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Catching Up On Sleep (video)
January 07, 2003

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Interviewees: Patrick Doherty, night-shift worker; Neil Kavey, Columbia University Sleep Disorder Center.

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Produced by Sanjanthi Velu

Copyright © ScienCentral, Inc., with additional footage courtesy of Cephalon Inc.

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Have you made a resolution to get enough sleep in the new year? Shift workers seem to have the hardest time doing that.

This ScienCentral News video reports on why it’s important to catch up on your sleep.

Why do we need to sleep?

Scientists do not yet fully understand the importance of sleep, but according to Dr. Neil Kavey, director of the Sleep Disorder Center at New York Presbyterian Hospital/Columbia Presbyterian Medical School, they do know that sleep serves in the restorative and re-building process that allows us to function efficiently the next day. Kavey says that just as your car needs a regular tune-up, your brain and body need sleep to function smoothly. A poll conducted by the National Sleep Foundation suggests that many problems and frustrations that have become part of the American way of life, from anger and stress to obesity, may have inadequate sleep and widespread sleep problems as contributing factors.

Kavey says sleep deprivation affects the brain and the body in a variety of ways. “We are not the same cognitively when we are sleep deprived,” he says. “We don’t think as quickly, we don’t think as accurately, we make more mistakes, our memory is affected, focus, concentration—all these cognitive processes are compromised.” He also says it affects us emotionally, as we tend to be less optimistic and more vulnerable to depression when we are sleep deprived.

Recently, researchers like Eve Van Cauter and colleagues at the University of Chicago have been studying how a shortage of sleep affects the basic functioning of the body and its organs. They found that sleep deprivation causes alterations in both metabolic and endocrine functions. A change in the ability to process glucose was detected. Sleep loss resulted in a rise in blood glucose that prompts the body to release more insulin, which in turn leads to insulin resistance, a hallmark of adult-onset diabetes. It also leads to storage of body fat and the risk of obesity and high blood pressure. They found “changes in thyroid hormones and in thyroid function, and changes in cortisol, which is a basic stress level hormone,” according to Kavey. They also found the immune system was impaired because the participants in a study were less responsive to the flu vaccine during a period of shortened nights.

Hazards of Shift Work

While most adults need at least eight hours of sleep, shift workers are known to sleep less than their non-shift counterparts as they work and sleep against their body’s natural circadian rhythm. According to the Bureau of Labor Statistics, shift workers are people who work non-traditional hours, usually between 10 p.m. and 8 a.m. More than 20 percent of the American workforce is composed of shift-workers, with a 3 percent increase every year.

The normal sleep-wake cycle is a 24-hour rhythm and it is synchronized to the body’s circadian temperature and hormonal rhythms. Circadian rhythms are the natural measurement of the daily changes in the psychological and biological rhythms of the body produced by the suprachiasmatic nucleus (SCN). The SCN is a discreet brain region lying within the hypothalamus, and is responsible for the generation of many biological oscillations, including body temperature, the sleep-wake cycle and a variety of hormonal changes.

Kavey explains how the sleep-wake cycle of our circadian rhythm works. He says that there are two separate systems in our brains—the alerting or waking system, and the sleep system—that are located at the base of the brain, in an area called the brain stem. These two systems interact with each other over the course of a 24-hour day. For the sleep system to function well at night the alerting system has to wind down completely. And for the alerting system to work efficiently during the day, the sleep system has to wind down. “And we have to have had enough of the restorative process of sleep to rebuild the full function of that waking system,” says Kavey. “That’s how we function optimally.” Shift work is one of the most common disruptions to this circadian rhythm, so many shift workers find it difficult to sleep, and can’t function as well in the awake state.

Alertness Pills

Currently, clinical trials are underway to study the safety and efficacy of a drug called Provigil for persons diagnosed with shift work sleep disorder, or excessive sleepiness associated with working night shifts on a regular or rotating basis. Provigil has already been approved by the US Food And Drug Administration for the treatment of excessive daytime sleepiness associated with narcolepsy.

Kavey says he would consider giving the medication to a patient who is a shift worker “if the patient’s ability to function on their shift is significantly compromised because of the nature of their job, if they are a danger to themselves driving to and from work, and if I can give them that medication and ensure their safety and higher function and in no way compromise their sleeping when they are supposed to be sleeping.”

“However,” says Kavey, “sleep is a basic restorative process and one always has to be sure to get enough sleep, to re-build, to re-oil, to tune up that engine.” So he warns that medication “must not be used to compromise the amount of sleep that the individual gets,” because that would stop the re-building, restorative process that’s crucial to the health of the individual.

by Sanjanthi Velu

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