Today's #Sleeptember FACT--- How to know if you are sleep deprived

People who are sleep deprived either make light of it, or imagine they will get used to it, or ignore it, believing it will just go away.

It doesn't really work that way.

There are five easy ways to know that you are sleep deprived, even if you don't think you are.

#SLEEPTEMBER

1. Eyelid twitching. Your eyes want to close! Your lids are tired and need a break. You might also discover your vision has blurred, or you might be compelled to rub your eyes because they are dry or itchy, also signs you have kept them open much longer than they are meant to be open.
   
   Remedy: Go to sleep. Seriously. Do it now.
2. Fidgeting. You might call this a "second wind," but what it really means is that your body is using stores of adrenalin to function because you are sleep deprived and need to sleep so your body can recover from lack of sleep. You might feel antsy or hyperactive or on edge.
   
   Remedy: Find a way to relax (warm bath, massage, soothing music), then... Go to sleep.
3. Unexpected appetites. You might be hungry at odd hours, or you might feel like you can't satiate your hunger, or you have some odd cravings that aren't normal for you. Your body has more than one biological clock; besides the main one that controls your overall processes, which aligns with the circadian rhythms of the Earth, your body also has clocks that time your hunger drive and digestive processes so that you eat at wakeful times and sleep during slow digestive periods. This is why you normally don't need to empty your bowels overnight; your body's separate digestive clock is in charge of slowing the process so you can have a period of sleep uninterrupted by the need to use the bathroom.
   
   What does this have to do with sleep? If you are sleep deprived, your circadian rhythms are confused and your biochemistry suffers as a result, as hormones and neurotransmitters rely on balanced circadian rhythms to do their work. A sleep-starved brain turns to survival mechanisms if this imbalance continues, signaling your body to feel hungry to inspire it to consume calories to compensate for the exhaustion that sleep deprivation brings.
   
   Remedy: Go to sleep. After a good night's rest (or several in a row, if you are seriously sleep-deprived), your body and brain will re-coordinate your eating plan.
4. Illness. If you allow yourself to go for too long, too frequently, without quality sleep, your body's immune system can become compromised. Sleep brings healing at the cellular level to fix the day's insults and injuries; it also cleans out the pathways of the brain and sends growth hormone out to recharge the body. Without sleep, you don't get these benefits and general malaise, dizzy spells, nausea and, more seriously, viral and bacterial infections and immune system challenges can be the result.
   
   Remedy: Go to sleep.
5. Microsleeping. Ever just nod off briefly, then catch yourself and reawaken? That is considered a "lengthy" microsleep. Many instantaneous moments when your brain dips into sleep mode occur without the sleep deprived even being aware of them. Your brain is equipped with both sleep and wake drives (much like hunger and thirst drives) and if you don't allow your body to surrender naturally to the sleep drive (because you are on a long road trip or working a late shift or trying to finish your thesis, for instance), you may intellectually think you are awake when, actually, your sleep drive is stealing microseconds of sleep.
   
   This is a very big deal. A microsleep on the job can result in a performance error or an accident. A microsleep behind the wheel is predictably what leads to drowsy driving accidents. If you are sleep deprived, you will not be a match for an under-indulged sleep drive. The brain's need to shut down is a powerful force and it will eventually shut you down, even if you are still placing finishing touches on that master's thesis.
   
   Remedy: Go to sleep. 

Drowsy driving is not a fun fact. But it is a real fact that drowsy driving is a leading cause of traffic fatalities every year in the United States. The AAA reported in November 2014 that 21 percent of all traffic fatalities were caused by drowsy driving. Don't be a statistic. Arrive alive. 

Today, if you wear a sombrero, do it right... wear it on your face!

This image drew attention in 2012 in San Antonio for being considered an offensive stereotype of the "lazy Mexican." 

From a clinical point of view, the image of a person taking an afternoon nap (regardless what culture) does not illustrate laziness at all, 

but common sense.  A quick rest period during the hottest time of the day can be rejuvenating and lead to a more highly productive afternoon, giving fresh meaning to the saying "work smarter, not harder." Hardly the tactic of a lazy person. 

It's Cinco de Mayo, which may or may not be relevant to you and your family customs. You might see a sombrero (or ten!) before today is through, some of them holding tortilla chips and guacamole, others worn by dancing revelers at a local Mexican restaurant. But the original use for the sombrero was not as a party bowl... Sombrero in Spanish comes from sombra which means “shade” or “shadow.” The sombrero is, you guessed it, meant to be used as the ultimate napping hat.

Let's review the notion behind the afternoon nap. Siesta means "sixth hour" in Spanish and refers to midday, which is typically the hottest time of the day. The siesta has come to be a traditional opportunity to take a midday break to restore one's energy, spend time with family, eat and rest. It's not a practice limited to Spain and Mexico, however. Naps are still a normal part of daily life in Greece, the Philippines, Nigeria and other countries across Europe. Though widely believed to have Spanish origins, the siesta may have actually been introduced far earlier in ancient Islam (napping was noted in the Koran as a practice ruled by Islamic law) and Rome.

Sometimes it's easy to forget that some of our cultural habits are grounded in physiological realities. Take, for instance, this explanation about "the midday slump" from the National Sleep Foundation:

Our internal circadian biological clocks... regulate the timing of periods of sleepiness and wakefulness throughout the day. The circadian rhythm dips and rises at different times of the day, so adults' strongest sleep drive generally occurs between 2:00-4:00 am and in the afternoon between 1:00-3:00 pm... The sleepiness we experience during these circadian dips will be less intense if we have had sufficient sleep, and more intense when we are sleep deprived."

The body knows what it needs to do in the afternoon. It needs to sleep. When you're at your desk at work after lunch, how easy is it for you to stay awake through your usual tasks, meetings and email replies? Maybe what you need is your own personal sombrero hanging, at the ready, in your cubicle, for those times when your circadian rhythm is calling out for breaktime.

It's not unreasonable to ask for a little shut-eye; in fact, some companies are installing nap rooms or pods for employees who may need to grab some quick sleep because management is beginning to figure out that sleep deprivation is not good for productivity. 

For a complete history of this widely valued cross-cultural practice, check out the excellent article, "Siesta: The Little Nap With a Big History," over at Slumberwise.

Definitions || What is Normal Sleep?

Happy New Year! I hope that, among your personal resolutions for 2015, you've thought about adding "more and better sleep" to the list. Sleep is not an optional process, after all; you can only replace lost sleep with found sleep. And if you don't, you accrue sleep debt that, over time, can have a detrimental effect on your ability to do just about anything.

Yawning Newborn Baby
[public domain image]

The vast majority of people in the US (all ages, all genders, all races) do not sleep well or for long enough, and new research in sleep medicine shows that this has a whole-body impact that can aggravate or even lead to other chronic illnesses like heart disease, diabetes and neurological disorders. When one considers that lack of sleep can lead to dangerous behaviors like drowsy driving, it's not a stretch to suggest that poor sleep has silently become both a public health and public safety crisis in this country.

Fortunately, many sleep-related problems and disorders can be prevented or treated easily with lifestyle changes, simple therapies, improved breathing devices and new classes of medications.

But how do you know if your sleeping life is problematic for you? It can be hard to know if you have apnea, for instance, if you do not have a bed partner witnessing you asleep and gasping for air. Lots of people sleep all night but, because they sleep in fragments (unknowingly), they do not wake up feeling refreshed and alert. Maybe it seems normal for some to take a long time to fall asleep, while others insist they can "get by" on 6 or less hours of sleep. But the facts bear out that none of these experiences or conditions can really be described as a normal part of the sleeping process.

In order to know what could be abnormal about sleep, it's probably best to start with an understanding of what's normal. Here are some basic notions about what NORMAL sleep resembles.

• The definition of sleep is not just "not awake." Sleep is "a physiologic state characterized by decreased consciousness, metabolism and movement." Sleep is not a state of unconsciousness, by the way. Your brain is quite active while you sleep; you just don't have any awareness of all the electrical and chemical activity taking place in your brain (Spriggs, 2010).
• Most people need to sleep around 8 hours a night. That may seem like a lot in our time-pressed world, but the fact is we are generally "entrained" (or matched) to a circadian system that ties in closely with the day and night cycles of the earth. Our circadian systems effectively shift into sleep mode by way of chemical and neurological processes that require sleeping for about 8 hours.  It's normal to sleep, in other words.
• Several factors affect your ability to sleep. Light (or lack thereof) is perhaps the most effective influence over sleep cycles, but other factors include body and room temperature, eating habits, drug use (even legal and prescribed) and your daily level and timing of physical activity. 
• Sleep is ruled by a complicated network of systems inside the brain which regulate sensory information, body temperature, breathing, blood pressure, alertness and sleep drive. It's not just the body shutting down; in fact, it's quite the opposite.
• The body has a sleep drive, which is similar to a sex drive or a thirst or hunger drive. Basically, your body develops pressure to sleep during the day's deprivation of sleep. The more awake you are over a long period of time, the higher your drive to sleep will become (this is a simplification of a more complex process, but I think you get the picture).
• There are two states of sleep: REM and NREM sleep. REM stands for "rapid eye movement" sleep and indicates when the brain has reached a stage of sleep in which body processes shift and the brain becomes as active as if it were awake. The eyes dart back and before beneath the eyelids; this is the stage where most dreaming takes place. REM sleep is the stage when the brain is in recovery mode, healing and repairing itself after a long day of hard work. NREM, or Non-REM sleep, generally leads up to and away from REM sleep. There are 3 stages of NREM: stage N1 transitions from wakefulness to stage N2 sleep, which shows signs of neurological and physiological shifts which represent the body falling to sleep. Stage N3 is the deepest, dreamless phase of sleep which helps aid the body in recovering from the physical stresses of the day.
• Periods of REM and NREM alternate as we sleep in cycles that last about 90 minutes each.
• Sleep efficiency is a way to measure how much sleep you actually experience while in bed. Normal sleep efficiency is around 90% of total sleep time. In other words, if you are in bed for 8 hours, you would have a normal sleep efficiency if you slept at least 7 hours and 12 minutes of that 8-hour period. Not surprisingly, an insomniac will have a lower rate of sleep efficiency, as they are in bed for quite a while before they fall asleep, or they may waken early and never return to sleep, or they might experience both problems. 
• Related to sleep efficiency is sleep latency, which is the measure of how long it takes to fall asleep (the point of sleep onset). Most people take anywhere from 5 to 20 minutes to fall asleep (or to return to sleep after waking in the middle of the night).
• One's ability to sleep is affected by body chemistry (hormone changes, in particular) as well as by sleeping environment (how light, how quiet, how comfortable, etc.) and other physiological factors (like chronic pain or allergies). 
• One's ability to wake up is also affected by similar factors. New mothers know very much how easy it is to awaken upon the sound of their crying baby. This has a hormonal component as well as a physiological one and is quite normal. 
• An occasional awakening at night to use the bathroom or get a drink of water isn't abnormal, but regular and/or multiple awakenings every night might suggest something is amiss.
• Other things to know about normal sleep:
• You don't have to lie down or even shut your eyes to fall asleep. 
• Your body typically undergoes a sensory blunting and almost complete paralysis as part of the normal sleeping process (specifically, during REM sleep).
• Memory consolidation is one of the key activities that takes place while you sleep.
• Dreaming is a normal function of sleep.

Understanding what comprises normal sleep is key to recognizing when one's sleep processes or habits aren't in balance. Awareness makes all the difference in the world. If you aren't feeling rested every morning when you wake up, it's high time you found out why. Chances are good it'll be an easy fix and then you can move on, with more energy and better health.


Reference
Spriggs, WH. (2010). Essentials of Polysomnography. Sudbury, MA: Jones and Bartlett Publishers.

Sleep Hygiene Tip of the Week || Melatonin is tricky

"Walgreens Melatonin" (2010) by Jed Carroll,
UK. CCA:2.0 Generic. Publication of this
image does not imply endorsement of this
or any products by SleepyHeadCENTRAL.

The seemingly kneejerk practice of automatically turning to medications to treat health disorders, even over-the-counter supplements (which are essentially unprescribed drugs), is a discussion for another time.

Over-the-counter sleep aids that are touted for their sleep-promoting properties (namely diphenhydramine, valerian and melatonin) have their fans and detractors, as well.

For this week's tip on sleep hygiene, melatonin is going to nab a little of that spotlight.

Some people LOVE using melatonin and swear by it for their problems with falling asleep or maintaining sleep. Others find it useless.

Sleep science is not conclusive on the benefits of melatonin, either. Melatonin dosages currently available from the drugstore may or may not be adequate. Also, melatonin requires a very careful schedule of dosing for it to work, and that schedule will depend entirely on the individual using it.

SHC maintains the policy of asking your doctor for advice before using melatonin, and if you should decide to go this route, to seek exact advice regarding timing and dosage from a medical professional. With any medication or supplement, there can be side effects as well, so please look at this aspect of melatonin use before taking this popular sleep aid.

Below are some articles that help explain how and why melatonin works (or can work) and why it may or may not be for you.


YourSleep || AASM.net
Over the Counter: Will Melatonin Cure Your Sleep Problems?

Natural Practitioner
Monograph: Melatonin

Drugs.com
Melatonin

Wellness || Cleveland Clinic
Melatonin Supplement Review

Drugs and Supplements || Mayo Clinic
Melatonin (N-acetyl-5-methoxytryptamine)

Sleep Hygiene Tip of the Week || MONSTERS OF SLEEP: When naps set you up for a visit with the Insomnia Vampire

Sometimes a poorly timed nap can turn you into an insomnia vampire...

Napping is not usually a bad thing. A cat nap here or there can be wonderfully restorative. However, if you take naps later in the afternoon, you could be setting yourself up for an unnecessary visit with the insomnia vampire.

Your body has two cycles during the 24-hour period we call a day: Wake and Sleep. Generally speaking (and science confirms this), most human beings function best when they are awake during the day and get their sleep at night. This is due, in part, to the way we relate to circadian rhythms. We tend to rise because our body is stimulated by morning light and that turns our pineal gland's production of melatonin down so we can wake up and go about the day doing the things humans do.

There's another process in play, however, that most people aren't aware of. Just like with hunger, thirst and sex, our brains have a built-in sleep drive. How it works is pretty simple: our drive depends on how sleepy we are. If you sleep a solid 8 hours on Monday night and then go to bed at the same time on Tuesday night, you will be sleepy to more or less the same extent. However, if you have really fragmented sleep on Monday night and then go to bed at the same time on Tuesday night, you will probably be more sleepy than you were on Monday night because your body did not get enough sleep to fulfill all the physiological demands that the process of sleep takes care of. With any luck, Monday night's crummy night of sleep will be replaced by a solid night of hard sleep on Tuesday.

Unless you decide to take a nap late in the day...

How do naps enter into this equation?

Naps are a good thing for people who are young or old, as their bodies require a little extra sleep to keep up with various physiological processes at play. Also, people who work night or overnight shifts can benefit from naps prior to their shifts because they can, in essence, make a deposit in their own personal sleep bank account so as not to accrue any sleep debt while at work.

However, if you are a normal, healthy adult with lifestyle that suits daytime work and nighttime rest, you are cautioned against sleeping in the late afternoon because, in doing so, you might rob yourself of some of the sleep drive that will help you get a full night's rest that night. Taking a short nap after 4pm can mean that at 1am the following morning, you might be finding yourself staring at the ghoulish circles growing under your eyes as you struggle to fall back to sleep. This can lead to more daytime sleepiness and potentially more naps at later times in the day on the days that follow, all of which messes with both your circadian rhythms AND your sleep drive.

So if you had a bad night of sleep the night before, put off the nap if you are able to, and just go to bed early the following night. This is the easiest way to put you back on trap and keep your sleep drive from falling out of rhythm.