Sleep+Deprivation

=Introduction = toc = =

Sleep is as essential to the human body as food and water are, but sometimes sleep quality and quantity is inadequate, which is known as sleep deprivation. Sleep deprived people are sleepy and fatigued, making them prone to causing accidents, impairing their judgement, and they are more likely to make mistakes and bad decisions. Not sleeping for 24 hours reduces hand-to-eye coordination, which can be compared to having a [|blood alcohol content] of 0.1 and contributes to road accidents and work injuries. A child’s school performance is negatively affected by the lack of sleep and may cause emotional problems such as depression. Sleep deprived adults suffer from lack concentration, irritability, sleep inertia and a grogginess that lasts all day long as they are constantly yawning and dozing off. [1] All these problems come from not obtaining an adequate amount of sleep hours. There are methods and medications that can help prevent sleep deprivation as well as methods and techniques that utilize sleep deprivation as a tool.

=Causes =

Controllable
Most people don’t know that their bodies need an adequate number of hours sleeping, so their lifestyles eventually lead to sleeping problems. Instead of going to bed early, some people decide to socialize, watch television, or read a book until late at night. Working late shifts disrupts [|sleep-wake cycles] on a regular basis and extra hours with long nights of work often contribute to lack of sleep. Frequent travelers also have inconsistent sleep patterns due to jet lag, which is caused by the change in time zones. High school and college students usually stay up late doing homework, writing papers, and pulling all-nighters to study for an exam. Some habits like drinking coffee or smoking cigarettes close to bedtime stimulates the nervous system and makes sleep less likely. It is also hard to sleep if one is lying in bed worrying, rather than relaxing. Drugs used to treat disorders like [|epilepsy] or [|attention deficit hyperactivity disorder (ADHD)] may cause [|insomnia]. [1] These factors can be changed to promote better sleep and it is up to each person to decide whether they want to change them or not.

Uncontrollable
Some other causes are not as easily managed, since they are out of our control. Sleep disorders and illnesses such as [|sleep apnea], colds and [|tonsillitis] may cause [|periodic limb movement disorder (PLMD)], snoring, gagging, and night terrors. These factors cause fragmented sleep, which disturbs the person’s rest several times. Sleep can be disrupted by a range of environmental reasons; for example, having noisy neighbors, a snoring bed partner, the bedroom being too warm or too cold, etc. Babies and toddlers often make parents experience sleep deprivation because their young children wake frequently in the night for feeding or comfort. [1]

=Psychological Effects =

Depression
Sleep deprivation symptoms predict suicidal thoughts and attempts, since depression is among the strongest predictors of suicide risk. [5] This association is slightly stronger among women than in men. [6] A 25% to 38% increased risk of depression was found in people with sleep deprivation, (defined as 6 hours or less of sleep on weeknights). [8] [11]

Fatigue and Balance
There is an increase in facial [|muscle tone] and tremors that compensates for lack of attention, which occurs during sleep deprivation-induced fatigue. An entire 24-hour duration of sleep deprivation causes a negative impact on posture control and balance, which weakens by prolonging sleeplessness. Failure to maintain body balance occurs when stimulating the sleep deprived muscles that are involved in posture control with a constant 205-second vibration. However, the most significant balance disorders occur after 100-150 seconds of stimulation and it intensifies by closing the eyes or sitting rather than standing. This effect, however, could not be seen before the 20th hour of sleep deprivation. While a 24-hour wakefulness doesn’t alter the body’s oxygen level, sleep deprivation lasting 36 hours results in a decreased oxygen intake. This lower oxygen level reduces stamina, making your muscles get tired faster and causing a general feeling of fatigue. Furthermore, sleep deprivation leads to a decrease in amplitude of the [|anaerobic power] parameters across the [|circadian rhythm]’s cycle. This explains why moderate sleep loss is endured more by people who practice sports involving a brief use of great force (running sprints, long jumping, weight lifting, etc.) than those who require precise movements, attention, concentration and frequent decision making (shooting, sailing, cycling, team sports). [9]

Mood
Adolescents exposed to one night of sleep deprivation show an increase in depressed mood, anxiety, confusion, anger, fatigue, and a decrease in vigor. For adults, their mood is shown to be slightly different when affected by sleep loss. Sensitivity to mood deficits following sleep deprivation show larger effects for moods like confusion, vigor, and fatigue (with more than 10% change) than for depressed mood, anxiety, and anger. The differences between anxiety and anger following sleep deprivation were similarly small. However, it is important to note that significant increases in depressed mood and anxiety following sleep deprivation are only shown in females. [10]

Cognition
While sleep deprived, concentration and attention becomes impaired as it is easier to get distracted. There is also an increase in the length of [|micro-sleep]. This all leads to lower effectiveness at performing tasks as well as slow cognitive processing. For example, while performing a simulated surgery, one night of sleep deprivation causes a 20-32% increase in errors made and a 14% increase in the time required to finish it. 36 hours of sleep deprivation provokes speech with word repetitions, clichés and a monotonous slow tone of voice. This impairs many people by not allowing them to properly express and verbalize their thoughts. Reasoning becomes schematic, which impairs the ability to perform tasks that required flexible thinking. There is a lack of innovation and proper decision making, which increases the tendency to take risky decisions. When solving a series of problems that include a changing element, someone suffering from sleep deprivation tends to choose the same solution without considering the changing factor. [9]



= = =<span style="font-family: Arial,sans-serif; font-size: 10pt;">Physiological Effect =

<span style="font-family: Arial,sans-serif; font-size: 10pt;">Weight
<span style="font-family: Arial,sans-serif; font-size: 10pt;">Habitual sleep duration below 7.7 hours is associated with increased [|Body Mass Index] (BMI) due to its effects on the levels of [|leptin] and [|ghrelin]. Short sleep duration causes a decrease in leptin and an increase in ghrelin, which is also observed while on food restrictions. Leptin deficiency increases appetite and decreases energy expenditure, which causes obesity. Levels of ghrelin, another appetite stimulator, were higher in those with sleep deprivation. Within 3 months of dietary supervision, a 5% reduction in BMI is associated with a 12% increase in ghrelin and a 15% decrease in leptin. In animal experiments, the food intake increased by 29% when the sleep deprivation lasted longer than five days. These changes contribute to the role of sleep deprivation in the development of obesity. [2] [3] [4] With sleep deprivation, the risk of gaining 5 kg increases by 35% and the risk of obesity by 27%. The sleep deprivation provoked obesity accompanied by low energy expenditure and weakened glucose metabolism eventually leads to diabetes. The tendency to gain weight from sleep deprivation in pre-teenagers (8-13 years old) is lower than among younger children (3-8 years old). However, the lower tendency to gain weight in younger children is related to going to bed at earlier hours. For the older teenagers, it relates to waking up later in the morning. [9]

<span style="font-family: Arial,sans-serif; font-size: 10pt;">Heart
<span style="font-family: Arial,sans-serif; font-size: 10pt;">Inadequate sleep duration (too short and too long) increases the probability of developing diabetes and high blood pressure. Sleep apnea worsens the quality of sleep and requires an increase in the amount of sleep time that is needed. [9]

<span style="font-family: Arial,sans-serif; font-size: 10pt;">Brain
<span style="font-family: Arial,sans-serif; font-size: 10pt;">Sleep deprivation weakens the functions of several brain structures. A 6-8% decrease in the brain’s metabolic rate occurs after 72 hours without sleep. In some cases, there have also been reports of a 15% decrease in metabolic rate in some areas of the brain. There is a reduction in the metabolism of [|glucose] in the dorsal part of the thalamus, as well as in the striatum, hypothalamus, pre-frontal and frontal cortex, parietal, temporal, cingulate and primary visual cortex, and cerebellum. After 3 days of sleep deprivation, a left-sided hypo-metabolism clearly indicates a disruption in motor speech functions which correlates with behavioral observations. A lack of alertness and weak cognitive function is credited to a lowered activity level of the links between the cortex and the thalamus. After 35 hours of sleep deprivation, arithmetic proficiency tests show a bilaterally decreased activity of the prefrontal and parietal cortex. However, at verbal memory proficiency tests, brain activity is higher in these same areas. A possible explanation is that verbal communication is more important than the ability to calculate. It is believed that the activation of certain cortex areas, which have no set function, can help sustain the effectiveness of tasks performed while sleep deprived. This explains the greater capacity of short-term memory while suffering from sleep deprivation. [9]

<span style="font-family: Arial,sans-serif; font-size: 10pt;">Healing and Growth
<span style="font-family: Arial,sans-serif; font-size: 10pt;">A full day of sleep deprivation causes the [|growth hormone] (GH) peak secretion to disappear on the next night’s sleep, however the overall secretion of GH remains unchanged. The significance of the GH’s peak release at early nocturnal hours is not yet fully comprehended and whether the lack of such can be compensated during the day. When it comes to healing, the impaired recovery of the damaged skin and lower immune system is attributed to stress reactions and not sleep deprivation. However, in animals, a lowered immune system is linked to sleep deprivation, as an animal’s wounds become prone to infection. It is still not clear whether sleep deprivation is beneficial or detrimental to a human’s immunological system. [9]

<span style="font-family: Arial,sans-serif; font-size: 10pt;">Hormones
<span style="font-family: Arial,sans-serif; font-size: 10pt;">Rats going through sleep deprivation show a decrease of [|plasma] concentration in the [|thyroid hormones], mainly Thyroxine (T4) and Triiodothyronine (T3). This is surprising since there is also an increase in metabolic rate and body temperature. In humans, 24 hours of sleep deprivation increase T3, T4 and Thyroid Stimulating Hormone (TSH) concentrations. The level of the [|corticotropin-releasing hormone] (CRH) in the rats changed after 72 hours of sleep deprivation. CRH increased in the striatum, limbic structures and hypophysis, while it decreased in the hypothalamus. There was also an increase in levels of [|adrenocorticotropic hormone] (ACTH), [|corticosteroids] and [|noradrenaline], which shows how sleep deprivation affects the [|sympathetic system] and explains the higher amounts of energy being spent. In humans, a full day of sleep deprivation causes a linear increase in the following night’s ACTH sleep secretion from 3 to 5 a.m. [9] = = =<span style="font-family: Arial,sans-serif; font-size: 10pt;">Treatment =

<span style="font-family: Arial,sans-serif; font-size: 10pt;">Ideal Sleep Duration
<span style="font-family: Arial,sans-serif; font-size: 10pt;">Ideal sleep duration depends on the on age, physical activity levels, general health, and other individual factors. Primary school children generally need between 9 and 10 hours of sleep and as little as a 30-minute change can drastically affect school performance. Teenagers need about the same as children, but lifestyle factors such as starting school earlier in the morning can deprive them of the required amount of sleep. When becoming a teenager, there is a shift in the sleep-wake cycle that involves being sleepy late in the evening and a tendency to wake up later in the morning. Adults need just around eight hours of sleep per night, and tend to need less sleep as they age. However, it is suggested to sleep if one gets tired during the day. [10] [15]

<span style="font-family: Arial,sans-serif; font-size: 10pt;">Medicine
<span style="font-family: Arial,sans-serif; font-size: 10pt;">A common solution to insomnia is often sleep medication, relaxing teas, and supplements. Many sleep aids sold over-the-counter help people combat insomnia and prevent sleep deprivation. However, many of these pharmaceutical products have both uncomfortable side effects and failure rates that make them less reliable than natural supplements. [13] Some people rely on [|melatonin] or relaxing teas to calm them down and to fake the symptoms of sleep deprivation to induce sleepiness and make it easier to sleep at bedtime. [14] Allowing one energy drink, one coffee, or two caffeinated sodas per day may minimize the impact of sleep deprivation on mood. [10]

<span style="font-family: Arial,sans-serif; font-size: 10pt;">Good Practice
<span style="font-family: Arial,sans-serif; font-size: 10pt;">Going to bed earlier each night, will make going to bed early a habit. Do not smoke tobacco and do not drink alcoholic or caffeinated beverages within 6 hours of bedtime. Improve your sleeping environment by keeping the room dark, cool and sound-proof by turning off all the lights and wearing earplugs if you have noisy neighbors. Keep distractions such as the TV and the computer out of the bedroom. Relaxation techniques such as controlled breathing or clearing your mind may help you fall asleep quickly. Seek professional assistance if you think you may have a sleep disorder. [1] = = =<span style="font-family: Arial,sans-serif; font-size: 10pt;">At School =

<span style="font-family: Arial,sans-serif; font-size: 10pt;">A student’s performance in school during the day has a lot to do with his <span style="font-family: Arial,sans-serif; font-size: 10pt;">evening activities. The student’s sleep pattern requires attention from schools, parents, and students themselves. First, parents should pay more attention to their children’s sleeping habits. Parents should be better aware of their children’s technology use, as they create sleeping problems. It is also important to implement bedtime routines to increase both sleep duration and quality in children and adolescents. Prior research suggested that to improve sleep duration and quality, electronic entertainment devices like TVs, computers, gaming systems, music players, and mobile phones should be kept out of bedrooms. Mobile devices are becoming common household commodities, which makes it even more convenient for children and adolescents to play games and use other media. There was a 40 % increase in hours that youth spent on mobile games from 2011 to 2013. [12] <span style="font-family: Arial,sans-serif; font-size: 10pt;">There is currently a lack of sleep education and only a few schools offer these kinds of programs to students. Educational research tends to approach student learning without viewing students as human beings whose physical, cognitive, behavioral, and emotional functioning is intertwined. Adequate sleep is essential for he healthy development of children and adolescents since poor sleep leads to daytime fatigue, sleepiness, energy loss, and emotional disturbance, which affects one’s ability to learn. [12] There is no point in making home assignments and tests so hard that it negatively impacts a student’s ability to learn what the assignment is supposed to be teaching them in school.

= = =<span style="font-family: Arial,sans-serif; font-size: 10pt;">Applications =

<span style="font-family: Arial,sans-serif; font-size: 10pt;">Sleep deprivation is used in therapy to treat mood disorders. By preventing someone from sleeping for about 36 hours, mood is regulated in patients who suffer from chronic depression by resetting and adjusting the circadian rhythm. The magnitude of improvement after one night of sleep deprivation is often equal to that observed after 6 weeks of antidepressant medication. There is still debate on whether a short nap can block the powerful antidepressant effects of sleep deprivation or not. [7] Sleep deprivation can also be applied in the treatment of [|Parkinson's disease]. One-night wakefulness results in an one-week-long improvement, consisting of less tremors and stiffness. Restricting [|Rapid Eye Movement] (REM) sleep increases [|dopamine] release and decreases [|cholinergic] activity. This improvement takes place through an increase in [|adenosine] activity that hinders [|acetylcholine] (ACh). [9]

=<span style="font-family: Arial,sans-serif; font-size: 10pt;">Conclusion =

<span style="font-family: Arial,sans-serif; font-size: 10pt;">Sleep deprivation affects many people and causes many problems in their health. Parents and schools need to take care of their children and make sure that staying up at night doesn't become a problem. Adults need to manage their time in order to get the amount of sleep needed at night and plan work and responsibilities accordingly. Not everyone suffers from sleep deprivation the same way, so the causes and effects are very different depending on age and sex. <span style="font-family: Arial,sans-serif; font-size: 13.3333px;">There are many ways to deal with insomnia and other problems that can lead to sleep deprivation, asking a professional is usually the best way to get back on track. Getting a good amount of sleep maintains a healthy lifestyle. However, there are methods like wake therapy that use sleep deprivation to treat more serious problems. There is still much to learn about the effect of sleep deprivation on the body and much work is still needed to spread the word in preventing it.

<span style="font-family: Arial,sans-serif; font-size: 10pt;">General References:

<span style="font-family: Arial,sans-serif; font-size: 9pt;"> [1] “Sleep Deprivation.” (2014). Better Health Channel, (Jul. 9, 2017). <span style="font-family: Arial,sans-serif; font-size: 9pt;">[2] Taheri, S., Lin, L., Austin, D., Youong, T., and Mignot, E. (2004). “Short Sleep Duration Is Associated with Reduced Leptin, Elevated Ghrelin, and Increased Body Mass Index.” PLoS Medicine, 1(3). <span style="font-family: Arial,sans-serif; font-size: 9pt;">[3] O. A. Oyesola, D. E. Ehichioya and T. O. Oyesola, "SLEEP DEPRIVATION AND COFFEE CONSUMPTION INDUCED CHANGES IN BMI, BLOOD PRESSURE AND BLOOD GLUCOSE IN MALE WISTAR ALBINO RATS," Endocrine Practice, vol. 23, (1), pp. 2-8A,9A, 2017. <span style="font-family: Arial,sans-serif; font-size: 9pt;">[4] T. Kanagasabai et al, "Association between Sleep Habits and Metabolically Healthy Obesity in Adults: A Cross-Sectional Study," Journal of Obesity, 2017. <span style="font-family: Arial,sans-serif; font-size: 9pt;">[5] Ribeiro, J. (2012). “Sleep Problems Outperform Depression and Hopelessness as Cross-Sectional and Longitudinal Predictors of Suicidal Ideation and Behavior in Young Adults in the Military.” Journal of Affective Disorders, 136(3), 743–750. <span style="font-family: Arial,sans-serif; font-size: 9pt;">[6] Bernert, R. (2005). “Suicidality and Sleep Disturbances.” Sleep (New York, N.Y.), 28(9), 1135–1141. <span style="font-family: Arial,sans-serif; font-size: 9pt;">[7] F. Benedetti and C. Colombo, "Sleep Deprivation in Mood Disorders," Neuropsychobiology, vol. 64, (3), pp. 141-51, 2011. <span style="font-family: Arial,sans-serif; font-size: 9pt;">[8] Roberts, R. (2014). “The Prospective Association between Sleep Deprivation and Depression among Adolescents.” Sleep (New York, N.Y.). <span style="font-family: Arial,sans-serif; font-size: 9pt;">[9] J. Orzel-Gryglewska, "CONSEQUENCES OF SLEEP DEPRIVATION," Int. J. Occup. Med. Environ. Health, vol. 23, (1), pp. 95-114, 2010. <span style="font-family: Arial,sans-serif; font-size: 9pt;">[10] Short, M. (2015). “Sleep Deprivation Leads to Mood Deficits in Healthy Adolescents.” Sleep Medicine, 16(8), 987–993. <span style="font-family: Arial,sans-serif; font-size: 9pt;">[11] Al-Abri, M. A. (2015). “Sleep Deprivation and Depression: A Bi-Directional Association.” Sultan Qaboos University Medical Journal, 15(1), e4–6. <span style="font-family: Arial,sans-serif; font-size: 9pt;">[12] Zhang, M., Tillman, D. A., and An, S. A. (2015). “Global Prevalence of Sleep Deprivation in Students and Heavy Media Use.” Springer Link, 22(239). <span style="font-family: Arial,sans-serif; font-size: 9pt;">[13] B. Krakow M.D., V. A. Ulibarri B.S. and N. D. McIver B.S., "Pharmacotherapeutic Failure in a Large Cohort of Patients With Insomnia Presenting to a Sleep Medicine Center and Laboratory: Subjective Pretest Predictions and Objective Diagnoses," Mayo Clin. Proc., vol. 89, (12), pp. 1608-20, 2014. <span style="font-family: Arial,sans-serif; font-size: 9pt;">[14] J. Arendt, "Melatonin," BMJ: British Medical Journal, vol. 312, (7041), pp. 1242, 1996. <span style="font-family: Arial,sans-serif; font-size: 9pt;"> [15] C. Kittredge, “How Much Sleep Do You Need?”, EverydayHealth.com, 22-Feb-2016.