Saturday, March 29, 2014

Sleep Deprivation, Disorders, and Drugs




Each July, during rodeo season, I find myself up for two days straight.  As the past events coordinator for a local non-profit group, I organized an event called the Street breakfast.  A one day event that brings the western heritage, the military, and the community together for a pancake breakfast, concert, and parade with over 140 horses.  While this has been a beneficial event for everyone involved, as the coordinator, it takes many days, weeks, and months of communicating and coordination to make sure everything is prepared for this type of an event.  As the day approaches, there are many finite details that must fall into place.  The day before the Street breakfast is spent running around to other venues to make sure tickets are sold, deliveries are made, and people show up where needed.   After the event there is still no rest, with tear-down and clean-up.  As it always turns out, the coordinator obtains little to no sleep on these two days.  The effects this short-term sleep deprivation had on my mood, behavior, cognitive abilities, and motor skills was surprising; perhaps working on sleep reduction would have been the way to improve performance.
Reflecting back to those days, my mood was always cheerful; dealing with people in a public venue requires a friendly and respectful attitude.  While my behavior on the first day remained consistent; by the second day, I was showing outward signs of tiredness (e.g. yawning and resting frequently) and was less spirited than the previous day.  As the second day wore on, I found that my ability to lift and carry objects was reduced and I needed help to perform tasks that the previous days were easy (e.g. lifting bales of hay, moving food, and climbing stairs).  I also began to notice that I was less able to think about new ideas for the event and began referring to and taking notes on those items that needed attention.  According to Pinel (2009), cognitive abilities such as those involving innovative, lateral, and insightful thinking are a function of the prefrontal cortex referred to as executive function and is affected by sleep deprivation.
I must agree that sleep deprivation has an effect on cognitive function, as was my experience.  After the first year working this event and trying to maintain wakefulness to function at a job requiring the ability to think, reference, and work on detail-oriented documents, I decided that it was best to sleep instead of worrying about mistakes.  However, those times I was required to work I would experience microsleeps; as described by Pinel (2009), short bouts (two to three seconds) of sleeping while standing or sitting [even driving].  Although Pinel (2009) notes that short periods of sleep deprivation has little effect on physical activity; my finding is with as little as 24 hours of deprivation motor skill functions begin to decline.  As a result, short-term sleep deprivation causes weakness and fatigue, with longer periods causing twitching and kneejerk reactions. 
Mild sleep disturbances can turn into long-term sleeping disorders if not handled properly.  Insomnia, hypersomnia, and REM-sleep dysfunctions are the major categories of sleep related issues (Pinel, 2009).  REM-sleep dysfunctions are associated with anything that affects stage one (REM) sleep; studies on this disorder are still in process.  Sleep apnea, periodic limb movement disorder (PLMD), and restless legs syndrome (RLS) are common causes of insomnia.  For milder forms of insomnia (e.g. troubles falling and staying asleep), short-term use of hypnotic drugs such as benzodiazepines (e.g. sleeping pills) can be beneficial, but have addictive qualities.  The use of continuous positive airway pressure (CPAP) is helpful for sleep apnea and dopamine agonist is often prescribed for PLMD and RLS (Pinel, 2009).  Hypersomnia includes such disorders as narcolepsy (also a REM-sleep disorder).  Symptoms of narcolepsy are daytime sleepiness or inappropriate sleep episodes and cataplexy.  The latter, cataplexy is identified by symptoms of sleep paralysis and hypnogogic hallucinations.  Narcolepsy is traditionally treated with amphetamines and methylphenidate, which are stimulants; however, like benzodiazepines they also have addictive compounds.  
Although short bouts of sleep deprivation cause tiredness, microsleeps, mild physical fatigue, and in some cases insomnia; in long-term reduction of monophasic sleep cycles, subjects were found to fall asleep faster, have fewer nighttime wakeful periods, and increased stage four sleeps (Pinel, 2009).  In studies of polyphasic sleep cycles researchers have found the recuperative benefits of naps are powerful.  After several weeks to adjust, upon which sleepiness occurs, he or she develops a preferred schedule of sleep durations (e.g. 20, 30, or 40 minutes).  This adjustment period also includes a balance between REM and slow-wave sleep periods; however, Pinel (2009) indicates “seldom [do the two] occur during the same nap” (p. 369).  Additionally, effects on mortality, for long-term sleep reduction studies, have been shown to be beneficial for healthy individuals.  Sleeping one to three hours fewer than the currently recommend eight hours has produced fewer deaths in studies by Tamakoshi and Ohno (Pinel, 2009).
Although most doctors are still recommending at least eight hours of sleep, each person will vary on the amount of time he or she needs.  For me, tiredness, fatigue, and cognitive distress begin to show within 24 to 48 hours, while for others, it may take longer as in sleep-deprivation studies (Pinel, 2009).  When sleep deprivation is not corrected, the possibility of developing severe sleep disorders such as insomnia or hypersomnia is possible; although treatable, medications should be monitored because of the addictive qualities involved.  It appears that instead of going through short bouts of sleep deprivation, long-term sleep reduction may be the most beneficial way to escape troublesome sleep patterns.  If only people could adjust to the benefits of taking a few short naps throughout the day instead of trying to catch-up on lost sleep, perhaps fewer sleeping disorders would be experienced.  It’s worth sleeping on.

 

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