Are we winning the War on Sleeplessness?

Or, as the authors of this paper put it, are we seeing the “first signs of success in the fight against sleep deficiency?”

Abstract:

STUDY OBJECTIVES:

The high prevalence of chronic insufficient sleep in the population has been a concern due to the associated health and safety risks. We evaluated secular trends in sleep duration over the most recent 14-year period.

METHODS:

The American Time Use Survey, representative of US residents ≥15 years, was used to investigate trends in self-reported sleep duration and waking activities for the period 2003-2016 (N = 181335 respondents).

RESULTS:

Sleep duration increased across survey years both on weekdays (+1.40 min/year) and weekends (+0.83 min/year, both p < .0001, adjusted models). This trend was observed in students, employed respondents, and retirees, but not in those unemployed or not in the labor force. On workdays, the prevalence of short (≤7 hr), average (>7-9 hr), and long (>9 hr) sleep changed by -0.44% per year (p < .0001), -0.03% per year (p = .5515), and +0.48% per year (p < .0001), respectively. The change in sleep duration was predominantly explained by respondents retiring earlier in the evening. The percentage of respondents who watched TV or read before bed-two prominent waking activities competing with sleep-decreased over the same time period, suggesting that portions of the population are increasingly willing to trade time in leisure activities for more sleep. The results also suggest that increasing online opportunities to work, learn, bank, shop, and perform administrative tasks from home freed up time that likely contributed to increased sleep duration.

CONCLUSIONS:

The findings indicate first successes in the fight against sleep deficiency. Public health consequences of the observed increase in the prevalence of long sleep remain unclear and warrant further investigation

Here is the American Time Use Survey which the authors used for their study.

Sleep disturbances in girls associated with more difficulties staying awake in and out of school

From Pedro de Bruyckere’s blog:

Sleep disturbances in girls associated with more difficulties staying awake in and out of school

We’ve known for some time now that we all sleep less than a decade ago and that our children often nowadays don’t sleep enough. This new study describes that there are maybedifferences related to gender. I wasn’t able to read the study because it’s something that was presented at a conference last week. From the […]

via Sleep disturbances in girls associated with more difficulties staying awake in and out of school — From experience to meaning…

Preliminary results of a recent study show that teen girls reported a higher degree of interference of daytime sleepiness on multiple aspects of their school and personal activities than boys.

The study examined whether teen boys and girls report similar negative impact of sleep disturbances on their daytime functioning.

“What was most surprising is the fact that teenage girls reported a higher degree of interference of daytime sleepiness than teenage boys on multiple aspects of their school and personal activities,” said co-author Pascale Gaudreault, who is completing her doctoral degree in clinical neuropsychology under the supervision of principal investigator Dr. Geneviève Forest at the Université du Québec en Outaouais in Gatineau, Québec, Canada. “For example, teenage girls have reported missing school significantly more often than teenage boys due to tiredness, as well as reported having lower motivation in school due to a poor sleep quality.”

Circadian rhythms Nobel Prize for Medicine or Physiology 2017

When I was young, the Oscars had an air of naffness, and the likes of the Golden Globes or Emmys even more so. One of the many many ways internet culture has failed to live up to its utopian hype   is the glorification of these sort of jamborees into moments of Great Cultural Significance, endlessly teased over by scolding columnists determined to weed out wrong think even about a glorified trade awards ceremony.

The Nobel Prizes haven’t quite reached the same point – indeed, as I wrote here before, their cultural impact may be somewhat diminished – but nevertheless, they are also subject to a strained search for important messages. The Nobel Prize in Physiology or Medicine 2017 was awarded jointly to Jeffrey C. Hall, Michael Rosbash and Michael W. Young “for their discoveries of molecular mechanisms controlling the circadian rhythm”

The video illustrates nicely what Circadian Rhythms are. 

 

Here is Robash’s lecture (with 5250 YouTube views) which is a good place to start a consideration of circadian rhythms:

And here is Young’s, which ties it all back to human circadian rhythms (just over 4000 views):

Here is Hall’s Nobel lecture, I note he is wearing a Brawndo hat from the film “Idiocracy”. I also note this video has just over 6000 views on YouTube (the Brawndo ad linked to above has over 3 million) Then again, it is a little hard going – Hall is not as funny as he thinks he is… and while there is some interest in his anecdotal style of various prior Drosophilia researchers it is not that effective an entry into this world (so while it is the first lecture given and includes the overall introduction, I have left it to last):

Slides of Robash’s and Young’s lectures are available on the Nobel site. Rather endearingly, they are basic PowerPoint slides replete with credits for everyone in the lab.

So there you go. 3 Nobel lectures on a subject of direct relevance to all our lives have a grand total of less than 15000 views on YouTube. I could easily find some ephemeral/trashy/obscene video with several multiples, but what is the point?

In the New Yorker, Jerome Groopman identified the “real message” of the prize as a rebuke to those who ignore or underfund basic science (in fairness his piece is also a decent introduction to this research).  While there may be some merit to this, it strikes me as more likely that the Academy recognised scientific work of genuine merit and enduring relevance.

And Groopman’s piece was one of the only ones I could find online that discussed the science and the issues related in some context (even though it was one I found slightly suspect) – most of the others essentially recycled the press releases from the Nobel Foundation and the US National Science Foundation

In my post “Why isn’t William C Campbell more famous in Ireland?” I discussed an excellent piece by Declan Fahy on “the fragile culture of Irish science journalism”. One wonders if this fragility is perhaps not only an Irish phenomenon.

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“Mental health apps offer a head start on recovery” – Irish Times, 18/01/18

Here is a piece by Sylvia Thompson on a recent First Fortnight panel discussion I took part in on apps in mental health.

Dr Séamus Mac Suibhne, psychiatrist and member of the Health Service Executive research technology team says that while the task of vetting all apps for their clinical usefulness is virtually impossible, it would be helpful if the Cochrane Collaboration [a global independent network of researchers] had a specific e-health element so it could partner with internet companies to give a meaningful rubber stamp to specific mental health apps.

“There is potential for the use of mental health apps to engage people with diagnosed conditions – particularly younger patients who might stop going to their outpatients appointments,” says Dr Mac Suibhne. However, he cautions their use as a replacement to therapy. “A lot of apps claim to use a psychotherapeutic approach but psychotherapy is about a human encounter and an app can’t replace that,” he says.

Here are some other posts from this blog on these issues:

Here is a post on mental health apps and the military.

Here is a general piece on evidence, clinical credibilty and mental health apps.

Here is my rather sceptical take on a Financial Times piece on smartphones and healthcare.

Here is a piece on the dangers (and dynamics) of hype in health care tech

Here is a post on a paper on the quality of smartphone apps for panic disorder.

Circadian Rhythms video from Oxford Nuffield Sleep & Circadian Neuroscience Institute

From here

In Space, No One Can Hear You Snore

Amazon Alexa informed me, as one of its “crazy facts” available on request, that astronauts do not snore because in zero gravity their airways do not collapse.

Sounds good, and plausible, but is it true? I decided to fact check Crazy Fact on this. And obviously one factchecks Alexa via Google.

First port of call was this 2008 piece, which informed me that :

Research on two space flights found some interesting sleep statistics. A 2001 study [1] conducted found that five astronauts actually stopped snoring completely while in space. As well, some who had suffered episodes of stopping breathing, called sleep apnea, had none when they were in space.

This was a breakthrough. They had proveN that gravity was indeed necessary to constrict the airflow, aggravate the throat and cause the vibrations along the soft palate and uvula. No gravity made it easier to breathe. Oddly they also learned that astronauts sleep fewer hours and use sleeps medications to assist them in sleeping.

An earlier study was done in 1998 aboard the shuttle Columbia to see how astronauts sleep in the artificial environment of a space shuttle. The result surprised many scientists and sleep specialists when microphones picked up snores from the crew. They were surprised because the feeling was that astronauts likely breathed less.

This led me to David Dinges who has the cool title “chief of the division of Sleep and Chronobiology and director of the Unit for Experimental Psychiatry in the Perelman School of Medicine at the University of Pennsylvania” and this 2001 editorial from the American Journal of Respiratory and Critical Care Medicine:

An excellent example of the latter outcome
is the investigation by Elliott and colleagues in this issue
of the American Journal of Respiratory and Critical Care Medicine
(pp. 478–485) (1). They recorded respiration and sleep
physiology in healthy astronauts during two National Aeronautics
and Space Administration (NASA) space shuttle flights
and compared these recordings to those made when subjects
were Earth-bound before and after flight. They found that microgravity
was associated with marked reductions in sleep-disordered
breathing, in time spent snoring, in arousals during
sleep, in respiratory rate during presleep waking, and in heart
rate during both presleep waking and slow wave sleep. The results
highlight not only the relative importance of gravity in
ventilatory mechanics during sleep, but also reveal that within
physically fit subjects there is a covariation between upper airway
resistance, snoring, and the likelihood of respiratoryrelated
arousals during sleep. It suggests Earth’s gravity has a
key role both in upper airway resistance and obstruction, and
in the relationship of these factors to arousals during sleep

So next to the paper “Microgravity Reduces Sleep Disorder Breathing in Humans” by Elliot and colleagues in that journal. Abstract:

To understand the factors that alter sleep quality in space, we
studied the effect of spaceflight on sleep-disordered breathing.
We analyzed 77 8-h, full polysomnographic recordings (PSGs)
from five healthy subjects before spaceflight, on four occasions
per subject during either a 16- or 9-d space shuttle mission and
shortly after return to earth. Microgravity was associated with a
55% reduction in the apnea–hypopnea index (AHI), which decreased
from a preflight value of 8.3 1.6 to 3.4 0.8 events/h
inflight. This reduction in AHI was accompanied by a virtual elimination
of snoring, which fell from 16.5 3.0% of total sleep time
preflight to 0.7 0.5% inflight. Electroencephalogram (EEG)
arousals also decreased in microgravity (by 19%), and this decrease
was almost entirely a consequence of the reduction in respiratory-related
arousals, which fell from 5.5 1.2 arousals/h
preflight to 1.8 0.6 inflight. Postflight there was a return to near
or slightly above preflight levels in these variables. We conclude
that sleep quality during spaceflight is not degraded by sleep-disordered
breathing. This is the first direct demonstration that gravity
plays a dominant role in the generation of apneas, hypopneas,
and snoring in healthy subjects.

Later:

All five subjects in this study showed some degree of snoring
from mild to moderate during preflight PSGs. Time spent
snoring ranged from 2.8 to 32.6% of the total sleep time. In
microgravity, snoring was almost completely eliminated in all
subjects. Importantly, the change in snoring habits of this
group correlated well with the changes in the number of respiratory
events per sleep period both on the ground and in space
(Figure 3). The correlation between snoring and AHI suggests
that the hypopneas were likely obstructive as opposed to central
in nature.

So truly, in space no one can hear you snore.

“#Sleeping, as we all know, is the most secret of our acts.”- #Borges and #sleep in #literature

I have blogged both here and on my other blog quite a few quotes from novels and other literature on sleep. I have found these passages capture a sort of phenomenology of sleep as effectively as any clinical text. In this post I use a quote from Jorge Luis Borges as the starting point for a more general, although ultimately quite personal, discussion of literature and sleep and other altered states of consciousness.

Séamus Sweeney

Sleeping, as we all know, is the most secret of our acts. We devote a third of our lives to it, and yet do not understand it. For some, it is no more than an eclipse of wakefulness, for others, a more complex state spanning at one and the same time past, present, and future,; for still others, an uninterrupted series of dreams. To say that Mrs Jáuregui spent ten years in a quiet chaos is perhaps mistaken; each moment of those ten years may have been a pure present, without a before or after. There is no reason to marvel at such a present, which we count by days and nights and by the hundreds of leaves of many calendars and by anxieties and events; it is what we go through each morning before waking up and every night before falling asleep. Twice each day, we are the elder…

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