end note.
2nd note: The other thing I had going for me is a 19th century immune system because my parents didn't believe in giving me shots as a child. This meant at first I had no fever or elevated white cell count so the hospital could not define what was wrong with me because of having a much superior immune system to most people today from not having shots as a child. I talked to people who grew up with shots who spent 30 to 40 days in the hospital with their burst appendix and came very close to dying from sepsis. I spoke to a man who showed me his colostomy bag because of his burst appendix. So, I was incredibly lucky to survive this at each and every point. My doctor and nurse had also never seen anyone pull the plastic drain tube themselves out of their abdominal area because what they were doing was hurting me more than what I did when I slowly pulled it out from where it was draining. end note.
My most recent bout with PTSD came from a burst appendix operation the night before Easter 2015. I'm not one who is afraid of death. Having survived Whooping cough at age 2 and then Childhood Epilepsy from ages 10 to 15 if I was afraid of death before I am not now. I might be afraid of pain and suffering and confusion but not death because death is either the end or the beginning and after facing death like I did so many hundreds times before it's sting is gone for me. And I suppose this lack of a fear of death you could also call a type of PTSD in itself (or not).
However, not fearing death I don't tend to get nervous when I am around dead people's bodies or dying people. I watch people often faint at the sight of blood. This is not me. I watch people get scared when their lives are threatened. This is not me. All that is gone for me as I have become a warrior without fear. But, it could be thought of that this too is a level of PTSD that warriors attain.
I don't know how to look at this. But, I find it very useful and when I'm like this often people around me become terrified of my warriors fearless and ultimately calm stance that comes from facing death so many hundreds of times before in a variety of different ways. Being around someone truly fearless often makes other people quake to be around someone like this.
So, is this useful? Being fearless I find being ultimately useful to me. But, like I said, many people might consider this to be a PTSD reaction in itself, depending upon the person.
But as human beings we are either very adaptive or we are crazy or dead. There is not much middle Ground here. So, being extremely adaptive like many Americans tend to be like me who come from the people who settled America since the 1700s often are like me. Fearless.
So, this is a more typical American Quality of having had opportunity to have better lives than most people on earth the last few hundred years here in the U.S.
My operation on the night before Easter 2015 went something like this. First, my appendix exploded on a Friday night at about 11pm at night. I had been throwing up about 12 times before then. I had visited a friend's home in Mt. Shasta and had already thrown up about 3 times already and told my hosts the problem and that I didn't want to throw up the nice soup the lady had especially made for me and my friend. But, after having some I had to run outside and throw up a 4th time. I finally went back to my hotel room because I didn't want to be a bad guest for my friends. They were worried about me because this wasn't a normal thing I was going through. At about 11pm my appendix exploded and I didn't know what was wrong with me so I called my friends to come take me to the hospital. (Since my Dad died in an ambulance on the way to the hospital I likely will never choose to ride in an ambulance in my life).
So, I had them drive me in my truck to the hospital in case I threw up again in my truck. I called my friends because the pain was so bad I thought I might pass out before they got to the hotel just from the pain.
At the hospital I told them I had thrown up my heart medicine which would mean I wouldn't be able to adapt to the altitude of 3500 feet in Mt. Shasta because I live at sea level so I told the emergency room doctor this. They put me on oxygen and Morphine. I was scared about the morphine as I don't like hallucinating. But, the only hallucinating was me when my eyes were closed seeing the family pcitures on my Iphone going by in my head so I found this comforting and healing at the time.
However, morphine is extremely constipating so I had no bowel movements for 4 days. So, when they released me the next morning? I went back to the hotel room thinking they had completely failed me at the hospital and I was going to the hotel room to die. (Which I almost did). So, this meant I also couldn't eat for 4 days because nothing could move through me but water. I also thought I was going to die from this too. Finally, my daughter's boyfriend from Portland came and spent his weekend (Tuesday and Wednesday) with me, which helped me a lot begin to cope more (I didn't want my wife to see me die). But I could handle my daughter's boyfriend seeing me die. So, I was now at about 10% to 20% of a normal days energy. By Wednesday I had normal bowel movements finally again and I asked my wife to come because I was up to about 40% of normal energy at that point which would be the way most of you would be with a really bad cold or flu. I knew I likely wasn't going to die at this point.
When my wife arrived by Saturday I was able to eat total in the last week of about as much food as your fist doubled up within that week so I was very very weak still. On Saturday I agreed with my wife that we needed to go back to the hospital to ask for a sonogram of my intestinal area as we still didn't know what was wrong with me. They suggested a CT Scan and within an hour they told me I had a Burst appendix and I needed an emergency laproscopic operation or I would die. Remember this is a week and a day from when this all started. So, I expected to die in this operation because I felt I was too weak to survive this at this point. So, I said "Goodbye" to my wife thinking I was going to die in this operation.
I woke up in intensive care about 11pm Saturday night before Easter Sunday 2015 and my wife stayed with me in the hospital for the next 4 or 5 days. I was released the Thursday after Easter 2015.
However, my wife and I disagreed on anti-biotics. I realized I couldn't take them on the trip back home to the SF BAy area. So she got hysterical in the hotel room and a hotel manager had to counsel us. I told him I was trying to survive a truly awful experience and that I and my wife were disagreeing about treatment. So, I won out and didn't take any anti-biotics going home to SF AREA.
I didn't throw up along the way because I didn't take anti-biotics going home until I got there. But then my family doctor gave me great Anti-biotics by shots which were 100 times better than the oral ones I was given but they were expensive but wonderful.
I then entered into extreme sleep deprivation because of a breathing aparatus they shoved into my lungs to avoid death by reflux on the operation table. But the down side of doing this is you won't sleep at all for about a month. When you cannot sleep at all this brought the worst PTSD into my life where you no longer are sure what is real and what is not.
- Sleep deprivation is the condition of not having enough sleep; it can be either chronic or acute. A chronic sleep-restricted state can cause fatigue, daytime ...
Sleep deprivation
From Wikipedia, the free encyclopedia
Sleep deprivation is the condition of not having enough sleep; it can be either chronic or acute. A chronic sleep-restricted state can cause fatigue, daytime sleepiness, clumsiness and weight loss or weight gain.[1] It adversely affects the brain and cognitive function.[2] However, in a subset of cases sleep deprivation can, paradoxically, lead to increased energy and alertness and enhanced mood; it has even been used as a treatment for depression (see below).[3][4] Few studies have compared the effects of acute total sleep deprivation and chronic partial sleep restriction.[2] Complete absence of sleep over long periods has not been seen in humans (unless they suffer from fatal familial insomnia); it appears that brief microsleeps cannot be avoided.[5] Long-term total sleep deprivation has caused death in lab animals.[6]Sleep deprivation 
Minor dark circles, in addition to a hint of eye bags, a combination suggestive of minor sleep deprivation. Classification and external resources Specialty Sleep medicine eMedicine topic list MeSH D012892
Contents
Physiological effects
Generally, sleep deprivation may result in:[7][8]Main health effects of sleep deprivation.
- aching muscles[9]
- confusion, memory lapses or loss[8][10]
- depression[10]
- development of false memory
- hallucinations[10]
- hand tremor[11]
- headaches
- malaise
- stye
- periorbital puffiness, commonly known as "bags under eyes" or eye bags
- increased blood pressure[12][13]
- increased stress hormone levels[13]
- increased risk of diabetes[13]
- increased risk of fibromyalgia[14]
- irritability[7]
- nystagmus (rapid involuntary rhythmic eye movement)[15]
- obesity[13]
- seizures[16]
- temper tantrums in children[7]
- yawning[7]
- mania[17]
- symptoms similar to:
Diabetes
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.[19] 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.[20] 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).[21]
On the brain
Sleep deprivation can adversely affect the brain and cognitive function.[22] A 2000 study, by the UCSD School of Medicine and the Veterans Affairs Healthcare System in San Diego, used functional magnetic resonance imaging (fMRI) technology to monitor activity in the brains of sleep-deprived subjects performing simple verbal learning tasks.[23] The study showed that regions of the brain's prefrontal cortex, an area that supports mental faculties such as working memory and logical and practical ("means-ends") reasoning, displayed more activity in sleepier subjects. Researchers interpreted this result as indicating that the brain of the average sleep-deprived subject had to work harder than that of the average non-sleep-deprived subject to accomplish a given task, and from this indication they inferred the conclusion the brains of sleep-deprived subjects were attempting to compensate for adverse effects caused by sleep deprivation.
The temporal lobe, a brain region involved in language processing, was activated during verbal learning in rested subjects but not in sleep-deprived subjects. The parietal lobe, not activated in rested subjects during the verbal exercise, was more active when the subjects were deprived of sleep. Although memory performance was less efficient with sleep deprivation, greater activity in the parietal region was associated with better short term memory.[24]
A 2001 study at the Chicago Medical Institute suggested that sleep deprivation may be linked to serious diseases, such as heart disease and mental illness including psychosis and bipolar disorder.[25] The link between sleep deprivation and psychosis was further documented in 2007 through a study at Harvard Medical School and the University of California at Berkeley. The study revealed, using MRI scans, that sleep deprivation causes the brain to become incapable of putting an emotional event into the proper perspective and incapable of making a controlled, suitable response to the event.[26]
The negative effects of sleep deprivation on alertness and cognitive performance suggest decreases in brain activity and function, primarily in the thalamus, a structure involved in alertness and attention, and in the prefrontal cortex, a region sub-serving alertness, attention, and higher-order cognitive processes.[27] 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 h 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.[27]
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.[28]
Animal studies suggest that sleep deprivation increases stress hormones, which may reduce new cell production in adult brains.[29]
On growth
A 1999 study[30] found that sleep deprivation resulted in reduced cortisol secretion the next day, driven by increased subsequent slow-wave sleep. Sleep deprivation was found to enhance activity on the hypothalamic-pituitary-adrenal axis (which controls reactions to stress and regulates body functions such as digestion, the immune system, mood, sex, or energy usage) while suppressing growth hormones. The results supported previous studies, which observed adrenal insufficiency in idiopathic hypersomnia.
On the healing process
A study conducted in 2005 showed that a group of rats, which were deprived of REM sleep for five days, experienced no significant changes in their ability to heal wounds, compared to a group of rats not deprived of "dream" sleep.[31] The rats were allowed deep (NREM) sleep. However, another study conducted by Gumustekin et al.[32] in 2004 showed sleep deprivation hindering the healing of burns on rats.
On attention and working memory
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 function of hours of sleep deprivation.[33] Working memory is tested by such methods 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.
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.[34] 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.
On driving ability
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,[35] though the National Highway Traffic Safety Administration suggests the figure for traffic accidents may be closer to 100,000.[36] The AASM recommends pulling off the road and taking a 15- or 20-minute nap to alleviate drowsiness.[35]
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.[37] 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.[38]
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.
Other effects
In addition, as a result of continuous muscular activity without proper rest time, effects such as cramping are much more frequent in sleep-deprived individuals. Extreme cases of sleep deprivation have been reported to be associated with hernias, muscle fascia tears, and other such problems commonly associated with physical overexertion.
A 2006 study has shown that while total sleep deprivation for one night caused many errors, the errors were not significant until after the second night of total sleep deprivation.[39] However, combining alcohol with acute sleep deprivation results in a trebled rate of driving off the road when using a simulator.[40]
The National Sleep Foundation identifies several warning signs that a driver is dangerously fatigued, including 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.[41]
Sleep deprivation can negatively impact performance in professional fields as well, potentially jeopardizing lives. 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.[42] 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.[43]
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.[44][45]
Great sleep deprivation mimics psychosis: distorted perceptions can lead to inappropriate emotional and behavioral responses.[46]
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.[47]
Microsleeps
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.[48] The person usually falls into microsleep while doing a monotonous task like driving, reading a book, or staring at a computer.[49] 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 (~80 ms) but frequent (~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.[50]
Weight gain and loss
In rats, prolonged, complete sleep deprivation increased both food intake and energy expenditure with a net effect of weight loss and ultimately death.[51] 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.[1]
Several large studies using nationally representative samples suggest that one of the causes of high obesity rates in the United States might be a corresponding decrease in the average number of hours that people are sleeping.[52][53][54] The findings suggest that this might be happening because sleep deprivation could be disrupting hormones that regulate glucose metabolism and appetite.[55]
The association between sleep deprivation and obesity appears to be strongest in young and middle-age adults. Other scientists hold that the physical discomfort of obesity and related problems, such as sleep apnea, reduce an individual's chances of getting a good night's sleep.
Sleep loss is currently proposed to disturb endocrine regulation of energy homeostasis leading to weight gain and obesity. For instance, laboratory sleep deprivation studies in young men have demonstrated that one night of wakefulness (typically found in shift workers) exerts significant effects on the energy balance the next morning, including reduced energy expenditure,[56] enhanced hedonic stimulus processing in the brain underlying the drive to consume food,[57] and overeating that goes beyond satiety.[58] Further recent studies have shown that a reduction of sleep duration to four hours for two consecutive nights has been shown to decrease circulating leptin levels and to increase ghrelin levels, as well as self-reported hunger. Similar endocrine alterations have been shown to occur even after a single night of sleep restriction.
In a balanced order, nine healthy normal-weight men spent three nights in a sleep laboratory separated by at least two weeks: one night with a total sleep time of seven hours, one night with a total sleep time of 4.5 hours, and one night with total sleep deprivation (SD). On a standard symptom-rating scale, subjects rated markedly stronger feelings of hunger after total SD than after seven hours of sleep (3.9 ± 0.7 versus 1.7 ± 0.3; P = 0.020) or 4.5 hours sleep (2.2 ± 0.5; P = 0.041). Plasma ghrelin levels were 22 ± 10% higher after total SD than after seven hours of sleep (0.85 ± 0.06 versus 0.72 ± 0.04 ng mL(−1); P = 0.048) with intermediate levels of the hormone after 4.5 hours sleep (0.77 ± 0.04 ng mL(−1)). Feelings of hunger as well as plasma ghrelin levels are already elevated after one night of SD, whereas morning serum leptin concentrations remain unaffected. Thus, the results provide further evidence for a disturbing influence of sleep loss on endocrine regulation of energy homeostasis, which in the long run may result in weight gain and obesity.[59]
Uses
Scientific study of laboratory animals
In science, sleep deprivation (of rodents, e.g.) is used in order to study the function(s) of sleep and the biological mechanisms underlying the effects of sleep deprivation.This rat is being deprived of restful REM sleep by an animal researcher using a single platform ("flower pot") technique. The water is within 1 cm of the small flower pot bottom platform where the rat lies. At the onset of REM sleep, the exhausted rat will either fall into the deep water only to clamber back to its pot to avoid death from drowning, or its nose will become submerged into the water, startling it back to an awakened state.
Some sleep deprivation techniques are:
- Gentle handling: during the sleep deprivation period, the animal and its polysomnograph record are continuously observed; when the animal displays sleep electrophysiological signals or assumes a sleep posture, it is given objects to play with and activated by acoustic and, if necessary, tactile stimuli.[60] Although subjective,[61] this technique is used for total sleep deprivation as well as REM or NREM sleep deprivation. This technique often requires polysomnography.
- Single platform: during the sleep deprivation period, the animal is placed on an inverted flower pot, the bottom diameter of which is small relative to the animal's size (usually 7 cm for adult rats). The pot is placed in a large tub filled with water to within 1 cm of the flower pot bottom. The animal is able to rest on the pot and is even able to get NREM sleep, but at the onset of REM sleep, with its ensuing muscular relaxation, it will either fall into the water and clamber back to its pot or will get its nose wet enough to awaken it. Thus, this technique is only useful for studying REM sleep deprivation. This was one of the first scientific methods developed (see Jouvet, 1964[62] for cats[63] and for rodents).
- Multiple platform: in an effort to reduce the elevated stress response induced by the single platform method,[64] researchers developed the "multiple platform" technique of REM sleep deprivation. In this configuration, the animal is placed within a large tank containing multiple platforms, thereby eliminating the movement restriction in the earlier setup.
- Modified multiple platform: modification of the multiple platform method where several animals together experience sleep deprivation (Nunes and Tufik, 1994).
- Pendulum: animals are prevented from entering into REM sleep by allowing them to sleep for only brief periods of time. This is accomplished by an apparatus that moves the animals' cages backwards and forwards in a pendular motion. At the extremes of the motion, the animals experience postural imbalance, forcing them to walk back and forth to retain their balance.[65]
Interrogation
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.[66]
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 Russia 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.[67]
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.[68]
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 interrogations of Abu Zubaydah, described as a terrorist logistics specialist, including sleep deprivation. Memos from May 2005 introduced four more techniques and claimed that the combination of interrogation methods did not constitute torture under United States law.[69]
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.[70] Nicole Bieske, a spokeswoman for Amnesty International Australia, has stated the opinion of her organization thusly: "At the very least, sleep deprivation is cruel, inhumane and degrading. If used for prolonged periods of time it is torture."[71]
Depression
Studies show that sleep restriction has some potential in the treatment of 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 appears to have a therapeutic effect, alleviating depressive symptoms.[72] As many as 60% of patients, when sleep-deprived, show immediate recovery, although most relapse the following night. The effect has been shown to be linked to increases in the brain-derived neurotrophic factor (BDNF).[73] It has been shown that chronotype is related to the effect of sleep deprivation on mood in normal people: those with morningness preference become more depressed following sleep deprivation while those with eveningness preference show an improvement in mood.[74] 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.[75]
The incidence of relapse can be decreased by combining sleep deprivation with medication.[76] Many tricyclic antidepressants suppress REM sleep, providing additional evidence for a link between mood and sleep.[77] Similarly, tranylcypromine has been shown to completely suppress REM sleep at adequate doses.
Insomnia
Some common sleep disorders have been shown to respond to cognitive behavioural therapy for insomnia. This involves a controlled regime of "sleep restriction" in order to restore the homeostatic drive to sleep and encourage normal "sleep efficiency".[78]
Causes
Insomnia
Insomnia, one of the six types of dyssomnia, affects 21%-37% of the adult population.[79][80] 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.[81][82][83]
Primary insomnia is a sleep disorder not attributable to a medical, psychiatric, or environmental cause.[84] There are three main types of primary insomnia. These include: psychophysiological, idiopathic insomnia, and sleep state misperception (paradoxical insomnia).[81] 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.[85] Sleep state misperception is diagnosed when people get enough sleep but inaccurately perceive that their sleep is insufficient.
Secondary insomnia, or comorbid insomnia, occurs concurrently with other medical, neurological, psychological and psychiatric conditions. Causation is not necessarily implied.[86]
Voluntary
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.
Sleep apnea
Sleep apnea (obstructive sleep apnea, OSA) is a collapse of the upper airway during sleep, which reduces airflow to the lungs. It has many serious health outcomes if untreated, but can very often be effectively treated with positive air pressure therapy. 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) will maximise the airflow and correct the feedback loop to the brain which keeps awakening the sufferer so as not to asphyxiate.
Central sleep apnea is repeated stops in breathing during sleep when the brain temporarily stops sending signals to the muscles that control breathing.
Mental illness
The specific causal relationships between sleep loss and effects on psychiatric disorders have been most extensively studied in patients with mood disorders. Shifts into mania in bipolar patients are often preceded by periods of insomnia, and sleep deprivation has been shown to induce a manic state in susceptible individuals. Sleep deprivation may represent a final common pathway in the genesis of mania,[87] and sleep loss is both a precipitating and reinforcing factor for the manic state.
School
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.[88] 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.[89] 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.[90] 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.[36] One in four U.S. high school students admits to falling asleep in class at least once a week.[91] 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.[92]
Treatment
Several strategies are common in attempting to 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.[93] 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.[94]
Recovery of cognitive function is accomplished more rapidly after acute total sleep deprivation than after chronic partial sleep restriction.[2] Chronic deprivation is the more common in everyday life. Just one night of recovery sleep can reverse adverse effects of total sleep deprivation. Recovery sleep is more efficient than normal sleep with shorter sleep latency and increased amounts of deep and REM sleep.
Longest periods without sleep
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.[95] 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.[46][96][97]
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.[96]
Claims of not having slept in years have been made at times, by certain individuals, but either without scientific verification, or contradicted in independent verification:
- Never scientifically verified: Thái Ngọc, born 1942, claimed in 2006 to have been awake for 33 years or 11,700 nights, according to the Vietnamese news organization Thanh Niên. It was said that Ngoc acquired the ability to go without sleep after a bout of fever in 1973, but other reports indicate he stopped sleeping in 1976 with no known trigger. At the time of the Thanh Nien report, Ngoc suffered from no apparent ill effects (other than a minor decline in liver function), was mentally sound and could carry 100 kg of pig feed down a 4 km road,[98] but another report indicates that he was healthy before the sleepless episode but that now he was not feeling well because of sleep deprivation.[citation needed]
- Contradicted by claimant: in January 2005, the RIA Novosti published an article about Fyodor Nesterchuk, from the Ukrainian town of Kamen-Kashirsky, who claimed to have not slept in more than 20 years. Local doctor Fyodor Koshel, chief of the Lutsk city health department, claimed to have examined him extensively and failed to make him sleep. Koshel also said, however, that Nesterchuck did not suffer any of the normally deleterious effects of sleep deprivation.[99] However, when a reporter from The Guardian followed up on this report, Nesterchuk said he was getting 2–3 hours of sleep per night, and that "[h]e did not appear to notice the marked difference between never getting to sleep once in 240 months, and getting fewer than the recommended number of hours each week."[100]
- Contradicted in more accurate reporting: Rhett Lamb of St. Petersburg, Florida, was initially reported to not sleep at all,[101] 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.[102][103]
- Pathological condition: 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. Despite the extreme insomnia, psychological investigation showed no sign of cognitive deficits, except for some hallucinations.[104]
- Fatal familial insomnia: Fatal familial 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.
See also
- Effects of sleep deprivation on cognitive performance
- Narcolepsy
- Polyphasic sleep
- Sleep medicine
- Sleep onset latency
- Wake therapy
- Tony Wright, who claims to hold the world record for sleep deprivation.
- Foreign Correspondent a 1940 film depicting interrogation by sleep deprivation.
References
- Taheri S, Lin L, Austin D, Young T, Mignot E; Lin; Austin; Young; Mignot (December 2004). "Short Sleep Duration Is Associated with Reduced Leptin, Elevated Ghrelin, and Increased Body Mass Index". PLoS Med. 1 (3): e62. doi:10.1371/journal.pmed.0010062. PMC 535701
. PMID 15602591.
- Fischer-Perroudon C, Mouret J, Jouvet M; Mouret; Jouvet (1974). "One case of agrypnia (4 months without sleep) in a morvan disease, favourable action of 5-hydroxytryptophane". Electroencephalography and Clinical Neurophysiology. 36 (1): 1–18. doi:10.1016/0013-4694(74)90132-1. PMID 4128428.
External links
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This section's use of external links may not follow Wikipedia's policies or guidelines. (March 2017) (Learn how and when to remove this template message) |
- "How Much Sleep Do You Really Need?", U.S. National Sleep Foundation
- National Sleep Foundation 2005 Sleep in America Poll
- Why Do Humans and Many Other Animals Sleep?
- Effects of Sleep and Sleep Deprivation on Catecholamine And Interleukin-2 Levels in Humans: Clinical Implications
- Effects of Sleep and Sleep Deprivation on Interleukin-6, Growth Hormone, Cortisol, and Melatonin Levels in Humans
- Sleep Deprivation Julian Lim and David F. Dinges, Scholarpedia, 2(8):2433. doi:10.4249/scholarpedia.2433
. PMID 19300585. Although both conditions [total and partial SD] induce several negative effects including impairments in cognitive performance, the underlying mechanisms seem to be somewhat different.
|website= (help). PMID 10984335.. PMID 21525926. Lay summary. . PMID 25002497.. PMID 18519533. For this reason, the NIH conference [of 2005] commended the term "comorbid insomnia" as a preferable alternative to the term "secondary insomnia."
Two general categories of insomnia exist, primary insomnia and comorbid insomnia.
. PMID 25018659.. PMID 19766933.- So, the problem with my sleep deprivation was I was having difficulty deciding what was real and what wasn't. So, since my wife and her friend were literally driving me crazy I bought 4 new tires for my motor home and left without telling my wife where I was going.
The problem with this was that I blacked out about Corning on INterstate 5 while driving and almost hit a Semi Truck loaded with Gasoline. Then I called my doctor (this was a mistake looking back on it). She called the police and so 5 police cars showed up where I was. I told them I was okay but that I had blacked out driving and had stopped there to wait for my ex-wife and a friend who would drive me and my motorhome up to Mt. Shasta. They were okay with this.
Then when I got to Shasta I realized I wasn't right in the head and decided to go to ORegon slowly and stopped for a week at the Bard's Inn in Ashland Oregon. then I got on a plane in Medford after that week trying to get to my daughter in Oregon but I couldn't breathe right on the plane so I had to ask for Oxygen because I was coughing too much to breathe right. Then I rented a 2015 Camaro Convertible and had my wife and her friend come up to see the Moody Blues with me for my birthday there in Portland. She brought what finally saved me from any more of this which is called Serotone and Gabatone from my Ayurvedic nurse practitioner specialist. This brought me out of what I was dealing with was a combination of Sleep deprivation and Trauma caused PTSD or (post operational PTSD).
My physician who had operated on me wanted me to take Ambien to sleep and an anti- anxiety drug. I refused to do this but the Serotone and Gabatone which increase Seratonin in your brain brought me back to a more normal sleep and waking state and out of Post Operational PTSD.
But, it took me until the following Christmas to get to the point where I didn't react like I was going to die soon which is another type of PTSD reaction to extreme trauma and stress caused by illness and operations
I can write about it more effectively now because I am now 2 years away from this trauma and PTSD reactions of those times.
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