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Juggling sleep with work: what are the long-term effects?

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It’s 6am again. The unrelenting tone from your bedside table reminds you it’s time to roll out of your duvet cocoon and get ready to face the working world. You swat your shrieking phone as it gets louder and more persistent. A quick swipe of the screen and you notice the day. It’s Friday.

A relieved smile spreads across your face.

Well, at least tomorrow means a lie-in.

The typical working week for most will involve dragging ourselves out of our warm, cosy beds and forcing our legs to make the long cold trek to the bathroom. Yet, we know that come the weekend we will be able to catch up, even briefly, on the sleep denied to us during the week. Although we will moan to friends and colleagues, our society seems perfectly content with depriving ourselves of sleep during the working week only to catch it up during the weekend. We would likely prefer a few minutes (or hours) more in the morning, but many of us don’t consider this practice as detrimental to our health. The shift from short to long sleep is considered a part of life.

This is far from sensible as the effects of sleep deprivation are well known, even if you don’t spend your days buried in journals with helpful names such as ‘Sleep’.

There is a name (there always is) for the shifting of sleep patterns throughout the working week – social jet lag. This refers to the changes in our sleep timing and duration depending on when we’re working (e.g. sleeping less on workdays and more on free days), and how this can confuse our internal clocks which try to keep our sleep patterns regular and predictable. These are the same internal clocks which influence whether you are an owl or a lark – an evening or morning person. This misalignment affects people differently, and it is not hard to see why night owls, who want to sleep later and wake up later, may suffer more.

Social jet lag is a problem for society. It is associated with depression, an increased risk for heart disease, more frequent smoking, and increased stimulant use in general. Understandably, the effects seen from sleep deprivation, including difficulties in concentration, memory, social functioning and mood, are also associated with social jet lag.

Despite the mental and physical health issues reported, the available data had been largely correlational. This makes it hard to draw definite conclusions on whether society’s current schedule of sleep is bad for us in the long-term.

However, a recent study published earlier this year has attempted to address this.  A team of researchers at the University of Harvard sought to understand whether repetitive patterns of sleep restriction and catch-up sleep have a negative impact on our health and wellbeing, or whether we may simply get used to it.

More specifically, they wanted to try to work out whether there is a difference in our own subjective view of this sleep pattern and how our body, behind the scenes, might respond in terms of stress and immune functioning. Do we adapt to the sleep loss in both domains? Previous evidence suggested we might not but this hadn’t been convincingly tested over a long period until now.

To assess these questions, they recruited 14 participants who were studied in a controlled hospital setting over three weeks. During each week, the participants spent 5 days sleeping for 4 hours and 2 days sleeping for 8 hours. After a few months, the same participants were invited back to conduct the same experiment sleeping for 8 hours each day over the 25-day experiment. The results of each were compared to try to understand the impact of the working week’s sleep patterns.

The group asked participants about how sleepy they felt, their perceived effort to do anything, and how stressed they felt each day at 4 hour intervals throughout the study. Alongside this, objective measures of stress and immune functioning were also assessed via blood samples collected on 7 of the 25 study days. Specifically, they looked at the levels of a chemical messenger of the immune system known to promote inflammation, interleukin-6, and the levels (total and stability) of cortisol, a hormone released in response to stress (amongst other factors).

The participants’ diet and exercise were controlled to reduce the impact of these variables, and they could have visitors to reduce the impact of isolation, and deviation from normal routines, where possible.

So, what did they find?

Over the three weeks, when participants were restricted to only 4 hours’ sleep they (unsurprisingly) felt sleepier and reported a greater effort to do anything compared to when than when they could sleep for 8 hours (e.g. during the weekend in the restricted condition and every day for the control condition). Interestingly, the ‘effort to do anything’ ratings became increasingly similar for the restricted and control condition over the three weeks, and participants reported no extra stress when asked to halve their sleep to 4 hours for the restriction condition. Overall, this suggests that participants, although sleepy, were subjectively fine with the simulated typical work sleep pattern. There was even evidence that participants started to adapt as their reported effort to carry out tasks diminished by the third week of only 4 hours sleep.

By contrast, the objective results showed a less optimistic picture. The researchers found an increased dysregulation of cortisol as the weeks of sleep restriction went on, and an increase in morning cortisol compared to the control condition. However, both returned to normal following recovery sleep at the weekends. In terms of immune system functioning, unstimulated IL-6 levels were significantly higher for the first week of sleep restriction and then remained elevated but non-significantly so compared to the control condition. For the stimulated IL-6 levels, these were significantly elevated during the week for the second and third week of the restriction condition compared to the control.

These results highlight that although participants seemed to be no more stressed subjectively in depriving themselves of sleep during the week, it seems that this pattern of sleep was not something the body simply ‘gets used to’. Instead it seems that the body still shows an increase in the inflammatory marker IL-6, increased cortisol upon awakening, increased dysregulation of cortisol, and inhibition of IL-6 in the presence of cortisol-like molecule. This hints at a heightened stress and immune response which, importantly, does not appear to adapt to the effects of chronic sleep loss during the week. Although recovery sleep during the weekend mitigated this effect somewhat, there was some evidence to suggest that two days was not enough to return immune functioning (stimulated IL-6) back to normal.

You may be thinking that increases in IL-6 and increased inhibition of IL-6 seem counter-intuitive, but the authors had a potential explanation. They highlighted that this may be the product of a particularly active immune response following chronic sleep to deal with its physiological effects (i.e. the increased sensitivity to cortisol’s effect is lessened due to a need to remove toxins built up in the brain).

In addition, you may also want to argue that 4 hours sleep during the week is hardly typical of most people’s work schedule, and that this experiment is far from representative of real life. However, this is a weak argument as the effects of sleep deprivation have already shown to be cumulative. It is more likely that losing an hour or two during the workday has negative effects but over longer periods than are suggested by this study.

So, it seems that even though we may consider depriving ourselves of sleep during the week manageable, and even get used to it, the same cannot be said for our body. This study suggests that we don’t get used to sleep loss during the working week. Moreover, recovery sleep during the weekends may not be enough to compensate for a week of fighting our internal clocks.

Although this study only examined a small number of people and a small number of specific measures, it still highlights the persistent effects of restricted sleep on our immune and stress systems. It also provides some hints as to how we may be able to successfully convince ourselves that this pattern of sleep is not detrimental to our health. If we feel subjectively okay, if not slightly lethargic, about this lifestyle then there would be no immediate drive to change it – at an individual or society level.

Granted, necessity and an inability to pay the bills may also be powering this too…

Inquisitive Tortoise

References:

Rutters, F., Lemmens, S. G., Adam, T. C., Bremmer, M. A., Elders, P. J., Nijpels, G., & Dekker, J. M. (2014). Is social jetlag associated with an adverse endocrine, behavioral, and cardiovascular risk profile?. Journal of biological rhythms, 0748730414550199.

Simpson, N. S., Diolombi, M., Scott-Sutherland, J., Yang, H., Bhatt, V., Gautam, S., … & Haack, M. (2016). Repeating patterns of sleep restriction and recovery: Do we get used to it?. Brain, Behavior, and Immunity.

Van Dongen, H. P., Maislin, G., Mullington, J. M., & Dinges, D. F. (2003). The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. SLEEP-NEW YORK THEN WESTCHESTER-, 26(2), 117-129.

van Leeuwen, W. M., Lehto, M., Karisola, P., Lindholm, H., Luukkonen, R., Sallinen, M., … & Alenius, H. (2009). Sleep restriction increases the risk of developing cardiovascular diseases by augmenting proinflammatory responses through IL-17 and CRP. PloS one, 4(2).

Extra Reading:

http://www.huffingtonpost.com/margaux-mcgrath/social-jet-lag-and-sleep_b_7842074.html

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The Science Room

I recently wrote another science thing! This time it’s not about sleep but I imagine it’s something which some of you will find interesting. Please check it out and make sure you direct any interesting science questions to the Science Room too!

http://sciroom.org/articles/how-do-mirror-neurons-work

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Somniloquy: What causes sleep talking?

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Sleep(ing) is tricky.

We’ve already covered sleepwalking in some detail and identified how complex behaviours can be initiated during a period of seeming unconsciousness. These behaviours can take a wide range of different forms. For example, reports of sleep-texting are becoming more common, which highlights how changes in our daily routines lead to changes in the type of sleepwalking behaviours. Next on our list is to shed some light on why we might talk in our sleep too.

“Jack…? Are you awake? What’re you talking about?”

“Ignore him, he’s speaking in devil-speak again. He does that.  Admittedly, it’d be less freaky if he didn’t have his eyes open at the same time too…”

Apparently I didn’t form full sentences in my sleep during my spate of sleep-related weirdness as a child, but sounds resembling more than mumbling could be identified by friends whenever I stopped over. Alongside the heart-attack-inducing brush with sleepwalking which my parents were forced to endure, I also ‘entertained’ my friends by talking in my sleep – or engaging in somniloquy, as it’s also known.

Sleep talking is an experience which many of us will come across at some point in our lives.  It is a relatively common phenomenon and can be found predominantly during childhood, but also as a rarer occurrence within adulthood. However, the prevalence in adulthood varies considerably. It is one of the most frequent parasomnias (disorders of sleep which involve some form of unusual or unwanted behaviour during sleep) found between the ages of 3-13 years old (Laberge et al., 2000), and it appears slightly more often in boys of this age than girls.

Sleep talking is associated with sleepwalking, and one may predict the subsequent occurrence of the other (Ohayon et al., 1999). This is not surprising, as many parasomnias are found together, or increase the likelihood of someone experiencing another. The main concern during adulthood is the potential embarrassment which might come alongside the sometimes nonsensical muttering, and potentially the content which is said. However, it is generally accepted that sleep talking, although impressively coherent at times, is not necessarily truthful or meaningful. For example, it is not admissible in court and the individual will have no memory of what they said or even that they were talking in their sleep. This is part of the reason why it is so tricky to work out the prevalence of sleep talking in adults.

When does sleep talking occur? Well, like many other parasomnias, it appears that it can occur across the sleep-cycle. The quality and coherence of the speech during sleep may differ as an individual goes from light, deep and finally to REM sleep. The exact link between sleep stage and speech is uncertain, but it has been argued that REM sleep is associated with more coherent and daytime-like conversations. There is also evidence to suggest that it runs in families, although environmental factors may make it more likely.

What causes sleep-talking and should we be concerned? For the majority of us, no. It is a harmless, if amusing, occurrence and may only occur in episodes which can be traced to an environmental cause. For example, it can be brought on by a number of factors such as sleep deprivation, stress, alcohol and fever. However, there may be problems associated with the effect of sleep talking on a bed-partner. This may produce problems in the person who shares the bed with the sleep-talker, who may find themselves being kept up and experiencing insomnia-like symptoms. Some studies have highlighted a link between adult sleep talking and some psychiatric illnesses, but it is far from conclusive what the nature of this link is. For the most part, sleep talking is a harmless, if slightly embarrassing, behaviour.

Sleep talking can also occur in the context of other illnesses such as night terror, nightmares, sleep apnea and REM behaviour disorder (RBD).

Other areas in which sleep talking may occur:

Night Terrors

One way in which we can explore sleep-talking is in the presence of noted disorders during sleep. One example, where sleep-talking and movement are found, is night terrors. These are a form of sleep disturbance which occurs mainly during childhood. They are characterised by thrashing, panicked-like behaviour and screaming which occurs for several minutes. The child has no memory of this, and it can be considered a disorder of arousal like sleepwalking. In a similar manner, they can be exacerbated by anxiety, poor sleep schedules and behaviours which disrupt sleep (e.g. needing to go the toilet). Although this is not your archetypal description of sleep-talking, it is an example of how the boundaries between sleep and wake are blurred.

REM Behaviour Disorder

This is another disorder of arousal and, like night terrors, also involves elaborate movement and speech during a period of sleep. This occurs more commonly during middle age and is associated with more insidious origins such as the onset of Parkinson’s disease. At a basic level, RBD can be considered the acting of dreams, and the behaviours shown typically match with dreams had by the individual with RBD. However, dream ‘enactment’ can occur alongside many other sleep disorders, and the diagnosis of the disorder needs to be confirmed with the use of methods to study brain and muscle activity during sleep.

It’s important to note for that all the knowledge which we have amassed on the topic of sleep, we are still uncertain about so many different aspects of it. Sleep-talking fits into that snugly, and although I can provide indirect forms of evidence about what causes sleep-talking, it is very much left to scientists to further explore disorders of arousal and explore their causes in more detail.

Inqusitive Tortoise

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Header Image: Sleep Troubles

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Upcoming Articles

While trying to decide what article I’d like to write next I realised that I haven’t really introduced people to the basics of sleep science and why people like me get money to research it. I’ve already used terms which are familiar to most people, but there’s also been some which are probably less so. Hopefully, I’ve explained what these terms are in sufficient detail so far, yet I still think it makes sense to take a step back and examine why we sleep, how we measure it, and why its worth researching in the first place.

I will initially post these articles in a small, bit-sized, format so that they remain informative but also interesting. I’ll likely expand on these in the future, but their size should serve the purpose for the time being.

Thank you to everyone who has read and enjoyed these articles so far btw. These articles have really helped with my own research, and I hope they continue to interest you all!

Inquisitive Tortoise

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Fresh Beginnings

210_SLEEP Heart and Brain

It has been a long time since I’ve posted anything here but I feel it’s time for me to come back at long last. For a start, I’ve finally managed to snare funding and thus I have recently (last September) started a PhD at the University of Manchester to study sleep loss in individuals with mental illness. This project is so fascinating but there is so much I feel I need to learn in order to make a worthwhile contribution. So, as part of my research, I have started answering basic sleep questions which I think will help inform my own studies and thinking. I’ve written these so that they’re accessible to everyone as I feel that’s the best way for the work to stick in my head, and also potentially make these articles useful to someone besides me.

Although I have no idea how many people will read this (if any), I will still get some benefit from educating myself more about sleep, sleep problems and the impact of both of us on our daily functioning through writing these articles. If a few people were to read and enjoy them though, I would be overjoyed (simple academic, that I am)! As a disclaimer, nothing I post here will be set in stone – medically speaking – but will be the product of my own research, conversations and (in the future) own experiments within this field. I will likely touch common sleep problems such as insomnia and sleep apnoea in the near future, and although  what I write will be as as truthful as I can manage with the available materials, this blog will be no substitute for seeing a doctor about your own concerns.

I’m looking forward to exploring sleep in more detail and answering some of the questions I had before even starting on this PhD. However, on that note, if there are any questions which people have about sleep, I am would be more than happy to give it my best go to give you a satisfying answer.

Expect the first article shortly!

Inquisitive Tortoise

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Life, Liberty and Late Night Journal Trawling

Computer Dreams

It has been a long time since I last posted anything here and it only seemed right to come back as I near the start of my PhD. There are a few topics which I would like to give more consideration to (perhaps in their own posts or articles elsewhere) but I want to discuss the swirling thoughts in my head in something a little most concrete than scraps of paper sprawled around my room. This post may read in a stream of consciousness manner which I try to reserve for those ‘scraps of paper’ but I feel its a good way to get back into writing again.

The first thing I want to mention is that I have recently finished Oliver Sacks’ recent autobiography, ‘On the Move’ and was struck by the excitement and compassion which ran through this book. If any of you are familiar with his earlier works, this should come as a massive understatement but I can’t recommend this beautiful exploration of a highly talented man’s life more vigorously. His ability to go beyond the obvious and see a patient as a human being with a story to tell sets him apart from his contemporaries, and sheds light on why he was so beloved by the patients he cared for.

Alongside this, the role of twitter and social media in general in supporting the individual’s life has also caught my attention. We are well aware of the dangers facing unfettered usage of social media and how they may be taken advantage of by terrorist organisations, groomers, bullies or sexual deviants. However, considerably less attention is paid to the positive impact of being connected to large groups of individuals. I’ve already considered this briefly in an admittedly keyboard warrior sounding article I wrote for The Bubble (here), but it certainly goes further than simple outrage at a stigmatising depiction of mental illness. Case in point are the numerous groups which exist on Facebook which enables individuals suffering from a plethora of disabilities or chronic illnesses to chat and discuss worries / achievements with one another. An example personal to myself is Crohns and Colitis UK, whose Facebook group boasts an impressive 13, 850 (and growing) member base. CCUK’s social media forums provide an outlet for individuals suffering from debilitating illnesses to draw strength from one another and exchange wisdom.

Finally, the picture at the top of this post is the product of a very interesting project which is definitely worth checking out for anyone interesting in how the brain recognises the world around us (and who just like slightly trippy pictures).

That’s all for now! Watch this space for more (hopefully work relevant) posts to come.

InquisitiveTortoise

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This month in voices: November 2013

Another interesting round-up of voice-hearing research from SMJ!

This month in voices

Well, as I last posted on Christmas day, it seems appropriate to start up again on Easter Sunday. I’ll try and get through the backlog of research as soon as possible.

ICHR photoDurham, UK. Flavie Waters, Angela Woods and Charles Fernyhough report on what went on at the 2nd International Consortium on Hallucination Research, held in Durham.

Accessible summary: This is a clear and concise paper, plus free to read, so I won’t summarise it here. You can access it below.

Link to paper (free to read): http://dx.doi.org/10.1093/schbul/sbt167

Melbourne3Melbourne, Australia. Bendall and colleagues examine how childhood sexual abuse may lead to voice-hearing.

Accessible summary. It has been proposed that childhood sexual abuse (CSA) results in intrusive experiences associated with posttraumatic stress disorder (e.g., thinking about the event when you didn’t
mean to), which in turn underpin voice-hearing experiences. This study found, within people with first episode psychosis who…

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In the Key of Genius: An Incredible Insight into the Work of an Inspiring Musician

Yesterday, I attended a talk by Prof Adam Ockelford and was amazed by his ability to tap into the musical ability in autism and how this ability could be transformed into a form of communication not possible in the typical language domain. I will post a summary of his talk, but for now I just want to draw peoples’ attention to this video. It is impossible not to be amazed by the skills of Derek Paravicini within this video; equally, it is to the great credit of Prof Ockelford that he is able to extract and nurture this skills in many individuals such as Derek, with severe autism, and also that he is able to witness these skills advance. My own understanding of autism is limited, but this certainly seems a fantastic way of exploring the ways in which the autistic mind is a benefit.

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November 5, 2013 · 6:10 pm

Auditory Hallucinations – An Audio Representation

A friend of mine brought my attention this youtube video. It’s a collection of voices, compiled through the experiences of a mental health outreach worker, which attempt to capture the experience of pathological voice hearing. It captures many of the phenomenological characteristics which constitute auditory hallucinations; however, this is only an interpretation and so cannot be considered completely accurate. It is interesting, and terrifying, nonetheless.

With that in mind, it’s not advisable to listen to this in the middle of the night with no one around (as I did…)

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November 2, 2013 · 3:56 pm

Schizo Movie: A powerful and disarming look at mental illness

Although this video is quite old, as far as ad campaigns go, it portrays the stark contrast between what the public may perceive schizophrenia to be and what it actually is.

In light of last night’s flurry on Twitter, in response to Asda’s decision to sell their ‘mental patient’ halloween costume adorned with blood and wielding a butcher’s knife, videos such as this seem apt and in need of wider circulation.

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September 26, 2013 · 5:35 pm