Thursday, August 29, 2013

Five More Minutes Mom: Just About Everything Known About Sleep

Now that school is back in session you may be having a hard time waking up and find yourself leaning over to hit that snooze button once or twice like I do.  Since many of you are logging on for the first time to make sure that you are in the right blog, I thought I would throw up a second post for everyone to read. This post may be !!!!A LOT!!!! longer than the recommended length of most blogs found here, but I could not sleep last night and did some research on why I hit the snooze button five times every morning and now that I am a little bit sleep deprived I thought I would post just about everything that I found out.  If it makes you fall a sleep, maybe that is a good thing.  It starts off with a little bit of imagination. 




Imagine a time long before alarm clocks, a time where man still woke with the clock-a-doodle-do from a rooster call. I can see that man rolling over in the early morning, a little earlier than he would have wished as beams of sunlight were only thinking of crossing the horizon. Grasping for the stone just a little smaller than the size of his fist that he had methodically placed next to the spot of his slumber the night before and curving that stone right at the head of his rooster with the aim of a professional baseball player. Bang! The cries of morning glory that the rooster’s song so ungracefully pierced the atmosphere with ceases and a few more minutes of shut eye are able to be had. As time passes, the rooster, with consciousness slowly percolating back, clears its throat in preparation for its next verse and screams its song once again, the man is woken, but with that revered extra ten minutes of sleep. The snooze button is born.  

As I systematically scoured the internet for information on the snooze button I was a bit surprised to find very little information devoted to it, it seemed that there were more FarSide cartoon stills on the matter than scientific inquiries. A realization came over me that in order to understand why I use the snooze button three times a day, I would have to understand all aspects of sleep.  I figured I would start where the problem begins, with an alarm going off. 

According to Alarm Clocks and Lost Productivity (2005) the very first alarm clocks are credited to the ancient Greeks who had modified a water tank with a whistle, as water draining from the tank reached a certain level it would trigger the whistle to blow. The invention of more modern clocks, one that wouldn’t spring a leak and worked through cooperating mechanical gears would not come along until the 14th century. The first clocks that could actually fit into a house were not developed until 1620 in the German village of Nuremburg, these clocks even had alarm mechanisms that were capable of sounding an alarm every twelve hours (History of Alarm Clocks 2007).
 
Finding out where the snooze button fit within this historical timeline of clocks came with a surprising answer, Ben-Hur. So Ben-Hur is not technically the right answer here, however according to Alarm Clocks and Lost Productivity (2005) the author of Ben-Hur, Lew Wallace, beyond his fame of writing the fore mentioned prolonged agony, earning the rank of Brigadier General during the Civil War, becoming a lawyer, holding a seat on the Senate as well as serving as Governor, is also credited with the invention of the snooze button sometime in the late 19th century (Lew Wallace Wikepedia 2013), apparently the first man to snooze did not lose. However there is little information out there that would explain the workings of this original reset button, which I found to be "alarming." When the alarm as we know it today was first slammed with a sleepy fist several times in hopes of hitting the snooze button and not accidentally turning off the alarm first came in 1956 and was marketed by General Electric (It’s Alarming 2011).

 After the above history lesson, I thought I would get a quick census of what people think about the snooze button and where else would I turn than the blogging world. According to the most up to date and relevant online blogging sites the snooze button gets some mixed reviews. On one cutting edge blog site known simply as Discuz (“How Often Do You Hit the Snooze Button 2011), an author who identifies herself as Amy and uses an anonymous default white figure of a head with an orange background asserts, “I blame the snooze button for all life’s problems. I would love to meet the guy who invented it. I would kick him, wait four minutes and then kick him again.” Contrasting Amy’s hatred of the snooze button is the blogging conversation available at Yahoo answers, where Sharon, using her japanimation character of a young girl, tweets in to start a blogging session with, “Do you think it feels sooooo darn good to hit the snooze button???? I do….I love it. Just wanted to say that (Snooze Button 2011).” It appears that she is not alone because she is quickly answered by another user, jessp who is also using a japanimation character that responds, “OMG…OF COURSE!! It’s the best feeling ever…to get just those few minutes of extra sleep…its blisss….(Snooze Button Response 2011)” 
  
The unedited and apparently often abbreviated writings of the blog sites led me to think that some blogging posts are not the best scholarly sources (except for this one of course), so I turned my attention towards what actual experts on the matter might think about the snooze button, and like clockwork I quickly found my answer. As it turns out hitting the snooze button might just do more harm than good. An article in the Professional Safety Journal (2009) on sleep reports that the nine to ten minutes of sleep that a person gets after hitting the snooze button is not enough to reach REM sleep and that “the sleeper may be adding to his/her level of sleep debt instead of getting more solid snoozing.”  REM is an abbreviation of rapid eye movement sleep, and is the only stage of the sleep cycle where we dream, it accounts for about 20 – 25 percent a typical night’s sleep (“Rem Sleep,” Wikipedia 2013). 

Trying to find out what constitutes a sleep cycle I found an article through HelpGuide.com that explained the sleep cycle consists of five sleep stages that progress towards the final stage of REM sleep (Smith and Segal 2010). The first stage is transitioning into sleep characterized by slow eye movement, this is when you will wake up with the smallest amount of noise. The cycle continues into light sleep where eye movement stops, body temperature decreases, and heart rate slows, from this point most people will transition into deep sleep within 25 minutes. When a person goes into deep sleep they are very difficult to wake up, and will be slightly disoriented if they are awoken. The fourth stage is a more intense version of deep sleep where brain waves slow dramatically with blood flow is diverted from the brain and sent to the muscles to restore energy. On average people will enter the final stage of REM sleep 70 to 90 minutes after first falling asleep, although people can enter into REM sleep sooner if they are sleep deprived. REM sleep is where a person’s eyes will move very rapidly, their breathing will become extremely shallow, heart rate and blood pressure increase, and the arms and legs will become paralyzed (Smith and Segal 2010). While a person sleeps they are continually rotating through the cycles and that on average a person cycles into REM sleep about five times per eight hour period of sleep.
  
As I continued peering into sources I started searching for answers about why we actually sleep. I came to find out that not much is known about why we actually sleep and the experts are still sleeping on it. A recent article from Harvard Medical School Sleep Division (2008) explains that it might just be an unanswerable question, but some theories have been developed. One of the first theories developed is known as the inactive theory and took an evolutionary standpoint that asserted it would have been beneficial for us to sleep while it was dark ensuring that we would be still and quiet as to not attract things that go bump in the night.  Another theory explains that we sleep in order to conserve energy, research does show that metabolism is substantially reduced while sleeping. The restorative theory explains that we sleep in order to rejuvenate what we lose and conversely break down what we produce while awake. Things like “muscle growth, tissue repair, protein synthesis, and growth hormone release occur mostly, or in some cases only, during sleep (Why Do We Sleep Anyway? 2011).” 


Current experimentation being performed by Griffith and Rosbash (2008) suggest that sleep increases homeostatic control of synapse strength. Figuratively speaking every time a nerve or neuron fires it shoots a bullet, those bullets are neurotransmitters made up of synaptic proteins, so sleeping serves to reload the bullets. The more activity going on in the brain, the more the neurotransmitters need to be replenished, this explains why babies who are learning and making so many new connections within their brain need so much sleep. In order to keep the correct number of neurotransmitters available, also known as homeostatic plasticity, it is believed that our bodies measure the amount of Adenosine present within the brain (Griffith and Rosbach 2008), a substance that increases in concentration the longer we stay awake and induce feelings of tiredness. Subsequently caffeine and some other drugs are adenosine blockers, and by drinking caffeine you are blocking the receptors that measure the increase in adenosine, eliminating the symptoms of feeling tired.






After knowing as much as the experts on why we sleep, which is like saying, “I’m not entirely sure why,” I became interested in just how much sleep we need and shifted my research. Is eight hours enough sleep for most of us? Information from the National Sleep Foundation (How Much Sleep Do We Really Need 2011) recommends that most of us should really go to bed a little earlier than we do and the following amount of sleep is suggested depending upon age. Newborn babies up to the age of two months should have between 12 and 18 hours of sleep.  Infants younger than a year need an average of about 14.5 hours of sleep. Children up to the age of three should be getting close to 13 hours of sleep and preschoolers up to the age of five need about 12 hours. Elementary school children under the age of 10 are recommended to have between 10 and 11 hours. Preteens and teenagers should be getting on average nine hours of sleep and healthy adults should be turning in for anywhere between seven and nine hours of sleep. Knowing that I usually do not meet these guidelines I became interested in what happens when you don’t get enough sleep. 
  
While some people may be able to get away with less sleep than others, health-and-sleeptracks.com (7 Signs and Symptoms of Sleep Deprivation 2010) has developed seven signs of sleep deprivation that include, feeling tired during meetings, lectures, or driving, feelings of moodiness and irritability, needing an alarm clock to wake up and repeatedly hitting the snooze button, sleeping longer on the weekends, taking naps every day, the formation of dark circles or bags under your eyes. Well these criteria may not sound like such a big deal, research has shown that lack of sleep may cause, headaches, increased blood pressure, increased risk of developing diabetes, obesity, poor immune system functioning, lower levels of cognitive functioning, memory loss, and in the most extreme cases death (Brody 2007). 

During my research on understanding how much sleep that we need I came across a few articles that explained some alternative sleep patterns that have been used by several famous people. Leonardo Da Vinci, Benjamin Franklin, Thomas Edison, and Albert Einstein, four people who collectively developed and created ideas and inventions that have been the most relevant towards shaping our modern world, all had one thing in common, their sleep routine. The American Chronicle (Bisnar 2009) explains this sleep routine is known by several different names, polyphasic sleep, the Da Vinci sleep cycle, or the sleep of genius. A polyphasic sleep routine consists of taking 20 minute naps every four hours throughout a 24 hour period. When you do the math this accounts for about two hours of sleep, leaving 22 hours of wake time to be productive. If you are wondering if a person could be productive on so little sleep, just take a look at the accomplishments of the fore mentioned individuals and if that’s not enough it also explained through sleep science. 

A person who sleeps eight hours through the course of the night moves through the sleep cycle five times, receiving close to 30 minutes of REM sleep for each cycle, totaling about one and a half hours of REM sleep.  During polyphasic sleep, it is thought the body is able to adjust and go directly from stage one sleep into REM sleep, eliminating the other stages of what could be considered nonproductive sleep (Bisnar2009).  During a traditional sleep pattern of eight hours a night, REM sleep only accounts for 20 percent of sleep, polyphasic sleep induces REM sleep almost exclusively and REM sleep accounts for close to 100 percent of sleep, totaling close to two hours of REM sleep.  In an article appearing in the Washington Post, Dr. Stampi, a circadian physiologist warns that this sleep strategy is not for everyone and it can take two to three weeks for the body to adjust (Mallin 1990). However he also explains that subjects that have followed the routine closely do not show symptoms of sleep deprivation, but do lose the ability to dream and often feel very unsociable mainly due to simply not being on the same schedule as society.
  
On a final note, during the last stages of my research I came across an article that made me yawn and I wondered why that was. Like other mysteries surrounding some of the fundamentals of sleep, the truth behind yawns is still not fully understood. According to Dr. Barry Make (Little Mystery: Why Do We Yawn 1998) medical students are taught that we yawn because oxygen levels in our lungs are low, and that no correlation between tiredness and yawning exists.  Since normal respiration rarely completely fills our lungs with air, yawning helps to expand our lungs and to be sure that our entire lung become filled with air every once in a while so those portions of the lung not do not partially collapse. Other theories focus on a yawn helping regulate the temperature of the brain or equalizing pressure in the middle ear, while some theories just conclude that it is a residual effect of a past primitive instinct that no longer serves a purpose (9 minutes to snooze 2009). What is known is only socially aware animals yawn, which includes most vertebrate species including fish, birds, cats, dogs, chimpanzees, and humans. As for the contagious factor of yawning, children under the age of two as well as most children with autism (Little Mystery 1998) lack the contagious yawning response.  Like so many other aspects of sleep, the yawn has remained a mystery and scientist will continue to sleep on the answer, hit the snooze button and sleep some more.




Works Cited

“7 Signs and Symptoms of Sleep Deprivation.” SleepTracks.org.2010.

“9 Minutes To Snooze.” Professional Safety. 54.11 Nov. 2009: 48.

“Alarm Clocks and Lost Productivity (or How I Can’t Get No Satisfaction).” TheBlueSmokeBand.com. March 2005.

Amy. “How Often Do You Use the Snooze Button??” Discuz.Online posting. 11 Jan. 2011.

Bisnar, John. “Napping in the New year-The Da Vinci Sleep Cycle.” The American Chronicle. 14 Jan. 2009. LexisNexis Academic.

Brody, Jane E. “At Every Age, Feeling the Effects of Too Little Sleep” The New York Times. 23 Oct. 2007.

Griffith, Leslie C., Rosbash, Michael. “Sleep: Hitting the Reset Button.” Nature Neuroscience. 11.2 (Feb. 2008): 123-124. Academic Search Premier. 

“History of the Alarm Clock.” ClockHistory.com. 2007

“How Much Sleep Do We Really Need?” NationalSleepFoundation.org. 2011.

Jessp. “Snooze Button?” Weblog Post. Answers.Yahoo.com.

“Lew Wallace.” Wikipedia: The Free Encyclopedia. Wikimedia Foundation, Inc. 18 Mar. 20011.

“Little Mystery: Why Do We Yawn?” msnbc.msn.com. 15 Oct. 1998.

Mallin, Jay. “Sleep of Future: 15-Minute Naps.” The Washington Post. 6 July 1990: B7. 

McClelland, Cynthia A. “It’s Alarming.” Wamware.com. 2003-2011.

“Rapid Eye Movement Sleep.” Wikipedia: The Free Encyclopedia. Wikimedia Foundation, Inc. 16 Mar. 20011.
 
Sharon. “Snooze Button?” Weblog Post. Answers.Yahoo.com.

Smith, Melinda M.D., Segal, Robert M.A., “How Much Sleep Do You Need?” 2001-2010. HelpGuide.org. July 2010.

Jessp. “Snooze Button?” Weblog Post. Answers.Yahoo.com. Web. 18 Mar. 2011.

“Snooze Button?” Comment on Weblog Post of Snooze Button. Answers.Yahoo.com. Web. 18 Mar. 2011.

“Why Do We Sleep, Anyway?” HealthySleep.med.Harvard.edu. President and Fellows of Harvard College. 2008. Web. 18 Mar. 2011.

5 comments:

  1. Jason,
    This article was very interesting and the puns that you've scattered throughout made it a fun read! Your blog made me re-evaluate some of the information I know about sleep and also taught me quite a bit of new information. After reading this article, I was interested in finding out why roosters crow at sunlight, what physiological effect is causing them to do this? I searched a bit and found that this has to do with their circadian rhythm (Shimmura and Yoshimura 2013). The study basically had to groups of roosters that were placed under different amount of light. The first group was placed under bright light followed by dimmed light, as would be a normal day. The second group was placed under 24 hours of dimmed light. The group of roosters that was exposed to both bright and dim light crowed two hours before the bright light was exposed. Interestingly, the second group of roosters, exposed to only dimmed light, initially crowed at the same time they assumed dawn to be (about every 24 hours). Yet, as they remained only under dimmed light, their crowing pattern began to become irregular. The study concluded that the circadian rhythm had a stronger force on the crowing than did any external stimuli. However, Shimmura and Yoshimura believe that the roosters' circadian rhythm is set by external stimuli, which can be seen the the second group of roosters (only dimmed light).

    Reference:
    Shimmura T, Yoshimura T. 2013. Circadian clock determines the timing of rooster crowing. Current Biology [Internet]. 23(6):231-233. Available from:http://download.cell.com/current-biology/pdf/PIIS0960982213001863.pdf?intermediate=true.

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  2. Jason,

    That was definitely an interesting post. At first glance, I was nervous because it was long and seemed that it was going to be full of science jargon and more than I felt like taking on in a Sunday afternoon. However, I was surprised to find that it was an easy, informative, and fun read. Well done. Furthermore, I found that it made me reflect on my own sleep patterns and what may or may not be the most efficient manner of sleep that I could benefit from. This begged the question to get me thinking even further and applying it to the real world. Could there exist some sort of niche in healthcare, similar to nutritionists, but applied solely to sleep? A licensed, business professional who specializes in creating specific sleep routines and guidelines for a specific person based on their own physiology? I mean ,with the way healthcare and treatment options have developed over the past five years, personalized anything doesn't really seem too far-fetched. Interestingly enough, an algorithm developed and tested in Canada (Ray 2010) has pin pointed a way to hoan in on individual sleep spindles, the electrical oscillations that occur in Stage 2 of sleep that act as an "electro-fingerprint" given their specificity for the 10 individuals observed. Could we take this and apply it on a larger scale to give rise to an even more individualized sleep experience? Would this allow us, as humans, to reach our full "recharged" 100% potentials? Thoughts?

    References:
    Ray LB, Fogul SM, Smith CT, Peters KR. Validating an automated sleep spindle detection algorithm using an individualized approach. Journal of Sleep Research [Internet]. 19(2): 374-8. Available from: http://web.ebscohost.com.

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  3. Jason,

    I have to say I was pretty intimidated by the length of this post, but after skimming the comments, I figured I'd better go for it. I found this post extremely interesting and informative. Doan and Garrett weren't wrong in stating that you made it an easy and comical read. Throughout the post, I found myself thinking about my own sleep habits and how they could be affected by my education and career. With many of us pursuing careers in healthcare, I decided to research a little into the sleep deprivation of professional caregivers. I found a study published just last month that examined the health effects sleep deprivation has on caregivers of patients with primary malignant brain tumors. Though data was recorded over a short period after patient diagnosis, I was surprised to find that there was not a correlation between sleep loss and physical health. However, it does note that sleep loss and high anxiety resulting from this role places caregivers at a risk of developing health issues (Pawl et al, 2013). It makes me wonder if the individualized sleep experience Garrett mentions could become reality, then health providers could potentially provide higher quality care...

    References:
    Pawl JD, Lee S, Clark PC, Sherwood PR. 2013 Aug. Sleep loss and its effects on health of family caregivers of individuals with primary malignant brain tumors. Res Nurs Health [Internet]. 36(4):386-399. Available from: http://onlinelibrary.wiley.com.dml.regis.edu/doi/10.1002/nur.21545/full.

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  4. Jason,

    While lack of sleep has many detrimental effects on the body, at least it made you a star PhysioBlogger! It is interesting that it is universal knowledge that sleep is good, but medical professionals still don't really understand why and how much is the best! I recently heard on NPR that one "trick" to resetting your internal clock is camping (spending more time outside). The natural sunlight and lack of electronics helps your body follow the rhythm of nature. As humans we force our idea of what day and night should look like on nature. We turn on the lights, TV, stare at smartphones, and then take stimulants and depressants whenever we deem appropriate. Artificial light decreases melatonin and can interrupt with sleep patterns (Weller, 2013). Artificial light drives our lives! How, then, do we listen to what our bodies really want and need? Nature is pretty smart and turns out the more I listen to my body the better I sleep and the better I feel. I really liked Garrett's comment that perhaps the healthcare world could benefit from "sleep experts" as it does appear to be a very personal issue.

    Jason, take home lesson: no blogging after dusk!

    References:
    Weller, Chris. 2013 Jul. Exposure to artificial light from electronics disrupts sleep pattern, causes decreased melatonin and difficulty falling asleep. Medical Daily [Internet]. Available from: http://www.medicaldaily.com/exposure-artificial-light-electronics-disrupts-sleep-pattern-causes-decreased-melatonin-and-247286

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  5. Jason,

    I found this blog interesting and very informative. Who knew there was so much out there to learn about sleep during those times when you just can’t fall asleep?

    I came across some information recently in the book "Why Zebras Don’t Get Ulcers" under the chapter “Stress and a Good Night’s Sleep” in regards to how humans naturally wake up (without the assistance of any alarm clock). As it turns out, an hour before our eyes open and we get moving for the day, our brain wakes up. The author describes a study in which one group of volunteers was allowed to sleep through the night as long as they desired, and the other group was informed that they would be woken up at six in the morning. Researchers found that the volunteers who slept without the anticipatory stress of being awoken slept until about nine in the morning, but their brain began to increase their stress hormone (ACTH-adrenocorticotropic hormone) level around eight in the morning. In a similar way, the researchers observed that the stress hormone levels in the volunteers who were informed that they would be awoken at six in the morning began increasing at five in the morning. The main difference noted from this experiment was that the unlimited sleep group woke in response to being rejuvenated, while the limited sleep group woke in response to the stressfulness of the anticipation of being woken up.
    I now wonder whether the use of alarm clocks affects our bodies in a way that mimics the response of the limited sleep group, or perhaps the reason why it is so difficult for many people to awake in response to the first alarm of the morning is due to our brains not being able to take the needed hour prior to our wakeful state to increase the release of stress hormones. If this is the case, does our body make up for the inadequate release of stress hormone throughout the first few hours of our wakeful state? I think this would be a really interesting research study to take on, but as of now it is just something to think over on another sleepless night.

    References:
    Sapolsky, R. M. (2004). Stress and a good night’s sleep. Why zebras don’t get ulcers (pp.237-238). New York, NY: Henry Holt and Company.

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