Sleep Disorders

[joreth]

I have a collection of very interesting sleep disorders. First is Sleep Paralysis or Night Terrors. This is, essentially, a condition in which a person becomes at least semi-conscious during the stage that the body is paralyzed to protect itself from acting out dreams during REM sleep. During this state of semi-consciousness, an extreme feeling of paranoia or terror overwhelms the individual and, of course, the individual can't move, which only furthers the sense of paranoia and terror. Most children who suffer from this have no memory of the episode at all. I, however, do, and some adults are known to retain their memories.

One of my episodes can be identified and distinguished from a regular nightmare by, upon waking, I will take a huge gasp of air, as if I hadn't been breathing. Although I am quite proficient at Lucid Dreaming and utilize it regularly to end or change a nightmare, this technique does not work for this condition, I suspect, because I am not asleep.  It is also different in that there isn't a scary or unpleasant story, like in a nightmare.  Nothing much happens at all - I'm in my room, in bed, right where I *actually* am, only I'm terrified and convinced of some nebulous Bad Thing.  The most specific this Bad Thing ever gets to be is, occasionally I'll feel as though, if I allow myself to fall back to sleep, I'll get sucked down into the mattress.  Sometimes, I will even believe there is a shadowy figure just outside of my field of vision, who will do me harm if I fall back asleep.

Most children who suffer from this condition eventually grow out of it, but it is thought that, in the adults who continue to suffer, it is brought about due to emotional upset or possibly frequent interruption in the REM cycle (much like Sleep Apnea, which is an interruption of the breathing ryhthm).  I can hit my snooze button and fall back asleep so many times that the alarm clock eventually stops going off (usually this is approximately every 8 minutes for 3 hours).  It is possible that this regular interruption may contribute to this disorder, which is ironic because this snooze-button problem is a symptom of my other sleep disorder.

This one is actually not so bad. I know what it is, and it doesn't happen all the time, and when it does, I eventually wake up completely and go on with my day.

The other disorders, however, are much more debilitating.

I have Delayed Sleep Phase Syndrome combined with a very mild case of Non-24-Hour Sleep Wake Syndrome.

Essentially, what that means is that I'm a Night Owl. My circadian rhythm is set to sleep more or less between 4 AM and 2 PM. This means that I will have difficulty falling asleep until around 2-4 AM and difficulty waking until around noon-2 PM, regardless of how sleep deprived I am, regardless of what time I woke up that morning, regardless of what time I have to get up the next morning, regardless of sleep aids, regardless of how long I've had a "normal" schedule that has forced me to wake and sleep at the same socially-accepted times every day.

This is distinguished from Insomnia because I *do* sleep, and quite soundly, when I'm allowed to sleep during my body's preferred sleeping time. Insomniacs just don't sleep, and when they do, it's fitful and restless.

The ICSD (page 128-133) diagnostic criteria for Delayed Sleep-Phase Syndrome are:

1. There is an intractable delay in the phase of the major sleep period in relation to the desired clock time, as evidenced by a chronic or recurrent complaint of inability to fall asleep at a desired conventional clock time together with the inability to awaken at a desired and socially acceptable time.
2. When not required to maintain a strict schedule, patients will exhibit normal sleep quality and duration for their age and maintain a delayed, but stable, phase of entrainment to local time.
3. Patients have little or no reported difficulty in maintaining sleep once sleep has begun.
4. Patients have a relatively severe to absolute inability to advance the sleep phase to earlier hours by enforcing conventional sleep and wake times.
5. Sleep-wake logs and/or actigraphy monitoring for at least two weeks document a consistent habitual pattern of sleep onsets, usually later than 2 a.m., and lengthy sleeps.
6. Occasional noncircadian days may occur (i.e., sleep is "skipped" for an entire day and night plus some portion of the following day), followed by a sleep period lasting 12 to 18 hours.
7. The symptoms do not meet the criteria for any other sleep disorder causing inability to initiate sleep or excessive sleepiness.

I can't tell you how many arguments I've gotten into with my mother who insisted that if I just wake up at the "right time" for enough days in a row, I will develop a "pattern" and my body will "adjust", making it easier for me to wake in the mornings.  It is *possible* for me to be awake at the proper time, but I never "adjust".  Being a student, and working several years in a regular office gave me plenty of time to "adjust" if I were ever going to, but all it did was make me feel as though I were living with about 6 hours of jet lag every single day of my life.  And, it never failed, no matter how tired I was, I would not get *sleepy* at the time I was supposed to be sleeping in order to wake up 8 hours later at the socially-acceptable "appropriate" time.

No matter how early I woke up that day, if I did not force myself to lie in bed, I would be awake and energetic until 2 AM at the earliest, but 4 AM was much more likely.

An interesting study done recently on Night Owls, compared to Early Birds, found this curious difference: 

Researchers tested participants' leg muscle strength at various points in the day. They looked at nine "early birds" and nine "night owls," who were classified as such based on a questionnaire.

Surprisingly, morning people's strength tends to remain constant throughout the day, but night owls have peak performance in the evening, said researchers from the University of Alberta in Canada.

"We thought that morning people would be better at this in the morning, but they never changed," said study co-author Olle Lagerquist, a Ph.D. candidate in neurophysiology at the University of Alberta. 

That may be because evening people show increased motor cortex and spinal cord excitability in the evening, about 9 p.m., meaning they had maximal central nervous system drive at that time, Lagerquist said.

Morning people, on the other hand, never achieve this level of central nervous system drive because the excitability of the motor cortex does not coincide with the excitability of the spinal cord. In other words, these two measures never peak at the same time, he said. Early birds' brains were most excitable at 9 a.m. and slowly decreased throughout the day.

I am noticeably impaired, the earlier in the day it is.  Regardless of how early I went to bed the night before or how many hours of sleep I managed to get (usually with the help of sleep aids, because otherwise I'll just lie in bed awake until 2 AM), when I wake up in time to get to work at 8 AM, I physically move slower and my cognitive functions are slower and less accurate.  Coworkers and employers have commented on this before.  They have actually begun to pay attention to the rise in my energy levels, and by the time I'm joking and moving around at the same speed as everyone else, they know it must be close to our noon break.  

I will get a brief spike of energy once I've had lunch, but the early afternoon has always been prime nap-time when I'm forced to wake early.  That is because I prefer to still be asleep from the night before until about 2 PM.  But once the sun goes down, *that's* when my productivity takes a huge upturn.

This is most noticeable when I work rock and roll.  When I do a concert, I get to the arena at around 6 or 8 AM.  You'll see this trend I mentioned earlier, then around 4 or so we're done setting up for the concert and I go on an extended dinner break.  I might take a nap, but by this late in the day I probably won't unless I've been doing this for several days in a row and I'm extremely sleep deprived. 

But then, at 10 PM, I have to go back to the arena to take down the set at the end of the concert.  At this time I am energetic, happy, loud, boisterous, I move fast, I think fast.  Even if I did take a nap and have just woken up with approximately the same amount of time of being awake as I had that morning, I am significantly more awake and energetic.  I have actually had coworkers tell me that the first day they met me (in this environment), they didn't actually recognize me during the night shift as being the same individual from the morning shift that day.

Unfortunately, concert work pays the lowest of all the types of live events that I work, and it's also the most manual labor, so I don't do it much anymore.  I work mostly in the corporate scene, setting up for conventions, like Microsoft and InfoComm.  But, for some reason, because our clients are part of the corporate world, they think the stagehands ought to be too, and we have all sorts of silly rules like dress codes and 8 AM start times, as if we should be working in an office.  The only problem is that we have to set up the stage in time for *their* 8 AM start time, and we have to take it down at the end of *their* 5 PM ending time.  So we end up working double-duty sometimes (the medical conventions are the worst - they totally forget to schedule in lunch breaks for the crew because they like to schedule lunch meetings and they forget that we're working all morning before their meeting, then we work during their meeting, then we have to work after their meeting in order to get it ready for the next meeting, so our "meals" are really protein bars scarfed down while pushing boxes about 8 or 10 hours after we arrived that day).

So I still struggle with waking at the proper time, but I do not work every day, and sometimes the start and ending times are changed.  This allows me to deal with my disorder as a mild inconvenience, instead of the debilitating handicap it has been for most of my post-adolescent life.

But just to make things a little more complicated, I mentioned that I also have Non-24-Hour Sleep-Wake Syndrome.  This means that, on top of my body clock thinking that I should be sleeping from 4 AM to 2 PM, my body ALSO thinks the day is longer than 24 hours, so that 4 AM comes about 1-2 hours later every day.

Fortunately, this syndrome is very mild and erratic.  When left totally up to my own devices, with no intentional attempt to make a regular schedule, I will stay awake for about 24 hours, then sleep for about 12.  The last time I had this luxury was during my last stint through college, about 4 or 5 years ago now.  

So my body thinks the day is longer than 24 hours, but it doesn't insist too strenuously.   An argument could be made to support the hypothesis that I don't *really* have this syndrome, but I have a more severe case of that non-circadian-day symptom that was listed above in the symptoms for DSPS, except for that time in college that lasted for 2 semesters and was consistently delayed by the same amount of time every day.  But as long as I get to bed by about 4 or 5 AM, I will actually fall asleep fairly quickly and not sleep more than 10 hours.  If I try to sleep only 8 hours or less, though, I will actually sit up, hit the snooze button, and fall right back to sleep with no memory of it.  I can actually have an entire phone conversation during this time and have no recollection of the conversation, and the person I'm talking to will have no idea that I'm not awake.  They will recognize that I was awakened, because my words will be slurred, but they won't know that I'm not fully conscious.

My mother used to call me about 13 minutes before my alarm went off for school, to make sure that I got up in time and to give me my responsibilities for the day.  Then I would oversleep and be late for school because I didn't get my minimum requirement and my mom would come home and get pissed at me because I didn't do whatever it was she asked me to do.  I, of course, would have no memory of the phone call.  She, of course, thought I was lying and lazy.

Although these disorders are all fairly rare, they do present a lot of problems for people who suffer from them because they are not generally known or accepted in society.  People still think that those of us with these disorders are just "lazy" and there are few concessions to accomodate the disorder.  There are certainly jobs available that operate on alternate schedules, but they are very specific types of jobs, usually low-paid, low-skill, or manual labor jobs.  When was the last time you saw a sign for a 24-hour attorney's office or been able to make a dentist appointment after dinner hours?  When the higher-prestige jobs do require alternate hours, it is not *instead of*, but *in addition to*, which is why employers like the idea of salaries for these types of positions.  My dad often brought home accounting work when he got backlogged, but he was still expected to be at the office first thing in the morning, and he didn't get paid for those extra hours because he was salaried.  Also, he couldn't call clients or service providers if he needed while managing the accounting until the next morning either because *they* were not at work.

So if someone tends to sleep a lot during the day and stay up all night playing video games, it's not because they're lazy or childish or irresponsible.  It might be because they have a sleep disorder, a medical condition that actually prevents them from performing the activities you might want them perform (and since there's nothing else to do at 3 in the morning when the nightclubs and grocery stores are closed, if you can't sleep, why not play video games?).  Maybe, by understanding that this is not something that can be fixed simply by sheer willpower (anyone who knows me should know that I do not lack for willpower, and I'm one of the most stubborn people on the planet - if I say I can't do something, then I really can't do it), alternate compromises can be found to enable people to work around  these kinds of issues, and to allow those with the disorder to be productive, functioning members of society, not simply that lazy guy who might be smart but can't find any job other than 3rd shift gas station attendant.
 

 

Comments

[phyrra.livejournal.com]

I've always flat out hated 'early bird' schedules as they make me resent having to be up and moving. Or people who told me what they told you 'you'll get used to it.' My parents always told me I'd have to grow up and get used to that sort of schedule (as high school was hell on me) and I was so glad when I got my current job and didn't have to get up at 6 or 7am.

[leora.livejournal.com]

While I believe this research is pretty recent so it may have been impossible for your parents to know this, saying that to a high school student is particularly cruel. Modern research shows that teenagers are biologically driven to keep later hours. The average teenager just won't function as well on a morning schedule. Sure, there will still be some exceptions who work best with an early morning schedule, but most of them will function better with a later schedule.

The idea of getting used to it just doesn't hold up, because when they become older most of them will have their bodies change such that they work better with earlier schedules than they did as teens.

I am a strong supporter of having our high schools start later. We have a lot of evidence at this point that it would be far better for the students. We'd have likely gains in health (both physical and mental, since we're starting to learn that chronic lack of sleep or sleep problems contributes to the likelihood of having mental health problems when we used to think the causation ran purely the other way), learning (you learn better when reasonably awake), and safety (mainly for things like teen driving). It's not a magic cure-all that will fix all of society's ills, but it does seem a significant set of benefits.