Sleep(less) in Boston

It is my third time to visit Boston. This time I came to Boston to catch up on sleep.

No, I’m not saying that Boston is a sleeper city, for it is an exciting place to visit. Nor am I’m saying that it is a place most conducive for sleeping. In fact since we stayed in a hotel in the heart of the city, it was quite noisy, with all the cars honking and with loud police and ambulance sirens wailing. Added to that, we landed past midnight in Boston, contributing to my sleepy predicament.

Why I came to Boston is to attend a conference to catch up with the current studies, trends and technology in the practice of Sleep Medicine. Honestly I nap a little in some of the lectures, so I literally catch up on my sleep too!

IMG_5069

theme poster of the convention

The science behind sleep has fascinated me since I was in high school, so it’s not a surprise that one of the subspecialty I pursued was on this field.

One of the fascinating sleep phenomenon that I wanted to learn more of are the Parasomias, which includes nightmares, night terrors, sleep walking, and more that goes bump in the night.

One Parasomnia is REM Behavior Disorder (RBD), in which people with this disorder reenact their dreams. Normally when we are in REM (Rapid Eye Movement) stage, a sleep stage when dreams usually occur, our muscles are disengaged and we are temporarily paralyzed, so we don’t move and act out our dreams. In people with RBD, for some reasons the muscles are not paralyzed, so they can kick, swing a punch, crawl out of bed, or even perform a complex activity while sleeping. Not only this put the patient in danger, but also the sleep partner.

One interesting fact I heard from one lecturer is that soursop which is a tropical fruit, or also known as guyabano in my home country, the Philippines, can potentially increase the incidence of RBD. I can almost read a headline news: sleeping wife punch husband, after drinking guyabano punch.

img_5086

opening session

Besides the medical implications, there’s also societal implications of people having poor sleep. These are also topics discussed during the convention.

Research have shown that birds can sleep, as half of their brain can go to sleep, while on long flights. But not humans. We need all our faculties when we are doing complex task like flying a plane. Though aviator Charles Lindbergh, the first man to cross the Atlantic on solo flight was awake for more than 34 hours when he accomplished that feat, nowadays we have instituted regulations for pilots limiting their hours of flying and assuring they have a sufficient amount of sleep in between flight.

Same principle applies with operating any machinery or driving any motorized vehicle. Studies have shown that a significant number of vehicular accidents are due to driver fatigue and sleepiness. For instance a sleepy driver can have a slower reaction time. A decrease of even 50 milliseconds in reaction time in hitting the brakes means 5 feet more before coming to a stop, and that can mean safely stopping or crashing, or escaping an accident or dying.

For the medical community, especially the ones who are undergoing residency training, there’s now an imposed 16 hour limit for a first year resident for continuous work. Beyond that they should be relieved, for they need to go to sleep. During my residency training in the mid 90’s, the limit for continuous hospital duty was 30 hours. This regulations though are not enforced to doctors after they are done with their training.

We as a community really need to change our opinions. Staying awake all night to study or pulling an all-nighter to finish the job has become a badge of honor. We view sleep as only for slackers. When we should view that those people who get adequate sleep, that is 7-8 hours a night, should be the ones commended. So no more sleepless in Seattle, or Boston, or New York, or Tokyo, or any part of the world for that matter.

Just like when you’re hungry, the solution is to eat. For people who are sleepy the solution is not more coffee or energy drink, but getting adequate amount of sleep. Of course if you have a sleep disorder and not getting a restful sleep then you need to see your doctor.

Sleep is important in so many levels. Not only for health but also for safety and being more productive. In addition, dreams come when we sleep, and life without dreams would be uninspiring.

From Boston,

img_5081

Boston Common (central public park in downtown Boston)

Pinoytransplant

 

(*photos taken with an iPhone)

Wonders of Sleep

One boring and sleepy afternoon, while I was reviewing and interpreting sleep studies, which are 6 to 8 hour-long tracings and video of a patient’s sleep data, a reflective thought came upon me. I came a long long way from the boy who got intrigued with the mystery of sleep. I never imagine at that time that I will earn a living by watching people sleep. I can also claim that I interpret people’s sleep info, though not necessarily their dreams.

I love sleep. I don’t mean that I love to sleep (though that may be true sometimes), but the science of sleep. Long before I became a sleep specialist, I was always fascinated with the phenomenon of sleep. I admit though that as a little boy I hate taking naps, and I would often sneak out of my room during afternoons when my mother told me to do so.

When I was in grade school, I clipped and collected Johnny Wonder’s strips about scientific facts of sleep from a newspaper cartoon section. So long before the rock band REM became popular during my college days, I already knew what REM means, that is rapid eye movement, which is a stage of sleep, and is probably the most intriguing phase of our sleep.

In highschool, I wondered if people can hear and learn things while they are sleeping. So I did an experiment. I recorded myself reading my world history book. Then I played back the tape while I was sleeping, and determine how much facts I will retain for our test the next day. The result? I passed the test! Maybe it was the reading that helped me remember the facts and not necessarily that I learned something while I was sleeping. However a recent study from Israel showed that people can really learn new information while they are sleeping.

new way of learning?

The phenomenon of sleep is not something to snore about, for it is really an interesting science. Here are some amazing facts about sleep.

1. A human can last longer without food, than without sleep. Because at some point after several hours or days of continued wakefulness or sleep deprivation, a person will involuntarily fall asleep even how much he fights it. The record for longest period without sleep is 18 days, 21 hours, and 40 minutes during a rocking chair marathon. But a human can survive more than a month without food, though with water.

2. All mammals sleep. All birds, many reptiles, amphibians, and fish too. Humans sleep on average around three hours less than other primates like chimps, rhesus monkeys, and baboons, all of whom sleep for 10 hours. A giraffe sleeps an average of less than 2 hours per day. (And they still grow so tall!) Though some people try to be giraffes! Adult humans need 7-9 hours of sleep a day to function properly. Newborns needs up to 18 hours, while toddlers and school children require 10 hours and more.

3. Anything less than 5 minutes to fall asleep at night means that you are sleep deprived. The normal sleep latency is between 10 and 15 minutes. So if you’re falling asleep the moment you hit the pillow or faster than you can recite the alphabet, that is a telltale sign that something is amiss. Other signs of sleep deprivation includes  decreased performance, alertness, and memory and cognitive impairment.

4. During the REM phase of sleep, is when we dream dreams that we can vividly recall. Dreams though can also occur in non-REM phase of sleep. REM sleep occurs in bursts totalling about 2 hours a night, usually beginning about 90 minutes after falling asleep. It is thought that REM consolidates certain memories. It is also believed to help developing brain mature. Premature babies can have 75% REM phase, while a normal adult has an average of 20-25 % REM phase of his total sleep time. Life will be dull if you’re deprived of REM, because you won’t have much dreams! Unfortunately most of the sleeping pills used can actually suppress REM phase of sleep.

5. It is impossible to tell if someone is really awake without close supervision. People can take cat naps with their eyes open without even being aware of it. We use electroencephalogram (EEG) to determine if a person have fallen asleep and to determine the stage of their sleep, when we perform sleep studies. Some students are good example of this, sitting in a lecture hall with eyes wide open but are really sleeping. Especially after they stay up late partying the night before. But then again some people really go through life fast asleep, figuratively speaking.

Have a goodnight, sleep tight, and pleasant dreams to you.

(*photo from here)

(**some facts are taken from National Sleep Research Project)