personal/nunosempere.github.io

Fork 0

Nuno Sempere 643c10bf4f Some more changes to rat/sleep.md

2018-08-26 14:18:33 +02:00

29 KiB

Raw Permalink Blame History

Notes on: The Sleep Solution, by W. Chris Winter.

Prologue.

Helping a team plan out the best time to travel during a long road trip.

Or helping an athlete and his family adjsut to a new baby in the house.

|N: Status!

This book is meant to be read like a sweeping novel. It is not a reference book. I do not want you to skip ahead to the part of the book that you think is most important for you. It’s all important! Think of it as a complete process for understanding and overhauling both your sleep and the way you think about sleep. If you do it my way, you are going to finish this book with a newfound sense of what it means to have healthy sleep.

An Introduction to Sleep Medicine.

Sleep conditions are highly tratable.

Tom Roth (2007): Insomnia may accept as many as 1/3 of our population at any given time.

Restless leg syndrome?

Everyone in medical school studies everything.

REM behavior disorder: The normal paralysis that accompanies dreaming is impaired.

According to researcher Raymond Rosen, most physicians have received less than two hours of training about the entire field of sleep in their four years of medical education.

Given that our psychiatry lecture about men who fantasize about their wives’ footwear lasted thirty minutes, you can see just how dramatically underrepresented the whole of sleep medicine was in our curriculum.

Chapter 1: What is Sleep Good For? Absolutely Everything!

There is almost no disease or organ system in which you cannot find some kind of relationship Sleep as one of the foundational processes within your body that you can actually change.

To me, the three main pillars of good health that we can exert some control over are nutrition, exercise, and sleep.

Sleep is not the absence of wakefulness. Sleep is not a light switch in your braing that is either on or off. Your body is doing amazing things at night while you sleep.

Sleep resides in the brain. If you think your all-nighters or your crazy shift work schedule is no big deal, you might want to sit down before you continue to read. Long-term poor sleep is like bad cosmetic surgery: risky, costly, and not pretty.

Sleep and the Brain

The brain does have a system for removing waste: the glymphatic system. Discovered in 2015!! 60% more productive when we're sleep.

Making the decision to stay up late impairs your brain's ability to get rid of toxic waste products building up during the day.

Alzheimer has to do with that system.

Better sleep has an influence in Alzheimer.

|N: But, quantitatively, how much?

It seems to work better when you sleep on your side.

Also linked to other neurodegenerative disorders.

Sleep and Obesity.

Up until recently, the connection between sleep and obesity was largely ignored.

Increased body weight could cause poor sleep. And poor sleep, weight gain.

Sleeping fewer than 6/7 hours, and staying past midnight -> obesity.

Sleep ~> leptin, which makes us feel full.

After a poor night sleep, our energy levels are reduced. One compensatory mechanism is for us to eat more in an effort to boost our energy.

With poor sleep comes decreased impulse control and greater risk-taking behaviors.

For every hour of sleep an individual lost, he or she gained 2.1 points on their BMI.

|N: Quantitative!

Sleep, Your Heart, and Blood Pressure.

Poor sleep increases the risk for heart attack, elevated blood presure, heart failure, and stroke.

Any condition that fragments sleep has the potential to elevate blood pressure.

Complex relationship between lungs and heart.

Sleep and Mood.

Poor sleep can lead to depression and negative mood consequences

Frequent awakenings during the night, may contribute to worsened mood and negative emotions.

As patients spend more time in bed and withdraw from typical activities, their schedule and sleep-wake cycles become a big mess.

Bipolar patients can have significant issues with sleep. Manic episodes can feature long stretches of time in which the patient is unable to sleep.

Sleep and Cancer

"I wish I were making this section up".

Poor sleep and breast cancer ???

Shift work

|N: Working during the night, I suppose.

Sleep and Your Immune System.

Our immune system's function is intimately tied to the amount and quality of our sleep.

|N: Studies giving people the rhinovirus voluntarily!

I could virtually go organ to organ through the whole body and show you how lack of sleep is harmful

Chapter 1 Review.

When Sleep is not working properly, you don't work properly

|N: I've long known this as "When you fuck with your sleep, your sleep fucks with you".

When people say scientists don't know why we sleep, they're wrong.

Chapter 2: Primary Drives.

Cold reading: Sex has been on your mind in the last several ~~days~~

Food, Water, Sleep, and Sex (Not Necessarily in that Order.

"My psychic secret is all about primary drives".

"We have a primary drive for sleep. Because of this, the longer we go without sleep, the more determined our brains are to get it, ultimately to the point where it is no longer a choice".

|N: This "because" is spurious. The sentence doesn't explain shit.

People cannot go on with 4-6 hours of sleep.

"I've slept only two hours in the last fourteen days". Not the case.

Speaking of the Guinness Book of World Records, while they maintain records of virtually every kind of feat imaginable, they no longer recognize sleep-deprivation records. The current record holder, Randy Gardner, set the mark of 11 days and 24 minutes in 1964. During this trial, it became progressively more difficult for Gardner to stay awake. His brain engaged in microsleeps (brief periods of uncontrollable sleep usually lasting less than thirty seconds), and he suffered hallucinations, severe cognitive impairments, and even paranoia. This paranoia has been noted in several sleep-deprivation experiments, the most unfortunate of which was seen in the case of disc jockey Peter Tripp, whose sleep-deprivation publicity stunt of 201 hours seemed to have very lasting psychological effects (not the least of which was a belief that he was an impostor of himself).

True, honest-to-God sleep deprivation is difficult.

If, however, you think you are sleep deprived but you show no tendency to nod off when you are stretched out on a couch, does it really make sense to you, knowing what you know, that you really are sleep deprived?

The Do-nothing-for-a-really-long-time exercise.

IF YOU ARE SOMEONE WHO believes you are suffering from long-term sleep deprivation, and can’t sleep no matter how hard you try, do this little exercise.

Eat a little something and try to use the bathroom. Sleep Exercise 1 is going to take a while.
Turn off your cell phone and telephone ringer and ask that your family leave you alone until the experiment is over.
Demand total privacy because the situation you’re dealing with is “wicked serious.” Say it just like that and nobody will bother you.
Find a comfortable, private place in your house or office to lie down.
Kick off your shoes, turn off the lights and lie down there.
Do not sleep! Just lie there for the next seven hours.
Reflect on your experience.

To put things in perspective, not sleeping for four days and subsequently not being sleepy is analogous to an individual coming into my office saying that he has not eaten for four days and yet strangely feels no hunger and is gaining weight. Yes, I know that toward the end of terminal starvation, the body feels little to no pain, but you get what I mean.

The rats in the dirty cage showed more signs of hyperarousal and did not sleep as well as the rats in the clean cage.

The complaint "I can't sleep" is inaccurate and untrue, so stop reciting this mantra and reinforcing this in your mind-set.

"I don’t sleep. It’s not just me. My mother never slept. She would . . .” “No. Stop right there and try again.” “Uh, I have difficulty sleeping and my mother had difficulties with her sleep too.” “Much better. Continue.”

Compare sometimes not feeling hungry with getting into bed and simply not feeling like sleeping. Many people are immediately concerned about this development, and the stress it causes may prevent sleep later in the night or even later in the week. For many, the confidence that the boat will right itself when sleep is involved simply does not sleep.

Although I often compare the brain’s drive to sleep with its drive to eat, there are subtle differences. Our brains do not technically have the ability to make us eat. We can become terribly hungry and strongly driven to eat, but in extreme cases of anorexia or some kind of volitional hunger strike, an individual could overcome hunger and starve to death. With sleep, however, the brain retains the final say and actually has the power to force sleep on us all.

How much Sleep Do We Need?

Enough. You need enough sleep.

Questions: How can we get better sleep? Is napping a good thing? How much sleep do we need?

The following are guidelines. Keep in mind that sleep need is as individualized as caloric need.

All through our life, our sleep need is declining.

Young adults: Seven to nine hours.

Older adults, after retirement: Seven to eight hours.

This study did not seem to support the idea that members of modern society were sleeping drastically less than their counterparts from a generation ago.

Chapter 2 Review.

Animalistic primary drives include hunger, thirst, sex, and sleep. Without meeting these needs, you will die (except for sex, the lack of which results in the entire population fizzling out).
You sleep. You may not sleep well, but you do sleep.
The need for sleep varies from person to person and actually tends to decline as we mature.
Something about rats sleeping in dirty cages.

|N: Too lotus.

Chapter 3: Sleepy Versus Fatighed.

Sleepy vs fatigued. High vs low drive to go to sleep.

Fatigue: "I'm Tired of Being Tired".

Fatigue: Strength drained away.

Trouble finding motivation. Lacking the drive to simply pull a load of laundry?

The list of things that cause fatigue is endless.

Things that cause fatigue:

{Hypothyroidism, Parkinson’s disease, Vitamin B12 deficiency, Medication side effects, Iron deficiency, Malnourishment, Anemia, Pregnancy, Low testosterone, Urinary tract infection, Depression, Diabetes, Multiple sclerosis, Heart disease, Lyme disease, Glandular fever}

There are many things that can cause fatigue, other than lack of sleep.

Sleepiness: “I’m Not Sleeping; I’m Just Resting My Eyes” and Other Falsehoods.

Sleep that is disfunctional can also make you sleepy.

The Holes in Your Sleep-

Sleeping apnea: The sleeper awakens over and over because of breathing-related difficulties. He may wake up for an incredibly brief moment, so brief that his brain has no awareness of the awakening. But they can fragment sleep so terribly that sleep's restorative effects are all but negated.

Initally, you can compensate with increased quantity. But if that extra sleep becomes dysfunctional, more sleep won’t make a difference. Finally, your sleep is so poor that you feel like you could sleep for a week and not feel rested. You can put as much water into your gas tank as you’d like, but it doesn’t mean your car will run

Scientific studies have established that if an adult sleeps well, usually six to seven hours will suffice. Many of my patients with sleep problems often feel they need nine hours or more of sleep to feel okay.

Six to seven hours is absolutely fine for some people. For adults over the age of sixty-five, as little as five hours could be appropriate according to the 2015 consensus paper by Nathaniel Watson and his colleagues.

The hunter-gatherer cultures mentioned in the last chapter were averaging only about six and a half hours of sleep each night and yet they appeared to be quite healthy and well adjusted.

Bottom line: There is a tremendous amount of dysfunctional sleep out there, causing excessive sleepiness, and people cannot always “sleep more” to fix the problem.

Patients often lie during this questioning. It’s okay. I’m used to waking people up from my waiting room and seven minutes later asking them, “Ever fall asleep in public?” With a straight face, they respond "No". This is why I strongly suggest spouses come along to inject some reality into these appointments.

Sleep quality vs quantity.

A 2015 study published in the Journal of Neuroscience found that sleep deprivation may impair your ability to properly read facial expressions.

Why and How We Sleep: The Homeostatic and Circadian Systems.

There are two main systems in your body that work to produce sleepiness: the homeostatic system and the circadian system. These systems ideally work in concert to produce sleepiness in a way that promotes healthy and fulfilling sleep.

Homeostasis refers to bringing balance or equilibrium to a system; it’s in charge of bringing rest to a system that is not at rest. The longer you go without sleep, the more powerful the drive to sleep and get your system back in balance. In the same way, the longer you read this compelling chapter and ignore the urge you have to urinate, the stronger the drive to pee will be until it’s overwhelming and you can’t concentrate on anything you’re reading—again, the drive to balance.

A chemical called adenosine mediates the homeostatic system of sleep.

As you’re awake for longer and longer periods of time, more adenosine collects in your brain. Because adenosine induces sleepiness, the longer you’re awake, the more likely you are to be sleepy. This is the chemistry behind sleep being a primary drive.

A long time ago, they did an experiment by taking spinal fluid full of adenosine out of a sleepy dog and putting it into a well-rested dog. The infusion made the wakeful dog feel sleepy.

Caffeine blocks adenosine. Ever wonder why Red Bull makes you feel so awake? Caffeine, baby, and lots of it (about 80 milligrams per can or 9.64 milligrams per fluid ounce). Need more? Try a Starbucks double shot at 20 milligrams per ounce (mg/oz) or an espresso at 50 mg/oz. Some of the newer extreme energy drinks can reach levels of more than 100 mg/oz.

Why are these drinks so totally awesome and effective? When you’re awake at 4:30 A.M. organizing your wrapping paper or balancing your checkbook without some Rabid Opossum Dangerous Energy drink,35 you’ll understand how stupid that question is.

These drinks temporarily block the effect of all that accumulating adenosine on that poor noodle of yours that’s screaming for you to put down the remote and go to bed.

Physical activity also increases adenosine, so the harder you exert yourself, the more likely you are to be sleepy. Exercise is a vital part of any sleep program, with hard work often being a fantastic tool to combat occasional difficulty sleeping. We’ll talk more about that in Chapter 6.

Light plays a huge role in our sleep. Ever wonder why? Think we’re genetically and evolutionarily designed to seek out a killer tan? Not really.

Think about the accumulation of adenosine in the brain. If adenosine were allowed to accumulate in the brain unchecked, we would be pretty sleepy by lunchtime and really a mess by 4:00 P.M. This drive to sleep is sometimes referred to as homeostatic pressure. This is not how sleep works. In reality, for the most part our sleepiness level is not appreciably different at 9:00 A.M. from that at 9:00 P.M. How does that work? What other factors are involved in keeping our sleepiness levels low throughout the day?

Take a poppy and put it in a greenhouse closed off from outdoor light. Establish a twelve-hour on and twelve-hour off light cycle. The flower will thrive. Suddenly turn the lights on and off at random times, keeping everything else the same. Even if the amount of light remains the same, the random timing of the lights will significantly disrupt the natural rhythms of the flower, and it will die. The linking of sunlight and its day-night cycle with a biological rhythm is the basis of circadian rhythms.

In humans, this rhythm is facilitated by a chemical that is different from adenosine. It is called melatonin.

Melatonin is produced in conditions of darkness. Makes us sleepy.

raccoons have the opposite response to melatonin (!)

That spike in sleepiness is the reason it is so temping to sneak a little nap after lunch. In fact, in some cultures, a postlunch siesta is the norm, not the exception. Are these cultures right to give in to that urge to nap every day? Some scientists think so. I think a nap in the afternoon is fine as long as it does not affect your ability to sleep at night.

Most likely, these systems are working just fine, but you are disrupting them in some way.

Chapter 3 Review.

Fatigue refers to a lack of energy, rather than a desire to sleep.
True sleepiness is caused by one of three things: medication, sleep deprivation, or sleep dysfunction.
Our sleep is based on two systems, the homeostatic and circadian.
You are or you are not sleepy. If you were brave enough to take some sleepiness assessments, you should have a feel for how sleepy you are or are not.

Chapter 4: Sleep Stages.

People have so many weird notiong about stages of sleep that this section can be mindblowing. Poeple use terms like deep sleep and ream sleep all the time without really having a clue what in the hell they're talking about. People think they haven't slept, when they in fact did. Sleep perception and sleep reality are not always related. These perceptions are often strongly tied to the stages of sleep. if you are a poor sleeper who views yourself as being a confident, good sleeper, you may function as well during the day as a person with far better sleep quality. (!) Sleep has 3 important phases: Light sleep, between wakefulness and deep sleep. Awake <-> Sleep. Pick a state of being, any state of being. Bad model. Awake <-> light sleep <-> deep sleep. Slightly better model Deep sleep is our most restorative sleep, but you have to pass through light sleep to get there dream sleep = rem sleep. =/= deep sleep Awake <-> light sleep <-> a) Dream sleep or b) Deep sleep It's not common to go wakefullness <-> deep sleep, wakefullness <-> dream sleep, or dream sleep <-> deep sleep. Each of these stages of sleep has specific functions and thus specific consequences if they are disrupted.

Rem sleep

Eye movements that characterize REM = Rapid Eye Movement sleep. Using electrodes to measure brain activity, eye movements, and muscle activity, Kleitman and Aserinsky investigated REM sleep using techniques that would later form the basis of polysomnography, the modern sleep study. Using these devices, the researchers demonstrated that the brain activity during REM sleep mirrored that of wakefulness. Aserinsky and Kleitman’s later studies involved waking subjects during REM sleep. Approximately 70 percent of the subjects who woke from this sleep period reported dreaming. While new theories of sleep suggest that dreaming can occur in deep sleep, REM sleep is, for all intents and purposes, dream sleep.

Individuals usually spend about one quarter of their night in REM sleep. REM sleep comes in twenty- to forty-minute cycles, usually about four to five times a night. The cycles typically become longer in duration as the night progresses so the longer cycles occur during the second half of the night. The longest cycle usually terminates around the time an individual awakens in the morning. This is why dreaming is most common right before you drag yourself out of bed; that’s the time of your night’s longest dream cycle.

Set your alarm thirty to forty-five minutes earlier than your typical wake-up time. Go to sleep. When your alarm wakes you up, were you in the middle of a dream? Chances are that if your sleep follows a typical progression, that early awakening will occur in your biggest REM cycle of the night. Furthermore, when individuals are awakened out of dreaming, they typically remember their dreams. This illustrates an important point: When an individual states that he doesn’t dream, one of two things is happening: He truly does not dream, or he dreams, but does not remember dreaming. Your brain does not like to awaken during REM sleep, so it has taken measures to prevent it. Dream sleep begins approx 90 min after an individual falls asleep, commonly after a brief stay in light sleep and a cycle of deep sleep. The purpose of REM sleep is poorly understood. For years, REM sleep has been believed to be essential for memory processing Later, researchers would demonstrate that disruptions in REM sleep can lead to other cognitive difficulties besides memory difficulties, including attention problems, poor concentration, and potential mood disturbances. Sleepiness is not classically associated with REM disruptions. Regulation of pain perception? REM deprived subjects were more pain intolerant. Effects could be seen after a relatively short period of rem deprivation, potentially as little as 4h. Linked to chronic pain conditions. In a 2015 study, rats who got insufficient sleep before an injury were more likely to suffer from chronic pain than well-rested rats |N: Researchers injured the rats, I gather. For example, humans are a euthermic species, meaning we are warm-blooded. We can, to some degree, regulate our body temperature in different environmental conditions. We can sweat when it’s hot and shiver when it’s cold. During rem sleep, you stop regulating your body temperature (!). Think about that. During dreaming, your brain completely suspends the fundamental and complicated function of temperature regulation

Light sleep.

In light sleep, we are usually unconscious, but some people can retain a sort of awareness during this stage. It is usually fairly easy to awaken from this sleep as well, and so because of this, the state is relatively fragile. Light sleep can be further subdivided into stage N1 sleep and stage N2 sleep. N1 sleep represents the transition from wakefulness to sleep. In a normal night of adult sleep, only about 5 percent of the night is spent in this stage. During N1 sleep, the brain waves begin to slow down and the darting eye movements that characterize wakefulness become slow and rolling. Muscle activity begins to diminish. These changes continue in N2 sleep, which represents a deeper stage of light sleep. Unique brain wave patterns called sleep spindles and K-complexes are seen during N2 sleep, which help differentiate between N1 and N2 during a sleep study. Almost half of an individual’s night is spent in N2 sleep If transitions to deep sleep and REM sleep are disrupted, the individual will spend more time than normal in stage N2 sleep. Because light sleep is not terribly restorative, these individuals will feel like their sleep is poor and unrestorative, and in some cases, they may feel as if they were not sleeping at all.

Deep Sleep.

Deep sleep is the stage of sleep that seems to be the most poorly understood by patients. Stage N3 sleep constitutes deep sleep Typically, adults spend approximately 25 percent of their night in deep sleep with the majority of deep sleep activity occurring during the first half of the night. This sleep is restorative sleep and makes individuals feel rested (not sleepy) the following day. Why is deep sleep restorative? Mainly because the time you spend in deep sleep happens to also be the time of greatest growth hormone (GH) production. Basically it does so many things to help your body stay young and healthy, and perform better, it’s a wonder people don’t try to acquire it illegally and inject it into their buttocks in strange places like the locker rooms of professional sports teams make sure you value and protect your deep sleep at night and your brilliant brain will make all kinds of GH at night while you sleep, leading you to feel refreshed the following day. In addition, this GH will help strengthen your muscles and fortify your bones, help you recover from injuries and boost the functioning of your immune system Ever wonder why staying up late studying for your exams always leads to illness and a C |N: I have indeed wondered The amount of deep sleep declines as individuals age, and with it, so too does our GH secretion. Kids typically have tons of deep sleep.

Sleep cycles.

The stages of sleep ebb and flow in a predictable pattern during healthy sleep. Complex chemical reactions in the brain initiate transitions from one stage to the next. By tracking the presence of these stages during a sleep study, a visual representation of sleep stages as they progress can be made. This is called a hypnogram Consider the reverse—a patient waking directly out of REM sleep as seen in figure 4.8. This is often the pattern seen in nightmares or sleep paralysis and is also abnormal.

One last bit of sleep advice you are likely to encounter has to do with sleep cycles, hypnograms, and how you can plan out your sleep to be more beautiful, healthy, and successful. The advice is based on the fact that we tend to sleep in cycles that last an average of ninety minutes. Life hackers have taken this information, consulted our grandparents, and come up with the sleep tip that we should sleep in ninety-minute cycles for optimal health. Some articles even suggest that the amount of sleep we need is irrelevant and it’s only about making sure we time our sleep to end at a mark that is an interval of ninety minutes. This is what real scientists refer to as total horseshit (TH)

Keep in mind the ninety-minute cycle is an average. Maybe I have eighty-minute cycles. Maybe you have hundred-minute cycles. That’s a big difference.

Also, we usually have four to six cycles through the night, meaning that the time my third cycle ends could be an hour off from when your third cycle ends. Trying to time these things perfectly is a little absurd.

|N: That was useful to me.

As someone who looks at sleep studies all day, I can tell you that hypnograms follow a general pattern, but they are not precise.

Some personal sleep monitors have the ability to awaken you during naturally occurring “lighter” stages of sleep, typically when the device detects that you are moving around a little. While there are no compelling studies supporting this practice as performance enhancing, it probably makes sense, as waking up out of REM can feel pretty awful.

Probably the best way to avoid the need for such an alarm is to try to make your wake time as consistent as possible.

Chapter 4 recap

Get all the sleep you need and work toward consistency in your sleep schedule. Consistency does not mean you must wake up at a ninety-minute interval.

Thoughts by Nuño

In comparison with my medieval philosophy, this book is more useful.