercise and increase your energy level. If necessary, stop in a rest area to take a 15-20 minute nap to avoid falling asleep behind the wheel. Once you begin driving again, make a point of sitting up straight. Slouching down in the seat can promote sleepiness, particularly if you are driving at night.


    Blacking Out

    People say they black out all the time: at parties, during arguments, while taking tests, and under distress in general. Some blame alcohol. Others claim to be overcome by something they cannot quite pin down. Either way, it raises the question: What really happens?

    For your reference, here’s a picture of the human brain. We’ll be talking quite a bit about it, so make sure you familiarize yourself with it.

    As you can see from all the arrows, Latin nomenclature, and tubular stuff, this organ is no picnic. Once this is clear, it should come as no surprise that any meaningful answer about this system requires a very precise question. In other words, we need to be perfectly clear about what we are asking.

    Personally, I had to learn this the hard way: last week, I emailed a dozen neurologists asking them to define unconsciousness for me. While those who got back to me brimmed with enthusiasm about the topic, everyone seemed to tread lightly, citing a limited scientific consensus. Put simply, unconsciousness is the temporary or permanent absence of consciousness — and without a clear definition of consciousness, we can’t really talk about either in a meaningful way.


    How to Fall Asleep Easier As a Teen

    This article was co-authored by Alex Dimitriu, MD. Alex Dimitriu, MD is the Owner of Menlo Park Psychiatry and Sleep Medicine, a clinic based in the San Francisco Bay Area with expertise in psychiatry, sleep, and transformational therapy. Alex earned his Doctor of Medicine from Stony Brook University in 2005 and graduated from the Stanford University School of Medicine's Sleep Medicine Residency Program in 2010. Professionally, Alex has dual board certification in psychiatry and sleep medicine.

    There are 21 references cited in this article, which can be found at the bottom of the page.

    wikiHow marks an article as reader-approved once it receives enough positive feedback. This article received 13 testimonials and 82% of readers who voted found it helpful, earning it our reader-approved status.

    This article has been viewed 1,130,263 times.

    Balancing school, activities, and homework makes it hard for teens to get the recommended amount of sleep each night. That balancing act is even tougher to manage if you’re up late tossing and turning. Try to relax and clear your mind if you have trouble falling asleep. To prevent insomnia, make your bedroom as sleep-friendly as possible, and work on developing a relaxing nightly routine.


    Timing Is Everything

    When a sleeping brain hears a word proved to be an important component in sleep learning. During slow wave sleep our brains alternate between “up states” and “down states” every half-second. During up states, the brain is highly active and interconnected — prime for learning.

    “We looked how often we managed to hit these up-states with our word presentation, and what we found was that there is a clear dose-response curve: the more often you hit an up-state, the better the memory.”

    In other words, people were more likely to correctly classify the words they heard during slow-wave peaks than the ones they heard during less-optimal periods of brain activity. To see what was happening inside the brain, a subgroup of participants performed the post-sleep memory test while being imaged with fMRI. As participants classified the new words they learned while sleeping, fMRI imaging showed that the language areas of the brain and hippocampus were activated.

    It’s an indication that these structures allow for memory formation whether we’re awake or asleep, according to Züst.


    "Guga" means elephant: Learning languages during sleep?

    Andrillon and his colleagues have found that learning in sleep can go beyond simple conditioning. In their 2017 study published in the journal Nature Communications, subjects were able to pick out complex sound patterns that they had heard during sleep.

    Learning abilities in sleep may extend to the learning of words. In a study published in the journal Current Biology in January, researchers played pairs of made-up words and their supposed meanings, like that "guga" means elephant, to sleeping participants. After this, when awake, the people performed better than chance when they had to pick the right translation of made-up words in a multichoice test.

    What all these studies have in common is that they show an implicit form of memory. "It's not some knowledge they'll be able to use spontaneously, because they don't know this knowledge is even there," Andrillion said. "The question is, 'Where do we go from there?'"

    Learning a new language involves many different layers: recognizing the sounds, learning the vocabulary and mastering the grammar. So far, research suggests it may be possible to get familiarized with the tone and accent of a language or even the meaning of words while sleeping, but to a weaker level than what we already do all the time during the day without noticing. [Why Don't We Remember Being Babies?]

    And then you have to consider the cost, Andrillion said. Stimulating the sleeping brain with new information likely disrupts the functions of sleep, negatively affecting the pruning and strengthening of what we have learned over the previous day, he said.

    While losing quality sleep to potentially learn a few words is not a smart trade-off, researchers continue to study sleep learning because the compromise may be worth it in special cases. For example, sleep learning could be useful when people need to change a habit or alter stubborn disturbing memories in cases of phobias and post-traumatic stress disorder.

    And some forms of implicit learning that may help in those situation may occur more strongly during sleep. The conditioning that happened in the smoking and rotten egg study, for example, doesn't work well when done during wakefulness. If you smoke every day near a garbage bin, you know the two are unrelated, so you don't link them. We are not easily tricked when awake.

    "But the sleeping brain is not so smart, and we can manipulate it for our own good," Andrillion said. "It sounds a lot like the 'Eternal Sunshine' [movie], and this is still ongoing work, but the possibility is there."

    Until then, remember that a good night's sleep is already sleep learning at its best.


    New study says that it’s okay to let babies cry at night

    ARCHIVED CONTENT: As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date each article was posted or last reviewed. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

    When my eldest was a baby, I remember feeling so torn when she cried during the night. Our pediatrician and my mother both said that it was okay to let her cry for a while and let her learn to go back to sleep. But as I listened to her cry, I wondered: Will this make her too stressed? Will it damage her emotionally? Will it ruin our relationship?

    The answer to all of those questions, according to a new study published in the journal Pediatrics, is no. Not only that, if I’d done it (I didn’t, I was too worried), my daughter and I might have gotten a bunch more sleep.

    Researchers from Australia worked with families who said that their babies (ages 6-16 months) had a sleep problem. They divided the families into three groups. One was told to do “graduated extinction,” during which they let the baby cry first just for a minute before going in and interacting with them, and then gradually increased the amount of time they let them cry. Another group did something called “bedtime fading,” where they told the parents to delay bedtime so that the babies were more tired. The last group was the “control” group and got education on babies and sleep, but nothing else.

    To measure the effects on the babies, the researchers did something interesting: they measured the level of cortisol, a stress hormone, in the babies’ saliva. They also asked the mothers about their levels of stress. Twelve months later, they looked for any emotional or behavioral problems in the babies, and they also did testing to see how attached the babies were to their mothers.

    Here’s what they found. The babies in the graduated extinction group and the bedtime fading group both fell asleep faster and had less stress than the control group — and not only that, their mothers were less stressed than the control group mothers. Of the three groups, the extinction group babies were less likely to wake up again during the night. And when it came to emotional or behavioral problems, or attachment, all three groups were the same.

    This means that it’s okay to let your baby cry a little. It’s not only okay, it may lead to more sleep all around. Which makes everyone happier.

    In another study published about four years ago, researchers looked even further out than a year. They compared families who did sleep training and families who didn’t and followed them for six years. There was no difference between the two groups. Whether parents let babies cry or got up all night to hold them, the kids turned out the same.

    We can get sleep and still have well-adjusted kids who love us. How great is that?

    Just to be clear, “graduated extinction” doesn’t mean letting your kid cry all night. It just means that you slowly but surely help your baby learn to soothe himself when he wakes up at night, instead of always relying on you to do it. (Dr. Richard Ferber has a great book called Solve Your Child’s Sleep Problems that explains all of this and is very helpful.)

    It’s a natural instinct to want to stop your baby from crying. But sometimes, milestones in life involve some crying — whether it’s learning to fall back to sleep, learning to walk (there’s always a tumble), starting daycare or school (leaving parents is hard), making friends (kids can be mean), playing sports (you don’t always win), or learning to drive (oh, wait, it’s the parents who cry with that one). Never letting our children cry doesn’t help them in fact, it can end up hurting them.

    And let’s face it: getting sleep helps us be better parents.

    If your baby is waking up crying at night, talk to your doctor. There are lots of reasons babies cry at night. But if your doctor tells you that everything is okay, don’t feel that you have to respond to every single cry.


    Contents

    Insomnia Edit

    Insomnia, one of the six types of dyssomnia, affects 21–37% of the adult population. [7] [8] Many of its symptoms are easily recognizable, including excessive daytime sleepiness frustration or worry about sleep problems with attention, concentration, or memory extreme mood changes or irritability lack of energy or motivation poor performance at school or work and tension headaches or stomach aches.

    Insomnia can be grouped into primary and secondary, or comorbid, insomnia. [9] [10] [11]

    Primary insomnia is a sleep disorder not attributable to a medical, psychiatric, or environmental cause. [12] There are three main types of primary insomnia. These include: psychophysiological, idiopathic insomnia, and sleep state misperception (paradoxical insomnia). [9] Psychophysiological insomnia is anxiety-induced. Idiopathic insomnia generally begins in childhood and lasts the rest of a person's life. It's suggested that idiopathic insomnia is a neurochemical problem in a part of the brain that controls the sleep-wake cycle, resulting in either under-active sleep signals or over-active wake signals. Sleep state misperception is diagnosed when people get enough sleep but inaccurately perceive that their sleep is insufficient. [13] [ citation needed ]

    Secondary insomnia, or comorbid insomnia, occurs concurrently with other medical, neurological, psychological and psychiatric conditions. Causation is not necessarily implied. [14]

    Sleep is known to be cumulative. This means that the fatigue and sleep one lost as a result, for example, staying awake all night, would be carried over to the following day. Not getting enough sleep a couple days cumulatively builds up a deficiency and that's when all the symptoms of sleep deprivation come in. When one is well rested and healthy, the body naturally spends not as much time in the REM stage of sleep. The more time one's body spends in REM sleep, causes one to be exhausted, less time in that stage will promote more energy when awakened. [15]

    Sleep apnea Edit

    Obstructive sleep apnea is often caused by collapse of the upper airway during sleep, which reduces airflow to the lungs. Those who suffer from sleep apnea may experience symptoms such as awakening gasping or choking, restless sleep, morning headaches, morning confusion or irritability and restlessness. This disorder affects between 1 and 10 percent of Americans. [16] It has many serious health outcomes if untreated. Positive airway pressure therapy using a CPAP (Continuous positive airway pressure), APAP or BPAP devices is considered to be the first line treatment option for sleep apnea. [17] Mandibular displacement devices in some cases can reposition the jaw and tongue to prevent the airway from collapsing. For some patients supplemental oxygen therapy may be indicated. Nasal problems such as a deviated septum will shut down the airway and increase swelling in the mucus lining and nasal turbinates. Corrective surgery (septoplasty) in some cases may be an appropriate choice of treatment.

    Central sleep apnea is caused by a failure of the central nervous system to signal the body to breathe during sleep. Treatments similar to obstructive sleep apnea may be used as well as other treatments such as Adaptive Servo Ventilation and certain medications. Some medications such as opioids may contribute to or cause central sleep apnea. [18]

    Voluntary Edit

    Sleep deprivation can sometimes be self-imposed due to a lack of desire to sleep or the habitual use of stimulant drugs. Sleep deprivation is also self-imposed to achieve personal fame in the context of record-breaking stunts.

    Mental illness Edit

    The specific causal relationships between sleep loss and effects on psychiatric disorders have been most extensively studied in patients with mood disorders. [ medical citation needed ] Shifts into mania in bipolar patients are often preceded by periods of insomnia, [19] and sleep deprivation has been shown to induce a manic state in about 30% of patients. [20] Sleep deprivation may represent a final common pathway in the genesis of mania, [21] and manic patients usually have a continuous reduced need for sleep. [22]

    The symptoms of sleep deprivation and those of schizophrenia are paralleled, including those of positive and cognitive symptoms. [23]

    School Edit

    The National Sleep Foundation cites a 1996 paper showing that college/university-aged students got an average of less than 6 hours of sleep each night. [24] A 2018 study highlights the need for a good night's sleep for students finding that college students who averaged eight hours of sleep for the five nights of finals week scored higher on their final exams than those who didn't. [25]

    In the study, 70.6% of students reported obtaining less than 8 hours of sleep, and up to 27% of students may be at risk for at least one sleep disorder. [26] Sleep deprivation is common in first year college students as they adjust to the stress and social activities of college life.

    A study performed by the Department of Psychology at the National Chung Cheng University in Taiwan concluded that freshmen received the least amount of sleep during the week. [27]

    Studies of later start times in schools have consistently reported benefits to adolescent sleep, health and learning using a wide variety of methodological approaches. In contrast, there are no studies showing that early start times have any positive impact on sleep, health or learning. [28] "Astronomical" data from international studies demonstrate that "synchronised" start times for adolescents are far later than the start times in the overwhelming majority of educational institutions. [29] In 1997, University of Minnesota research compared students who started school at 7:15 am with those who started at 8:40 am. They found that students who started at 8:40 got higher grades and more sleep on weekday nights than those who started earlier. [30] One in four U.S. high school students admits to falling asleep in class at least once a week. [31]

    It is known that during human adolescence, circadian rhythms and therefore sleep patterns typically undergo marked changes. Electroencephalogram (EEG) studies indicate a 50% reduction of deep (stage 4) sleep and a 75% reduction in the peak amplitude of delta waves during NREM sleep in adolescence. School schedules are often incompatible with a corresponding delay in sleep offset, leading to a less than optimal amount of sleep for the majority of adolescents. [32]

    Hospital stay Edit

    A study performed nationwide in the Netherlands found that general ward patients staying at the hospital experienced shorter total sleep (83 min. less), more night-time awakenings, and earlier awakenings compared to sleeping at home. Over 70% experienced being woken up by external causes, such as hospital staff (35.8%). Sleep disturbing factors included noise of other patients, medical devices, pain, and toilet visits. [33] Sleep deprivation is even more severe in ICU patients, where the naturally occurring nocturnal peak of melatonin secretion was found to be absent, possibly causing the disruption in the normal sleep-wake cycle. [34] However, as the personal characteristics and the clinical picture of hospital patients are so diverse, the possible solutions to improve sleep and circadian rhythmicity should be tailored to the individual and within the possibilities of the hospital ward. Multiple interventions could be considered to aid patient characteristics, improve hospital routines, or the hospital environment. [35]

    Internet Edit

    Study published in the Journal of Economic Behavior and Organisation found out that the broadband internet connection was associated with sleep deprivation. The study concluded that the people with a broadband connection tend to sleep 25 minutes less than those without the broadband connection, hence they are less likely to get the scientifically recommended 7–9 hours of sleep. [36] According to another study published by 9 out of 10 people use their smartphones, browsing the Internet before bedtime and this affects their sleep quality poorly. [37]

    Brain Edit

    One study suggested, based on neuroimaging, that 35 hours of total sleep deprivation in healthy controls negatively affected the brain's ability to put an emotional event into the proper perspective and make a controlled, suitable response to the event. [38]

    The negative effects of sleep deprivation on alertness and cognitive performance suggest decreases in brain activity and function. These changes primarily occur in two regions: the thalamus, a structure involved in alertness and attention and the prefrontal cortex, a region sub-serving alertness, attention, and higher-order cognitive processes. [39] This was the finding of an American study in 2000. Seventeen men in their 20s were tested. Sleep deprivation was progressive with measurements of glucose (absolute regional CMRglu), cognitive performance, alertness, mood, and subjective experiences collected after 0, 24, 48, and 72 hours of sleep deprivation. Additional measures of alertness, cognitive performance, and mood were collected at fixed intervals. PET scans were used and attention was paid to the circadian rhythm of cognitive performance. [39]

    A noted 2002 University of California animal study indicated that non-rapid eye movement sleep (NREM) is necessary for turning off neurotransmitters and allowing their receptors to "rest" and regain sensitivity which allows monoamines (norepinephrine, serotonin and histamine) to be effective at naturally produced levels. This leads to improved regulation of mood and increased learning ability. The study also found that rapid eye movement sleep (REM) deprivation may alleviate clinical depression because it mimics selective serotonin reuptake inhibitors (SSRIs). This is because the natural decrease in monoamines during REM is not allowed to occur, which causes the concentration of neurotransmitters in the brain, that are depleted in clinically depressed persons, to increase. Sleep outside of the REM phase may allow enzymes to repair brain cell damage caused by free radicals. High metabolic activity while awake damages the enzymes themselves preventing efficient repair. This study observed the first evidence of brain damage in rats as a direct result of sleep deprivation. [40]

    Animal studies suggest that sleep deprivation increases levels of stress hormones, which may reduce new cell production in adult brains. [41]

    Attention and working memory Edit

    Among the possible physical consequences of sleep deprivation, deficits in attention and working memory are perhaps the most important [2] such lapses in mundane routines can lead to unfortunate results, from forgetting ingredients while cooking to missing a sentence while taking notes. Performing tasks that require attention appears to be correlated with number of hours of sleep received each night, declining as a function of hours of sleep deprivation. [42] Working memory is tested by methods such as choice-reaction time tasks. [2]

    The attentional lapses also extend into more critical domains in which the consequences can be life-or-death car crashes and industrial disasters can result from inattentiveness attributable to sleep deprivation. To empirically measure the magnitude of attention deficits, researchers typically employ the psychomotor vigilance task (PVT) which requires the subject to press a button in response to a light at random intervals. Failure to press the button in response to the stimulus (light) is recorded as an error, attributable to the microsleeps that occur as a product of sleep deprivation. [43]

    Crucially, individuals' subjective evaluations of their fatigue often do not predict actual performance on the PVT. While totally sleep-deprived individuals are usually aware of the degree of their impairment, lapses from chronic (lesser) sleep deprivation can build up over time so that they are equal in number and severity to the lapses occurring from total (acute) sleep deprivation. Chronically sleep-deprived people, however, continue to rate themselves considerably less impaired than totally sleep-deprived participants. [44] Since people usually evaluate their capability on tasks like driving subjectively, their evaluations may lead them to the false conclusion that they can perform tasks that require constant attention when their abilities are in fact impaired.

    Mood Edit

    Many people already know that sleep affects mood. Staying up all night or taking an unexpected night shift can make one feel irritable. Once one catches up on sleep, one's mood will often return to baseline or normal. Even partial sleep deprivation can have a significant impact on mood. In one study, subjects reported increased sleepiness, fatigue, confusion, tension, and total mood disturbance, which all recovered to their baseline after one to two full nights of sleep. [45] [46]

    Depression and sleep are in a bidirectional relationship. Poor sleep can lead to development of depression and depression can cause insomnia, hypersomnia, or obstructive sleep apnea. [47] [48] About 75% of adult patients with depression can present with insomnia. [49] Sleep deprivation, whether total or not, can induce significant anxiety and longer sleep deprivations tend to result in increased level of anxiety. [50]

    Interestingly, sleep deprivation has also shown some positive effects on mood. Sleep deprivation can be used to treat depression. [4] Also, chronotype can affect how sleep deprivation influences mood. Those with morningness (advanced sleep period or "lark") preference become more depressed after sleep deprivation while those with eveningness (delayed sleep period or "owl") preference show an improvement in mood. [51]

    Mood and mental states can affect sleep as well. Increased agitation and arousal from anxiety can keep you awake and stress can make you more aroused, awake, and alert. [45]

    Driving ability Edit

    The dangers of sleep deprivation are apparent on the road the American Academy of Sleep Medicine (AASM) reports that one in every five serious motor vehicle injuries is related to driver fatigue, with 80,000 drivers falling asleep behind the wheel every day and 250,000 accidents every year related to sleep, [52] though the National Highway Traffic Safety Administration suggests the figure for traffic accidents may be closer to 100,000. [30] The AASM recommends pulling off the road and taking a 15- or 20-minute nap to alleviate drowsiness. [52]

    According to a 2000 study published in the British Medical Journal, researchers in Australia and New Zealand reported that sleep deprivation can have some of the same hazardous effects as being drunk. [53] People who drove after being awake for 17–19 hours performed worse than those with a blood alcohol level of 0.05 percent, which is the legal limit for drunk driving in most western European countries and Australia. Another study suggested that performance begins to degrade after 16 hours awake, and 21 hours awake was equivalent to a blood alcohol content of 0.08 percent, which is the blood alcohol limit for drunk driving in Canada, the U.S., and the U.K. [54]

    Fatigue of drivers of goods trucks and passenger vehicles have come to the attention of authorities in many countries, where specific laws have been introduced with the aim of reducing the risk of traffic accidents due to driver fatigue. Rules concerning minimum break lengths, maximum shift lengths and minimum time between shifts are common in the driving regulations used in different countries and regions, such as the drivers' working hours regulations in the European Union and hours of service regulations in the United States.

    The Exxon Valdez Oil Spill was the second largest oil spill in the United States. This accident occurred when an Exxon oil tanker struck a reef at the Prince William Sound in Alaska. Approximately 10.8 million gallons of oil spilled into the sea. The accident caused great environmental damage including the death of hundreds of thousands of birds and sea creatures. Fatigue and sleep deprivation were the major contributors to the accident. The captain of the ship was asleep after a night of heavy drinking he was severely fatigued and had been awake for 18 hours. The entire crew was suffering from fatigue and inadequate sleep. [55]

    Sleep transition Edit

    Sleep propensity (SP) can be defined as the readiness to transit from wakefulness to sleep, or the ability to stay asleep if already sleeping. [56] Sleep deprivation increases this propensity, which can be measured by polysomnography (PSG), as a reduction in sleep latency (the time needed to fall asleep). [57] An indicator of sleep propensity can also be seen in the shortening of transition from light stages of non-REM sleep to deeper slow-waves oscillations can also be measured as indicator of sleep propensity. [57]

    On average, the latency in healthy adults decreases by a few minutes after a night without sleep, and the latency from sleep onset to slow-wave sleep is halved. [57] Sleep latency is generally measured with the multiple sleep latency test (MSLT). In contrast, the maintenance of wakefulness test (MWT) also uses sleep latency, but this time as a measure of the capacity of the participants to stay awake (when asked to) instead of falling asleep. [57]

    Sleep-wake cycle Edit

    Research studying sleep deprivation shows its impact on mood, cognitive and motor functioning, due to dysregulation of the sleep-wake cycle and augmented sleep propensity. [57] Multiple studies that identified the role of the hypothalamus and multiple neural systems controlling circadian rhythms and homeostasis have been helpful in understanding sleep deprivation better. [57] [58] To describe the temporal course of the sleep-wake cycle, the two-process model of sleep regulation can be mentioned. [57]

    This model proposes a homeostatic process (Process S) and a circadian process (Process C) that interact to define the time and intensity of sleep. [59] Process S represents the drive for sleep, increasing during wakefulness and decreasing during sleep, until a defined threshold level, while Process C is the oscillator responsible for these levels. When being sleep deprived, homeostatic pressure accumulates to the point that waking functions will be degraded even at the highest circadian drive for wakefulness. [57] [59]

    Microsleeps Edit

    Microsleeps occur when a person has a significant sleep deprivation. Microsleeps usually last for a few seconds and happen most frequently when a person is trying to stay awake when they are feeling sleepy. [60] The person usually falls into microsleep while doing a monotonous task like driving, reading a book, or staring at a computer. [61] Microsleeps are similar to blackouts and a person experiencing them is not consciously aware that they are occurring.

    An even lighter type of sleep has been seen in rats that have been kept awake for long periods of time. In a process known as local sleep, specific localized brain regions went into periods of short (

    40/min) NREM-like states. Despite the on and off periods where neurons shut off, the rats appeared to be awake, although they performed poorly at tests. [62]

    Cardiovascular morbidity Edit

    Decreased sleep duration is associated with many adverse cardiovascular consequences. [63] [64] [65] [66] The American Heart Association has stated that sleep restriction is a risk factor for adverse cardiometabolic profiles and outcomes. The organization recommends healthy sleep habits for ideal cardiac health along with other well known factors like blood pressure, cholesterol, diet, glucose, weight, smoking, and physical activity. [67] The Centers for Disease Control and Prevention has noted that adults who sleep less than 7 hours per day are more likely to have chronic health conditions including heart attack, coronary heart disease, and stroke compared to those with adequate amount of sleep. [68]

    In a study that followed over 160,000 healthy, non-obese adults, the subjects who self-reported sleep duration less than 6 hours a day were at an increased risk for developing multiple cardiometabolic risk factors. They presented with increased central obesity, elevated fasting glucose, hypertension, low high-density lipoprotein, hypertriglyceridemia, and metabolic syndrome. The presence or lack of insomnia symptoms did not modify the effects of sleep duration in this study. [69]

    The United Kingdom Biobank studied nearly 500,000 adults who had no cardiovascular disease, and the subjects who slept less than 6 hours a day were associated with a 20 percent increase in the risk of developing myocardial infarction (MI) over 7 years of follow-up period. Interestingly, long sleep duration of more than 9 hours a night was also a risk factor. [70]

    Immunosuppression Edit

    Among the myriad of health consequences that sleep deprivation can cause, disruption of immune system is one of them. While it is not clearly understood yet, researchers believe that sleep is essential to provide sufficient energy for immune system to work and allow inflammation to take place during sleep. Also, just like sleep can reinforce memory in our brain, it can help consolidate the memory of immune system or adaptive immunity. [71] [72]

    An adequate amount of sleep improves effects of vaccines that utilize adaptive immunity. When vaccines expose the body to a weakened or deactivated antigen, the body initiates an immune response. The immune system learns to recognize that antigen and attacks it when exposed again in the future. Studies have found that people who don't sleep the night after getting a vaccine were less likely to develop a proper immune response to the vaccine and sometimes even required a second dose. People who are sleep deprived in general also do not provide their bodies with sufficient time for an adequate immunological memory to form, and thus, can fail to benefit from vaccination. [71]

    People who sleep less than 6 hours a night are more prone to infection and are more likely to catch a cold or flu. A lack of sleep can also prolong the recovery time in patients in intensive care unit (ICU). [71] [73] [74]

    Weight gain Edit

    A lack of sleep can cause an imbalance in several hormones that are critical in weight gain. Sleep deprivation increases the level of ghrelin (hunger hormone) and decreases the level of leptin (fullness hormone), resulting in an increased feeling of hunger and desire for high-calorie foods. [75] [76] [77] Sleep loss is also associated with decreased growth hormone and elevated cortisol levels, which are connected to obesity. People who do not get sufficient sleep can also feel sleepy and fatigued during the day and get less exercise. Obesity can cause poor sleep quality as well. Individuals who are overweight or obese can experience obstructive sleep apnea, gastroesophageal reflux disease (GERD), depression, asthma, and osteoarthritis which all can disrupt a good night's sleep. [78]

    In rats, prolonged, complete sleep deprivation increased both food intake and energy expenditure with a net effect of weight loss and ultimately death. [79] This study hypothesizes that the moderate chronic sleep debt associated with habitual short sleep is associated with increased appetite and energy expenditure with the equation tipped towards food intake rather than expenditure in societies where high-calorie food is freely available. [80]

    Type 2 diabetes Edit

    It has been suggested that people experiencing short-term sleep restrictions process glucose more slowly than individuals receiving a full 8 hours of sleep, increasing the likelihood of developing type 2 diabetes. [81] Poor sleep quality is linked to high blood sugar levels in diabetic and prediabetic patients but the causal relationship is not clearly understood. Researchers suspect that sleep deprivation affects insulin, cortisol, and oxidative stress, which subsequently influence blood sugar levels. Sleep deprivation can increase the level of ghrelin and decrease the level of leptin. People who get insufficient amount of sleep are more likely to crave food in order to compensate for the lack of energy. This habit can raise blood sugar and put them at risk of obesity and diabetes. [82]

    In 2005, a study of over 1400 participants showed that participants who habitually slept few hours were more likely to have associations with type 2 diabetes. [83] However, because this study was merely correlational, the direction of cause and effect between little sleep and diabetes is uncertain. The authors point to an earlier study which showed that experimental rather than habitual restriction of sleep resulted in impaired glucose tolerance (IGT). [84]

    Other effects Edit

    The National Sleep Foundation identifies several warning signs that a driver is dangerously fatigued. These include rolling down the window, turning up the radio, trouble keeping eyes open, head-nodding, drifting out of their lane, and daydreaming. At particular risk are lone drivers between midnight and 6:00am. [85]

    Sleep deprivation can negatively impact overall performance, and has led to major fatal accidents. Due largely to the February 2009 crash of Colgan Air Flight 3407, which killed 50 people and was partially attributed to pilot fatigue, the FAA reviewed its procedures to ensure that pilots are sufficiently rested. Air traffic controllers were under scrutiny when in 2010 there were 10 incidents of controllers falling asleep while on shift. The common practice of turn-around shifts caused sleep deprivation and was a contributing factor to all air traffic control incidents. The FAA reviewed its practices of shift changes and the findings saw that controllers were not well rested. [86] A 2004 study also found medical residents with less than four hours of sleep a night made more than twice as many errors as the 11% of surveyed residents who slept for more than seven hours a night. [87]

    Twenty-four hours of continuous sleep deprivation results in the choice of less difficult math tasks without decreases in subjective reports of effort applied to the task. Naturally caused sleep loss affects the choice of everyday tasks such that low effort tasks are mostly commonly selected. Adolescents who experience less sleep show a decreased willingness to engage in sports activities that require effort through fine motor coordination and attention to detail. [88] [89]

    Great sleep deprivation mimics psychosis: distorted perceptions can lead to inappropriate emotional and behavioral responses. [90]

    Astronauts have reported performance errors and decreased cognitive ability during periods of extended working hours and wakefulness as well as due to sleep loss caused by circadian rhythm disruption and environmental factors. [91]

    One study has found that a single night of sleep deprivation may cause tachycardia (in the following day). [92]

    Generally, sleep deprivation may facilitate or intensify: [93]

    • aching muscles [94] , memory lapses or loss [95][95]
    • development of false memory and hypnopompichallucinations during falling asleep and waking, which are entirely normal [96]
    • hand tremor[97] , commonly known as "bags under eyes" or eye bags
    • increased blood pressure[98]
    • increased stress hormone levels [98]
    • increased risk of Type 2 diabetes[98]
    • lowering of immunity, increased susceptibility to illness [99]
    • increased risk of fibromyalgia[100][93] (rapid involuntary rhythmic eye movement) [101][98][102] in children [93]
    • violent behavior [103][93][104][105]
    • symptoms similar to:
        (ADHD) [93][96][106][107][108]
    • Patients suffering from sleep deprivation may present with complaints of symptoms and signs of insufficient sleep such as fatigue, sleepiness, drowsy driving, and cognitive difficulties. Sleep insufficiency can easily go unrecognized and undiagnosed unless patients are specifically asked about it by their clinicians. [109]

      Several questions are critical in evaluating sleep duration and quality, as well as the cause of sleep deprivation. Sleep patterns (typical bed time or rise time on weekdays and weekends), shift work, and frequency of naps can reveal the direct cause of poor sleep, and quality of sleep should be discussed to rule out any diseases such as obstructive sleep apnea and restless leg syndrome. [109]

      Sleep diaries are useful in providing detailed information about sleep patterns. They are inexpensive, readily available, and easy to use. The diaries can be as simple as a 24-hour log to note the time of being asleep or can be detailed to include other relevant information. [110] [111] Sleep questionnaires such as the Sleep Timing Questionnaire (STQ) can be used instead of sleep diaries if there is any concern for patient adherence. [112]

      Actigraphy is a useful, objective wrist-worn tool if the validity of self-reported sleep diaries or questionnaires is questionable. Actigraphy works by recording movements and using computerized algorithms to estimate total sleep time, sleep onset latency, the amount of wake after sleep onset, and sleep efficiency. Some devices have light sensors to detect light exposure. [113] [114] [115] [116]

      Although there are numerous causes of sleep deprivation, there are some fundamental measures that promote quality sleep as suggested by organizations such as Centers for Disease Control and Prevention, the National Institute of Health, the National Institute of Aging, and the American Academy of Family Physicians. The key is to implement healthier sleep habits, also known as sleep hygiene. [117] Sleep hygiene recommendations include setting a fixed sleep schedule, taking naps with caution, maintaining a sleep environment that promotes sleep (cool temperature, limited exposure to light and noise, comfortable mattress and pillows), exercising daily, avoiding alcohol, cigarettes, caffeine, and heavy meals in the evening, winding down and avoiding electronic use or physical activities close to bedtime, and getting out of bed if unable to fall asleep. [118]

      For long term involuntary sleep deprivation, cognitive behavioral therapy for Insomnia (CBT-i) is commonly recommended as a first-line treatment, after exclusion of physical diagnosis (f.e. sleep apnea). CBT-i contains five different components: cognitive therapy, stimulus control, sleep restriction, sleep hygiene, and relaxation. These components together have shown to be effective in adults, with clinical meaningful effect sizes. As this approach has minimal adverse effects, and long-term benefits, it is often preferred to (chronic) drug therapy. [119]

      There are several strategies that help increase alertness and counteract the effects of sleep deprivation. Caffeine is often used over short periods to boost wakefulness when acute sleep deprivation is experienced however, caffeine is less effective if taken routinely. [120] Other strategies recommended by the American Academy of Sleep Medicine include prophylactic sleep before deprivation, naps, other stimulants, and combinations thereof. However, the only sure and safe way to combat sleep deprivation is to increase nightly sleep time. [121]

      To facilitate abusive control Edit

      Sleep deprivation can be used to disorientate abuse victims to help set them up for abusive control. [122] [123]

      Interrogation Edit

      Sleep deprivation can be used as a means of interrogation, which has resulted in court trials over whether or not the technique is a form of torture. [124]

      Under one interrogation technique, a subject might be kept awake for several days and when finally allowed to fall asleep, suddenly awakened and questioned. Menachem Begin, the Prime Minister of Israel from 1977 to 1983, described his experience of sleep deprivation as a prisoner of the NKVD in Soviet Union as follows:

      In the head of the interrogated prisoner, a haze begins to form. His spirit is wearied to death, his legs are unsteady, and he has one sole desire: to sleep. Anyone who has experienced this desire knows that not even hunger and thirst are comparable with it. [125]

      Sleep deprivation was one of the five techniques used by the British government in the 1970s. The European Court of Human Rights ruled that the five techniques "did not occasion suffering of the particular intensity and cruelty implied by the word torture . [but] amounted to a practice of inhuman and degrading treatment", in breach of the European Convention on Human Rights. [126]

      The United States Justice Department released four memos in August 2002 describing interrogation techniques used by the Central Intelligence Agency. They first described 10 techniques used in the interrogation of Abu Zubaydah, described as a terrorist logistics specialist, including sleep deprivation. Memos signed by Steven G. Bradbury in May 2005 claimed that forced sleep deprivation for up to 180 hours ( 7 + 1 ⁄ 2 days) [127] [128] by shackling a diapered prisoner to the ceiling did not constitute torture, [129] nor did the combination of multiple interrogation methods (including sleep deprivation) constitute torture under United States law. [130] [131] These memoranda were repudiated and withdrawn during the first months of the Obama administration. [127]

      The question of extreme use of sleep deprivation as torture has advocates on both sides of the issue. In 2006, Australian Federal Attorney-General Philip Ruddock argued that sleep deprivation does not constitute torture. [132] Nicole Bieske, a spokeswoman for Amnesty International Australia, has stated the opinion of her organization thus: "At the very least, sleep deprivation is cruel, inhumane and degrading. If used for prolonged periods of time it is torture." [133]

      Treating depression Edit

      Studies show that sleep restriction has some potential in treating depression. [4] Those who suffer from depression tend to have earlier occurrences of REM sleep with an increased number of rapid eye movements therefore, monitoring patients' EEG and awakening them during occurrences of REM sleep appear to have a therapeutic effect, alleviating depressive symptoms. [134] This kind of treatment is known as wake therapy. Although as many as 60% of patients show an immediate recovery when sleep-deprived, most patients relapse the following night. The effect has been shown to be linked to an increase in the brain-derived neurotrophic factor (BDNF). [135] A comprehensive evaluation of the human metabolome in sleep deprivation in 2014 found that 27 metabolites are increased after 24 waking hours and suggested serotonin, tryptophan, and taurine may contribute to the antidepressive effect. [136]

      The incidence of relapse can be decreased by combining sleep deprivation with medication or a combination of light therapy and phase advance (going to bed substantially earlier than one's normal time). [137] [138] Many tricyclic antidepressants suppress REM sleep, providing an additional evidence for a link between mood and sleep. [139] Similarly, tranylcypromine has been shown to completely suppress REM sleep at adequate doses.

      Treating insomnia Edit

      Sleep deprivation can be implemented for a short period of time in the treatment of insomnia. Some common sleep disorders have been shown to respond to cognitive behavioral therapy for insomnia. One of the components is a controlled regime of "sleep restriction" in order to restore the homeostatic drive to sleep and encourage normal "sleep efficiency". [140] The main goal of stimulus control and sleep restriction therapy is to create an association between bed and sleep. Although sleep restriction therapy shows efficacy when applied as an element of cognitive-behavioral therapy, its efficacy is yet to be proven when used alone. [141] [119]

      National Geographic Magazine has reported that the demands of work, social activities, and the availability of 24-hour home entertainment and Internet access have caused people to sleep less now than in premodern times. [142] USA Today reported in 2007 that most adults in the USA get about an hour less than the average sleep time 40 years ago. [143]

      Other researchers have questioned these claims. A 2004 editorial in the journal Sleep stated that according to the available data, the average number of hours of sleep in a 24-hour period has not changed significantly in recent decades among adults. Furthermore, the editorial suggests that there is a range of normal sleep time required by healthy adults, and many indicators used to suggest chronic sleepiness among the population as a whole do not stand up to scientific scrutiny. [144]

      A comparison of data collected from the Bureau of Labor Statistics' American Time Use Survey from 1965–1985 and 1998–2001 has been used to show that the median amount of sleep, napping, and resting done by the average adult American has changed by less than 0.7%, from a median of 482 minutes per day from 1965 through 1985, to 479 minutes per day from 1998 through 2001. [145] [146]

      Randy Gardner holds the scientifically documented record for the longest period of time a human being has intentionally gone without sleep not using stimulants of any kind. Gardner stayed awake for 264 hours (11 days), breaking the previous record of 260 hours held by Tom Rounds of Honolulu. [90] LCDR John J. Ross of the U.S. Navy Medical Neuropsychiatric Research Unit later published an account of this event, which became well known among sleep-deprivation researchers. [90] [147] [148]

      The Guinness World Record stands at 449 hours (18 days, 17 hours), held by Maureen Weston, of Peterborough, Cambridgeshire in April 1977, in a rocking-chair marathon. [147]

      Claims of total sleep deprivation lasting years have been made several times, [149] [150] [151] but none are scientifically verified. [152] Claims of partial sleep deprivation are better documented. For example, Rhett Lamb of St. Petersburg, Florida was initially reported to not sleep at all, but actually had a rare condition permitting him to sleep only one to two hours per day in the first three years of his life. He had a rare abnormality called an Arnold–Chiari malformation where brain tissue protrudes into the spinal canal and the skull puts pressure on the protruding part of the brain. The boy was operated on at All Children's Hospital in St. Petersburg in May 2008. Two days after surgery he slept through the night. [153] [154]

      French sleep expert Michel Jouvet and his team reported the case of a patient who was quasi-sleep-deprived for four months, as confirmed by repeated polygraphic recordings showing less than 30 minutes (of stage-1 sleep) per night, a condition they named "agrypnia". The 27-year-old man was suffering from Morvan's fibrillary chorea, a rare disease that leads to involuntary movements, and in this particular case, extreme insomnia. The researchers found that treatment with 5-HTP restored almost normal sleep stages. However some months after this recovery the patient died during a relapse which was unresponsive to 5-HTP. The cause of death was pulmonary edema. Despite the extreme insomnia, psychological investigation showed no sign of cognitive deficits, except for some hallucinations. [155]

      Fatal insomnia is a neurodegenerative disease eventually resulting in a complete inability to go past stage 1 of NREM sleep. In addition to insomnia, patients may experience panic attacks, paranoia, phobias, hallucinations, rapid weight loss, and dementia. Death usually occurs between 7 and 36 months from onset.


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      Make a to-do list

      &ldquoWorries keep people awake, and they don&rsquot have to be negative worries,&rdquo says Findley. &ldquoIt could also be something positive you&rsquore planning, like a trip or a big event with a lot of things you have to remember.&rdquo Spending time during the day or earlier in the evening to sit and address those concerns may help, he says&mdashbut if it&rsquos too late for that, grab a notebook and try physically writing them down in a list for the next day.

      A recent study found that writing out a to-do list of future tasks helped people fall asleep nine minutes faster than people who wrote about tasks they&rsquod already accomplished that day. (The longer and more detailed the participants&rsquo lists, the faster they fell asleep.) It may seem counterintuitive that focusing on tomorrow&rsquos responsibilities would lead to faster sleep, but researchers think the act of getting them down on paper helps clear the mind and stop rumination, at least temporarily.