Category: news

Do they even exist? ― that would likely be the first question that pops up in people’s heads. And rightly so. Besides ubiquitous symptoms such as drowsiness and a shortened attention span, it seems as if there’s little else to go on. Indeed, the exact mechanism of sleeping is still somewhat of a mystery, even to scientists. Sleep-related illnesses such as insomnia often have no particular underlying cause. Narcolepsy is less of an enigma, but still puzzling. Hypersomnia, and Insufficient Sleep Syndrome, particularly, tend to have plausible explanations. More-or-less, they correlate with one’s personal choice, behavior and overall lifestyle. However, there are, by-and-by, readily recognized as symptoms and, a correlation having been made with some observable disorder, as syndromes― but what specifics bring them about is anyone’s guess.

Have you ever tried your hand at guessing why you couldn’t get a good shut-eye the night before some appointment? Why does your headache even if you had? Maybe you’ve written it off as ‘stress,’ ‘anxiety’ or something else, caused by anticipation. Well, you might as well be correct, but the exact problem  ― what caused this negative bodily reaction ― is a probably a tad bit more complex. Going through regular and irregular routines, our sleep-adjustment changes and modifies itself in turn. But what in our body brings this change about? What is it? That’s precisely the overarching question we’d like to share with you.

What Their Discovery Entails

Experts all around the world would relish the chance to get to the bottom of this problem. More than anything else, it would provide a coherent set of measurables. Once measured and ascertained, this problem would be reduced to something more quantifiable. We would have a clearer picture of the exact graphs and numbers behind our sleep and sleeping schedule. And this alone should prove a great impetus to aspiring chemists and doctors. Ideally, the discovery of such a biomarker would give us insight into:

1. The relationship between bodily functions and the quality and quantity of sleep
2. The way certain sleep disorders function in regard to the presence/absence of particular biomarkers
3. Finally, how we might effectively manage these biomarkers and even get the better of them in the long run

Plainly put, these biomarkers would indicate with great precision the many variables involved with sleep. They would show us people’s personal propensity to sleep and the mechanisms behind sleep disorders. Perhaps, but only perhaps, we would even have a glimpse into the anthropological history of  such a mundane activity. The answer is, you’ll have noticed, really of great importance, scientifically. But it is also tremendously important to every non-specialist and us as its repercussions affect that great third part of our lives ― our convalescence in dreamland.

Since a good deal of life is indeed spent dozing off, one way or another, wouldn’t it be nice if we knew why we had to sleep? If that’s asking far too much, then it would be undoubtedly handy if we at least knew what causes it. Is it not true that all mysteries are made to be unraveled. If not that, then at least pondered. It does affect both our memory and mental, as well as physical well-being, after all. And so finding, or coming close to finding sleep biomarkers, might not be just a scientific adventure, chemicals, brains and all that jazz. It might also be a deeply human search for the meaning of our nocturnal and diurnal visitations into dreams. Still, better not get ahead of ourselves!

Sleep Biomarkers, Sleep Disorders and Sleep Debt

Quite a few articles in recent years have shown a correlation between sleep or lack thereof, and the multitude of effects it can have on us. From our daily jobs to personal relationships, and from physical consequences to mental health, it does seem to be one of the pressing issues of the modern world. More and more, in fact. Not knowing how to manage one’s sleep can lead to loneliness, social withdrawal, ill health, and so on. Hence, resolving the issue of sleep biomarkers is fast becoming, if it has not already become, an urgent matter. The pace of life is such that one simply has to optimize one’s sleep or, sadly, suffer the consequences. This is why we’d like to draw attention to this. For the everyman, it could make all the difference between a quality life and one of just ‘getting by’  ― getting by tired, baggy-eyed and wretched.

More to the point, the human body is, needless to say, a complex organism. The intricacies of its many biomarkers and their relationship can be hard to pinpoint. How many times have you felt something ― a back-pain or a headache ― and been unable to specify its cause? Science tells us there are usually several. The same, in all probability, holds true for anything that bothers or enhances our ability to sleep. One thing leads to the next and back again. Many conditions, whatever they are, exist in a sort of link. For example, some studies have shown parallels between ADHD and sleep disorders. Other such cases abound and show us a profound interconnectedness between one facet of our body and another. And this is where we encounter a major problem ― in this vast matrix of cause-and-effect, how are we to determine what is primary and what secondary? Well, no objective methods have been as yet employed on a large scale to give a satisfactory answer. But this is just some food for thought. Raising awareness of this issue is but the first step to solving it, especially in this technology-dominated age. And on that point, it might be wise to consider how tech influences our biorhythm. It is of such profound importance to modern society that it just cannot be overlooked. Indeed, the developments in technical sciences have added yet another layer on top of this. Our biorhythm is less and less in tune with the ‘natural’ world and more and more ‘online.’ For better or worse, this certainly makes finding select biomarkers that much more difficult.

In any case, it can be safely assumed that sleep disorders and abnormalities must have something to do with their putative biomarkers. More often than not, however, they can also be misleading in regards to biomarkers of sleep per se. For example, biomarkers for sleep debt status showed little overlap with previously identified biomarkers for circadian phase. Biomarkers for acute and chronic sleep loss also showed little overlap. We can see, then, that even amongst themselves, sleep disorder biomarkers can diverge into separate categories. If it’s like that regarding relatively similar biomarkers, then we can only imagine how subtle the one we’re searching for is!

In (Re)Search of the Elusive Sleep Biomarkers

So far, there has been experimental research conducted in order to identify the chemical basis of sleep. How? This is done mostly by analyzing subjects in instances of sleep deprivation and chronic sleep restriction or sleep reduction. The samples taken are usually blood, urine, and saliva. And though the nature of these tests is a bit of a hit-and-miss affair, some facts can at least be established.  This study shows several things. Firstly, a change in metabolism has been observed in both humans and non-human animals, as well as certain changes in the bloodstream. Whether this is indicative of a biomarker is questionable. Still more promising, however, is the usual saliva test which has shown reduced mRNA encoding amylase in sleep-deprived patients. This, again, may be a useful signal for showing us the culprit. And many other tests ― the so-called multivariate tests ― have been performed to that end.  These have so far been used to detect biomarkers for cancer and dementia, for example. So they show some promise, despite the rather more complex nature of the biomarkers we’re talking about.

The main problem with this is the very nature of sleep. It is an emergent property of the brain that takes over when enough cortical columns go to sleep. There is not a point in time in which all ‘shut down’ ― some are always active. Thus the presence or absence of certain chemicals in the blood/saliva is simply not precise enough to determine, by itself, whether a person is asleep, or even sleepy. And even if handled with greater precision, this method still sorely lacks the ability to specify what the trigger was. So the specific biomarker again eludes us.

An even more perplexing issue emerges, however, when we take into consideration variable daily sleep. It is become all the more common, especially for younger people, to have flexible sleeping schedules. This is, technically speaking, unhealthy. Not only that, but it appears that it can further muddle the precise nature of the underlying sleep biomarkers. Apparently, changing your sleeping schedule can shift the balance of bodily and sensory secretions. However, bluntly put, it is most noticeable when going to bed later than usual. This is as apparent from changes in body temperature and specific inflammatory functions. From this, we see that sleep variability is associated with a biomarker strongly influenced by sleep and circadian regulations. So we can see the change, yet again, and what set off at least one biomarker ― the one showing a shift in sleeping behavior. Alas, though it may exist, no study has yet shown us what it is exactly. Who knows? It might even be that it’s not a single biomarker, a sole culprit. Perhaps it is. But then again, it just as well might be a whole array of processes that bring sleep about. After all, there is so much we don’t know about it. Besides the peripheral knowledge of what influences sleeping, the question still stands open.

Sleep or Sleepiness Biomarkers?

Could it all be a mistake? ― would be the appropriate punchline. Well, not quite. But I would draw your attention this anyway. Namely, what’s been so far neglected is the rather significant difference between sleep and sleepiness. And, of course, the difference between their biomarkers. That is if they even correspond on a one-to-one basis. A die-hard skeptic may also ask, ‘Do they correspond at all?’ In certain points, sleepiness and actual sleep are assuredly linked, however tentative that bond may be. But as to whether one leads to the other  ― well, let’s get down to that.

All of us yawn, and most of us yawn when other people yawn. It is also one of the most socially-recognized cues that one is tired. The latter has little scientific backing, though. Still, this is what most people would conjure up when asked what they thought was a prototypical sign of sleepiness. And the relationship between sleep and sleepiness is just as deceptive as this. This is why I’ve mentioned yawning, as a sort of symbol for this divide.

Droopy-eyes, on the other hand, is a quite clear indication of one’s fatigue. You can be as dopey when utterly tired as when you’ve had an excellent meal (and a lot of it). In the first case, if one is genuinely exhausted after a long day, this might be indicative of a biomarker playing its part. But is it the sleep biomarker, and is it possible to differentiate it from the others? In the second case, we might be tempted to say that the lack of blood supply to the brain is responsible. And partially it is. But how then to separate this biomarker of a metabolic function, i.e., digestion, from another that is, nonetheless, noticed by us through the same symptoms — droopy eyes, in this case.

Conclusion

The precise sleep biomarker or biomarkers remain an enigma. But a less puzzling one, we would like to think. To wrap this up, we do hope this article has offered its readers some good food for thought (from which you won’t get droopy eyes!) and stimulated them to think about the role sleep plays in their own lives.

Polysomnography, or PSG for short, is regarded as the number one when it comes to monitoring sleep for diagnostic purposes, and as such, deserves the first mention in the article covering such devices. Its ability to detect markers of various milder and more severe sleep disorders like obstructive sleep apnea, periodic limb movement, and narcolepsy, to name a few, earned it much popularity and unchallenged use around the globe. Polysomnography monitors a number of functions that occur during an individual’s sleep:

Eye movements via electrooculography (EOG);

Brain activity via electroencephalography (EEG);

Heart rhythms via electrocardiography (ECG);

Muscle movements via electromyography (EMG).

Besides these aspects, PSG frequently measures blood oxygen levels, respiratory airflow, and includes video or audio recordings to detect patient’s body movements and snoring.

This study is performed in a laboratory during the night, or at a customized time window to accommodate the patient’s usual bedtime circumstances (useful for people with circadian rhythm disorders who sleep at different times of day or night compared to the average nightly bedtime), and its results are reviewed by a licensed professional.

Despite its wide utility, PSG’s high cost and the mere inconvenience a lab sleepover poses for the patients have prompted the discoveries and development of many novel devices similar in purpose, but versatile in logistic aspects and indications of use. Many of them carry potential clinical value, but the particular interest among the audience has arisen for at-home sleep monitoring gadgets. Hence will they also be the focus of our attention in this article.

Devices for Sleep Monitoring at Home

Although the idea is relatively new, home-based sleep monitors are already quite a few, and the numbers are only expected to grow. They mostly target breathing abnormalities and circadian rhythm deviations; most are worn somewhere on the individual’s body, and some aren’t even initially meant for sleep scanning purposes, but their targeted aspects may also be sleep-informative. The devices we will discuss in some depth can be categorized into the following categories, depending on the way they work:

• Monitoring based on brain activity
• Monitoring based on autonomic signals
• Bed-based monitoring
• Monitors based on body movements
• Devices with “accidental” sleep-monitoring properties, or other devices

Sleep Monitoring Based on Brain Activity Signals – ZEO

This exemplary device works via a headband that is intended to be worn during sleep. It detects electroencephalogram (EEG), electrooculogram (EOG) and electromyogram (EMG) signals through the night and transfers them to an iPhone or similar receiver station for analysis.

Zeo was evaluated in research where healthy adult subjects underwent polysomnography while also wearing the headband. The results showed around 75% of overall matching between the screenings from PSG and Zeo. Such a study wasn’t conducted on patients with diagnosed sleep disorders, so the accuracy of Zeo monitoring isn’t known – the possible effects of medication, as well as opioids like caffeine, cigarettes or alcohol on Zeo’s precision,  aren’t yet explored. Still, the device may be useful to have in a sleep disorder-free household if only to keep track of one’s general state.

Sleep Monitoring Based on Autonomic Signals – M1

A representative model in this category is M1 (SleepImage). Working via a patch containing a wire electrode that one wears on their chest, along with a small processing unit, this device records ECG signals, actigraphy, and the person’s body position. A limitation established with this model is the fact that some people don’t have a typical response to ECG – such is the case with patients experiencing autonomic dysfunction and some types of arrhythmia.

Bed-Based Sleep Monitors

EarlySense Mattress is indicated to be placed under one’s mattress to measure snoring, coughing, heart rate, respiration, and body movement.

Air Cushion is a pressure-sensitive thin cushion that you are supposed to put on top of your mattress. It measures heart rhythm, snoring, respiratory airflow and movements you make during sleep. Compared to PSG screenings, wake and NREM stages are accurately scanned by the Air Cushion the majority of the time, while REM was correctly displayed only about 38% of the time.

Home Health Station (TERVA) is a more complex system that screens and shows heart rhythm, respiratory airflow, blood pressure, body movements and even contains a diary for subjective entries of the individual who is only to position this station somewhere in their house. It has been shown to provide accurate results for sleep-wake differentiating and also was able to record a significantly increased disordered breathing rate in sleep apnea patients versus the people who don’t have this disorder.

SleepMinder is a sleep monitor placed above and near the bed, preferably in the radius of less than a meter away. It works by measuring movements through a radiofrequency monitor and is estimated to recognize slow wave sleep in 96% of the cases, although it has some issues with identifying REM and NREM sleep phases. Much like other movement-measuring devices, SleepMinder overestimates the amount of time a person spends asleep, which makes sense seeing as how one usually stays still while first attempting to fall asleep.

Touch-Free Life Care (TLC) is a wireless data transmitting system that works via a device placed below one’s mattress. It screens heart and respiratory rate as well as one’s activity during sleep but requires a more careful examination and validation from experts.

Other Devices

This category includes many gadgets that weren’t initially intended for sleep surveillance like SmartShirt or Zio. SmartShirt is a T-shirt that has sensors in the cotton material which track heart rhythm, body movement and one’s temperature in real-time. Zio is a gadget designed to scan cardiac arrhythmias and heart rate via a patch with two electrodes intended to be worn on one’s chest for up to 14 days.

Device Hardware and Software Issues

For an at-home sleep surveillance method to work, it needs to live up to certain standards. Cost and convenience are two essential factors to keep in mind, as patients could simply undertake PSG if these two didn’t present as difficulties. A device that is to be worn by a person needs to be light in weight and comfortable to a degree to ensure they won’t be reluctant to keep using it after the initial time. Further, the software needs to provide information in a form that anybody could understand with minimum guidance. If a person is to receive their results in a complicated, technical language, they will get discouraged from using the device or misinterpret the feedback it provided. Clarity is key with such sensitive information.

Combining the Objective and Subjective

Doctors are used to complementing PSG with a sleep diary to make up for the personal angle that PSG lacks. Not only does the sleep log make sure patients don’t forget to mention an important medical event, but its two or three weeks minimum duration creates enough of a chance for a visible pattern to form. Potential circumstantial events that would have been confusing in a single-day model can thus easily be spotted and disregarded. This harmonious combination should be the aim of all home-based sleep monitoring systems. The setting in the patient’s home would automatically eliminate the sterile atmosphere encountered during a lab sleepover while keeping track of specific bodily functions and their fluctuations. On top of that, a sleep log provided as a second part of the procedure would cover for the personal outlook moment, and the whole system would be able to last as long as necessary to eliminate “accidentals” and leave only real, contributing factors.

Of course, such an ideal mechanism remains out of reach so far but is a goal in mind for the development of future tools and devices.

How Do We Measure “Normal”?

By now, everybody knows the rule of thumb that adults need an average of eight hours of sleep per night in order to function to their best ability. Uninterrupted, quality sleep is what we are all going for, but measuring how long a person has been asleep, or how long they spent in various stages per night isn’t enough to tell whether their sleep is normal, let alone optimal. The tendency of researchers to combine the total of time one had spent in each stage during sleep and view them as blocks to compare amongst one another is still present and often harmful. Such a practice disregards the importance of the number of transitions between phases and their order, which can very well be the indicator that something is wrong and help with diagnosing a sleep disorder. For instance, patients with sleep apnea tend to rush through sleep stages and switch between them many times during the night. However, the total amount of time the person cumulatively spent in each phase will summarize to the same amount as that of healthy sleep and their apnea, characterized by fragmented sleep, might pass under the radar.

Furthermore, many medications and stimulants have been shown to interfere with and even suppress some sleep phases (REM and slow wave most commonly). Other factors like a person’s age, overall health state, other present conditions, immediate environment, etc. must all be taken into account as well to neutralize the otherwise out of context results, but these variables have their own dimensions, and it’s their average that’s used as the reference.

To summarize, perfectly correct algorithms don’t exist, and we can only get so close to calculating exact measurements of optimal sleep. Experience-based predictions and statistics are all we’ve really got in our arsenal when faced with such issues.

Device Validation

All measuring devices are evaluated based on how they compare to the “golden standard” which is PSG. Although the best we’ve got at the moment, PSG itself scores about 85% when it comes to precision and reliability, which automatically affects the validity of other devices measured against it.

Other than that, all of these devices simply register the events in one’s body, but don’t necessarily indicate as to why they might occur, or take into account the influence of another present condition or external factors such as age, sex, body mass index (BMI) and so forth.

Most of these devices measure relatively correctly the time spent awake and asleep but have issues distinguishing between exact stages, the REM stage being particularly tricky. A generally accepted time frame of stage duration is thirty consecutive seconds. If a monitor measures intervals as longer or shorter than that, the results might present differently, and comparison to PSG will be more difficult.

Finally, it is crucial to note that these devices get developed faster than specialists are able to test them thoroughly and validate them. Using a monitoring device at home can be helpful for an individual to grasp some basic knowledge about what goes on in their sleep, experiment with their routine and potentially notice when something goes downhill, but these gadgets, in reality, are as efficient as a weight scale or a thermometer (but less accurate). They are by no means intended to replace sleep clinic appointments, studies, and diagnostic procedures! Even if there were a home-based sleep screening system as sophisticated as PSG, sleep specialists would be the ones to review and analyze the collected data, diagnose patients and plan any future action.

The verdict on at-home sleep tracking systems is that, albeit more lazy and practical, they aren’t to be overestimated and used without consultation with professionals. Most of the gadgets one comes across on internet platforms haven’t yet been validated, so patients need to be cautious and responsible. If you suspect an issue, reach out to a sleep doctor. Not only are they trained to know all the problems related to the individual aspects of diagnostic criteria you may have only heard of, but they will also know how best to combine them in order to take the most advantage of them, all in your benefit.

Sleep deprivation can be tough and draining, but have you ever thought that it could be a somewhat efficient way of torture and interrogation? It seems that we always underestimate the effects of sleep deprivation on our health and mind, no matter how often we discuss its consequences. We are willing to stay up all night binge-watching, suffer the day after and be fine later, but it is hard to imagine the aftermath of such mental torture as forced deprivation of sleep is.

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.

It seems that today it does not matter if we live in a big city or the countryside, because it looks like it is almost impossible to avoid the daily commute.

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.

On the market of sleep-related products, gel-infused memory foam was always highly praised for its cooling features, but how cooling can a gel be, and how does it work in comparison to regular memory foam products? What is the difference between them, and why are not all memory products infused with gel if it has more advantages than the ones without it?

Sleeping cool is a relative term since it depends on various factors including the individual feel of what is hot or cool for someone, body temperature, room temperature, and so on, but somehow it became preferred and desired feature of mattresses and pillows. We usually have issues with hot temperatures during the summer nights, and since sleeping with AC on is not recommended, even a slightly higher temperature can keep as awake in bed. Having a cooling gel-infused mattress does not necessarily mean that sleeping on top of it would be as cool as sleeping on ice; instead, it should help with heat regulation which is something that regular memory foam material struggles with.

Memory Foam 101

Before the memory foam revolution, we were sleeping on feather-stuffed pillows and spring mattresses, which we all quickly forgot in order to try out this new and revolutionary comfortable material. We opened the door of our bedrooms to memory foam during the 80s and 90s, quickly after NASA developed their first products from this material. While trying to improve the safety of air cushions, NASA created this temperature-sensitive foam, which subsequently became widely used for many different purposes.

Also known as viscoelastic foam, memory foam is a type of foam which reacts and molds in touch with body temperature, and since it contours the body so well, it became popular material among many mattress and pillow manufacturers. At first, it was mostly recommended and used for medical purposes as it was claimed that it could alleviate aches such as back pain, or be beneficial for people with fibromyalgia. Heat-retaining feature of memory foam made it suitable for people who deal with chronic pains since additional warmth can decrease the aches.

But, as much as it can be considered an advantage, that extra heat provided by memory foam is mainly a disadvantage for most sleepers. Companies and manufacturers of memory foam pillows and mattresses tried solving that problem by releasing the second generation of memory foam products, designed with open cell structure to enhance the breathability. Since that was not enough, in 2006. the third generation of memory foam sleep products was introduced, and they consisted out of gel-infused visco foam which was supposed to deal properly with heat regulation finally. After the development of gel memory foam, other components have been frequently added to it to reduce the odor, some of them are aloe vera, silver-ions, activated charcoal, green tea extract, etc.

Gel Memory Foam

Gel-infused foam is probably the most innovative foam on the market, it has all the benefits of regular memory foam, but it does not heat up as quickly. The way material feels is the same, amount of nice and even body support and motion transfer isolation is also the same, so basically adding gel did not cause any change that would significantly affect sleepers experience of sleeping on a memory foam pillow or mattress in terms of form, comfort, and support. It is still the same memory foam just mixed with gel microbeads.

However, different brands use various ways to incorporate gel into memory foam; some insert a gel-pad layer beneath or on top of other foam layers, others insert gel beads into foam or pour it onto foam while it is setting.

Gel microbeads create a structure similar to the design of open cell memory foam, providing that much-needed extra space for airflow through the foam. In that way, more heat can be drawn away from the body in addition to the heat already absorbed by the gel, but the efficiency of heat regulation depends on the quality and the amount of gel which was used.

Two types of gel can be incorporated in the foam this way. The first one is thermally conducted, which feels cool at a touch, almost as a stone countertop. The second one is phase-changing material which transforms from a solid to the liquid condition once it gets in contact with body heat and can store and release heat within the specific range of temperature, regulating the temperature as the body cools down during the sleep.

Besides the fact that it can contribute to heat regulation, gel microbeads also contribute to the density of the foam, which will add up to its durability and comfort. But, in terms of durability, it has been proven that gel-infused memory foam mattresses can degrade quicker than the regular ones due to the amount of gel beads. The level of degradation varies and depends mostly on the size of gel beads, larger beads are more likely to break the cellular structure of a mattress over time. Another concern is the heat regulation which does not last as long as some sleepers would expect, and we will discuss that topic separately below.

When it comes to price, people are often willing to pay more for greater quality and durability, especially if it is up to something essential that they have to use each day, such as pillows and mattresses. Gel foam products come with a slightly higher price than the ones made from regular memory foam, so there is no significant difference in cost, but keep in mind that the gel foam can deteriorate faster, so seek for the one with smaller gel beads, or go for the regular foam if you do not tend to sleep hot.

Besides all-foam products, gel material can also be founded in some hybrid mattresses which include a layer of gel memory foam in their comfort system. Also, there are some gel-infused latex and polyfoam mattresses.

Is Gel Memory Foam Cooler?

Memory foam products over flooded the market, but most consumers agreed in one thing, they overheat and sleep hot on them, that is why gel-infused foam and its heat regulating abilities fall under top innovations in the industry. That cooling claim became the key selling point of memory foam products since many are willing to pay more for that enhancement. But, there are yet no official or science backed up evidence that gel can impact heat regulation that much, although the idea of using a gel to cool down dense foam is somewhat scientific.

Liquids can be an effective way of cooling down the surface, and since the gel used for memory foam products is a semi-liquid, it can draw away the heat from the human body. But, the question is, what happens with that heat, where does it go? The thing is, this semi-liquid is not able to evaporate, so it just stays there with the temperature of its surroundings. Gel encased in memory foam will quickly adapt to the temperature of the foam around it, it will probably warm up slower than the regular foam, but in the end, it cannot stay cool during the entire night. So at first, gell will take on the room temperature, which is cooler than the temperature of our bodies, that is why at first when we lay down on gel memory foam mattress or pillow, we might think that it is indeed cooling, because opposed to our warm bodies it does provide somewhat cooler feeling and temperature. However, sooner or later, it will reach and match the temperature of our body, and that cooling effect will fade away.

One more important thing to look after is the amount of gel infused in the foam, lower percentage of gel will have little or no effects of cooling, and some mattresses with such low percentage of gel perhaps do not have it at all. Anything below 30% is not enough to provide the “cooling” benefits at least during the first period of bedtime while you are trying to fall asleep.

Although most brands continue to sell their products under the claim that gel-infused foam products are cooling, recently a few studies which refute those claims have shown up. For example, one of the foam manufacturers, Cargill, performed studies which showed that plant-based memory foam sleeps around 25% cooler than gel infused one, which is a significant difference and perhaps a hint of the direction in which the memory foam industry will develop in the upcoming years.

Another interesting situation regarding the cooling claim is the issue between some of the leading brands on the market of memory foam products, Serta and Tempur-Pedic. Serta claimed that their iComfort foam sleeps cooler than the Tempur-Pedic foam, so at the end of 2012. the National Advertising Board brought up a decision that if Serta wants to continue using that statement, they need to provide scientific evidence that supports such a statement. As we are familiar with the situation, that did not happen.

So, if you naturally tend to sleep hot, the chances are high that neither the gel-infused memory foam would not work for you. Although they are not as heat conductive as the regular foam and would not make you sweaty or anything like that, it still can be not enough for some sleepers. But, be careful because many brands tend to exaggerate in their claims in order to sell more or make their products look better than the others. The point is to keep your expectations realistic and don’t entirely trust everything they claim.

Gel Memory Foam Vs. Others

As you know, there any many types of mattresses on the market, and we are now going to compare their heat regulation abilities with the ones from gel-infused foam, and to summarize their pros and cons.

• Gel-infused memory foam – one or more layers of foam in mattresses adapt to body contours and conform closely. Their comfort system usually consists of a base made from high-density foam and one or more layers of polyfoam or viscoelastic foam. As we mentioned previously, the heat retention can be a problem for those sleepers who tend to sleep hot, since cooling gel has its limitations.
• Latex – this highly durable material that comes from rubber tree is becoming a more and more popular material for sleep-related products, and although it may seem that latex is another heat-trapping material, it actually sleeps cooler than the regular memory foam. Its support core is a dense polyfoam, on top of which latex layers are settled.
• Hybrid – according to customers experiences, this type of mattresses is probably the best one on the market when it comes to temperature regulation. Its comfort system is more complicated than the others since it can combine all the other material in order to provide the best sleeping experience. It consists of a pocketed coils core, layers of latex, micro coils, and memory foam or polyfoam.
• Innerspring – this type of bed also sleeps fairly cool, even cooler than the foam mattresses, but it lacks that close conforming and softness of memory foam. In its base, there is a layer of steel coils and on top of them is one or more layers of conventional polyfoam.
• Airbed – heat retention can be an uncomfortable problem with many airbeds, but that depends on the type and thickness of used material. Their support core usually consists of adjustable air chambers, and they can include foam layers.

Complaints about poor and disrupted sleep are common among people. It is shown that sleep disorders affect people all around the world. Most common ones are insomnia, obstructive sleep apnea, restless legs syndrome, circadian rhythm sleep disorder, and hypersomnia. Not treating these disorders can lead to many health problems and potentially life-threatening symptoms. They often affect the development of other health conditions as well. Inadequate sleep can lead to impaired cognitive ability, attention deficit, stress, anxiety, depression, poor mood, weight gain, high blood pressure, heart disease, diabetes, and many other conditions. It affects your mood, daily performance, and overall health and the quality of life.

Adequate detection is essential when it comes to different health and sleep disorders. That’s why clinicians and researchers have tried to develop the best method for detecting sleep problems in the general population. A perfect detection technique should be cheap, easy to administer, quick, and it should give the most accurate results. It is tough to accomplish all of the mentioned criteria, so some parts need to be sacrificed to get the adequate technique. Pittsburgh sleep quality index (PSQI) is a method made to asses the sleep quality in individuals.

What is the Pittsburgh Sleep Quality Index?

PSQI is a self-reported questionnaire about sleep. It looks into one month period and tries to rate your sleep quality based on your answers. PSQI is relatively new, as it was developed by Buysse and colleagues at the University of Pittsburgh in 1988. It has been created after the observation that it is widespread that people who suffer from mental disorders also have a much higher prevalence of sleep problems. For instance, people with a generalized anxiety disorder (GAD) are much more likely to have troubles falling asleep, as well as maintaining it and going back to it after they have been awoken. They are also more likely to report a sleep that wasn’t restorative, as they feel tired after waking up.

PSQI consists of 19 self-report items, and it may also include five related questions for your bed partner. However, only these 19 items reflect a final score, of which 4 are open-ended questions while 15 require a rating of 0 to 3. Questions are grouped into seven individual components, that then produce a score. Seven areas that it looks into are subjective sleep quality, sleep latency (the time it takes you to fall asleep), sleep duration, sleep efficiency (how much time of total bedtime you spent sleeping), sleep disturbances, the use of sleep medication, and daytime functionality. PSQI is practical to use as it only takes 5 to 10 minutes, and you don’t need to be additionally trained to interpret the scores.

Questions cover a wide area of sleep. First, you’ll be asked to state your usual bed and rising time, as well as how long it takes you to drift away and how much rest you get. Other questions might be about your nighttime wakings, nightly trips to the bathroom, snoring, coughing, problems with breathing, feeling hot or cold, having bad dreams or body pains. Some questions include the use of medication and alcohol. There are also some items to rate your energy levels during the day, as well as how much of a mental effort it takes to do things daily. You’ll rate those questions on a scale from “very good” to “very bad,” and there are usually four options to choose from so that you can pick the one that suits you best.

Each segment is rated from 0 to 3, 0 meaning that there are no sleep disturbances and 3 with the least sleep quality. That means that the overall score can range between 0 and 21. PSQI score of over five is considered to indicate sleep problems in a person taking the test, and the higher the score, the worse the quality of sleep.

Is Pittsburgh Sleep Quality Index Reliable?

PSQI is one of the most widely used health-assessment tools in both clinical and non-clinical populations. It is also applicable everywhere around the Earth, so it has been translated to over 55 languages so far.

Validity and reliability of PSQI have been widely confirmed. It can distinguish between people with regular sleeping patterns and the ones who have sleeping problems pretty accurately. However, it can not give us an answer on what exactly is wrong with our sleep. For that to happen, further sleep study called polysomnography is needed.

Like all self-report health questionnaires, PSQI has its strengths and flaws. Its primary advantages are that it is cost-effective, easy to administer, and it has high patient compliance. However, it is self-reported, so it is a subjective reality of a person who fills it. It is possible that they can exaggerate or minimize scores, and the way that it is administered can affect the ratings as well. Also, two people with the same score can have very different sleep conditions. As it is relatively new, it needs more investigating before giving a final verdict of its quality.

One systematic review from 2018 tried to look into the dimensionality of the PSQI. While it is a useful tool, they found a few shortcomings, and they concluded that the various PSQI factor structures might need further investigation.

PSQI is not used as a diagnostic tool, but as a sleep quality assessment. If you get a score that indicates poor sleep quality, an objective diagnosis technique is needed. That’s when polysomnography comes in place. It is an overnight sleep study conducted in a sleep facility. You’ll be observed throughout the night, with a bunch of electrodes attached to you to monitor your brain waves, limb and chest movement, respiration, heart rate, as well as snoring and other noises you might produce during the night. After that, a sleep specialist goes through the obtained information, and they discuss further treatment based on their findings. PSQI is mainly used for that, to determine who has sleep problems that require further objective investigation. It saves a lot of money, since questions are self-explanatory, so no specialist is needed while filling it. It is a kind of like an advanced sleep diary, with specific questions to assess your sleep quality adequately.

One study from 2008 also looked at the effectiveness of PSQI and Epworth sleepiness scale compared to polysomnography findings and found that the objectiveness of these questionnaires is not at the satisfying level.

Should We Make the Pittsburgh Sleep Quality Index Shorter?

Lengthy questionnaires tend to bore the participants, and they might be more inaccurate. An article from 2018 suggests that maybe we need to shorten the PSQI. They had a group of 1246 college students who filled both standard and short versions of the survey. In contrast to the 19 item questionnaire, this new version had only 13 items. It turned out that the short PSQI was just as reliable at predicting sleep problems in younger adults as the standard PSQI.

If you are having sleep problems, taking a PSQI might show you where you stand. You should aim to develop a healthy sleep routine to improve the quality of your nightly rest. Go to bed and wake up at the same time every day, make your bedroom free of distractions and don’t use the electronic devices one hour before bedtime. Try to do something that relaxes you to help you fall asleep faster, and you should always try to lead a healthy lifestyle. Eating right and exercising are very important for good sleep, and proper rest is also essential for your health and the overall quality of life.

Research has shown that most animals do sleep in some form. While REM sleep and dreaming might only be reserved for mammals and birds, all other animals also require some rest. Even jellyfish, one of the oldest known multicellular organism, with the most simple nervous system, has been observed to experience some form of sleep. They have been around for more than 500 million years, long before the dinosaurs even existed. Because of this discovery, it is proposed that sleep is widespread among all of the animal kingdom, and it serves a crucial purpose of restoring body and mind, as well as forming memory and learning.

When we think about how sleep works, we often imagine laying down in a comfortable position in our bed, with our eyes closed, disconnected from the world. Because of that image, people often have a hard time imagining if animals can sleep. It’s easy for mammals, as we’ve seen tons of cute sleeping dog and cat videos, but when it comes to animals that we are less familiar with, we don’t have a clue. If your kid has asked you if their pet goldfish sleeps, and you didn’t know what to say, don’t worry, we have all of the answers for you.

How Do Fish Sleep?

Fishes do not have eyelids, so they can’t close them. One of the purposes of eyelids beside protecting an eye is to spread the fluid across it, so it can function adequately without drying out. When you are always in the water, you don’t have that problem. Fishes also have a far simpler central nervous system than mammals, so they don’t have specific regions of the brain that we do. Take neocortex, for example, that plays a considerable role in sleep. It is a part that produces certain brain waves that are distinctive in different stages of sleep in humans. Also, it is very active while we are dreaming in REM sleep, which means that fish don’t experience REM sleep and that they most likely don’t dream. We say most likely because we can’t be a hundred percent certain, considering how complicated even the fishes’ central nervous system is. Future scientific research might show that they, in fact, experience dreams, but that the other parts of the brain are involved.

Because fish are lacking these structures that would undoubtedly say that they are sleeping, we had to define other parameters to describe the way they rest. These are:

• A state of prolonged inactivity
• A typical resting posture
• The repetitive pattern of this inactive behavior during the 24-hour cycles
• Reduced perception of external stimuli

According to these criteria, sleep in fish is a period of inactivity, almost always with the same posture and in the same location, at the same time every day, while having decreased sensitivity to outside disturbances. Another criterion might be the presence of “rebound sleep.” The induced absence of sleep-like behavior for some time should mean that the inactivity will be more present during the following days that fish is left alone.

The Difference in Sleep Habits Between Fishes

There are over 30,000 species of fish, so naturally, there is a lot of variation in the way that they sleep. Sometimes, even those four parameters that we have described are not enough to tell if the fish is sleeping or not, cause they might not fulfill all four, but it is apparent that they are resting.

Some quietly float on the surface or near the bottom, while others drift round with an occasional flick of a fin to keep them going. Some get the needed rest under a rock, in a whole, or in hiding between marine algae. There are some that even create nest-like structures in the sand and the ones that bury themselves when going to sleep. Some parrotfish have glands inside the gills that secrete mucus. This way, when going to sleep, they produce a cocoon, that protects them from parasites, but it also blocks their smell from potential predators lurking nearby.

Some species like green bromis sleep in branching corals, and they have evolved an interesting symbiotic relationship. While fish is sleeping, it energetically moves its fins, increasing the flow of oxygenated water around the corals. Because algae that live there can’t photosynthesize and produce oxygen during the night, it looks this peculiar sleep behavior is needed for the coral survival.

Spotted wolfish is a beautiful example of how fish behavior can be similar to our sleep. Because it doesn’t have pelvic fins to stabilize its body, this fish flips on its side while sleeping. Others, like bluehead wrasse, are so unresponsive during the resting period, that scientist stated that they were even able to pick them up by hand and bring them to surface without waking them up.

Some fish even catch some rest while schooling. There are a lot of fish in the school that can spot the predator if it comes nearby, so some members decide to turn on autopilot and snooze for a bit. Another fascinating thing about fish is that they can produce electrical waves and communicate by them, so electrical signal can fastly spread between school and alarm everybody about the danger.

As the quality and quantity of light can vary drastically with the depth of the water, other factors can tell fish when is the time to rest. The temperature of water, availability of food, and the presence of predators are all valid signals for a fish for adjusting their sleep/wake rhythm. Some even can switch between sleeping at night or day, depending on these other factors.

The most studied fish is zebrafish (Danio rerio). It’s a great model organism as it shows clear signs of sleep, it stops moving, it’s breathing and heart rate slow down, and it takes much longer to respond to outside stimuli. It’s also observed to get a rebound effect, meaning that when deprived of sleep for some time by the researches, it tries to catch up on the lost sleep when it is left alone in the dark again. However, if the light stayed on, the rebound effect has not been observed. The study of zebrafish is providing some good info about how sleep works, and how the sleep deprivation can affect animals as well.

Do All Fish Sleep?

Most fish are diurnal animals, meaning that they are active during the day and sleep at night. However, there are some that are nocturnal, so they are active during the night and resting during the day. Weirdly, there are some fish that seem not to sleep at all.

Bluefish and mackerel continuously swim in the big seawater aquaria, and even though they seem to slow down at night, they remain responsive to outside disturbances and the introduction of food. However, scientists argue that this state is induced due to the high stress of living in captivity.

There are some fish that have a prolonged period of sleep absence, or they seem to be completely lacking the rest:

• Tuna and some sharks seem not to sleep at all. Scientists are still not sure why that is, but they hypothesize that it is because of the role that sleep has on memory and storing information. Rest serves a purpose to embed memories in our brain and to process all the stimuli that we get during the day. Since those fishes sleep in a rather boring environment, in the deep ocean where the scenery doesn’t change much, it is suggested that they don’t need to relax. Some cave-dwelling fish are also restless, and it may be for the same reason, lack of visual sensory input. However, some scientists are not sure that these creatures are entirely sleepless, and they attribute it to a lack of observation. They propose that some sharks and tunas might have bursts of microsleep, that are observed in some other animals.
• Some fish lack sleep during the juvenile stage. Mozambique tilapia is one of those, and it is observed that it doesn’t sleep for the first 22 weeks of its life. Since tracking rest patterns for a long time in fish is not the most attractive topic of research, scientists still need to figure out whether this is a common phenomenon. Larvae and adults of zebrafish seem to follow the same sleep patterns.
• No rest during migration. Fish seem to be occupied during the period of movement, so there is no time to catch some snooze time. It’s interesting that scientists have created an experiment where they simulated the autumn condition during the winter to see how the tautog would behave. They usually migrate during the fall, so they started to be more active and didn’t sleep. The juveniles weren’t affected which is consistent since they don’t migrate; only adults do.
• Lack of sleep during spawning or parenting period. Some species like the mentioned tautog, bullhead, minnows, yellow perch, and many others seem to be active continuously through spawning season. Others do that when it’s time to care for their eggs. Because eggs need the flow of oxygen all the time, fish look after them and fan them to provide a continuous stream of oxygenated water.

Why Do Fish Sleep?

It seems that this resting period in fish has the same crucial restorative function as it does in humans. Sleep is a time when our brain can do a little maintenance, and it can send signals to repair muscles and other tissues in our body. It’s also a period necessary for our memory storage and learning, and it seems that it plays the same role in fish as well. It’s just that their brains are much simpler than ours, so the effects are not as apparent. Because of the simplicity of their central nervous system, they also don’t go through the same sleep stages as we do, and they don’t experience REM sleep and don’t seem to dream.

Fish can also switch the time of the day when they sleep depending on the outside conditions. Water temperature, the presence of predators, and availability of food can trigger this. Atlantic salmon is an example of this, as they turn nocturnal in colder waters. Fish are not endothermic organisms, like mammals and birds, and their body temperature depends on the temperature of water. Their muscles also produce heat while swimming, so they have to keep move to be warm. Some fish like tuna produce so much heat that they are considered partially endothermic. When the salmon gets in the colder waters, they slow it down (as they turn a bit sluggish) so being active during the night provides them some safety against predators.

Sleeping Goldfish

Another valid question about our pets, since they are not in the wild is how they sleep in a tank. And do our pets like goldfish, guppies, and betta fish sleep at all?

Guppies like sleeping in the dark, so they mostly rest at night when all the lights are off. They usually hover in one place just above the bottom. Sometimes they can float on the surface, but if this happens during the day, it is an indication of some problem.

Bettas sleep in a variety of ways, some float in one place, while others can rest on a substrate or plants in their aquarium. Their gill movement is considerably lower during this period.

Goldfish are diurnal, meaning that they are active during the day. They’ll most likely sleep at night when you turn all your lights out. These pets are low maintenance, and despite the popular belief, they are quite smart. Forget about that myth that they only have a few second memory span; they can remember things for months, even a year. They can also be trained to respond to different kind of music, color, or other sensory cues. In one interesting experiment, scientists thought goldfish to press a lever to get food. Then they limited the time during the day when they would get food by pressing a bar to one hour. It took them very little to learn this, and not only did they use this opportunity to get extra food, but they also didn’t touch the leaver during the hours that it didn’t have a rewarding effect, meaning that they very much have a developed memory and a sense of time.

If your fish is sleeping upside down or on its side, know that this isn’t a usual behavior, unless they told you that it is how that species rests. Other than that, it most likely indicates a health problem, and you should take your pet to the vet.

If you sleep peacefully at one moment and are wide awake in bed the next, not being able to fall back asleep, you already know how annoying and unpleasant something like this can be. You lie there in bed in the middle of the night, in a dark room, wait until you drift off to dreamland again, but it doesn’t happen. The worst thing is that the next day is very important, you have meetings and deadlines that you need to meet, need to be well-rested to get through the day properly focused and productive, but instead of getting a much-needed rest you just toss and turn in bed. Don’t worry; you are not alone as many people have experienced this type of sleeplessness before. If it happens very rarely, it is not a big deal. It has happened to every person on this planet at some point. However, if it happens regularly, it is about time to do something about it. According to studies, one-third of the general population in the United States experiences nocturnal awakenings, and the prevalence of these awakenings increases with age. 43% of these people have difficulties falling back asleep after waking up at night. If you want to know how to fall asleep again, we will suggest some tips that can help you get a good night’s rest that you deserve. 

Relax Your Mind and Body 

If you want to fall back asleep faster, you should relax your body and mind. You can do this by giving your mind something to focus on, instead of worrying about how to fall asleep. If you want to relax your body, progressive muscle relaxation can help you. It is done by first tensing your muscles for five seconds and then relaxing them as you lie in bed. You should do this over and over again for different muscle groups throughout the body, starting with your feet, and working your way up. Something like this will relax your body enough to go back to sleep, and it will give your mind something to focus on. 

Another thing that you should try is doing deep breathing exercises. Close your eyes, relax, and start taking slow and deep breaths. Deep breathing will prepare your body for sleep. Visualization technique can also help, and it is done by closing your eyes and picturing yourself in a peaceful place, far away from stress and worries. You can picture fantastic beaches or mountains, and imagine the sounds and scents of this peaceful place to make the entire experience more vivid.  

Avoid Looking at Your Clock 

When we wake up in the middle of the night, the first instinct that most of us have is to take a look at the clock to see what time it is. Most of us have no idea that this habit can harm our sleep. Worrying about the time when we are trying to fall back to sleep will only increase our stress. Counting the minutes that we have been awake, and hours before we need to get up in the morning will probably backfire as we will start being stressed about losing sleep, which will make it more difficult to drift off to dreamland again. You shouldn’t worry about the time as it is out of your control. Instead, you should turn the clock away from you so that you don’t see it, or simply ignore it if you can. If these things don’t help you can remove it from your bedroom. 

Stay Away from Electronic Devices 

Maybe you are not aware of this, but the soft blue light that comes from your favorite electronic devices is the worst enemy of sleep. This light suppresses the melatonin receptors and disrupts your sleep cycles. It will energize your brain and trick it into thinking that it is daytime, which means that, the longer you look at their screens, the more awake you will feel, and you won’t be able to return to sleep easily after using them. The noise coming from these devices can also prevent you from getting enough rest. Text alerts and the ringtone when someone is calling you can disrupt you, and your sleep will suffer even if call and message notifications are set to vibrate. 

Turn Down the Heat 

If you want to sleep comfortably throughout the night, the temperature in your bedroom should be between 60 and 67 degrees Fahrenheit as it is the best temperature for sleep. When our bodies start powering down for the night, our body core temperature drops, and it helps us enter and stay in REM sleep. If we turn down the heat in our bedroom, it will make us feel sleepy, and it will encourage the sleep onset. No matter how cozy it feels to be in a warm bedroom, especially during cold winter months, it can inhibit your sleep. In case you tend to wake up from night sweats during the night, you should also try to sleep naked. 

Get Out of Bed 

In case you can’t seem to fall back to sleep, you should get out of your bed and do something. However, it doesn’t mean that you should do this immediately after you wake up. It is the best idea to stay in your bed for 15-20 minutes, and if you are still not asleep after this period of wakefulness, you should get out of bed and go to another room to do something relaxing, such as listening to soothing music or an audiobook, doing yoga nidra, or reading a book. Something like this will prevent you from stressing about not being able to sleep, and associating your bed with not sleeping well. However, make sure you don’t do anything exciting, such as working out, watching Netflix, playing video games, scrolling through social media, etc. as it will only wake you up and you won’t feel sleepy anymore. The point is to do something boring that won’t overstimulate you. Also, while doing unexciting things in a different room, you should avoid turning too many lights on.  

Put on Cozy Socks 

We already mentioned that cooler bedroom temperatures are ideal for quality sleep, so this tip may not make sense, but it certainly helps. Here is how it works – when you put on a pair of socks, they will warm your feet, which will draw blood flow to this part of your body, and lower your core body temperature. In other words – if you wear socks, you will fall asleep faster. However, many people have reservations when it comes to wearing socks to bed, and they simply don’t like it, whereas others consider this normal. If you can’t stand the thought of sleeping with socks on, you can use a heating pad at your feet as it will also do the trick. 

Use Essential Oils 

Essential oils have many different purposes, and they can do wonders when it comes to helping you fall asleep faster. Some essential oils, especially lavender, are miracle workers that can have a positive impact on your sleep. They will put you into an increased state of relaxation and prepare you for getting enough ZZZs. All you need to do is to use an essential oil diffuser or add a few drops on your pillowcase, and you will sleep better. 

Create a To-Do List 

We live in a fast-paced world, and we often don’t have enough time to relax and do everything that we are supposed to do because of our obligations and tasks. As a result, we often have to wait until going to bed to have some time to relax and think. Many people start thinking about everything that they have to do after they get in bed to sleep. Something like this can be very stressful, especially if we think about them excessively, and this stress can keep us awake at night and prevent us from falling back to sleep. If you want to avoid something like this, you should write everything down as soon as you wake up in the middle of the night, if you can’t fall asleep again. You should get a pen and a paper, and create a to-do list as it will clear your mind. You won’t have to stress about things that await you and think about them excessively when you have already written them on your to-do list.  

Reasons Why You are Waking Up Mid-Sleep 

Millions of adults have sleep difficulties. Even if they can fall asleep easily in the evening, some people have troubles staying asleep throughout the night. Although they are tired and drift off to dreamland quickly, they sometimes find themselves wide awake at 2 a.m. tossing and turning and not being able to sleep again. We all know that getting sufficient shut-eye is the key to feeling refreshed and being ready for new challenges that await us the next day. When our sleep is interrupted, we are likely to feel sleepy and tired. Some things that interfere with our ability to get enough shut-eye at night include: 

You Drink Too Much Caffeine 

We all know that caffeine is a stimulant that energizes us, and that’s why we drink it. However, it can also interfere with our ability to fall asleep if we consume it in the late afternoon or evening, and it can lead to poor quality sleep and waking up in the middle of the night. It takes around six hours for our body to get rid of half the caffeine that you consumed, which means that you will feel its effects several hours after the consumption. If you tend to wake up regularly at night, you should cut down on caffeine, especially within a few hours before bedtime. 

You Drink Alcohol in the Evening 

Having a couple of drinks in the evening can make it easy to drift off to dreamland, but it also causes restless sleep. As the alcohol that we consumed metabolizes, its effects wear off, and it prevents deep sleep and contributes to restless nights. If you are looking for quality rest, you should limit the alcohol consumption to a few hours before going to bed. Of course, everyone metabolizes alcohol differently, based on different factors including weight, genetics, and diet, but you should allow your body at least a few hours to process it until you decide to hit the sack.  

You Have Anxiety 

People with anxiety tend to wake up at night occasionally. Difficulties sleeping is one of the most common symptoms of an anxiety disorder. When people are anxious, their heartbeat tends to rise, which makes it difficult to relax and stay asleep. Anxiety can also contribute to nightmares, and it can cause nocturnal panic attacks, which are the episodes of intense panic that wake people up from their sleep. If your anxiety wakes you up frequently in the middle of the night, you should consult your doctor. 

Your Bladder Can’t Wait 

If your bladder can’t wait until the morning, and you need to go to pee at least once during the night, this condition is called nocturia, and it is more common than you think. Some of the causes of this condition include bladder obstruction, sleep disorders, and drinking too much fluid before going to bed. It occurs in both women and men, and it becomes more common as we age. You should restrict your fluid intake a couple of hours before bedtime and see if it will reduce the number of nightly bathroom trips. If restricting fluids doesn’t help, you should consult a doctor for explanations and potential treatment. 

You Eat Too Late 

If you are hungry before sleep, you should have a light snack before going to bed. Eating heavy meals close to bedtime is a terrible idea as you will toss and turn during the night, and it can lead to acid reflux and indigestion. If you want to avoid waking up at night without being able to fall back asleep, you should stay away from greasy and spicy foods before bed. 

As you can see, there are numerous reasons why you are waking up at night, some of which are easily changeable. 

Sleep is a naturally occurring, dynamical process that affects our body and mind, our natural developmental changes, and fluctuations in our daily state. We instinctively sleep almost every night of our lives, but there’s a lot more to sleep than making yourself comfortable and closing your eyes. As sleep science still experiences the surge of information since the landmark discoveries made over the last few decades in this area, progress has certainly been made; knowing that sleep happens doesn’t automatically explain why and how exactly.

Quantification of sleep is not an easy task – too many variables are involved in inducing and regulating this process, and as far as it lead us already, sleep science is still very much in its infancy. In best attempts to answer as many questions posited when faced with this problem, specialists have come up with a number of theories and models.

In this article, we will explore some of these models one by one, observations about them, as well as some newer and promising work.

A Mathematical Model of the Sleep-Wake Cycle

This model works around the “flip-flop” models previously posited to account for REM/NREM stages of sleep and explores how well the neuronal components in these models fit in the sleep-wake cycle as we know it. It is essentially the biological basis for the two-process model and explains features like the timing of wakefulness and sleep, how deprivation affects this timing, the effects of orexin loss, ultradian rhythms and more.

Two-Process Model of Sleep Regulation

The two-process model is one of the most authoritative sleep posits to date. It describes what happens in one’s body during the 24-hour timespan and why we get sleepy or alert at different stages of the day. The processes in question are the circadian rhythm (also known as process C) and the sleep-wake homeostasis (process S). These two combined regulate our sleep and wake times of a single day.

Circadian rhythms in one’s body are in charge of monitoring other processes and time them to match the external time of day. One such circadian rhythm is meant to synchronize our sleep time with nighttime and our wake time with daytime, triggered by external cues like light levels. In essence, process C is what alerts you to wake up in the morning, keeps you awake throughout the day, and then lets you sleep in the evening.

Homeostatic processes are those in charge of monitoring a specific function in our body in narrow-range. A homeostatic process regulates the blood salinity levels; another one takes care of thermoregulation, and so forth. The sleep-wake homeostasis is responsible for the increasing sleepiness we feel the longer we are awake, making our bodies and minds slower and heavier until we finally go to sleep. This process increases the sleep pressure over the day, but goes into decline when we sleep (specifically in non-REM stages of sleep).

Brought together, these processes overlap and override one another constantly to enable sufficient sleep. In essence, it works like this: the morning, after a bit of sobering up from sleep, is when we are most alert. Process S has just begun the sleep debt build-up which will only go upwards until the next time we sleep. In order to prevent us from succumbing to this pressure, Process C keeps us alert, so that we would stick to the schedule and stay awake until nightfall. With nightfall, our brain will start secreting some sleep-inducing hormones like melatonin, and the sleep-wake homeostasis will finally be in the clear to take over. As we fall asleep, this process will be satiated, releasing the sleep pressure until the moment we wake up, once again alerted by process C, and the whole story repeats from the top.

The two components mentioned in this model function together and can’t be looked at independently. Disrupt one of them, and you automatically have disrupted sleep with common consequences like excessive daytime sleepiness and sleep deprivation after as little as a couple of nights. If continued for a longer timespan, one might develop a disorder. Examples of disorders triggered by environmental or behavioral factors would be the circadian rhythm disorders like jet lag, shift work, delayed or advanced sleep-wake phase disorder and insomnias. This mostly happens when light exposure is insufficient, or one’s internal clock is forcefully opposed to the time of day (like when you switch timezones suddenly).

As it is, the two-process model is a useful tool for the initial outlining of sleep architecture, but its simplistic nature has some shortcomings. Namely, the stages of sleep including 1, 2 and Slow Wave Sleep (SWS) are all molded into “non-REM” besides REM-sleep and aren’t differentiated between one another. This is important because both different stage durations and the frequency of switching between stages of sleep can potentially signal that something isn’t right and might indicate a disorder, sleep-related or otherwise.

Sleep Architecture and the Bayesian Network

Because of the reasons stated above, sleep researchers have decided to go a bit further into sleep mathematics, although while relying on the two-process model as a base. Using the Bayesian network and information based on around 3200 nights of sleep from different sources, researchers were able to lay the ground for a newer, updated model of sleep to come. Before we get into it, we will clarify some terminology and basic sleep structure.

Bayesian network is a statistical model that uses conditional dependency between a set of variables and an outcome, to determine which variable was more likely to cause the outcome and predict future events based on this information. For example, we could have a set of symptoms and predict the likelihood of various diseases or disorders using this network. For our purposes, different sleep stages and their dynamics, as well as factors like one’s body weight, age, sex and external factors like time of day could all be proved to affect sleep using the Bayesian network.

Different sleep stages are as following: stage 1, stage 2 (light stages), Slow Wave Sleep (SWS), Rapid Eye Movement (REM) and Waking After Sleep Onset (WASO). The standard order of these includes stage one proceeding into a cyclic repetition of stage 2, SWS, stage 2 and REM. The first two stages have shown to be mostly consistent in duration for the entire night (meaning, they last the same as the first time they occurred every next time as well), while SWS and REM phases have bigger fluctuations. Typically, SWS will take a larger portion of sleep in the evening or night, while REM will occur and last longer in the early morning hours. During the night, brief moments of WASO will occur somewhere between the other stages.

Doctors and researchers will often take the total time one has spent in each stage during sleep and normalize it into an average in order to compare the stages and measure their proportions during a night’s sleep. This can be beneficial on occasions when multiple patients or groups are examined. However, in an individual, it fails in noting whether some stages re-appeared more times but lasted shorter, or they cycled less but for longer durations. Differentiating between these situations is very important, as fragmented sleep can indicate the possibility of obstructive sleep apnea, for instance. Another issue with this approach is that researchers won’t be able to tell if any single stage was consistent in duration or not. For example, a stage could occur only two or three times during sleep but last equally long each time, or it could occur more times but last for shorter or longer periods in every appearance, with the total sum of time spent in that stage staying the same.

To effectively predict the probability of the next stage transition, its duration, total sleep efficiency, and REM onset, researchers have also considered each individual’s age, sex, sleep latency, and its overall length.

Results were able to establish that both age and sex make a difference in sleep stages transition and duration. The older an individual, the more of their sleep goes into stages 1, 2, and WASO, and less time is spent in SWS. Their quality of sleep was also worse compared to that in younger people. People’s sex only changed the transitioning between various stages, but the difference in other aspects wasn’t significant. Finally, a thorough examination was unable to detect any links between sleep latency, efficiency, and one’s BMI.

In conclusion, this work shows some progress has been made since the two-process model and calls for a new, refitted one. The Bayesian network is worthy of mention as a promising tool for further use in studies, and we can expect to see some exciting discoveries in the future of sleep science.

Contrary to hypnotics and sedatives, stimulants are substances that affect the body and the central nervous system by increasing our level of alertness and making it hard to fall asleep. That is why stimulants are usually connected with wakefulness, but they can also improve your mood and lower stress on a daily basis. When given in certain doses, stimulants can actually be used to improve sleep.

A stimulant is basically any substance that impacts the body by increasing its nervous or psychological activity. Most often they affect the nervous system to reduce sleepiness and increase mental alertness. One widely available and probably the most common stimulant is caffeine, which many people use on their own to handle excessive daytime sleepiness.

For more severe cases, such as sleep apnea or narcolepsy, a more profound approach is needed, so some legal stimulants such as Modafinil (Nuvigil), Amphetamines (Adderall), Armodafinil (Nuvigil) or Methylphenidate (Ritalin), may be the best option.

Before treating the condition, the underlying cause of sleepiness should be examined to see if it is possible to solve it naturally by adjusting the sleep schedule or routine, reducing stress or creating a more sleep-friendly environment. For example, shift workers that have irregular sleep schedule due to their job, often feel excessive sleepiness and fatigue while they are working. For them, changing something in their sleep pattern is not an option, so they have to reach for medications and stimulants to stay awake and complete their obligations.

Adderall

The US Food and Drug Administration (FDA) has approved the use of Adderall in only one case, to treat the disorder of attention deficit hyperactivity. But, regardless of that fact, Adderall is most commonly used off the label as a stimulant that keeps us awake and in focus. Many college students use it as a study aid, as well as people who work under high pressure. Adderall improves abilities of certain neurotransmitters such as dopamine, a brain chemical which boosts our alertness and energy. Besides that, Adderall will increase the heart rate, decrease the blood flow and open up breathing passages, as a result of it, this drug causes a feeling of invigoration and energy, something similar to what cocaine does too. Also, it creates that rewarding feeling of euphoria which is why it has become so popular as one of the recreational drugs.

Some short-term adverse effects can include dry mouth, restlessness, suppression of appetite and weight loss, cardiac issues, heart palpitations, etc.

Even in the countries where Adderall is available through prescription, it is still recognized as a drug with high potential for abuse, so its supplies are often limited, and in some countries, like Japan, it is completely banned.

Long-term consequences of Adderall abuse are paranoia, erratic behavior, psychological disorders, increased risk of heart attack, extremely high blood pressure, vitamin deficiency, etc.

Addiction to Adderall might be either physical or psychological.

• Physical dependence occurs when a user is so used to the presence of Adderall in its brain that if he stops using it, it will cause some of the withdrawal symptoms.
• Psychological addiction happens when someone uses Adderall compulsively, and their addiction and urge became so strong that they are willing to put their well-being at risk in order to attain and use the drug.

When it comes to withdrawal treatments, there are yet no medications that can assist users during the process of withdrawal, although there is some evidence that antidepressants might manage some of its psychological aspects such as include depression, anxiety, and fatigue.

Ritalin

Besides Adderall, Ritalin is the second most popular stimulative study drug, taken to keep people awake and enhance their memory and focus. The most common side effect of taking this drug is sleep issues, which many are willing to ignore. Since 1950s doctors use Ritalin to treat different conditions such as depression, narcolepsy, and fatigue. The FDA also approves Ritalin as a drug for ADHD, but it has also been proven that it helps patients with brain injuries, but it does not restore their memory. Some research hinted that small doses of Ritalin actually improved cognitive performance and working memory among healthy people, while higher doses impaired their focus and performance.

Ritalin improves the action of a brain neurotransmitter called catecholamines, and it achieves that by blocking dopamine and noradrenaline reabsorption by neurons.

Because Ritalin is a stimulant similar to cocaine because they have a very similar chemical structure, it has the potential for abuse and may cause some undesirable changes in the brain. Since it is a legal prescription drug, it is easy to abuse since many neglect its potential side effects. Studies of long-term use were performed on animals and have shown that extended use may cause anxiety, sleeping issues, psychosis, nervousness, nausea, reduced appetite, brain plasticity, and weakened memory.

Nuvigil

Nuvigil belongs to a group of stimulants called eugeroics which all promote mental arousal and wakefulness. It is often prescribed to patients dealing with obstructive sleep apnea, excessive daytime sleepiness, narcolepsy or shift work sleep disorders.

Some reported side effects include nausea, headache, insomnia, dry mouth, and dizziness. Using a higher dosage than it is prescribed can lead to overdose, symptoms of it are disorientation, mania, hallucinations, chest pain, increased blood pressure, etc.

The exact way of how Nuvigil works is still unknown since it does not bind or inhibit any of the receptors in charge of regulation of the sleep-wake cycle.

How Caffeine Acts as a Stimulant

Caffeine is the mostly used stimulant that keeps millions of people awake each day, and many even develop caffeine addiction as they cannot function without it. Most of us rely on a cup of coffee in the morning or/and later in the afternoon to push us through the next few hours. It has been estimated that around 80% of adult Americans take caffeine in some form each day.

Apart from using caffeine to stay awake, this substance can affect your body in other ways too. Although caffeine temporarily and almost immediately eliminates the symptoms of fatigue and drowsiness, too much caffeine can cause headaches, heartburn, vomiting, and nausea, and also raise your blood pressure. On the other hand, some other benefits besides keeping us awake and alert are decreased risk of oral and throat cancer, lower risk of Alzheimer and dementia, and according to one study, even 45% lower risk of suicide since caffeine has mood-enhancing abilities. These benefits are only related to high-octane coffee, not to decaf.

Although we mostly connect caffeine to coffee, it can be found in some medications, or even in food, since it does not have any taste and nutritional values on its own we can hardly know if it is present. A safe amount of caffeine for adults per day is anything below 400 milligrams, which is around four cups of coffee, but the amount of caffeine in coffee varies among different types of it. One standard coffee cup has eight ounces, a mug or a cup at certain coffee shops can contain even up to 16 ounces or more.

If we consume approximately the same amount of caffeine every day, our body will develop a sort of tolerance to it. Our age and other personal preferences determine our caffeine tolerance. Sudden decrease or increase of caffeine is not recommended, so if you are thinking about withdrawal, you might do it by slowly reducing the amount you consume each day. Caffeine withdrawal can be harsh, and some symptoms include headaches, irritability, drowsiness, and anxiety.

Caffeine stimulates our central nervous system, once it reaches to the brain, the most noticeable effect is alertness, the feeling of tiredness will be erased, and that is why caffeine is a common ingredient in many medications that are meant for drowsiness, migraines, and headaches.

It is possible to overdose with caffeine, but it is extremely rare, some signs of it are hallucinations, vomiting, and confusion, and sometimes convulsions can lead to death. Overdosing is a result of large consumption of caffeine, usually in pills or energy drinks, or if you drink more than 400 milligrams of it.

Can Stimulants Improve Sleep For People With ADHD?

ADHD stands for attention-deficit/hyperactivity disorder, and it is one of the most common mental disorders that affect children. Their brains develop differently, affecting their attention, self-control, focus, ability to sit still, and so on. Many children and adults who suffer from it usually develop some sleep disorder over time. Studies have shown that people with ADHD have troubles with falling and staying asleep because when they are tired, their ADHD symptoms get worse, which prevents them from falling asleep. Around 67% with ADHD reported this problem, while approximately 50% of children with ADHD has signs of some sleep-related breathing disorders.

Common sleep disorders among adults with ADHD include disorders of the circadian rhythm, sleep apnea, restless leg syndrome, and periodic limb movement syndrome. There are some differences in behavior among sleep-deprived children and adults with ADHD. When adults are tired they slow down, but children tend to accelerate and overcompensate, they can also often be very moody, aggressive or emotionally explosive as a result of sleepiness.

A study from 2018. gathered 34 adults who were ADHD diagnosed in childhood, and showed that methylphenidate, which is a central nervous system stimulant, can improve sleep among adults with this disorder. The polysomnographic sleep study showed that stimulant reduced not only the sleep latency, a period between going to bed and falling asleep but also the number of nocturnal awakenings and sleep quality. This study also confirmed that ADHD symptoms developed during childhood continue into adulthood.

Side Effects of Stimulant Use

As with any other substances, downsides are always an option, and here are some things that you should take into consideration before you decide to use stimulants as a form of sleep-aid. Side effects depend on the type of drug, dosage, duration of usage, and individual characteristics. Since all of them promote wakefulness, sleep-related problems or disorders can be certainly expected. It is very easy to start abusing these drugs and get addicted to the feeling that these stimulants can provide. The best way of making stimulants work for you is to combine them with other behavioral changes and habits, and to not take it on your own.

Most common side effects include insomnia, hypertension, headache, back pain, dizziness, irritability, nausea, diarrhea, anxiety, etc. while some long-term effects can be more severe and potentially dangerous for our life.