Category: news

Every minor action within our bodies necessitates the use of energy. The act of merely moving an arm encompasses your brain deciding to initiate movement, sending instructions through neurons, and ultimately triggering muscle activity, which culminates in the hand motion you intended to perform. Many are unaware, but this process involves millions of cells, with each and every one demanding energy.

Metabolism represents the reactions that happen in our bodies, and it is defined by two parts. Katabolism is burning of the more complex molecules, during which we get energy, and anabolism represents reactions in our bodies where smaller chemicals are used to create building blocks for our bodies, such as proteins, amino acids, and fats.

We get our energy from food, that is constructed of proteins, carbohydrates, and fats that we burn down or store once they enter our body. The amount of energy that food provides us with is mostly measured in calories. Most energy-related processes happen in the mitochondria, and that’s where it got that nickname “the powerhouse of the cell.”

Most people think that their body and mind are inactive while sleeping, which is not true as our brains are active during sleep, and our body still requires energy to function. During our nightly rest, our brains have a vital mission, to repair everything that went wrong the previous day. That is when our muscles, joints, and vital organs are restored, and it’s one of the reasons why we feel refreshed in the morning.

How Do We Spend Our Energy?

Energy expenditure depends on many factors. It is the highest in newborn babies, as their growth rate is incredibly high. Infants double their size in the first six months of their lives, and at the end of the first year, they grow as much as three times. After that, the growth rate is slowed, and then it bursts again in the adolescence, which affects energy expenditure. The elderly need less energy to maintain their body functions, and this amount starts dropping after 40 years for men, and usually after menopause at about 50 years for women.

The amount of energy spent is also affected by your sex. Males spend 16% more power than females, and that is mostly attributed to different hormonal statuses, and different compositions of the bodies. Energy expenditure depends on metabolism and fitness levels as well. People who have more muscles and less fat spend more energy on average. Muscles burn more calories and require more energy to maintain, so that’s why fit people need to ingest more calories than inactive people. That is part of why men need more energy, as they usually have more muscle, while women have a bit more fat stored on average.

Humans need energy for the following:

• Basal metabolism. It consists of many functions that are essential for life and body integrity, such as cell functioning and repairment, synthesis of different hormones and enzymes and their transport, making of proteins and other building blocks, thermoregulation – maintaining the temperature of the body, uninterrupted work of respiratory and cardiac muscles to create breathing and heart rate, brain function and many more. Basal metabolic rate (BMR) is an amount of energy used for basal metabolism in a certain period. It is measured in a lying state, after 8 hours of rest, and 12 hours of fasting, and while being in a relaxed mental state. All of that is so you don’t use energy on brain activity or digesting, and it is also crucial that room temperature is just right, so you don’t need to spend energy to warm up or cool down. BMR is basically what your body needs to survive without any additional activity, and depending on the age, sex, lifestyle, body size and composition it takes up about 45 to 70 percent of your daily energy needs.
• Metabolic response to food. Eating is essential for our production of energy, but it also requires it for absorption, transport, conversion, oxidation, and deposition. These processes increase oxygen consumption and heat production. Also, response to food increases the BMR for about 10% in the next 24 hours of eating a meal.
• Physical activity. It takes the most energy expenditure after BMR, and it is also the most variable. People perform obligatory and discretionary daily operations. Obligatory ones involve working, going to school, tending to family and home demands, and other needs based on an individual’s social, economic and cultural environment. Discretionary activities are not socially and economically essential, but they are crucial for one’s well-being, health, and overall quality of life. They include exercise and fitness activities, optional tasks that provide more family comfort, as well as activities that provide personal enjoyment, social interaction with friends, and community development.
• Growth. We need the energy to make new tissues and deposit energy in those tissues. In the first few months of baby’s life, as much as 35% of energy is spent on growth and development. That number falls to about 5% at 12 months, and then to 3% during the second year. It is pretty steady from there at about 1-2 percent, with a little peak in the puberty.
• Pregnancy. During this period, extra energy is needed for the developing of fetus, placenta and other maternal tissues such as breasts and fat stores. More energy is also required for the changes in metabolism and increased maternal effort at rest and during various activities.
• Lactation. There are two parts of energy consumption in this case, for the production of milk, and the energy stored in the milk secreted. Part of this requirement can be derived from the fat storages that women obtained during pregnancy.

How Much Energy Do You Spend During Sleep?

At the beginning of sleep research, the idea was that the sleep was a state in which we were inactive, in it passively served to conserve energy. Nowadays, studies are showing something completely different. Our brain is very much active during this period, and it is doing the needed housekeeping. Also, this is the time when our memories and knowledge are consolidated.

We spend 90% of the energy during sleep that we usually spend during the awake resting period, or we spend 0.9 of our BMR. There haven’t been considerable differences observed in energy usage, between different stages of sleep, but there haven’t been too much research done in that area either.

Out of all the energy we use, 20% goes to brain energy consumption. That is an extremely high amount for an organ that is that small. But that shows you how important the central nervous system is, as no function in our body can go without its supervision.

A calorie is a standard energy measuring unit, and it is defined as the energy needed to increase the temperature of 1 kilogram of water for 1 degree Celsius. On average, a 125-pound person spends 38 calories per hour while sleeping, a 155-pound individual spends 46 calories an hour, while a 185-pound person burns around 56 calories per hour. You see that the more you weight, your BMR is higher, and the more energy you need to maintain your body. These numbers might not be correct for everybody, as there are a lot of different factors affecting that other than body weight.

If you spread these numbers to a whole night of sleep, ranging between 7 to 9 hours, you get that a 125-pound person burns 266-342 calories, a 155-pound person burns 322-414 calories, while a 185-pound person spends 392-504 calories each night.

How Much Energy Do You Spend During Different Activities?

Metabolic equivalent (MET) is an objective measure of metabolism rate during some activity compared to a sitting and resting state. The more physical the action, the more energy, and oxygen are used, and the higher the MET will be. Here is the list of some activities, and the energy required for them:

How to Burn More Calories While Sleeping?

Because you burn fewer calories while sleeping than being awake, some people thought that it would be a good idea to skip sleep and stay awake instead, as that would lead to more calories burned and losing weight. Don’t do this, as it is not good for your health, and it won’t even have the desired effects. Lack of sleep affects leptin and ghrelin, the body’s hormones in charge of hunger. When you are sleep deprived, their production is all messed up, so you will eat more, and you will gain weight. Not only do you crave more food when you are sleep deprived, but you are also more likely to for full of sugars unhealthy meals. Lack of sleep also increases the levels of cortisol, a hormone that is stimulating your body to store more energy as fat.

There are a few things you can do to help boost your metabolism.

• Don’t eat too close to bedtime. It won’t slow down your metabolism, as it is often thought, but it might prevent you from falling asleep, and that affects your metabolism in the long run.
• Consider losing extra weight. Fat burns fewer calories than muscle while resting, so maybe pay a visit to a dietitian to discuss healthy meal plans.
• Exercise regularly. As we said, more muscle means more calories burned, even when you are resting. So aim for 105 minutes of moderate, or 75 minutes of vigorous exercise every week. Also, make sure to increase strength training for the best results. Exercise will also help you sleep better, but make sure that you don’t do it too close to bedtime, as it can make it harder to fall asleep.
• Caffeine might help for more effective training. People who drink caffeinated drinks before going to the gym can usually do more reps, than when they don’t drink it. Be aware, that drinking caffeine later in the day also affects your sleep.
• Don’t use metabolism supplements. These can include some harmful ingredients that might have a counterproductive effect on the weight loss you are trying to accomplish. If your doctor hasn’t prescribed you anything, don’t do it.
• Take regular treatment for your conditions. Certain conditions like hypothyroidism and Cushing syndrome can slow down your metabolism. Make sure to follow your treatment and consult them with any exercise you want to try out.
• Maintain healthy sleep habits. This is very important, so aim to get 7 to 9 hours each night. Also, make sure to make a schedule where you go to bed and wake up every time each day, even during the weekends. Create a quiet, dark bedroom environment, free of any distraction. You should avoid screens before bed, and do something relaxing. You can try taking a hot bath, reading a book, some light yoga, or listening to calming music. Limit your naps to 30 minutes a day, and avoid using stimulants like alcohol and nicotine as they can disrupt your sleep.

The number of sleep disorders is quite large. Learning about their triggers and factors, it seems somewhat logical to believe that nearly any human activity could lead to sleep disturbances. Since our sleep cycles are crucial for maintaining our immune health, the thought of missing out on necessary sleep is troubling. The situation gets more complicated because many sleep disorders lack definitive cures. Instead, individuals are often provided with ongoing treatments to manage the symptoms and hopefully achieve some level of restful sleep. Furthermore, some medications prescribed for these conditions can have side effects that seem as problematic as the disorder they aim to treat, or they may even lead to additional sleep issues or increased tiredness.

What could be scarier than all of those things? Well, what if we told you that there’s a breathing condition that can damage your liver, brain or other organs within minutes of symptoms appearing – possibly in your sleep? Hypoxemia and its sleep-related counterpart are some of the most threatening breathing-related conditions you can encounter, and it’s important to call 911 the moment you experience their symptoms. In this article, we will go over what makes hypoxemia so threatening, as well as how it can be diagnosed and treated.

An Overview of Hypoxemia

Hypoxemia is a breathing-related condition characterized by a low amount of oxygen in the blood. As soon as the percentage of oxygen drops to 90%, it is considered quite harmful to your body. Reaching 80% means you have a severe case of hypoxemia, where the symptoms are at their worst. 92-98% is what’s considered a “normal amount of oxygen in the blood.” If you have less than the necessary amount of oxygen in your blood, it means your body cannot distribute the correct amount to each bodily organ and various tissues. As a result, parts of your body stop functioning properly, which can lead to disastrous consequences after mere minutes – such as liver damage, brain damage or cardiovascular problems. Being able to recognize the symptoms of hypoxemia quickly is incredibly important, especially if you’re already aware of a chronic breathing problem in your life. Illnesses such as asthma or sleep disorders like obstructive sleep apnea are some of the most common causes of hypoxemia, so be alert if you’re facing conditions like these. Here’s the list of symptoms:

–          Noticeable changes in the person’s skin color, usually towards blue or cherry red

–          Intense coughing

–          Confusion and disorientation

–          Fast, shallow breathing, usually through the mouth

–          Increased heart rate

–          Intense sweating

–          Wheezing and similar breathing abnormalities

–          Slow heart rate

–          Mouth breathing and excessive drooling are a big telltale sign of hypoxemia in children

–          Problems forming coherent sentences and frequent pauses for breath while speaking

All of these are clear indicators of respiratory distress and hypoxemia and should be responded to as early as possible. Severe hypoxemia can easily lead to coma or even death, so there’s never any time to spare.

Diagnosing Hypoxemia

The earlier you can discover your susceptibility to hypoxemia (or identify its symptoms), the safer you are. Luckily, there are multiple reliable methods of diagnosing this condition, which lets treatment begin as soon as possible. We will go over each of these diagnostic methods, so you have a rough idea of what to expect when you make an appointment with your doctor. None of these methods are very painful, and the analysis typically doesn’t take too long. Here’s the list:

–          Listening to your heart and lungs is most likely going to be the first step the doctor takes. If they detect any abnormalities in how your lungs or heart operate, it is considered an indicator of breathing problems (and consequently, hypoxemia). Even if they don’t immediately hear it, almost every doctor will continue the diagnostic process because of how threatening hypoxemia is. There are no preliminary screenings here.

–          The second thing they often check is color changes on certain parts of your body, such as your lips, fingernails or skin in general. If they discover any bluish parts or cherry-red skin patches, it’s a clear sign that something is wrong with your oxygen levels.

–          An arterial blood gas test is one of, if not the most reliable method of identifying a lack of oxygen quickly. As with all blood tests, this is done using a needle, which is still pretty low on the discomfort scale (and if you have hypoxemia, it’s the last of your worries).

–          Pulse oximetry is a completely non-invasive method of checking your blood oxygen levels. It is performed using an oximeter, which is typically attached to your fingertip and used to inspect the peripheral oxygen saturation. While this method doesn’t directly analyze blood in your arteries, the results of pulse oximetry will match those of arterial blood gas tests done on the same patient in almost 100% of cases. For this reason, it’s used as a quick and reliable diagnostic method for hypoxemia.

–          Several breathing tests can help paint a clearer picture of the patient’s blood oxygen levels. Most of them involve blowing into some device (or a tube connected to the said device) and getting a reading. While not as prevalent as pulse oximetry or arterial blood gas tests, these methods find their niche thanks to their accessibility and overall reliability.

Once it’s established that you are dealing with hypoxemia, it’s time to begin treatment. It should go without saying, but follow every single instruction you’re given to the letter.

How Hypoxemia Treatment Works

Treatment is the make-or-break point in dealing with hypoxemia. The safest approach is to call 911 immediately and get taken to a hospital where health care providers will conduct oxygen therapy. Failure to administer this treatment as soon as possible can result in serious health complications for the patient. Even though all the relevant medication requires a prescription, exceptions are always made in case of severe emergencies. Hypoxemia is threatening enough to be considered an emergency. Almost every hospital has a protocol that allows for emergency oxygen therapy. Be aware that hypoxemia primarily occurs as a result of other health conditions, such as asthma, obstructive sleep apnea, heart failure, shock, myocardial infarction, etc. It’s equally as important to treat these underlying problems because ignoring them makes it much harder to get rid of hypoxemia.

Oxygen therapy may at first seem simple – the primary goal is to administer enough oxygen to hit the target saturation of 88-98%, depending on the patient’s age, medical history and other situational factors that may create special requirements. However, health care providers have to follow a list of guidelines that help them provide optimal therapy for any given patient. These guidelines may include one or more of the following steps:

–          Raising the patient’s back into a 45-degree position helps them breathe easier. The chest expands more naturally; the diaphragm moves more easily; the inhalation is much stronger and takes less effort. Patients with COPD (Chronic Obstructive Pulmonary Disease) may prefer to sit with their backs against a chair instead.

–          One of the best things to teach a patient is how to practice “controlled coughing” and various deep breathing exercises. These are all done to help clear the airway of any unwanted secretions and substances, which automatically increases the effectiveness of oxygen therapy. Patients who can’t quite muster up a strong cough can instead resort to “huffing,” where they make an intense exhalation. This technique often enables more reliable coughing later on.

–          Regular equipment inspections are mandatory. Make sure the airflow is set to the correct rate, and that any source of oxygen you’re using has enough to sustain the patient. Sometimes problems can arise if the hose connected to their facemask or nasal prongs gets twisted or bent in a way that slows down or stops the flow of oxygen.

–          Pain relief is of crucial importance. While the obvious reason is the comfort level of the patient and their responsiveness, there’s also another thing to consider. Pain increases our body’s metabolic demands, which also includes the demand for oxygen.

–          People with COPD or similar conditions tend to experience a lot of stress and anxiety. These two go hand-in-hand and are almost always overlooked or underestimated in terms of threat level. Make sure your patient receives stress relief through breathing retraining, relaxation techniques, counseling or even medication that alleviates stress and anxiety.

Sleep-Related Hypoxemia

The term “sleep-related hypoxemia” refers to hypoxemia that manifests itself as a result of sleep-related breathing disorders or during sleep in general. While most of the symptoms are the same, it’s important to keep track of where the patient tends to fall asleep. For example, sleeping during high-altitude travel or in areas full of smoke is a risky prospect, as it can lead to hypoxemia – sometimes in locations where you can’t quickly get medical help.

Diagnosis is performed in much the same way as with “normal” hypoxemia. The main unique thing here is that a formal sleep study is almost always conducted on top of everything else (such as arterial blood gas tests or pulse oximetry). If you’re dealing with sleep-related hypoxemia, make sure you maintain a sleep journal that can help any medical expert quickly deduce where the problems lie. Sleep-related hypoxemia is almost always treated through emergency oxygen therapy coupled with treatment options for underlying breathing problems, like obstructive sleep apnea, COPD and similar conditions. A diagnostic method called a “home sleep study” is used to monitor the patient’s blood oxygen levels while they’re asleep – typically through the use of an oximeter attached to their fingertip or a smart device that tracks biological functions, usually in the form of a watch. Consider this a part of sleep tracking. Home sleep studies are much less expensive and offer convenience to both the patient and their physician.

In the United States, it’s calculated that more than 4.4% of adults are diagnosed with bipolar disorder during their lifetime, a proportion that might surprise some. The condition manifests with symptoms that are significantly broader and more severe than those seen in ADHD, leading to greater fluctuations in mood, as well as increased risks of substance use and disruptive behaviors. However, diagnosing bipolar disorder can be challenging, as its symptoms often go unnoticed or are mistaken for other issues. This oversight could be partially attributed to the fact that manic episodes, which can feel pleasurable unless they’re severe and involve psychosis, might not be readily reported by sufferers as indicative of a problem.

On the other hand, the depressive episodes in bipolar people might simply be mistaken for clinical depression. Finally, sleep deprivation is known to cause many of the symptoms related to bipolar disorder, like irritability, hyperactivity, mood swings and even depression, to name a few. Sleep disorders cover a vast array of symptoms on their own.

In reality, disturbed sleep is a core symptom of bipolar disorder. It is no surprise, seeing as how mania and depression both negatively affect it. Sleep disorders often go hand in hand with bipolar disorder, and make its symptoms even worse  – but more about that later. First, let’s cover some ground on this specific disorder.

What is a Bipolar Disorder?

Bipolar disorder, also known as manic-depression illness, is a mental health disorder consisting of extended periods of extreme peaks (mania) and ebbs (depression) in a person’s mood and energy levels, with normal periods in-between. Contrary to popular opinion, this doesn’t refer to being emotional or having mood swings during a single day. People with bipolar disorder experience several days of long highs, known as manias, and several days of long depressive episodes. These can happen in a few different ways, don’t necessarily follow one another and can have a neutral state in between.

Bipolar disorder occurs in one’s adolescent or early adult years, often causing poor performance at school, work, and severely disrupting virtually all other aspects in one’s life (and the lives of those around them). Even so, many people suffer it needlessly for years without the appropriate diagnosis and treatment.

The cause of bipolar disorder is unknown. It has been shown to have a familial tendency, but the exact link hasn’t been discovered. The current consensus among psychiatrists is that a traumatic event triggers bipolar disorder to occur in a genetically predisposed individual.

Although bipolar disorder cannot be cured, it can be treated. With enough support and a good therapy plan, people with bipolar disorder can live fulfilling lives, have good careers and cultivate relationships.

Symptoms

Bipolar disorder symptoms are split into two categories: mania and depression symptoms.

Mania symptoms can last over three months if not timely treated. They include:

•         Extreme, euphoric feelings. In a manic episode, this extreme high is unphased by one’s sad experiences or even tragic news
•         Extreme restlessness. Extreme amounts of energy, inability to slow down or sit calmly
•         Racing thoughts and inability to speak at a normal pace
•         Diminished need for sleep. Going days on end with minimum to no sleep without feeling exhausted or even slightly tired, frequently resulting in insomnia
•         Feeling very excited
•         Extreme self-confidence. Feeling “on top of the world” with unrealistic assurance in own abilities; planning ambitious, overly-optimistic projects and feeling all-powerful
•         High irritability and sometimes aggression
•         Being easily distracted, poor focus
•         Poor judgment. Acting impulsive and noticeably out of character
•         Substance abuse and increased sexual activity
•         Psychosis

A manic episode is characterized by at least three of these symptoms (frequently including psychosis) happening at the same time and lasting for at least a week. During this time, behavior patterns are not only noticeably out of character, but functioning in usual environments like home or work is almost impossible. The symptoms are so severe that the person might get hospitalized to prevent serious self-harming or harming others around them.

When at least three of the listed symptoms occur together for a minimum of four days, but without the presence of psychosis, the episode is called hypomania. This term signifies a less severe and shorter lasting episode, with some noticeable impairment of the usual functioning but not to the extent as with mania. Hospitalization isn’t required as the person experiencing hypomania isn’t nearly as dangerous for self or others as one often is in a manic episode.

After a manic or hypomanic episode, one often feels ashamed of how they behaved and remembers little to none of what happened during the episode. These people may suddenly feel the burden of the responsibilities they signed up for, or promises they made during the manic episode that now don’t seem realistic or achievable.

Depression symptoms:

•         Persistent hopelessness or guilt
•         Anxious or even suicidal thoughts
•         Changes in meal patterns – eating less or more than usual, fluctuating weight
•         Reduced energy, lethargia
•         Daytime sleepiness and fatigue
•         Changed sleep pattern – hypersomnia or insomnia
•         Poor memory, inability to concentrate or finish simple tasks
•         Restlessness

A depressive episode might occur right after a manic episode, due to the sobering effect of the mania ending and the realization of how one behaved. Many people find depressive episodes more difficult to handle than manic or hypomanic episodes. It is probably because of the contrast between them; after a week-long period of euphoria, depression can seem that much more miserable. Depressive episodes can also occur after a neutral period.

A mixed episode is a term referring to an episode that features symptoms from both mania and depression lists and often carries a heightened suicide risk.

Types of bipolar disorder

Based on how frequently the episodes occur, and the nature of their symptoms, bipolar disorder is often split into four main types:

1. Bipolar I disorder. To be diagnosed with this type of disorder, one has to have experienced at least a single manic episode. Although frequently accompanied by hypomanic and depressive episodes, a person diagnosed with bipolar I disorder may only ever experience manic episodes.
2. Bipolar II disorder. This type of bipolar disorder describes a person who had at least one major episode of depression, and one of hypomania. People with this diagnosis often experience longer depressive episodes compared to people diagnosed with bipolar I disorder.
3. Cyclothymic disorder. Much like the one before, this disorder includes depressive and hypomanic episodes, but to fall into this category, they have to occur on a fairly regular basis. The symptoms in these episodes are less severe than with the first two types of bipolar disorder, but their sheer frequency poses a problem in a person’s life.
4. Rapid cycling refers to a disorder where one experiences at least four, and often more episodes of either mania, hypomania or depression within the time frame of a year.

Treating Bipolar Disorders

The treatment plan is not the same for everyone, as everybody has their own set of bipolar disorder symptoms, along with other contributing factors like one’s immediate surroundings, daily schedule, stress levels, etc.

For all bipolar disorders, a few types of treatments have been shown to help:

Medication, most commonly used being lithium, mood stabilizers, and antipsychotics.

Behavioral therapy, including cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT) and some others.

Support and self-care groups entered alone or with family and friends. These help to create a sense of community and relieve the feeling of isolation and otherness.

How bipolar disorder affects sleep

After learning more about the types of episodes that occur in people with bipolar disorder, it’s no surprise that sleep issues would follow these. During manic episodes, a person can go a few days with barely any or no sleep while being overly active and spending more energy than their body can handle. After the episode is done, this debt catches up, resulting in major fatigue and a disrupted sleep pattern. Depressive episodes, on the other hand, come with sleep issues generally linked to clinical depression, like insomnia, hypersomnias and excessive daytime sleepiness.

Vice versa applies as well – sleep deprivation and other sleep-related difficulties make bipolar disorder symptoms during an episode even worse; if happening outside of an episode, they may even trigger one. Sleep issues that progressively get more annoying can also signal the beginning of the next episode.

Sleep issues linked to bipolar disorder include insomnia, hypersomnia, sleep apnea, decreased need to sleep, fatigue, and delayed sleep-wake phase disorder.

Insomnia

Insomnia is a sleep disorder characterized by difficulties with either sleep onset or its maintenance over the course of the night. People who have this disorder might take over an hour to fall asleep, even though they physically feel tired. Some people only struggle with one of the two symptoms of insomnia, managing to fall asleep but waking up frequently or taking long to onset sleep but then staying asleep until morning. In any case, people who experience this disorder suffer excessive daytime sleepiness and poor sleep quality. Studies have shown that almost all people with bipolar disorder experience insomnia in depressive episodes.

Hypersomnia

The over-sleeping disorder affects over 78% of people with bipolar disorder according to recent studies. For comparison, out of the unipolar population, only about 4% are affected by this disorder. As with insomnia, long sleep hypersomnia issues usually happen during a depressive episode or signal the beginning of one. However, excessive daytime sleepiness (wishing to sleep more) may signal the proximity of a manic episode instead.

Decreased Sleep Needs

At first glance, this issue looks similar to insomnia, but in reality, they are easily distinguished by a simple difference. People who have insomnia can’t fall or stay asleep despite their physical tiredness. They want to sleep; it is just that they achieve this goal with difficulties. On the other hand, people who experience decreased need to sleep don’t physically feel tired because the mania powers them, so to speak. Although the sleep deprivation takes a toll on their body, they only feel tired after the manic episode is over, and the sleep debt swamps them. An estimated 99% of people with bipolar disorder experience decreased need to sleep during a manic episode.

Sleep Apnea

This form of sleep-disordered breathing describes a sudden airway blockage that happens when one’s asleep, often occurring in people with obesity. It is also frequent among the people with bipolar I disorder. The suggested treatment for severe cases of apnea involves CPAP therapy, a mask worn during sleep to help keep the airways open. However, in some cases, this method might trigger the symptoms of mania and may not be appropriate for people with bipolar disorder.

Fatigue

The least surprising, often constant sleep-related issue universally experienced by people with all types of bipolar disorder, fatigue occurs as a result of big fluctuations in moods and energy between manic and depressive episodes. After the sleep deprivation typical for periods of mania, the person is physically and emotionally exhausted, making it easy to fall straight into depression.

Delayed Sleep-Wake Phase Disorder (DSPD)

This circadian rhythm disorder isn’t rarely provoked by extreme sleep pattern changes in people with more severe types of bipolar disorder. People who have this disorder have a later bedtime than average, meaning they naturally fall asleep but also wake up later. It causes a lot of difficulties to accommodate school and work schedules. In attempts to do that, people with DSPD often try to forcefully wake up earlier than they normally would, resulting in daytime sleepiness and fatigue.

Treatment Options

While sleep issues frequently comorbid bipolar disorders, treating both is possible and methods vary between different problem combinations. We listed some common methods below to give you a general idea of how a treatment procedure might go.

Cognitive behavioral therapy is an overall helpful treatment method, used for a vast scale of different sleep disorders. The method is simple and pill-free; works by setting up a set of steps to help form a base of a healthy relationship with sleep.

Light therapy used strategically can help solve different types of sleep problems by boosting the body’s circadian rhythm and alerting you to stay awake until the desired bedtime. Unless otherwise specified, this method is used only in the morning or early afternoon.

Melatonin supplement is commonly used to complement light therapy. This supplement is a form of a hormone that is produced in our brains shortly before and during sleep and has a role in inducing this process. Melatonin is supplemented in a prescribed dose before going to bed and has virtually no health risks unless taken in large doses.

Some drugs like benzodiazepines are used to treat bipolar disorder but also insomnia. If you are taking this or any other drug for bipolar or sleep disorder, talk to your doctor about side-effects and risks. Unless carefully instructed by a specialist, don’t combine any two medications; otherwise, you will needlessly put yourself at great risk.

If you find yourself less than satisfied with treatment results or think there might be some better therapy method to try, discuss it with your doctor before taking any action or giving up altogether. Lastly, don’t forget that any method of treatment alone won’t work unless you do your best to cultivate healthy sleep hygiene. Diet, exercise, and stress levels are just some external factors that play a role in how well you sleep. Whether this role will be positive or negative is up to you.

Our bodies require a steady supply of oxygen for cellular energy production. This oxygen is transported to the cells through the bloodstream, and the energy-producing metabolic reactions similarly generate waste. One such waste product is carbon dioxide, which must be expelled from our bodies as urgently as they require oxygen. Elevated levels of carbon dioxide in the blood can cause symptoms ranging from headaches and fatigue to coma and possibly death.

We inhale through our nose and mouth, and then air passes through the main windpipe called trachea, and continue through two bronchi to each lung. Air goes through smaller and smaller pipes until it reaches small sacks of air called alveoli. This structure of tubes in our lungs is often called a tracheobronchial tree because it is remarkably similar to the branching pattern of trees. Alveoli are surrounded by a fine network of tiny blood tubes called capillaries. This is where the exchange of gasses happen; oxygen enters blood where it is taken by red blood cells (erythrocytes) and later delivered further in the body. Erythrocytes also carry carbon dioxide to alveoli, where it is released, and then let out during the next expiration. Any breathing dysfunction can compromise this, and leave your body in a suboptimal state.

Hypoventilation during sleep is one of the sleep-related breathing disorders, and it involves slow or shallow breathing, known as respiratory depression. Usually, there is some problem in the communication between the brain, neurons, and the muscles, and it results in inappropriate breathing regulation. That can lead to a lack of oxygen and build up of carbon dioxide, which can even have fatal consequences.

Symptoms of Hypoventilation

This type of breathing disorder can occur in anyone, even babies and young children. The exact prevalence of this respiratory problem is not known, but it is not considered to be a common disorder. Because many different underlying conditions can be to blame for nocturnal hypoventilation, the symptoms vary between individuals. The most frequent ones include excessive daytime sleepiness, fragmentation of sleep, insomnia, morning headaches, stomach problems, difficulty breathing, faintness, mood changes, lack of focus, impaired memory, and reduced exercise capacity.

A lot of people don’t experience, or the symptoms are very mild in the beginning, so they don’t realize that they have a progressing condition. Chronic hypoventilation can lead to serious health problems such as respiratory and heart failure, and blood and brain disorders. Keep in mind that most of these signs also occur in other sleep-related disorders, so you need to check with a medical professional if you are experiencing any of them.

Causes of Hypoventilation

Many factors can lead to sleep hypoventilation syndrome. The autonomic nervous system that is in charge of involuntary movements like breathing may not work correctly, and it can lead to hypoventilation problem. Usage of specific medications such as opiates and benzodiazepines could also lead to this condition.

Obstructions of the airflow often caused by a medical condition such as emphysema, bronchitis and cystic fibrosis for the lower, and obstructive sleep apnea for the upper airway, are also risk factors. Nocturnal hypoventilation can also be due to a physical disorder such as an abnormally shaped chest wall, that is not letting lungs to move. People with muscular dystrophy are also more likely to suffer from this condition.

People with diseases of lung tissue are also more prone to hypoventilation. Smoking is a significant risk factor that causes inflammation and obstruction of the lower airway. Environmental factors, such as breathing in pollutants, chemicals, and other dangerous molecules can lead to damaging of the lungs and can cause a lack of respiration.

Neurological disorders where the brain’s control is impaired also leads to lack of respiration. Congenital central ventilation syndrome and central sleep apnea are good examples of that. Other medical conditions that could cause it are asthma and other pulmonary disorders, obesity, and hypothyroidism.

Different Types of Sleep-Related Hypoventilation Disorder

Within the term sleep-related hypoventilation, there are a few distinct disorders, that all have one thing in common, lack of gas exchange happening during sleep. Whether it is the cause of shallow or slow breathing, or a lung, brain or blood disorder, the body lacks oxygen and has excess carbon dioxide.

Hypoventilation can be caused by the excess weight that a person is carrying, and it is called obesity hypoventilation syndrome. Obesity is linked with many health problems, and all of the professionals agree that the goal for everybody would be to reach a healthy weight, as it greatly improves health, happiness, longevity and overall quality of life. Extra fat can block the airways, thus providing obstructions, and preventing the proper ventilation of the lungs.

Congenital hypoventilation syndrome appears in infants, and it is characterized by the abnormally slow and shallow breathing. Infants with this syndrome can appear bluish after or during sleep, and this condition is known as cyanosis (derived from the Greek kyanos meaning dark blue). Babies with this syndrome need an artificial diaphragm pacemaker to stimulate normal breathing patterns, and might also need mechanical ventilation. In most cases, that is only required during the night, but in more severe cases, they need this assistance all day long.

Central hypoventilation with hypothalamic dysfunction looks similar to congenital hypoventilation, but it appears later in childhood. Symptoms of this disorder are accompanied by signs of hypothyroidism, that include fatigue, feeling cold, and slow metabolism.

In some rare cases, the cause of the hypoventilation can be unknown, as everything looks normal upon observation. This condition is called primary alveolar hypoventilation.

Diagnosis and Treatment

A series of tests are done to determine if the patient is suffering from the sleep-related hypoventilation. Firstly, doctors will determine if the lungs are working correctly, then they’ll asses the respiratory muscle strength. Daytime oxygen and capillary gas tests are done to determine the quantity of oxygen and carbon dioxide in the blood during the day. All those tests can tell doctors if there is anything wrong with your respiration.

Additionally, they’ll need to do an overnight sleep study, called polysomnography. You’d have to stay in a sleep facility, where they hook you up to a bunch of electrodes and different machines that measure your brain waves, respiration, heart rate, oxygen blood levels, limbs, and chest movement, as well as any snoring or other sounds you might produce during sleep. The information gained from this study is essential, and it helps doctors to see what is exactly the cause of your nocturnal hypoventilation, and to treat it properly.

Treatment of sleep-related hypoventilation depends on the case, and it usually involves treating any underlying condition that might be the cause of it. For instance, for obese individuals, weight loss will be advised. For people with hypothyroidism, the regulation of hormone levels will be needed, while for people with a narrowed airway, respiratory stimulants might be prescribed. These substances help to correct the closed pipes that might be the consequences of drug or alcohol abuse.

For some other conditions, you might be prescribed oxygen or continuous positive airway pressure (CPAP) therapy. CPAP is mostly used as a treatment of sleep apnea, but it can be beneficial to other conditions as well. You usually put a mask over your nose or mouth, that is connected with a machine that sits next to your bed. The device is continuously pumping pressurized air so that you get the amount you need. There are different types of masks, and settings, so you can get the ones that suit you best, and you’d also need to follow your doctor’s instructions with the amount of air that is delivered to you.

Some people have problems with CPAP therapy as they have trouble breathing out with air continuously coming in. That’s why decide for a bilevel positive airway pressure (BiPAP) therapy. The principle behind this is similar to CPAP; it is just that there are two different pressures when you try to inhale and exhale. During inspiration, the pressure is stronger, filling you with the needed air, while it is weaker during expiration so that you don’t have any trouble doing it. These machines can also be programmed to take automatically take a breath if you haven’t inhaled for a certain amount of time, thus additionally preventing hypoventilation.

About half of the global population will face some sort of sleep disturbance throughout their lifetime. Although these issues vary in severity, with some posing serious health risks and others simply altering sleep patterns, they all cause discomfort to some degree. Among the most widespread issues are teeth grinding (also known as bruxism), insomnia, various parasomnias, and catathrenia, which involves making a moaning sound when exhaling in sleep rather than the more common snoring. These conditions affect different demographics in unique ways, with some being widespread, others targeting specific groups, and a few so rare they’re hardly recognized outside of specialized sleep studies. This is true for circadian rhythm disorders, except for the delayed sleep-wake phase disorder, which is relatively more common among sleep disorders.

What each one out of this family has in common, as the name suggests, is some form of abnormality of the circadian rhythm. A normal human circadian rhythm is a process that oscillates and re-occurs every 24 hours, regulated by the circadian clock. These rhythms control our core body temperature, hormone secretion, alertness levels, and regulate the sleep pattern in response to our exposure to light. The purpose of this is to make sure we do the right things at the right times: we fall asleep when it’s dark outside and wake up in the morning.

Abnormalities of this rhythm have a few variations: our sleep onset can be delayed or advanced; our sleep nonrestorative, stuck by jet-lag or shift-jobs, scattered throughout the day, or sometimes “run free” of the standard 24-hour rhythm. The last two disorders are often grouped into a subcategory called the “sleep-wake rhythm disorders.”

What are Sleep-Wake Rhythm Disorders?

The two disorders that fall under this category are irregular sleep-wake rhythm disorder and non-24-hour sleep-wake disorder. These two neurological disorders are typically the rarest forms of all circadian rhythm disorders; their prevalence is practically unknown in otherwise healthy people, without the presence of another condition. However, the incidence rate among blind individuals, the elderly and people who have Alzheimer’s is significantly higher between these disorders.

Irregular Sleep-Wake Rhythm Disorder

The main characteristic of the irregular sleep-wake rhythm disorder is its unpredictable sleep pattern, with sleep periods occurring randomly throughout the 24-hour cycle. People who have this condition sleep a few times a day for shorter periods that can last anywhere from one to four hours, but their daily sleep sums up to eight or nine hours overall. They take multiple naps over the day but usually sleep the longest at nighttime.

While this disorder doesn’t impair the length of sleep an individual gets per day, the uncontrollable, scattered manner of it results in struggles with handling daily responsibilities; shifts at work and tasks requiring attentiveness can be compromised by an unpredictable, spontaneous sleep urge in the middle of the day. It can quickly put you and the people around you in danger. Besides that, if continued over a longer timespan, irregular sleep-wake rhythm disorder can lead to sleep deprivation, risking other potential complications for your health.

The exact cause of the irregular sleep-wake rhythm disorder is unknown, but infrequent light exposure and unpredictable mealtimes are the two factors believed to contribute to its development. Since these stimuli have a direct impact on the circadian rhythm, their infrequency lessens its ability to time sleep properly. Such a situation may happen when the patient lives in a nursing home, hospital, or has some debilitating condition that deters them from going outside and getting enough sunlight on a steadier, more regular basis.

Another possible factor could be age. Our body gradually stops producing certain circadian rhythm regulating hormones as we get older, making it harder for our brains to differentiate sleep time from wake time. Aside from that, Alzheimer’s disease and dementia are believed to be related to the irregular sleep-wake rhythm disorder; it is much more prevalent in patients who have one of these neurological conditions than in otherwise healthy people. In people under the age of 60 who don’t have another medical condition, the incidence rate is estimated to be under 1%, making this sleep disorder very rare.

Symptoms include:

•         Difficulties falling asleep
•         Waking up after sleeping for only 1-4 hours, even at night
•         Excessive daytime sleepiness
•         Unpredictable but very strong sleep urge
•         Having a fragmented sleep manner, napping a few times during the day

Diagnosis and treatment

In order to diagnose irregular sleep-wake rhythm disorder, a doctor will start by taking your medical history and asking to hear your subjective impressions about the problem you came to address. A sleep diary is something you can start even before you go to your first appointment. Simply record everything you notice about your sleep pattern for a few weeks. How often you sleep, for how long, at which times of day, whether you are sleepy during daytime or not – all of these can be useful for a specialist to narrow down your symptoms much faster. Although used as a subjective overview, the information provided in a sleep log is often much more detailed and precise because it was fresh when you recorded it.

To rule out some other sleep disorders, the doctor might order polysomnography. This test is performed during the night, or during the patient’s usual sleep time; it tracks all the major bodily processes that occur during sleep, monitored by a sleep specialist. It could help determine whether or not you have the irregular sleep-wake rhythm disorder by tracking the circadian rhythm markers in the body – melatonin production and core body temperature oscillations.

The treatment of irregular sleep-wake rhythm disorder usually consists of a combination of behavioral therapy, phototherapy and melatonin supplementation.

• Behavioral changes include re-associating your bed with sleep – setting up a comfortable atmosphere in the bedroom and sticking to a planned daily bedtime and waking up schedule. Your eating pattern also needs to be regular and predictable.
• Phototherapy is a treatment using bright light in the morning or as needed until noon, to help the circadian rhythm boost your alertness level and prolong your time awake until nightfall.
• Melatonin is a hormone naturally secreted in our brains that serves a purpose in inducing sleep. Supplementing the prescribed dose of melatonin in the evening, before bedtime, helps cue your body to fall asleep and maintain it for longer than a few hours.

Non-24-Hour Sleep-Wake Disorder

The other neurological sleep-wake condition is known for causing the usually 24-hour long circadian rhythm to stretch beyond that time frame, moving the person’s sleep time later and later, seemingly at free will. This time frame gets progressively longer over time and causes fatigue and excessive sleepiness.

Non-24-hour sleep-wake disorder is caused by anomalies in the suprachiasmatic nucleus, the area of our brain that maintains the circadian clock. As mentioned above, this clock normally responds to light and synchronizes the body with external light-dark times of the day. Occasional disturbances in this cycle may happen prompted by travel, shift work, illness and so forth, usually when our light exposure changes, but then fall back in place after a bit of adjustment. However, in people with the non-24-hour sleep-wake disorder, this function is impaired, for two possible reasons:

1. The brain’s response to light in the patient with non-24-hour sleep-wake rhythm is abnormal, or there is little to no exposure to light. Melatonin levels might also be higher than average.
2. The person is blind. People with blindness can’t use light as a cue for alertness, as usually regulated by the circadian rhythm, which makes them more prone to this disorder.

The non-24-hour sleep-wake disorder is highly prevalent in blind individuals; up to 70% of them also have this disorder. The exact incidence rate of this disorder among sighted people is unknown, but those with current issues or a history of delayed sleep-wake phase disorder are prone to developing the non-24-hour sleep-wake disorder as well, pushing their already late bedtime even later. If this keeps going on for long enough, the person will get stuck, going back and forth between night owl and early bird sleep schedule, forming full circles before starting new rounds. This wheel results in excessive sleepiness and exhaustion, making any social life or work shift impossible to maintain for longer than a day.

Sleep scientists have recently begun researching the possibility of a genetic predisposition towards developing the non-24-hour sleep-wake disorder, but no significant evidence has yet linked the two.

Symptoms include:

•         Bedtime moving later and later as time goes by
•         Waking up progressively later as well
•         Difficulty onsetting sleep
•         Current issues or a history of the delayed sleep-wake phase disorder
•         Insomnia
•         Depression
•         Excessive daytime sleepiness
•         Unsatisfactory quality of sleep
•         Feeling isolated from other people

Diagnosis and treatment

As with irregular sleep-wake rhythm disorder, after questionnaires, a physical exam and a thorough medical history, your doctor might suggest using a sleep tracking tool. Actigraphy is a device worn around the wrist to record your sleep-wake cycles – this method is used when polysomnography isn’t available or necessary.

As far as the treatment goes, a combination of melatonin supplements and light therapy is frequently used for patients with the non-24-hour sleep-wake disorder. The procedure is standard – melatonin is used in the evening to help with sleep onset, and light therapy is used in the morning, to alert the body and keep it awake until bedtime. However, unlike the other circadian rhythm disorders, non-24-hour sleep-wake disorder has to be treated even after optimal results have been achieved; that is, even when the circadian rhythm gains its usual functionality back. If the treatment stops abruptly and the new, balanced sleep hygiene isn’t properly maintained, the non-24-hour sleep-wake disorder often recurs. For blind people with this disorder, carefully timed and dosed melatonin is the most effective and frequently used method of therapy. Maintaining the normal circadian rhythm is especially difficult for them as well; regular medical help is often needed.

Tips for Maintaining Healthy Sleep

In addition to virtually all methods used for treating sleep disorders, some behavioral changes are a safe bet to keep your sleep in check and make sure past issues don’t return in the future. Try to follow these guidelines:

• Don’t procrastinate sleep. Some adjustments to your schedule are fine once in a while, but no treatment or medication will eradicate issues caused by poor organization or complete neglect of your sleep. Take responsibility to avoid unnecessary complications.
• Abusing substances, doctor approved or not, is another no. Just because your sleep pills might have been prescribed at some point, using them while disregarding the doctor’s instructions will do more harm than good. Steer clear of alcohol, caffeine, antihistamines, and other drugs before sleep.
• Make sure you get out of the house during sunlight. It will help maintain the healthy circadian rhythm, plus any physical activity that you can fit into your day is worth it – exercise has been shown to boost sleep among other systems in your body, like immunity and metabolism.
• In the late afternoon and evening, try dimming the lights, especially in the bedroom. Lowering the light levels will be suggestive to the circadian rhythm, preparing you for nighttime and sleep.
• Do daytime activities away from your bed. By limiting the use of your bed to sleep-related activities, you will establish the relationship between the two in your mind. Falling asleep at night will be easier when your body is trained to expect sleep simply by being in bed.

Ever experienced a sudden jerk in your body just as you were drifting off to sleep? You find yourself suddenly awake, often with the sensation of having tripped, slipped, or fallen in a dream. Your pulse races, and settling back into sleep takes a moment or even proves challenging for a return visit from the Sandman. If this sounds familiar, rest assured, you’re in good company; it’s entirely normal.

These events are called sleep starts, or hypnic or hypnagogic jerks, and they are quite common. Almost everybody experiences it at some point in their lives, and they can also affect anybody, no matter your sex, racial background, or age.

Sleep starts are usually harmless, and they don’t require any medical assistance. However, there are some reported cases of hypnic jerk anxiety, where person’s events were so frequent and unpleasant, that they developed a negative attitude towards going to sleep. Sometimes, sleep starts can be a sign of some underlying sleep or a mental disorder.

Hypnic jerks are a part of a wider variety of involuntary movements called myoclonus. Sleep starts are not considered a sleep disorder, and they usually don’t require any treatment. There are some things you can try to lower the chances of these events if you experience them frequently or they feel startled by them.

What is Myoclonus?

Myoclonus refers to a sudden twitching of muscles. If sudden muscle contractions cause it, it is called positive myoclonus, and in case of muscle relaxation it is negative myoclonus. They can be single events, or they could happen in a sentence or a specific pattern.

Besides sleep starts, hiccups are another excellent example of myoclonus. While these are entirely harmless, severe cases of myoclonus affect a person’s ability to move, eat, or talk. Those are often a sign of some underlying condition, or brain and nerve damage, and need to be treated.

Myoclonus can develop as a result of head or spine injury, infections, liver or kidney failure, brain tumors, drug poisoning. Myoclonic jerks can also occur in patients who have multiple sclerosis, Alzheimer’s disease, Parkinson’s disease. They are frequent in people with epilepsy because the brain’s electrical signals are distorted.

Types of Myoclonus

There are some forms of myoclonus; here we listed the ones described by the National Institute of Neurological Disorders and Stroke (NINDS):

• Action myoclonus is characterized by the jerks when making a voluntary movement, or even thinking about it. It can affect legs, arms, face, even the voice. It is one of the more disabling types of myoclonus, and it’s usually caused by the nerve damage that is due to the lack of blood flow and oxygen delivered to the brain.
• Cortical reflex myoclonus is typically triggered by a specific action, just like action myoclonus, or it can be due to some sensation.
• Essential myoclonus is not caused by the abnormalities in nerves and brain, and the cause is still unknown. It usually occurs in the same families, hinting that it may be possible to inherit it. It seems stable over time, and people who are experiencing it are not reporting the increase of symptoms severity.
• Palatal myoclonus is a contraction of the soft palate, a back end of your mouth, and happens regularly. These may be accompanied by jerks in other parts of face, tongue, throat, or diaphragm. This condition mostly affects adults, and the contractions can be very rapid, as many as 150 per minute. It mostly happens at night, and for most of the people, it’s a minor problem, while others hear a clicking sound in their ears, or report pain and discomfort.
• Progressive myoclonus epilepsy (PME) refers to a group of disorders with symptoms like myoclonus, trouble walking or speaking, epileptic seizure, and other severe symptoms. There are many forms of PME. They usually begin in childhood, and get worse over time, with sometimes fatal outcome. Luckily, these disorders are extremely rare.
• Reticular reflex myoclonus is a type of generalized epilepsy that is correlated with the brain stem, a part of the brain responsible for vital functions like heart and breathing rate. These jerks usually happen in the whole body, but there are some cases where they affect only a part of the body, like the legs. They occur on both sides at the same time, and jerking involves all muscles in that body part. Reticular reflex myoclonus occurs voluntary movement or due to some some external stimulus.
• Stimulus-sensitive myoclonus as the name says, is caused by external stimuli like noise, movement, and light. Not expecting the stimuli may increase the chances of jerks appearances.
• Sleep myoclonus mostly occurs in the first stages of sleep, most likely at the very beginning. Some cases report that the external stimuli can trigger it. While mostly harmless, it can sometimes be a sign of a sleep disorder such as restless legs syndrome, and it may require medical treatment.

Why Do Hypnic Jerks Occur?

It is still unclear why do sleep starts happen, and researchers are trying to figure that out. It is most likely due to misfiring of neurons when some parts of the brain fall asleep faster than the others. Another interesting hypothesis says that hypnic jerks are an ancient primate reflex. They supposedly happen because of the relaxation that is sometimes misinterpreted as a falling out of the nest in the trees, so twitching happens to wake us up.

Whatever the cause, they are thought to affect most of the population, and they are more frequent in young children. Some risk factors are shown to increase the chances of sleep starts occurring. High intake of the caffeine and other stimulants, especially too close to bedtime may set it off. Emotional trauma, stress, poor sleeping habits, and high-intensity exercise before sleep are common triggers as well. Medication abuse, iron deficiency, and urea build up are also suspects for potential causes. Certain sleep disorders like obstructive sleep apnea can play a role too. Frequent unpleasant episodes of sleep starts need a medical examination, as they can lead to anxiety and sleep onset insomnia, or they can be a sign of a more complex underlying problem.

Other causes of sleep movements include:

• Restless legs syndrome is described by the uncomfortable feeling in the legs when resting, with an urge to move them and relieve the pain.
• Periodic limb movement disorder occurs during sleep, and it is described by the periodic rhythmic contraction and relaxation of the muscles. Unlike hypnic jerks, these are not single events.
• Shivering while sleeping in a cold environment can cause nocturnal movements as well. It affects the whole body and can be resolved by warming up or treating the fewer that is causing it.
• Fasciculations happen in a specific muscle or group of muscles. It appears as quivering, they are more persistent than hypnic jerks, and can occur during wakefulness.

How to Deal With Sleep Starts

In most cases, hypnic jerks can be improved through changing lifestyle habits like:

• Avoiding high-intensity exercise before bed. Although regular physical activity is one of the best ways to get better quality sleep, it seems that exercising too close to bedtime can be counterproductive and increase the chances of sleep starts.
• Avoiding caffeine. Caffeine is a stimulant, and it is found in coffee, tea, chocolate, and many other things. It helps us get alert in the morning, but having it later in the day might affect our sleep quality.
• Avoiding other stimulants. Alcohol and nicotine can lead to disrupted sleep and hypnic jerks, especially if taken close to bedtime.
• Creating a relaxing bedtime routine. It is essential that you unwind before bed as it will help you fall asleep faster, and stay sound asleep during the night. Different things work for different people, so you might try reading, taking a hot bath, drinking caffeine-free tea or a warm glass of milk, listening to mellow music, meditating, breathing exercises, light yoga, taking a hobby, or any other thing that helps you relax.
• Creating a pleasant sleep environment. Your bedroom should be dark, quiet, fresh, and free of screens and distractions. Also, try to stick to a regular sleep schedule, where you’re going to sleep and waking up at the same time every day.

If your symptoms are persistent, and these sleeping tips don’t help you, you should consult a medical professional. They may need to do an overnight sleep study called a polysomnogram, where they will observe your brain waves, respiration and heart rate, and many other things. That way they can determine what is causing your sleep problems and prescribe the right treatment. Sleep starts can be treated with leg exercise, iron supplements, dopamine agonists in really bad cases, as well as other medical supplements.

Do you ever feel like you’re meant to be on a different temporal schedule? While everyone else is rising at dawn to begin their workday, you find yourself feeling drowsy and prepared to hit the snooze button, and the opposite occurs as well. People often describe you as a night owl, and despite your ability to adapt and feel alright, it’s likely you’re experiencing a sleep-wake phase disorder.

Sleep-wake cycle refers to our daily pattern which consists of optimally recommended 16 hours of wakefulness and 8 hours of sleep during the night. Our body’s circadian rhythm controls the sleep-wake cycle. Circadian rhythm is controlled by the body’s inner clock located in the brain which controls many biological functions such as hormone release, body temperature, and sleep-wake cycle. Our biological cycles are usually synchronized with the daily cycle of light and dark, which affects our sleeping and waking time. Beside disorders of the sleep-wake phase, our body’s circadian rhythm can be disrupted due to working in shifts, jet lag, etc.

Just like with other disorders of circadian rhythm, sleep-wake phase gets disrupted when our circadian rhythm is not aligned with normal sleep routine. People who suffer from this disorder have a strong biological urge to stay up when most of the other people are sleeping and to sleep when others are already fully awake. This disorder can sometimes be mixed with insomnia, or be prescribed to someone’s laziness or late night binge-watching habits, but the reality is that it is also a type of disorder which has a strong impact on everyday life since it can be hard for those people to socialize or hold a job with that particular lifestyle.

There are two main types of this disorder, advanced and delayed sleep-wake phase syndrome, for both cases, the best thing that you can do is to go to a sleep clinic and let them perform a sleep study on you. You might be asked to write a sleep diary for a few weeks or to wear an actigraph to track your sleep. All this is needed so that the doctors can set the correct diagnose, as these disorders are often caused by others or mixed with them due to similar symptoms.

Excessive daytime sleepiness and a struggle with maintaining a sleep routine are common symptoms of both types of sleep-wake phase disorder, and we are now going to discuss both of them.

Delayed Sleep-Wake Phase Disorder

DSPD stands for delayed sleep-wake phase disorder which is also known as DSPS, delayed sleep-wake syndrome. People who have been diagnosed with this disorder usually have their sleep pattern delayed by at least two or more hours. That means that the circadian rhythm of those people is shifted to later at night and in the morning too. Their sleep is generally healthy, there are not any disruptions or issues while they are asleep, but the fact that it occurs later than normal or socially acceptable can be a problem for them once it starts hindering their job or other activities. Since they are usually a minority in society, they have to struggle to fulfill expectations and do things on time. Getting up early to go to school or work can be challenging for them, and many people with normal sleep cycle are having problems to understand that. Parents, employers and even some doctors can sometimes show the lack of understanding for this disorder, which can be an additional aggravating factor for people dealing with this it.

People with DSPD prefer going to bed late, and when they are on their own schedule without any obstacles, they can get the desired amount of quality sleep time and function as normal as everyone else. The solution to this problem is not simply going to bed earlier, because these people really cannot fall asleep earlier; it is not something that they can easily control or change on their own. People with DSPD who are trying to live as “normal” as possible and go to work etc. are usually sleep deprived, which then triggers some other complications.

Symptoms of DSPD resemble the ones of insomnia, and people’s daytime functioning is jeopardized and followed by severe fatigue and daytime sleepiness. Around 10% of people who believe to have chronic insomnia actually have DSPD. We suggest consulting a sleep specialist at a sleep clinic to set you a correct diagnose and examine your sleep habits.

When it comes to age, teenagers and adolescents are especially affected by this disorder, around 7% to 16% of them have it, and girls experience it more often than boys. It is hard to tell what can be the cause of DSPD, and there are probably some genetic predispositions to it since around 40% of people with this disorder have a family history of DSPD. DPSD should not be considered a psychological disorder, since it more of a neurological disorder, but sometimes, living with DPSD can cause stress and lead to mental diseases such as depression. Environmental conditions, (such as lack of exposure to morning sunlight), other health problems, medications, substance abuse, or other sleep disorder can trigger DSPD

Most common symptoms include:

• Troubles with falling asleep at the preferred time of night
• Being unable to wake up at desired or socially acceptable time
• Chronic fatigue and daytime sleepiness
• People who experience this stable but delayed sleep routine for more than seven days can consider their condition for a sleep-wake phase disorder.

When it comes to treatment or cure for DSPD, timed melatonin has shown great results when used in teens, and it can also be an effective solution for adults. Melatonin is a hormone naturally produced by our body which helps to regulate our sleep-wake cycle by sending signals to our body when our bedtime is approaching. Although it is widely available in the form of a supplement, sleepers should not use it on their own. They should always consult a sleep specialist for the recommended dosage and timing. In theory, another possible treatment is bright light therapy which provenly enhances and changes the circadian rhythm, but it has not been yet scientifically tested and validated as a treatment for DSPD. After waking up at a desired time in the morning, a person that undergoes light therapy should be exposed to bright light, and in the evening hours, bright light should be avoided. Light therapy in combination with cognitive behavioral therapy should be highly efficient among teens and younger adults.

Advanced Sleep-Wake Phase Disorder

Contrary to people who have DPSD and are considered night owls, people with ASPD, advanced sleep-wake phase disorder or syndrome (ASPS), are known as early birds. Their sleep cycle is also out of balance but in a different way. They usually fall asleep several hours before regular bedtime and wake up hours before everyone else.

People with ASPD are already feeling sleepy in the afternoon, and their preferable bedtime is somewhere between 6 PM and 9 PM, which means that they will wake up naturally between 2 AM and 5 AM. Just like with people with DSPD, their sleep is healthy, good quality and not disrupted. All processes of circadian rhythm occur earlier for them, the release of hormones including melatonin, body temperature curve also, and that is used for detecting this syndrome.

Unlike people with DSPD, those with ASPD have no problem with working and functioning normally during the morning hours. For them, the problem occurs during the afternoon and especially evening hours when they start struggling to stay awake and “shutting down.” Missing those few hours of sleep during the early evening will eventually result with sleep deprivation, and even when they are sleep-deprived, people with ASPD will still wake up way earlier than everyone else.

ASPD is also often mixed with insomnia or depression, people start to worry about waking up so early, they are not feeling good about themselves, and that may lead to developing a secondary form of insomnia.

For people with ASPD, it can be a bit easier to organize their life around their early bird lifestyle, since they are the ideal workers for notorious early morning shifts. They should not push themselves to stay awake in the late afternoon by drinking gallons of coffee or taking some stimulants to stay up. The same applied to morning hours; sleeping pills and alcohol should not be used as a way of “help” to prolong their sleep time.

This disorder is not so common since it affects only 1% of middle-aged people, but it is more common among seniors, regardless of their sex. ASPD also runs in families, so genetics are most likely the primary cause of it.

Main symptoms that are signals for ASPD are:

• Falling asleep in the afternoon hours
• Waking up between midnight and 5 AM
• Functioning normally as an early bird for more than a week

ASPD is a disorder with whom people can live if they can adjust to it, as it does not hinder everyday life functioning as much as DSPD. But if it is bothering you and jeopardizing your social life, consult with a doctor, preferably with a sleep specialist. They will examine your family medical history and probably perform a sleep study, for example, polysomnogram, which will follow your brain waves, heart rhythm, and breathing while you are sleeping. It will show if any other sleep disorders caused or increased the effects of ASPD, some of them might be sleep apnea or periodic limb movement disorder.

You will probably have to wear a device called actigraph on your wrist, for around one or two weeks. This device measures and records sleep activity during that time. Some other methods and tests may be included, but these are the most common ones.

When it comes to treatment, as we mentioned, sometimes it is not necessary if people are able to adjust their life to their sleep pattern. Try looking at it in a positive way – a lot of things can be done in the morning or while others are sleeping, and you will be more productive and have more time for yourself. Also, try consulting with a sleep specialist in behavioral counseling. They will provide you with some useful tips such as, for example, not making any plans for evenings, avoiding afternoon shifts or shift work in general, also avoiding caffeine during the late afternoon and not using any pills to help you stay asleep longer.

But, if you want to try ”fixing” it, bright light therapy during the evening hours can help with resetting their inner clock. The light should be brighter than regular indoor lighting, and there are specialized light boxes or portable devices that you can try out for that. You should practice bright light therapy for around two hours before the desired bedtime, at least for one week. Melatonin supplement is another option, but you will have to ask your doctor to prescribe you the optimal dosage.

Polysomnography stands out as one of the top approaches for detecting and pinpointing sleep disorders. This overnight test is conducted in a sleep laboratory, allowing medical professionals to observe different bodily functions during sleep, such as brain waves, respiration rates, muscle activity, and eye movements. Nevertheless, the cost of this procedure might be prohibitive for many, and its duration could conflict with individuals’ work commitments or other responsibilities.

Because of that, the first diagnosis options often include more accessible stuff. One of the most popular approaches to quickly identifying the presence of a sleep disorder is through various questionnaire-style tools. The advantage of these tools is that they often don’t require any formal training, and you can theoretically find them online and answer them before bringing the results to the doctor. Many of these questionnaires and scales have been translated into multiple languages for added accessibility.

However, criticisms have been made over the years about the subjective nature of potential answers. According to critics, it’s far too easy to misremember something or answer in a biased way, making the tests inaccurate. In this article, we will be looking into how this subjective nature manifests using one of the most popular diagnostic tools for sleep disorders out there – the Epworth Sleepiness Scale – as an example. Let’s get into it.

How Does the Epworth Sleepiness Scale Work?

The Epworth Sleepiness Scale (or ESS for short) was developed for adults by Dr. Murray Johns in 1990. It was named after the Epworth hospital in Melbourne, where he had previously (in 1988) established a sleep center. The modified version from 1997 is the one that sees professional use today and requires a license to be used. The primary purpose of the ESS is to measure average sleep propensity (ASP, known elsewhere as excessive daytime sleepiness) through the application of a simple and accessible questionnaire.

The questionnaire consists of 8 questions that the patient must answer and rate on a scale of 0-3 (meaning there are four different responses to each question). A rating of 0 means the patient would never doze off in that scenario. A score of 1 indicates a slight chance of dozing, while 2 and 3 correspond to “moderate” and “high” chance of falling asleep. This rating determines how likely the patient is to fall asleep or doze off in various situations. Here’s the full list, as it’s important to be aware of one crucial factor:

–          Sitting and enjoying a good book

–          Sitting, idle, in a public place (such as a park)

–          Watching television

–          Lying down to get some rest in the afternoon

–          Sitting and holding a conversation with someone

–          Sitting, inactive, after having lunch (without any alcohol involved)

–          Being a passenger in a vehicle for an hour with no breaks

–          In a car, stuck in traffic for around 5 minutes

If you look at official information about the ESS, you may come across the word “somnificity.” This term was also introduced by Dr. Johns, somewhere around 2002. Somnificity is a measure of how much a specific activity or posture contributes towards you falling asleep, or how much it hinders the prospect of sleeping for a majority of people. The ESS questions introduce scenarios with different levels of somnificity to provide a varied selection of situations and help doctors get an insight into the patient’s sleep propensity and sleeping habits.

You may also notice that no timeframe is referenced by the questionnaire (as in, you’re not asked to specifically look at the last week, for example). Instead, it’s presented as remembering these situations “in recent times.” This was specifically arranged so the period (often referred to as the “recall period”) is adaptable to what the patient can remember, which helps increase response accuracy. The only situation in which this doesn’t apply, and a clearer timeframe would be introduced, is treatment progress monitoring. The doctor may want you to remember how likely you were to fall asleep since the treatment started so that they can compare it to results from before the treatment plan began. For example, CPAP treatment for obstructive sleep apnea is guaranteed to cause a drop in the patient’s ESS score, as that treatment consolidates the sleep architecture of the patient, preventing fragmented sleep (a huge potential cause of fatigue, here as a result of blocked airways)

How Are ESS Scores Interpreted?

As mentioned before, each of the eight questions has four potential answers (0-3). These numbers will either be written in a small box next to the question, or the option to tick one of four checkboxes will be present. Other times (though much less often), these answers can be provided electronically or via phone or personal interview. It is of utmost importance to answer every single question as honest as possible because, without those answers, the whole test becomes invalid. The main modification of the upgraded ESS version from 1997 is the added instruction that says just that. Additionally, it’s not allowed to explain each question in detail for the patient, as this can potentially cause bias in their answers. If the patient answers the questions using half-values (such as responding with 1.5 instead of 1), it is recommended not to interrupt their questionnaire, and just accept the result. However, if the end result includes a half-point, round it up to the next integer.

Originally, the average score range was considered to be anywhere between 2 and 10 points (established by Dr. Johns himself). However, after more data, the lower limit was pushed towards zero points and is the average score range you will encounter these days. A resulting score higher than 10 points indicates an increased average sleep propensity or excessive daytime sleepiness. Increased ASP is almost always caused by a sleeping disorder, and so this test can often be used as a preliminary, “filtering” method to determine which patients need to be looked into further. The higher the score goes, the more sleepy the person is during the day, and the more fatigue endangers their overall health and safety. Here’s a brief list that can give you a rough idea on how severe your sleeping problems (and subsequent EDS) are:

–          A score between 0 and 5 points indicates a lower level of normal daytime sleepiness. Naturally, this is the best score you can get.

–          A score between 6 and 10 points indicates a higher level of normal daytime sleepiness. There is still nothing to worry about with this score, as it is considered in the “safe” range and doesn’t point towards sleeping disorders.

–          A score of 11 or 12 is the breaking point at which doctors may conclude you have a potential sleeping disorder. While nowhere close to severe, this score indicates a small amount of excessive daytime sleepiness.

–          A score between 13 and 15 points reaches the “moderate” level of excessive daytime sleepiness. While the interpretation can often resemble that of light EDS (depending on your doctor), this is already a troublesome result. There is no doubt that a person with this many points has a sleeping disorder.

–          A score between 16 and 24 points is considered a clear indicator of severe EDS. This level of fatigue is incredibly dangerous for the patient, and a more thorough diagnosis plan should begin as soon as possible. Methods include a Multiple Sleep Latency Test (or MSLT for short), polysomnography, etc.

Oddly enough, gender and age contribute almost nothing as factors towards the overall score. However, ethnicity does affect things – African-Americans have a noticeably higher average ESS score than most Caucasian Americans. Other significant contributors include depression or sleep-disordered breathing, which can alter the result to some degree. A large number of score reports collected from the general population so far indicate an above-average ASP. It corresponds to the fact that depending on individual demographics, a percentage ranging between 10% and 40% suffer from excessive daytime sleepiness in the United States. Almost every single person with narcolepsy gets a score that indicates moderate or severe EDS.

Criticisms and Downsides to the Epworth Sleepiness Scale

The biggest concern that plagues many critics of the ESS is its inherent subjectivity. Much like the Pittsburgh Sleep Quality Index (PSQI for short) or Stanford Sleepiness Scale (SSS), the Epworth sleepiness scale is susceptible to various forms of bias or inaccuracy. There are no guarantees that the patient will remember all their sleeping habits and patterns well enough to provide a good answer. As a result, the ESS is not meant to be used as the only diagnostic method in scenarios where the person’s ASP may cause legal problems or similar obstacles – in these cases, seek out additional tools, to get more substantial info. It is also unsuitable for diagnosing patients with cognitive impairments that are unable to provide precise answers as a result of their condition.

A common consequence of excessive daytime sleepiness is drowsy driving, one of the riskiest yet routinely performed activities, especially for working adults. The problem here is that the ESS can’t predict the exact amount of fatigue the person feels or how much it hinders their road performance – at least until the scores start hitting values of 15 or higher. At that point, it can be argued that the level of EDS is definitely a massive problem for any potential drivers.

Additionally, the ESS is not precise enough to detect which specific sleeping disorder the patient is dealing with. An increased average sleep propensity is a symptom of basically every sleeping disorder, making it hard to determine a single condition. Instead, the ESS is a good “first” test, a way to disqualify people without dangerous levels of excessive daytime sleepiness, since their likelihood of having a sleep disorder is very small. On top of that, it doesn’t specify what the major contributing factors may be for that potential sleeping disorder, making it less-than-ideal as a standalone diagnostic tool. Always ask for further examination if your score is 11 or higher, in case the doctor doesn’t mention it.

Note: If you’re unsure about any part of the ESS questionnaire, don’t write down your answers at home. Consult your doctor so they can know what’s happening early on, and ask them to supervise your answering process. Also, if you’re worried that you may have a sleeping disorder, don’t hesitate to open and maintain a sleep journal. Sleep tracking is one of the most helpful methods of contributing to a proper diagnosis.

Translations and Reception of the Epworth Sleepiness Scale

The original language used for the development and application of the ESS was English, as it was created in Australia. However, its incredible ease of use and accessibility even without formal training (you basically know enough about the procedure now to answer all of those questions yourself even before a doctor’s appointment) have led to its authorized translation into many different languages. It is very important to keep the translation as close as humanly possible in meaning to the original. The questions are all very deliberately worded to produce the most accurate answers, and dodgy translation, even if it’s tiny inaccuracies, can invalidate the whole procedure. Copyright protects the ESS from any changes, although special circumstances can justify it – with written permission, of course.

Overall, the ease with which a doctor or researcher can conduct ESS testing (for an individual patient or subject, or an entire group of people) has led to its widespread use in clinics all around the globe. It’s considered one of the most reliable subjective sleepiness scales, especially for keeping track of patient progress as a result of regular treatment.

Nowadays, it appears irrelevant whether our homes are in bustling metropolises or tranquil rural areas, as the necessity of the daily commute seems unavoidable.

In cities it appears that we have everything just around the corner, but when your job or school is in one part of your town, you live in second, your boyfriend in third and you take yoga classes or whatever in some other area, commute becomes an important thing that takes quite some time. And people who live in the countryside know it well too, whether they want to supply themselves with groceries, go to work or drive their kids to school, they also spend a significant amount of their time in transportation.

Commuting is cutting off a significant part of our day, and it can be a very stressful, boring and exhausting experience that can affect our health and sleep. Longer commute time has been connected to sleep deprivation, especially in cities that have bad public transit systems. Americans already have a huge problem with sleep deprivation since the number of people who sleep less than 7 hours is continually rising. With that in mind, it seems that workers who commute longer sleep less in order to try and get everywhere on time.

How Long Do We Commute?

For example, if you work from 9 to 5, you are going to leave your house at least half an hour earlier, if you are lucky enough and live somewhat close to your job so you can walk or drive quickly to it. Many people travel longer to work, if they catch rush hour in the morning, or later in the afternoon when the majority is going back home from work, those 8 hours of work time can quickly turn into 10 hours, or more, all together with commuting. It can be somewhat more comfortable if you are sitting in your car, listening to your favorite radio station or music, but people who have to use subways or buses often do not have that luxury even to sit. Except for a few lucky ones, most people have no other choice than to stand and squeeze with others. People also often have to combine two or more means of transportation, whether they travel from suburbs or a different city, and that all adds up to that time we spend at work, because we commute mostly for our work, and we cannot do many other productive things while commuting.

If we count that we work 40 hours per week, that means that we spend a quarter of our week at work, without counting in the commute time. According to the newest data released by US American Community Survey, the average American will spend 26 minutes while commuting to work in one way, so that is approximately one hour per day, and that number has only grown during the past decade. Twenty-six minutes in one way does not sound so bad, but if you do that five days a week, for 52 weeks in a year, that is around 9 and a half days wasted in traffic each year. The duration of one average holiday we spent commuting each year, but at the moment for the majority it is impossible to avoid that.

Long distance commuting delivered a category of people called mega-commuters, which refers to people who travel 90 minutes or more in one way, only 3% of Americans fall into this group which spends at least three hours commuting each day.

All means of transportation can be bad for our sleep, but researches have shown that people who commute using public transit are suffering more from it. Those commuting by bus are feeling the most negative impact since they tend to develop depression and anxiety.

Longer Commute = Shorter Sleep?

As commuting became a part of our everyday life, it also became one of the things that cause our sleep deprivation. A study based on the data collected from the American Time Use survey showed that each minute of commuting means 0.2205-minute less of sleep time. Another study examined the sleep habits of commuters who use Long Island railway transit. Questionnaires were left at each station and researchers collected answers from 21.000 people during the six consecutive weekdays. They came to the conclusion that longer commute hinders people’s ability to get enough sleep each night. According to their results, people who commuted longer than 75 minutes were sleeping for 97 minutes longer during the weekend than on weekdays, they also napped more often during their commute in comparison to those who needed 45 minutes or less to get to work.

The US Census publishes data about commute times for each state every five years. Those rates were combined with CDC’s data on sleep deprivation for every country in an attempt to find a correlation between the lack of sleep and commute time. It is considered that around 35.2% of Americans are sleep-deprived, while the average commute time is 26 minutes in one way. When the numbers are compared on the state level, there is a clear connection between those two, states that are on the top of sleep-deprived countries are also the ones with the longest commutes, such as Hawaii, New York, Maryland, and Georgia.

Comparison of states that have the shortest average commute distance to work and the lower percentage of the sleep-deprived population also confirms this connection. Some of those states are Nebraska, South Dakota, Montana, Idaho, Iowa, and Kansas, their citizens are getting enough sleep without wasting too much of their time on the commute.

When it comes to the battle of the different cities in the US, none is ideal in terms of commute and sleep, but when the numbers got compared, some of them stood out. The Brooking Institution did the review of quality of public transit which was then compared to CDC’s data on sleep deprivation in top 500 states in the US to see how the best and worst cities for the commute in public transit correlated with the worst and best cities for sleep. The criteria used for this survey included the number of available jobs within the 90 minutes predicted for the commute and the number of people who live within 0.75 miles of a bus stop or any station.

The main question was, how convenient and accessible it is to use public transit in certain cities. As it was expected, there is not a city that has public transportation available to each one of its residents, and the same is with sleep since over one-third of the Americans are getting less than 7 hours of sleep each night.

Some of the cities that have the worst public transit also have the above average percentage of sleep-deprived people. The average national sleep deprivation among Americans is now 35.2%, and it keeps rising, so take a look at this chart below to see which cities are the worst for sleep and commute. For example, residents of Palm Bay, Florida, are more sleep deprived than the average citizen of the US, they have a small percentage of jobs that are accessible with public transit which means that they need to wait longer just to be able to board on.

On the other hand, cities with higher coverage of public transit such as San Jose, Fresno, Salt Lake City or Tucson, have a below the average level of sleep-deprived population. For example, 90% of people who live in Salt Lake City live near the station or stop of some public transit, and they have 58.9% of jobs accessible within the 90 minutes. Their average commute time is below average at 22.5 minutes while the wait time during the rush hour is bearable 8.5 minutes. Sleep deprivation is also below the national average at 32%, which is not significantly lower but it is an improvement.

Effects of Commuting

Commuting is one of those annoying aspects of our modern and urban lives, we want to make it everywhere, but in order to get somewhere we have to commute, sometimes more than once in a day, sometimes longer than predicted, which all affects our daily to-do schedule. Besides sleep deprivation, here are some main negative impacts of commuting on our life.

• Time – many things that are lost can be easily compensated, but time is not one of them, and commuting is nothing but a huge waste of our time. We lose time being stuck in traffic on the roads and in public transit too. New York, for example, has a problem with subway delays which significantly increase commute duration. Some offices allow their workers to stay longer at work, to compensate for the time loss due to commute, but that is just cutting off your personal time even more.
• Pollution – exposure to air pollution coming from vehicles is one of the leading causes of asthma, cardiovascular diseases, and cancer. One slightly “cleaner” solution is to use trains, but they are not as widespread as other means of transportation.
• Stress – as we mentioned, commuting can be stressful since we are under constant pressure of getting somewhere on time. However, many unpredicted things can happen and prolong our commute, but that is not the only cause of stress. A study from 2004. showed how longer commute affects health, the researchers examined the saliva from people who commute with the subway from New Jersey to Manhattan and came to the conclusion that longer commute can be connected to higher levels of a stress hormone called cortisol.
• Immunity – many things can have an impact on the way our immune system works, and if you keep getting sick and catching up on every possible virus, this can be the result of stress, unpleasantly long commutes and the fact that we get in touch with many microbe-ridden surfaces while we are commuting. We advise always wearing an antibacterial gel and listening to some relaxing music to combat stress.

Napping Commuters

Many people find the commute necessary but not so pleasant experience, and it is hard for them to relax enough to fall asleep at a public place, surrounded by strangers. On the other hand, some people sleep in a sitting position with no problem in subways, trains, buses, without worrying too much about missing their stop. But, how is it possible that most of them wake up just on time when they need to get out?

It is somewhat similar to setting an alarm clock; once we set it, our brain gets prepared to wake up at a particular time each day. If we regularly commute within a specific time-based schedule, it will become a habit for our body and our internal clock will get used to it if we repeat it each day at the same time, it will become a routine. Another reason can be the fact that although we are napping, we still can partially hear the station announcements because our brain is not completely turned off during those naps since we tend to wake up often for a few seconds.

If this is not something that is working for you, and you have slept over your stop, it could be because you have a deep sleep or your body is not so used to it, or that you are not repeating often enough that it can become a pattern. But there is no reason to worry, snoozing your stop is also one way of training yourself to wake up at a certain time. If not, you can always set the alarm on your smartphone approximately three to five minutes before predicted time for your stop.

The struggle with lack of sleep can be exhausting and difficult, yet have you ever considered its potential effectiveness as a method of torture and interrogation? It appears we consistently downplay the impact of sleep deprivation on both our physical health and mental wellbeing, despite frequent discussions about its repercussions. While we often willingly sacrifice a night’s sleep for binge-watching, enduring the consequences the following day and eventually recovering, the long-term psychological damage inflicted by forced sleeplessness is hard to comprehend.

We differ two types of sleep deprivation, partial and total. Total one only occurs during some emergency cases, while partial one can be caused by, for example, shift working. Total sleep deprivation is not so common, and many things are still unknown about it, but it can appear as a consequence of interrogation and torture. It is harder to lie when you are mentally drained and tired, and interrogators know that; that is why they prefer inspecting their subjects while they are tired. But forced and severe sleep deprivation does not necessarily mean that someone will speak the truth just because they are in such condition because it can mess up their mental state and lead to many irrational statements.

When you think about many other ways of torture, sleep deprivation may even sound like a tame and mild way to break someone’s will, but when an expert does it, it can last for days and be extremely severe. Keeping someone awake for days leaves no visible or physical harms, only mental ones, and it is a preferred way of torture by regimes who claim to respect human rights and international laws. But, just because it is more “subtle,” it does not mean that it should be legal.

Is Sleep Deprivation Legal?

Police interrogations are never a pleasant experience, but whether you are guilty or not, be sure that the officers who are interrogating you will do anything they can to get at least a glimpse of your confession. The interrogation environment is their advantage, they keep their suspects for hours in rooms with bright lighting and without windows. They control when or if you will eat and drink, and most importantly, will you get a chance to sleep or not.

Studies have shown that sleep-deprived people are more likely to confess things that they did not do, in comparison to those who got enough sleep.

Although currently, the eighth amendment protects US citizens from unusual and cruel punishments, sleep deprivation is not an illegal form or interrogation. Most courts interpret this amendment in a way that it can only be applied after someone is already convicted. But, in 2014. United Nations published a report in which this way of interrogation was defined as torture, but that only refers to extreme cases of sleep deprivation that last up to 180 hours, which could hardly ever happen during any police interrogation.

The United Kingdom, for example, recently banned interrogation of suspects who did not have the opportunity to sleep at least eight hours in previous 24, mostly because a large number of cases with false confessions is being returned to courts. In the US, 25% of cases turned out to be wrongly prosecuted due to false confessions; those mistakes are later proven and corrected thanks to DNA evidence.

Sleep Deprivation As a Means of Brainwashing

One way of attempting to “brainwash” prisoners was sleep deprivation, and it was widely used during the Korean war, but the CIA also used it as a part of their experiments with mind control.

Brainwashing is considered a mind-controlling process or an act that tends to control the human mind using mostly some psychological techniques. Brainwashing should result in the subject’s reduced ability to think independently, it should control its attitudes, acts, and thoughts until it basically becomes a marionette. The concept and idea of brainwashing were conceived during the 1950s to explain how the Chinese government managed to force people to cooperate with them. Today is brainwashing widely discredited, but it remained a popular subject of many spy novels and related literature.

The term brainwashing comes from Mandarin word xi-nao, xi stands for the word wash, while nao is a brain, as simple as that. This term was first introduced to Americans thanks to the journalist Edward Hunter and his article from 1950. in Miami Daily News. In this article, he writes about how Mao Zedong and his Red Army used ancient techniques to convert Chinese people to mindless communists.

After the US soldiers confessed some shocking things, the American public was horrified, and it was hard to find a reasonable explanation for their statements expect for brainwashing. That is when the idea of mind control blossomed in all fields of pop culture with movies such as The Manchurian Candidate and many others which featured brainwashing of POWs. It quickly became the subject of books, articles and even the American Psychiatric Association gave it credit, including brainwashing among dissociative disorders. So, did Chinese communists manage to find a way to control minds and free will? Of course, they did not.  

Many tried explaining the brainwashing process as some mysterious practice that could not be understood, but to scientists who were working on the case of the American POWs when they got back from Korea, it was pretty clear that the soldiers were tortured. One of the psychiatrists who worked with veterans reported the main criteria for brainwashing or thought reform as it was referred to by Mao Zedong. The process of brainwashing trapped American soldiers in Korean camps included deprivation of sleep and food, forced standing, exposure to communist propaganda and solitaries.

Sleep Deprivation Through History

It appears that people even centuries ago knew about the effects of sleep loss on mental health, and used it as a technique of torture and investigation. Some groups refuse to acknowledge sleep deprivation as a method of torture, but instead, they call it enhanced interrogation technique. However, extreme sleep deprivation can cause hallucinations, schizophrenia, and psychosis which can lead to wrong statements and false confessions.

Considering what we all know today, we can only assume how many people were falsely accused due to something they said while they were severely sleep deprived. So now we are going to go back through history to see how forced sleep deprivation was used as a form of torture in a few known cases.

Witch Hunting in 16th Century Scotland

Back in the notorious times of witch hunting, women who were accused of witchcraft and sorcery were hunted nationwide, captured and judged. Before people could convict them, they needed a confession from those women. To get anything that could be used against them, people tortured them by sleep depriving them for days until they begin to hallucinate. Everything that they did or said during those hallucinations or psychotic episode was considered as their confession and usually used against them as proof that they were practicing witchcraft. It sounds ridiculous from today’s point of view, but back in the days’ people were led by mass hysteria, ignorance, rumors, fear, and panic.

Japanese War Camps

There were around 175 war camps in Japan, but many more in countries that were occupied by Japan such as Thailand, China, Hong Kong, and Korea, in them civilians were mixed with military personnel (POW).

It is estimated that during the Second World War around 140.000 of military personnel were captivated since it was believed that they know some critical information. During their interrogations, many different ways of torture were used including sleep deprivation, blindfolding, meal restrictions, etc.

Apartheid in South Africa

The racial segregation movement known as Apartheid began in 1948. in South Africa and was abandoned in 1994. A famous case of sleep deprivation included a psychotherapist John Schlapobersky who was tortured in this way during the 1960s and kept awake for a whole week. He reported having hallucinations after only two nights, and after the third one, he started dreaming awake, which can be considered as a form of psychosis. Among other things, he described feeling distortion of people, time and place.

British Army

One of the most famous Britain’s POW facilities during the second world war was London Cage, run by the PWIS, prisoners of the war interrogation system. There were nine cages like that across Scotland and Southern England.

In 1971. British army performed an operation called Demetrius when 350 people were arrested because they were suspected of being involved with the Irish republican army. Prisoners reported that they were deprived of sleep, beaten, starved and abused.

Sleep deprivation was recognized as one of the five illegal interrogation methods used by the British army. Other four included hooding, wall-standing, drink and food deprivation and subjection to noise.

US Military

Before 2009. sleep deprivation was not considered for an illegal form of torture, and allegedly the US military used sleep deprivation to torture their prisoners. It was regarded as a non-physical way of torture, but although it does not leave any physical traces of harm, the United Nations (UN) still look at it as a way of torture because their definition of torture implies both, physical and mental pain or suffering.  

Effects of Long-Term Sleep Deprivation

• Hypertension – lack of sleep elevates the risk of hypertension. During sleep, our body regulates the release of stress hormones, which implies that sleep loss intensifies the effect of stress on our body. Also, higher blood pressure, heart rate, and inflammations are all side effects that put additional strain on the heart.
• Diabetes – everything less than 5 hours per night is far from enough, and it contributes to the development of type 2 diabetes. Sleep restriction hinders the way our body processes glucose and the amount of insulin which is produced.
• Heart attack and stroke – sleep deprivation causes a higher risk of cardiovascular problems, researchers believe that that happens because sleep loss disrupts the work of certain brain parts which are in charge of controlling the circulatory system.
• Immunity – our immune system is sensitive to our bad sleeping habits, and it performs its best only when we are getting an adequate amount of sleep. Sleep deprivation will lower the production of antibodies and make us more vulnerable to viruses and diseases.
• Anxiety and depression – many people are easily irritated if they did not get a chance to sleep well during the last night, but more extended or chronical sleep deprivation is associated with clinical depression as a major cause of it. Panic attacks and anxiety are also common symptoms of sleep disorders, and just like with depression, sometimes it can be difficult to determine what was the primary cause, sleep disorder or anxiety.
• Memory – scientists believe that while we are sleeping our brain is settling down all the things we previously experienced, and transferring some information from our short-term memory to the long-term memory. That is why a lack of sleep will hinder our ability to recall some memories.
• Brain function – just one sleepless night leads to fatigue, lack of focus, but when our brain is not able to properly rest for a while, our mental abilities can significantly decrease. Also, our motor-functions, balance, and reflexes will suffer, we will be more prone to injuries and accidents. Drowsy driving is one particularly dangerous example of it.
• Psychiatric disorders – an extreme lack of sleep will affect more than just the sharpness of our mind since it can lead to many different psychiatric disorders. Common symptoms of prolonged sleep deprivation include hallucinations, disorientation or paranoia, and they can often be confused or associated with schizophrenia.