According to Amway connection this article speaks about how sleep deprivation affects your brain and body. In this article sleep deprivation is a health condition that occurs when a person does not get enough sleep. Our bodies need a certain amount of sleep to function. While we are sleeping, our bodies perform all kinds of repair and maintains our internal organs and our muscles. Sleep plays a role in maintaining the memory in our brains, helping us retain what we’ve learned and seen so we can access that information again. Lack of sleep can cause a variety of symptoms such as daytime fatigue, sluggishness, eating problems, weight gain, mental fogginess, and cognitive issues that affect the brain. Sleep deprivation can weaken the immune system, increasing susceptibility to infections. Which means a longer recovery time is often expected to return to full health. Not sleeping enough can also result in significant weight gain due to a hormonal imbalance between the hormones and also has a toll on our mental health. Some ways to avoid sleep deprivation is avoid drugs/alcohol, caffeine, meditate and take shower before bed.
One of my reactions towards the article was that I thought the information given throughout the article was very clear and understandable. I now understand why we should get more sleep and the importance of it rather than overworking our minds and body. Sleep deprivation can affect your mental health and also how you perform on a daily basis especially around people. Being a student that attends university, I feel that all students suffer with sleep deprivation due to amount of assignments handed to us. We feel more comfortable when we “pull an all-nighter” to finish those assignments but don’t realize how this affects us badly. Some of us would lay in bed and won’t be able to sleep because were thinking and stressing about life.
Sleep deprivation is most often caused by the lifestyle choice. Many people don’t take action about being sleep deprived, they rather live their life with every little sleep they get and that is a big problem since it builds up through time and causes problems in the long run.
In conclusion I recommend that you read this article to gain more knowledge on sleep deprivation is. I think people should seek help since it causes severe problems in the future
REFERENCE
Article title: How Sleep Deprivation Impacts the Brain and Body
Sleep is defined as a periodic, temporary unconscious state of cognitive, and sensory disconnection from the external stimuli. Sleep peririod has its unique behavioral, electroencephalography, and physiological properties that it consists of four to six 90 to 100 minutes period which is alternative fashion cyclic during NREM and REM sleep periods which is taken 7 to 8 total sleep hours(1). Human being existence is impossible without sleep at all the life. Maslow defined the sleep state in his Hierarchy model as basic need sleep is a natural rest of the physiological activity to reserve the energy. In this sense sleep is an essential parts of the 24 hours cycle to restore the normal sleep state(2).
Intensive care units (ICU) are a highly complex area where critically ill patients are managed by Intensive care monitors and invasive devices(3). Difficult sleep is a subjective complaint of dissatisfaction with the quantity, timing of sleep that sleep discomfort is estimated to occur in approximately one-tenth of the general population(4). Delirium is acommon acute confusional state that is familiar for critically ill patients, affecting up to 80% of patients with intensive care unit patients especially on mechanical ventilation(5).
A commonly complication of ICU patients are not having adequate profound sleep. In critical ill-patients the happening of sleep deficit has been shown to be more than 50 % (6). Sleep in the intensive care unit (ICU) is characterized by repeated wakefulness and lack of the restorative sleep stages that are needed for the healing process(7). Sleep disruption during intensive care unit admission is frequent. It has been practiced in critical illness patients even after transfer out of the ICU. Sleep disturbances can widely influence patients’ recovery from critical illness(8,9). The sleep disturbance affect the body function that is essential for recovery from the illness that is respiratory systems effect muscle weakness, immunological effects reduce defense against infection, cardiovascular effects that result hypertension, heart failure and stroke, hormonal alteration that results insulin resistance diabetics. Generally sleep disorder potentially cause long-term consciences hypertension, diabetics mellitus, stroke and cardiovascular disease(10) Several factors are accountable for sleep disturbances n ICU.
A general approach to the patients regarding their night rest is a necessary(11). Factors are mentioned as the main cause of sleep disorder in the intensive care unit admitted patients sleep. From Environmental factors are take the main role of the sleep disturbing(12). Study revealed that are another medical activity and none environmental were mentioned as causes of the sleep disturbance in the ICU(13).
Numerous factors are contributed to sleep disturbance in ICU in different medical services. Environments together with none environments determined procedures employed in ICU make it not easy to recognize the causes of sleep deprivation. Evidence suggested that sleep disruption is mainly due to a combination of internal and external factors. Individual patient sickness and prior experiences, together with variable severity of illness impact on the potential to achieve effective sleep. Particular causes included discomfort, procedures, mechanical ventilation, medication administration and severity of underlying disease are contributed to sleep deprivation.(14–17) As the great nurse Florence Nightingale herself once said that “never to allow patient awake from sleep intentionally or accidentally”(18).
The importance of sleep for patient healing can be deprioritized in ICU due to the need to meet progressively more complex care needed. Sleep interruption has emerged as an indicator of adverse medical outcomes(19). Disrupted sleep is related with impairment of immune system, impaired resistance to infection, therefore, impaired wound healing, and cardio-respiratory consequences(20).
Measurements tool to assess level of sleep quality and related factors of intensive care unit patients are classified into objective and subjective assessment instruments which are Polysomnography is the golden standards that able to identify the stage of the sleep by recording electromyogram and electro-oculogram that are reliable recording sleep stages. Another objective method helping to assess sleep status of the patient is actinography which is worn at wrist and ankle by recording the movements of the body. The subjective measurements are self reporting questionnaire, Richards Campbell Sleep Questionnaire, Pittsburgh Sleep Quality Index and Modified Freedman sleep quality questionnaire(21). This study aims to identify the factors affecting sleep under the freedman sleep questionnaire which is answering the question of what are the factors disturbing sleep of the ICU patients the study area. The finding of this study will enable to minimize the factors by recommending stakeholders the possible resolution strategies.
It is a problem affects roughly seventy percent of adults at least one day of every month, and responsible for roughly twenty percent of fatal car crashes. Sleep deprivation, which according to Drug intervention today, can be defined as a condition of not having enough sleep; it can be either chronic or acute. Chronic sleep deprivation is a lack of sleep over a long period of time, while acute is lack of sleep over a short period of time, both can be damaging. Sleep deprivation is damaging, in children and adults, it affects their mental health and physical health in a negative way, as well as their overall safety. “Sleep is a necessary and ubiquitous behavior. Like eating and drinking., without it we will eventually die” (Japanese Psychological Research 170). Although sleep is essential to living, sleep deprivation is a worldwide issue that affects people of all ages and keeps progressing over time. The risks of sleep deprivation need to be widely known.
According to the CDC, teens are recommended to get eight to ten hours of sleep every twenty-four hours. A study done by the CDC in 2015 found that of high school students, grades nine- twelve, 72.7% of students did not get at least eight hours of sleep at night. Sleep is an imperative thing that your body needs. When falling asleep, your body is: processing, restoring and strengthening. Your brain processes new skills, memories, and information, usually things that are important in everyday life; this is why students and children need longer sleep periods than adults. Students are set up to learn in a flawed system that sets up students to have sleep deprivation. Encouraging high school students to take hard class, sign up for extracurriculars, get a job and study for the SAT or ACT, then do college applications. How are students supposed to retain all the information and give their full attention during school when only 27.3% of students are getting enough sleep? Having a start time of roughly 7:30 A.M. means waking up at 6:00 A.M. When including extracurriculars, homework for classes, a job and still trying to maintain a healthy social life, kids are not getting the full eight hours recommended.
Sleep deprivation is a serious problem that can lead to fatal incidents. A study done by sleep and biological rhythms, to further look at the effects of sleep deprivation on cognitive and physical performances in university students, found that sleep deprivation does increase reaction time, meaning that your brain will take longer to react. An increase in reaction time can be fatal if put in a dangerous environment; like driving or manual labor. According to the sleep research society, drivers who had slept for less than four hours have crash risks similar to drivers with blood alcohol concentrations of 1.2g/L. That shows how dangerous driving with very little sleep is since driving while intoxicated is illegal because of the dangers it creates. Every day there are almost thirty deaths in the united states involving drunk drivers, if people that are sleep deprived are at the same risk, this is a problem that needs more attention ( NHTSA 1). Additionally, according to the John Hopkins website and sleep researcher Patrick Finan, Ph.D. 6,000 fatal car crashes are caused by drowsiness while driving. Furthermore, Finan reports one in twenty-five adults have fallen asleep at the wheel in the last month. Those statistics are just for adults, not including the teenagers that are new to driving. New drivers are already more at risk, but new drivers that are sleep deprived from school are even more at risk for getting into an accident. Additionally, adults and students that work in an environment with machines or other things that could be dangerous if not used correctly, are at risk for an injury. When working in an area with manual labor it is important to pay attention, however, with increased reaction time, it increases the chances of an on the job injury. By not getting an adequate amount of sleep at night you are putting yourself at danger.
Your overall physical well-being is an important part of living a happy healthy life for people of all ages. Sleep deprivation can affect it instrumentally. “Mounting evidence supports the hypothesis that chronically restricted and disrupted sleep has significant health consequences. By dysregulating immune and endocrine pathways, sleep may contribute to an increased risk of inflammatory mediated diseases, including cardiovascular disease, diabetes, metabolic syndrome, and depression” (Japanese Psychological Research 170). Based on this you can see there are many side effects and risks from sleep deprivation. The immune system and endocrine system are two vital systems in the human body that keep us alive and healthy. The immune system is responsible for protecting our bodies against harmful bacteria and viruses, by killing whatever it doesn’t recognize. According to Eric J. Olson, M.D., “lack of sleep can affect your immune system. Studies show that people who don’t get quality sleep or enough sleep are more likely to get sick after being exposed to a virus, such as a common cold virus. Lack of sleep can also affect how fast you recover if you do get sick”. He then goes on to explain that cytokine, which some help to promote sleep and help with fighting diseases, is released while you are asleep. Sleep deprivation reduces the number of cytokines release causing your immune system to be weakened. This information is very important because you adults and kids are at schools stuck in classrooms with large amounts of other kids and their bacteria and germs. Being around the germs while over seventy-two percent of then have a weekend immune system from lack of sleep almost guarantees someone to, for example, catch a common cold. On the other hand, the endocrine system is responsible for regulating and controlling metabolism, growth, development and other factors through the release of hormones. Some of these hormones are only released while asleep, for example, the growth hormone, which is very important for children. Even in high school kids are still growing and over seventy-two percent of them are sleep deprived. Moreover, sleep deprivation over a long period of time can even lead to weight gain. Researchers in the nurses’ health study found that women who slept five hours or less per night were thirty-two percent more likely to gain a significant amount of weight over the course of a sixteen-year study than those who slept at least seven hours per night” (D’Arrigo 24). According to the national sleep foundation, people who have been slept deprived had an increased number of ghrelin, (a peptide that stimulates appetite) and a decreased number of leptin (a hormone that suppresses appetite). Additionally, a study done by Sleep & Biological Rhythms to further look at the effects of sleep deprivation on cognitive and physical performance in university students found that from a night of sleep deprivation there systolic blood pressure post-exercise was significantly higher. Also from a non-post-exercise point of view, Sheldon G. Sheps, M.D., from the mayo clinic says “ People who sleep five hours or less a night may be at higher risk of developing high blood pressure or worsening already high blood pressure”. High blood pressure can lead to stroke and heart attacks, both can be fatal.
The effects that sleep deprivation can have on your brain can be very damaging. It affects your mental health, cognitive abilities, and overall attitude for the day. Sleep deprivation puts you at great risk for depression, irritability, anxiety, forgetfulness and fuzzy thinking (Finan) “The sleep deprivation leads to severe mood changes such as depression and weak scientific performance” (Fundamentals of Mental Health 167). Sleep deprivation and mental illnesses go hand-in-hand, sleep deprivation can cause mental illnesses and mental illnesses can cause sleep deprivation. “Also, depression, anxiety, and stress can cause poor quality sleep in students” (Fundamentals of Mental Health 170) Mental illnesses play a big role, it can affect people’s job and schooling. “As you sleep, memories are reactivated, connections between brain cells are strengthened, and information is transferred from short to long-term. Without enough quality sleep, we can become more forgetful” (national sleep foundation) As previously stated, sleep is time for your brain to process and restore information. Your brain is unable to do that if you don’t fall asleep, or sleep for an adequate time.
A study done by the journal of American college health, looking at how sleep deprivation affects psychological variables related to college student’s cognitive performance, in which they had forty- four college students either sleep for eight hours or not sleep for 24 hours and then do a questionnaire/test. From the questionnaire they found that the sleep-deprived students did significantly worse than adequately rested students, however, the students who were sleep-deprived rated themselves at a higher concentration level than the students with an adequate amount of sleep. This shows that the amount of sleep does affect students’ cognitive abilities. Additionally, this study shows that students are unaware of the effect sleep deprivation has on their cognitive abilities. Not to mention when getting an insufficient amount of sleep, you are stuck feeling tired, unmotivated and emotional.
In 2016 over seven hundred and six billion dollars were put into the education system in the united states. All of that money put towards educating the youth so they can grow up and become doctors, lawyers, mechanics, business owners or whatever they want. But they skip class, school, and their education because they are tired. The students do not want to wake up at 6:00 A.M. to go to school to get their education. Over seventy percent of the students get less than eight hours of sleep every night and are sleep deprived. Something must be done to fix this issue. This is a serious problem. To help correct the issue of students not getting an adequate amount of sleep, they proposed moving the daily start time of high school to a later time. However, many do not like this idea because it will disrupt athletics, the bussing schedule, and how kids in the younger grades will be taken care of. When you move the start time to an hour later, the school will then get out an hour later. Many high school students with younger siblings have to pick up or walk home with their younger siblings after school. Athletic teams will then have practice later, which means they will be done an hour later than usual. Also, if they play teams out of the district, they may have to miss some class time to travel to other schools to keep the original game time. Not to mention the tight schedule busses are already on, the district may have to buy more buses and hire more bus drivers to fulfill the needs. However, a school district in Minnesota changed their start time from 7:25 a.m. to 8:30 a.m. and through a survey, they found that the teachers, students, and parents were very much satisfied. They found their tardiness and absences went down, and teachers reported students being more awake during class. The teachers even reported being better prepared for the lessons they are teaching. By tinkering with the bussing routes, they were able to accommodate everyone at a little cost. For the athletic teams, the students miss twenty minutes of class once a week for the athletic season and teachers were very accommodating and helped them not fall behind. Education is one of the most important things a child can have, moving the start time to a late time will increase the number of students going to class.
Overall sleep is an essential part of our daily lives and affects how we go about our day, it can either make or break it. Sleep is something that we cannot live without, it is a time when our bodies can restore and strengthen but is also not taken as seriously as it should be. Although sleep takes up a third of our lives, sleep deprivation and the problems that come with sleep deprivation, are not widely known. Sleep deprivation poses a danger to your safety, mental health, and physical health. It can cause car crashes and on the job injuries, as well as anxiety, depression and other mental health illnesses. Not to mention that sleep deprivation can lower your immune system leaving you at risk pf getting the common cold, or worse. It can also put you at a higher risk of obesity and high blood pressure, as well as creating issues within your endocrine system. The issue that is sleep depression is even common in students, starting in middle school. Children are still growing at that age and should not be getting any less than 8 hours of sleep every night. High schoolers have started sleeping through classes more often, skipping classes, or skipping school altogether, just to get a few more hours of sleep. Students at universities pull all-nighters, where you stay awake all night and are not aware of the cognitive side effects it has. Students who pull all-nighters do worse on exams even though they are focused. Sleep deprivation is a big issue that needs more attention, it is an issue that affects your physical health, mental health, and your overall safety. It is and over-looked issue that’s needs to be addressed.
Sleep deprivation among healthcare clinicians as a result of irregular, demanding work schedules has been shown to be a significant obstacle in the healthcare field (Friedman et al., 1973). In comparison to other cognitively demanding industries such as aviation, healthcare professionals work longer and more continuous permittable hours (Owens, 2001). A wide range of literature has shown that acute sleep deprivation (recent 24-hour complete sleep loss) impairs one’s performance in the workplace which allows for more clinical errors (Gaba et al., 2002). Health professionals may regularly work during the night. Biologically, during this time alertness is decreased. The circadian pacemaker controls rhythms of sleep. Due to the endogenous circadian pacemaker, greatest alertness occurs during the biological day, and the greatness feeling of sleepiness occurs during the biological night. By varying work schedules from day to night on an irregular basis, the circadian rhythmic system is unable to adapt. This phenomenon is called “circadian misalignment” (Cajochen et al., 1999). When an individual has 24 hours of wakefulness its psychomotor dysfunction is equivalent to a blood alcohol concentration of .10% (Leung et al., 1992). While many states have a blood alcohol limit for performing cognitive tasks, there may not be a limit on the amount of hours healthcare clinicians can continue performing tasks without sleep.
Cardiovascular perfusionists work extended hours and may have unpredictable events which may force them back to the hospital. Perfusionists must be available at times to operate the heart-lung machine. According to the American Society of ExtraCorporeal Technology Standards and Guidelines for Perfusion Practice, a guideline is that an on-call Perfusionist should be present and clinically ready for unscheduled and emergent procedures within sixty minutes of being called. Along with cardiopulmonary bypass procedures, this may also include a perfusionist supervising extracorporeal membrane oxygenation (AmSECT Standards and Guidelines for Perfusion Practice, 2017). According to standard 16.1, in order for the perfusionist to ensure proper provision of care, he/she shall receive an adequate rest period between schedules work hours. Unfortunately for perfusionist, the adequate rest period described in the standard is not quantified and that number may vary based on institutional policies.
[bookmark: OLE_LINK1][bookmark: OLE_LINK2]While sleep deprivation and performance have been examined in other medical specialties, only one study has investigated the effect of sleep deprivation on the performance of perfusionists. Trew and colleagues surveyed 445 perfusionists to collect data on their experiences with fatigue and working variable, extended hours. Three-fourths of the respondents had concerns that their operation of the heart-lung machine was impaired when they are sleep-deprived. According to the results of this study, perfusionists are not excused from the effects of job-induced sleep deprivation. Unfortunately, no study has investigated the effect of sleep deprivation on the performance of perfusionists. A study by Hodge and colleagues looked at the effects of sleep deprivation on the performance of perfusion students however this study may not be applied to professional perfusionists with years of experience running the heart-lung machine. In this study, the simulation sessions lasted only 7 minutes which does not represent a realistic clinical scenario (Hodge et al., 2012). Also, using a small and homogenous study population makes it difficult for the results to be generalizable.
Previously, it would be unethical to perform randomized controlled studies using real patients as subjects. Due to recent advances in technology, we could now use high-fidelity simulation to study the effects of sleep deprivation on perfusionists. In this research proposal, I would like to use a mixed-methods approach that involves using the Orpheus cardiopulmonary bypass simulator and subjective questionnaires on sleepiness to elicit the effect of sleep deprivation on simulated clinical performance in experienced perfusionists.
A survey by Trew and colleagues at SUNY Upstate Medical University (2011), sought to collect preliminary data on the prevalence of fatigue in perfusion and to identify if there were concerns regarding fatigue, performance and perfusion safety. A 50-question survey was distributed to perfusionist in May of 2010. 68.9% of surveyed perfusionists have worked at the hospital for greater than 23 hours straight. 17.5% of perfusionists have worked continuously for over 36 hours. Microsleep while performing cardiopulmonary bypass was reported by 49.5% of respondents. 51.5% of perfusionists believe they perform less effectively when they are fatigued. Another 75.9% of perfusionists indicate that they have been concerned about their ability to perform their job adequately due to fatigue-related acute sleep deprivation. The survey data establishes that there are concerns of fatigue and acute sleep deprivation in the perfusion community. The study notes that further research must be performed to understand actual performance degradation that may occur in fatigued perfusionists performing cardiopulmonary bypass. This study captures the need for the research I am proposing to complete. A study on real perfusionists should be completed where sleep deprivation is measured on cardiopulmonary bypass performance.
Utilizing a mixed-methods approach involving a focus group discussion, subjective questionnaires, and the high-fidelity Orpheus cardiopulmonary bypass simulator, Hodge and colleagues (2012) sought to determine the effect of sleep deprivation on simulated clinical performance in perfusion students compared with their rested, baseline states. Seven second-year Medical University of South Carolina cardiovascular perfusion students were enrolled in the study. Each student was experienced with the Orpheus cardiopulmonary bypass stimulator and had not been medically diagnosed with a sleep disorder. For the control, participants received a normal night of rest before their first simulation session which was started at 6:00AM. The last simulation consisted of the subjects being kept awake for 24 hours without the consumption of any caffeine or stimulants. Before each study the sleep scale questionnaires were completed. Subjects were given a patient history and protocol for adult surgeries. During the seven-minute cardiopulmonary bypass case, the investigators manipulated several parameters while the subjects ran the heart-lung machine. Performance was based on the subject’s response time to initiate correcting the action. The study’s results demonstrated that cardiovascular perfusion students were affected by sleep deprivation. Significant differences in reaction times were found between the baseline values and the different intervals in which the participants were retested (Hodge et al., 2012). I included this study in the literature review because the Orpheus cardiopulmonary bypass stimulator is used as a research tool. This is a device I plan to use in my research project. I also plan to use the repeated-measures ANOVA to establish a baseline and then retest my subjects as I deprive them of sleep.
In a simulated surgical case performed by twelve anesthesiology residents, the effects of sleep deprivation on psychomotor and clinical performance, subjective and objective sleepiness, and mood were examined (Howard et al., 2003). The anesthesiology residents performed a four-hour anesthetic on a simulated patient the morning after two conditions. In the first condition, the residents were sleep-extended. Here, they did not need to arrive at work until 10:00AM. In the second condition, residents were awake for at least 25 hours. The subjective data was collected by using the Profile of Mood States and the Stanford Sleepiness Scale. There was also a psychomotor test battery completed to retrieve psychomotor vigilance task data in both the sleep-extended and sleep-deprived controls. During the psychomotor performance probe there was a longer but no statistically significant mean response time during sleep-deprived vs. sleep-extended states. The task patterns and reported workload of subjects was not significantly affected by the lack of sleep. The study did not have a definitive relationship between sleep deprivation and clinically relevant errors. This study shows that there may not always be a relationship between sleep deprivation and clinical performance.
In a cross-sectional comparative study, the effect of acute sleep deprivation, due to working long on-call shifts, on mood and alertness was examined. The study included eighty-eight junior physicians in Saudi Arabia (Wali et al., 2012). A self-reported profile of mood states questionnaire was used measuring depression, anger, tension, confusion, fatigue, and vigor. The total score was calculated to determine the mood of the junior physicians. The junior physicians also completed the Stanford Sleepiness Scale to measure the impact of short-term sleep loss on subjective sleepiness. For on-call days, 25% of the participants reported sleeping fewer than 2 hours and 87% reported obtaining 5 or fewer hours. The percentage of physicians who were alert post on-call was significantly reduced compared to the percentage pre on-call. The profile of mood states was significantly worse post-call than pre-call. The variables of depression, anger, confusion, fatigue, and vigor all have an effect on job performance. Increased confusion may impair a perfusionist’s ability to operate the heart-lung machine and may jeopardize patient safety.
Methods In July of 2020, cardiovascular perfusionists will be sent an invitation to participate in our study via Perfmail and Perflist. Participants will be enrolled in the study under a protocol approved by the SUNY Upstate Medical University Institutional Review Board. All participants must give written informed consent. Each participant should have similar experience with the Orpheus CPB simulator and should demonstrate baseline competencies using it. A maximum of twenty subjects will be able to participate in the study. According to Lewis and colleagues (2016) the majority of perfusionists are over the age of 55 years of age with 3 male perfusionists for every 1 female perfusionist. For this reason, I would like the study to be composed of 15 males and 5 females over the age of 55. Participants may not have a diagnosed sleep disorder.
Materials Participants will complete the Epworth Sleepiness Scale (ESS) and the Stanford Sleepiness Scale (SSS) to assess their level of sleepiness (Appendix A). Both questionnaires have been used in as a means of establishing baseline data when testing a change in performance (Johns, 1991& Hoddes et al.,1993). The ESS questionnaire is a self-administered sleep propensity test that measures one’s likelihood of falling asleep during eight common, daily activities (Johns, 1991). ESS scores range from 0–24 and a sum score of 16 or greater indicates excessive daytime sleepiness (Johns, 1991). In contrast, the SSS questionnaire is a simple way to measure subjective sleepiness at a given time interval. Subjects will rate their level of sleepiness on a 7-point, predetermined scale. Both questionnaires will be administered before each simulation session. Clinical performance will be measured by the high-fidelity Orpheus cardiopulmonary bypass perfusion simulator. The system comprises a hydraulic simulator, an electronic interface unit and a controlling computer with associated real-time computer models. It is designed for use within an actual operating theatre, or within a specialized simulation facility. The hydraulic simulator will be positioned on an operating table and physically connected to the circuit of the SUNY Upstate Medical University high-fidelity center’s heart-lung machine (Morris et al., 2007). Both machines are commonly used in hospital settings and each participant can pick the machine they feel more comfortable with. The SUNY Upstate Medical University high fidelity center OR used for this study will consist of an operating table with sterile blue drapes and a patient mannequin to mask the hydraulic simulator. Two monitoring screens will display real-time mean arterial and central venous pressures, electrocardiography (EKG) waveforms, sinus pressure and temperature.
Procedures The participants will be instructed to get a full night’s rest before the start of the study. The subjects will serve as their own controls and will be assessed at three intervals. We will start with a baseline and then reassess them at 12, 18, and 24 hours. Before each assessment, participants will take the sleepiness scale questionnaires. An investigator will remain with the participants at all times to make sure there is no sleep taking place. Each session will be 30 minutes long. An investigator will act as the surgeon and will manipulate variables. The subjects will be timed on how long it takes them to initiate correcting the variables. Mean arterial pressures, Partial pressures of oxygen and carbon dioxide, decreased venous return, high line pressures and mixed venous oxygen saturation will all be manipulated throughout the case. If participants neglect a variable they will be given the maximum time allocated.
References
Cajochen, Christian, et al. ‘EEG and ocular correlates of circadian melatonin phase and human performance decrements during sleep loss.’ American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 277.3 (1999): R640-R649.
Friedman, Richard C., D. S. Kornfeld, and T. J. Bigger. ‘Psychological problems associated with sleep deprivation in interns.’ Academic Medicine 48.5 (1973): 436-41.
Gaba, David M., and Steven K. Howard. ‘Fatigue among clinicians and the safety of patients.’ New England Journal of Medicine 347.16 (2002): 1249-1255.
Hoddes E, Zarcone V, Smythe H, Phillips R, Dement WC. Quantification of sleepiness: A new approach. Psychophysiology. 1973;10:431–6.
Hodge, Ashley B., et al. ‘The effect of acute sleep deprivation and fatigue in cardiovascular perfusion students: a mixed methods study.’ The journal of extra-corporeal technology44.3 (2012): 116.
Howard, Steven K., et al. ‘Simulation study of rested versus sleep-deprived anesthesiologists.’ Anesthesiology: The Journal of the American Society of Anesthesiologists 98.6 (2003): 1345-1355.
Johns, Murray, and Bruce Hocking. ‘Daytime sleepiness and sleep habits of Australian workers.’ Sleep 20.10 (1997): 844-847.
Leung, Lucy, and Charles E. Becker. ‘Sleep deprivation and house staff performance. Update 1984-1991.’ Journal of occupational medicine.: official publication of the Industrial Medical Association 34.12 (1992): 1153-1160.
Lewis, Doreen M et al. “Results of the 2015 Perfusionist Salary Study.” The journal of extra-corporeal technology vol. 48,4 (2016): 179-187.
Morris, Richard W., and David A. Pybus. “Orpheus” cardiopulmonary bypass simulation system.’ The Journal of extra-corporeal technology 39.4 (2007): 228.
Owens, Judith A. ‘Sleep loss and fatigue in medical training.’ Current opinion in pulmonary medicine 7.6 (2001): 411-418.
Trew, A., et al. ‘Fatigue and extended work hours among cardiovascular perfusionists: 2010 Survey.’ Perfusion 26.5 (2011): 361-370.
Wali, Siraj, et al. “Effect of on-Call-Related Sleep Deprivation on Physicians’ Mood and Alertness.” Annals of Thoracic Medicine, vol. 8, no. 1, Medknow Publications & Media Pvt. Ltd., Jan. 2013, pp. 22–27, doi:10.4103/1817-1737.105715.
Sleep deprivation among healthcare clinicians as a result of irregular, demanding work schedules has been shown to be a significant obstacle in the healthcare field (Friedman et al., 1973). In comparison to other cognitively demanding industries such as aviation, healthcare professionals work longer and more continuous permittable hours (Owens, 2001). A wide range of literature has shown that acute sleep deprivation (recent 24-hour complete sleep loss) impairs one’s performance in the workplace which allows for more clinical errors (Gaba et al., 2002). Health professionals may regularly work during the night. Biologically, during this time alertness is decreased. The circadian pacemaker controls rhythms of sleep. Due to the endogenous circadian pacemaker, greatest alertness occurs during the biological day, and the greatness feeling of sleepiness occurs during the biological night. By varying work schedules from day to night on an irregular basis, the circadian rhythmic system is unable to adapt. This phenomenon is called “circadian misalignment” (Cajochen et al., 1999). When an individual has 24 hours of wakefulness its psychomotor dysfunction is equivalent to a blood alcohol concentration of .10% (Leung et al., 1992). While many states have a blood alcohol limit for performing cognitive tasks, there may not be a limit on the amount of hours healthcare clinicians can continue performing tasks without sleep.
Cardiovascular perfusionists work extended hours and may have unpredictable events which may force them back to the hospital. Perfusionists must be available at times to operate the heart-lung machine. According to the American Society of ExtraCorporeal Technology Standards and Guidelines for Perfusion Practice, a guideline is that an on-call Perfusionist should be present and clinically ready for unscheduled and emergent procedures within sixty minutes of being called. Along with cardiopulmonary bypass procedures, this may also include a perfusionist supervising extracorporeal membrane oxygenation (AmSECT Standards and Guidelines for Perfusion Practice, 2017). According to standard 16.1, in order for the perfusionist to ensure proper provision of care, he/she shall receive an adequate rest period between schedules work hours. Unfortunately for perfusionist, the adequate rest period described in the standard is not quantified and that number may vary based on institutional policies.
[bookmark: OLE_LINK1][bookmark: OLE_LINK2]While sleep deprivation and performance have been examined in other medical specialties, only one study has investigated the effect of sleep deprivation on the performance of perfusionists. Trew and colleagues surveyed 445 perfusionists to collect data on their experiences with fatigue and working variable, extended hours. Three-fourths of the respondents had concerns that their operation of the heart-lung machine was impaired when they are sleep-deprived. According to the results of this study, perfusionists are not excused from the effects of job-induced sleep deprivation. Unfortunately, no study has investigated the effect of sleep deprivation on the performance of perfusionists. A study by Hodge and colleagues looked at the effects of sleep deprivation on the performance of perfusion students however this study may not be applied to professional perfusionists with years of experience running the heart-lung machine. In this study, the simulation sessions lasted only 7 minutes which does not represent a realistic clinical scenario (Hodge et al., 2012). Also, using a small and homogenous study population makes it difficult for the results to be generalizable.
Previously, it would be unethical to perform randomized controlled studies using real patients as subjects. Due to recent advances in technology, we could now use high-fidelity simulation to study the effects of sleep deprivation on perfusionists. In this research proposal, I would like to use a mixed-methods approach that involves using the Orpheus cardiopulmonary bypass simulator and subjective questionnaires on sleepiness to elicit the effect of sleep deprivation on simulated clinical performance in experienced perfusionists.
A survey by Trew and colleagues at SUNY Upstate Medical University (2011), sought to collect preliminary data on the prevalence of fatigue in perfusion and to identify if there were concerns regarding fatigue, performance and perfusion safety. A 50-question survey was distributed to perfusionist in May of 2010. 68.9% of surveyed perfusionists have worked at the hospital for greater than 23 hours straight. 17.5% of perfusionists have worked continuously for over 36 hours. Microsleep while performing cardiopulmonary bypass was reported by 49.5% of respondents. 51.5% of perfusionists believe they perform less effectively when they are fatigued. Another 75.9% of perfusionists indicate that they have been concerned about their ability to perform their job adequately due to fatigue-related acute sleep deprivation. The survey data establishes that there are concerns of fatigue and acute sleep deprivation in the perfusion community. The study notes that further research must be performed to understand actual performance degradation that may occur in fatigued perfusionists performing cardiopulmonary bypass. This study captures the need for the research I am proposing to complete. A study on real perfusionists should be completed where sleep deprivation is measured on cardiopulmonary bypass performance.
Utilizing a mixed-methods approach involving a focus group discussion, subjective questionnaires, and the high-fidelity Orpheus cardiopulmonary bypass simulator, Hodge and colleagues (2012) sought to determine the effect of sleep deprivation on simulated clinical performance in perfusion students compared with their rested, baseline states. Seven second-year Medical University of South Carolina cardiovascular perfusion students were enrolled in the study. Each student was experienced with the Orpheus cardiopulmonary bypass stimulator and had not been medically diagnosed with a sleep disorder. For the control, participants received a normal night of rest before their first simulation session which was started at 6:00AM. The last simulation consisted of the subjects being kept awake for 24 hours without the consumption of any caffeine or stimulants. Before each study the sleep scale questionnaires were completed. Subjects were given a patient history and protocol for adult surgeries. During the seven-minute cardiopulmonary bypass case, the investigators manipulated several parameters while the subjects ran the heart-lung machine. Performance was based on the subject’s response time to initiate correcting the action. The study’s results demonstrated that cardiovascular perfusion students were affected by sleep deprivation. Significant differences in reaction times were found between the baseline values and the different intervals in which the participants were retested (Hodge et al., 2012). I included this study in the literature review because the Orpheus cardiopulmonary bypass stimulator is used as a research tool. This is a device I plan to use in my research project. I also plan to use the repeated-measures ANOVA to establish a baseline and then retest my subjects as I deprive them of sleep.
In a simulated surgical case performed by twelve anesthesiology residents, the effects of sleep deprivation on psychomotor and clinical performance, subjective and objective sleepiness, and mood were examined (Howard et al., 2003). The anesthesiology residents performed a four-hour anesthetic on a simulated patient the morning after two conditions. In the first condition, the residents were sleep-extended. Here, they did not need to arrive at work until 10:00AM. In the second condition, residents were awake for at least 25 hours. The subjective data was collected by using the Profile of Mood States and the Stanford Sleepiness Scale. There was also a psychomotor test battery completed to retrieve psychomotor vigilance task data in both the sleep-extended and sleep-deprived controls. During the psychomotor performance probe there was a longer but no statistically significant mean response time during sleep-deprived vs. sleep-extended states. The task patterns and reported workload of subjects was not significantly affected by the lack of sleep. The study did not have a definitive relationship between sleep deprivation and clinically relevant errors. This study shows that there may not always be a relationship between sleep deprivation and clinical performance.
In a cross-sectional comparative study, the effect of acute sleep deprivation, due to working long on-call shifts, on mood and alertness was examined. The study included eighty-eight junior physicians in Saudi Arabia (Wali et al., 2012). A self-reported profile of mood states questionnaire was used measuring depression, anger, tension, confusion, fatigue, and vigor. The total score was calculated to determine the mood of the junior physicians. The junior physicians also completed the Stanford Sleepiness Scale to measure the impact of short-term sleep loss on subjective sleepiness. For on-call days, 25% of the participants reported sleeping fewer than 2 hours and 87% reported obtaining 5 or fewer hours. The percentage of physicians who were alert post on-call was significantly reduced compared to the percentage pre on-call. The profile of mood states was significantly worse post-call than pre-call. The variables of depression, anger, confusion, fatigue, and vigor all have an effect on job performance. Increased confusion may impair a perfusionist’s ability to operate the heart-lung machine and may jeopardize patient safety.
Methods In July of 2020, cardiovascular perfusionists will be sent an invitation to participate in our study via Perfmail and Perflist. Participants will be enrolled in the study under a protocol approved by the SUNY Upstate Medical University Institutional Review Board. All participants must give written informed consent. Each participant should have similar experience with the Orpheus CPB simulator and should demonstrate baseline competencies using it. A maximum of twenty subjects will be able to participate in the study. According to Lewis and colleagues (2016) the majority of perfusionists are over the age of 55 years of age with 3 male perfusionists for every 1 female perfusionist. For this reason, I would like the study to be composed of 15 males and 5 females over the age of 55. Participants may not have a diagnosed sleep disorder.
Materials Participants will complete the Epworth Sleepiness Scale (ESS) and the Stanford Sleepiness Scale (SSS) to assess their level of sleepiness (Appendix A). Both questionnaires have been used in as a means of establishing baseline data when testing a change in performance (Johns, 1991& Hoddes et al.,1993). The ESS questionnaire is a self-administered sleep propensity test that measures one’s likelihood of falling asleep during eight common, daily activities (Johns, 1991). ESS scores range from 0–24 and a sum score of 16 or greater indicates excessive daytime sleepiness (Johns, 1991). In contrast, the SSS questionnaire is a simple way to measure subjective sleepiness at a given time interval. Subjects will rate their level of sleepiness on a 7-point, predetermined scale. Both questionnaires will be administered before each simulation session. Clinical performance will be measured by the high-fidelity Orpheus cardiopulmonary bypass perfusion simulator. The system comprises a hydraulic simulator, an electronic interface unit and a controlling computer with associated real-time computer models. It is designed for use within an actual operating theatre, or within a specialized simulation facility. The hydraulic simulator will be positioned on an operating table and physically connected to the circuit of the SUNY Upstate Medical University high-fidelity center’s heart-lung machine (Morris et al., 2007). Both machines are commonly used in hospital settings and each participant can pick the machine they feel more comfortable with. The SUNY Upstate Medical University high fidelity center OR used for this study will consist of an operating table with sterile blue drapes and a patient mannequin to mask the hydraulic simulator. Two monitoring screens will display real-time mean arterial and central venous pressures, electrocardiography (EKG) waveforms, sinus pressure and temperature.
Procedures The participants will be instructed to get a full night’s rest before the start of the study. The subjects will serve as their own controls and will be assessed at three intervals. We will start with a baseline and then reassess them at 12, 18, and 24 hours. Before each assessment, participants will take the sleepiness scale questionnaires. An investigator will remain with the participants at all times to make sure there is no sleep taking place. Each session will be 30 minutes long. An investigator will act as the surgeon and will manipulate variables. The subjects will be timed on how long it takes them to initiate correcting the variables. Mean arterial pressures, Partial pressures of oxygen and carbon dioxide, decreased venous return, high line pressures and mixed venous oxygen saturation will all be manipulated throughout the case. If participants neglect a variable they will be given the maximum time allocated.
References
Cajochen, Christian, et al. ‘EEG and ocular correlates of circadian melatonin phase and human performance decrements during sleep loss.’ American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 277.3 (1999): R640-R649.
Friedman, Richard C., D. S. Kornfeld, and T. J. Bigger. ‘Psychological problems associated with sleep deprivation in interns.’ Academic Medicine 48.5 (1973): 436-41.
Gaba, David M., and Steven K. Howard. ‘Fatigue among clinicians and the safety of patients.’ New England Journal of Medicine 347.16 (2002): 1249-1255.
Hoddes E, Zarcone V, Smythe H, Phillips R, Dement WC. Quantification of sleepiness: A new approach. Psychophysiology. 1973;10:431–6.
Hodge, Ashley B., et al. ‘The effect of acute sleep deprivation and fatigue in cardiovascular perfusion students: a mixed methods study.’ The journal of extra-corporeal technology44.3 (2012): 116.
Howard, Steven K., et al. ‘Simulation study of rested versus sleep-deprived anesthesiologists.’ Anesthesiology: The Journal of the American Society of Anesthesiologists 98.6 (2003): 1345-1355.
Johns, Murray, and Bruce Hocking. ‘Daytime sleepiness and sleep habits of Australian workers.’ Sleep 20.10 (1997): 844-847.
Leung, Lucy, and Charles E. Becker. ‘Sleep deprivation and house staff performance. Update 1984-1991.’ Journal of occupational medicine.: official publication of the Industrial Medical Association 34.12 (1992): 1153-1160.
Lewis, Doreen M et al. “Results of the 2015 Perfusionist Salary Study.” The journal of extra-corporeal technology vol. 48,4 (2016): 179-187.
Morris, Richard W., and David A. Pybus. “Orpheus” cardiopulmonary bypass simulation system.’ The Journal of extra-corporeal technology 39.4 (2007): 228.
Owens, Judith A. ‘Sleep loss and fatigue in medical training.’ Current opinion in pulmonary medicine 7.6 (2001): 411-418.
Trew, A., et al. ‘Fatigue and extended work hours among cardiovascular perfusionists: 2010 Survey.’ Perfusion 26.5 (2011): 361-370.
Wali, Siraj, et al. “Effect of on-Call-Related Sleep Deprivation on Physicians’ Mood and Alertness.” Annals of Thoracic Medicine, vol. 8, no. 1, Medknow Publications & Media Pvt. Ltd., Jan. 2013, pp. 22–27, doi:10.4103/1817-1737.105715.
This article sets out to provide a discussion as to the role that sleep plays in the lives of human beings and animals. The author states that no one knows why sleep exists therefore setting the context for the article in which she advances the numerous theories that are advanced as to the role that sleep plays. The central theme advanced by the article is that the ultimate role of sleep may indeed be time management.
Article Structure and logic
Structure-wise, this article is well-formatted as the author begins by giving a brief overview of sleep and the ambiguity with which its role is viewed by members of the society thus laying a proper foundation for the main discussion of the paper. The author then proposes the role of sleep and subsequently proceeds to discuss and support the claims that she makes by quoting authoritative figures in sleep research e.g. Dr. Diegel who is ahead chief neurobiologist.
The credibility of the article
In this article, the author takes care to provide concrete evidence for the claims that she makes. For example, when advancing her main argument about sleep being nature’s time management too, the author reinforces her assertions by presenting the theories of authorities in psychiatry who also think that sleep optimizes animals’ use of time. However, I feel that the author provided only the bare minimum information on the other theories on the role of sleep thus presenting the reader with only one side of the coin. In my opinion, the paper would have been more informative if it had briefly discussed the other theories to enable the reader to critically evaluate their validity for himself
My opinion on the article
The article makes a good case for the role of sleep as nature’s time management tool. The article’s incorporation of the opinions of experts adds to the plausibility of the statements made therefore making it an authoritative paper. Given the mystery that surrounds the phenomena of sleep, I found this article informative as it provided a believable theory for explaining the role that sleep plays in the lives of human beings.
The study I analyzed presented an investigation of sleep’s ability to consolidate memory for long-term storage. Several theories of what contributes to the assimilation and structuring of memories during sleep are discussed in the scientific community. There is a theory that certain stimuli received during wakefulness and repeated during sleep can help refresh memories. This hypothesis is promising, as sleep’s memory consolidation abilities are entirely unexplored and of great scientific interest. The study’s primary goal presented in the article was to investigate the consolidation of hippocampus-dependent memories during sleep through stimulation by smell. The smell was chosen because it was not necessary to interrupt the integrity of the subjects’ sleep to introduce it into the experiment.
The preliminary study was conducted on volunteers who were asked to remember the order of things in a two-dimensional task. This task was chosen because it involved hippocampal function. The participants were exposed to the smell of a rose at varying intervals. Then the subjects slept, during which they were also introduced to the scent of a rose. The morning after they slept, they were asked to take a test to see how well they remembered the order of the objects. The study also included a control group that was not stimulated by the scent while memorizing the location of the objects. As a result, those participants for whom smell was used remembered 97.2 ± 4.1% of the information, while the control group remembered only 85.8 ± 3.8% (Rasch et al., 2007). The researchers concluded that once an odor became associated with the context of memorized object locations, repeated exposure to an odor during sleep reactivated new memories and thereby accelerated their consolidation.
Indeed, exposure of the hippocampus to an odor helps to refresh memory and better assimilate necessary images. However, it has also been concluded that such a procedure is ineffective when it affects other parts of the brain or when it is only performed in the waking state. This statement narrows the results base but also makes it more delineated. I think this study is very revealing and essential for the development of modern somnology. People have been struggling to expand memory capabilities for many decades (Cleary & Schwartz, 2020). Therefore, I would like to suggest several experiments that could open up new frontiers for research. For example, one could test stimuli that disrupt sleep – sound, and light – and compare their results. It may turn out that the consolidation of memories occurs only during uninterrupted sleep. This could significantly change the idea of memory consolidation during sleep and expand the boundaries for research.
In addition, one could investigate the reactivation of memories obtained several days before the experiment rather than a day before. With this, it will be possible to see if the information obtained less recently could be fitted into long-term memory. Less recent information tends to be stored in short-term memory and forgotten (Cleary & Schwartz, 2020). The experiment I am proposing will test whether these memories can be recovered. The technique of recovering older memories is undiscovered in modern science, and such a study could give it a fresh impetus. In this way, it will be possible to narrow the evidence base even more and derive a clear theory about memory consolidation in dreams under different conditions.
References
Cleary, A. M., & Schwartz, B. L. (Eds.). (2020). Memory quirks: The study of odd phenomena in memory. Routledge. Web.
The information in the article “Excessive Sleepiness May Be Cause of Learning, Attention, and School Problems” by Calhoun and Fernandez-Mendoza is used to show that heavy daytime sleeping may be a cause of attention, learning, and school problems among children even if they had enough sleep at night. It shows that children whose parent showed excessive sleepiness were likely to have learning, attention and conduct problems.
The important part of the article is to show the cause of the sleepiness. It shows that systems of inattention, obesity, anxiety, and depression contributed to excessive sleepiness. The article shows that few children had signs of short sleep nor was it associated with learning, attention, and behavior problems. Parents and educators should determine whether a child is suffering from excessive sleeping (Susan and Julio 2012). The questions are; what are the chemicals responsible for sleeping? Why do children sleep during the day? Can sleepiness have a clinical remedy?
Works Cited
Susan L. Calhoun, Julio Fernandez-Mendoza. “Excessive Sleepiness May Be Cause of Learning, Attention, and School Problems.” 2012. BiologyGuild. Web.
Sleep is a mental and physical state in which one becomes inactive and unconscious of the environment around him or her (Borbély, 2003). In the real sense sleep is just a partial disconnection from the world in which outside stimuli are obstructed from the senses. Normal sleep is indentified by a general reduction in most of the body functions including blood pressure, temperature, and the breathing rate. This is contrast to the human brain that never reduces in activity.
The brain is always active whenever a person is a wake or a sleep (Berger, 2007). A normal human being sleeps for eight hours. These eight hours are divided into two equal parts. The first part is the rapid eye movement, and the second is the non-rapid eye movement. The two parts form a cycle (Ishimori, 2004). The intention of this paper is to look at the basis of sleep in relation to the biological mechanisms that cause people to sleep and stay awake.
History of Sleep
The history of sleep is believed to have been introduced by a psychologist professor at the University of Nagoya in Japan about one hundred years ago (Bayliss, 2006). The psychologist proposed a theory that explains the concept of sleep regulation.
Kuniomi Ishimori and Heni Pieron neuroscientist state that, a hormonal chemical and not the neural network (Ishimori, 2004) cause sleep regulation. In earlier researches, researchers took some samples that were sterilized and dialyzed from dogs that had sleep then injected to the brains of the dogs that had no sleep. The dogs that received these samples fell after a short time.
The scientists went ahead and took samples from normal dogs that did not have any sleep then introduced into the brains of other normal dogs without any sleep (Berger, 2007). The response showed that the recipient dogs did not sleep. This research indicated that there are substances that cause sleep known as “endogenous sleep-promoting substances.” Although the contradiction fact is that the nature of the chemical substances that caused sleep was not identified.
Various research groups carried out their research and reported more than thirty endogenous sleep causing substances. In most cases, their physiological relevance was uncertain. Tokyo igakkai Zasshi from Japan published the first Ishimori’s paper entitled “true cause of sleep _ a hypogenic substance as evidenced in the brain of sleep deprived animals,” in the year 1909.
Ishimori made further suggestion that when a person continuously stays a wake, it may also cause accumulation of factors that cause sleep in the brain (Borbély, 2003). Currently this is referred to as homeostatic sleep regulation. Starling and Bayliss discovered “scretin” in 1902. This is in relation with the existence of blood-borne messengers. The new idea of hormonal control of the body functioning became quite fashionable and popular in those days.
Hans Berger a Germany neurologist in Jena invented an electroencephalogram (EEG) that records brain waves in 1920s. The discovery facilitated the qualitative and quantitative analysis of sleep. Until then, sleep was regarded as an unapproachable phenomenon mainly because it could not be explained scientifically.
Kleitman and his coworkers discovered rapid eye movement (REM) sleep in Chicago. This discovery took place in the year 1953 in human beings (Bayliss, 2006). Jouvet and his group in Lyon identified that sleep is never a uniform phenomenon, and it consists of two main different stages.
Sleep and wakefulness are the major complex, phenomena. Furthermore, sleep is divided into two parts: the REM and the non-REM sleep can easily be determined by examining the animal’s behavior (Berger, 2007). The authors suggest that it needs more accurate measurement of sleep and wake pattern by the use of the electrooculogram (EOG), the recording of the movement of the eye, EEG and (EMG) electromyogram, the recording of the tension of the muscles (Ishimori, 2004).
When a normal, healthy person goes to sleep at eleven, the first step in sleeping starts with the NREM and then followed by the REM sleep. This makes a cycle in the sleeping pattern. As in the example, it all begins with the NREM that which progressively becomes deeper.
It takes around four to five cycles in which one take about 90 minutes; arousal comes after the concluding REM sleep (Borbély, 2003). This principle has been in existence for a long time and yet the physiological regulatory mechanisms and the meaning have completely remained a mystery.
Alexander Borbely from the Zurich University in Switzerland came up with his two famous process model that show sleep regulation in 1982. He argues that homeostatic process is entirely controlled by sleep pressure or sleep propensity that build up during the wakefulness period. The process is related to the Ishimori’s thus the name Ishimori-Pieron type.
On the other hand, a biological or pacemaker clock that is independent of the prior waking and sleep determines the circadian process well known as the sleep-wake sequence during the night and day. This clock is found in the body of the animals. Researches indicate that Ultradian process can generate alternation of REM and NREM sleep (Piéon, 2003). From a scientific point of view, the molecular mechanisms that explain the sleep- wake regulation in all the processes have remained unknown.
Sleep and Prostaglandin
Prostaglandins (PGs) are the lipid mediators (Bayliss, 2006). There are more than thirty kinds of prostanoids, which are known worldwide. The compounds are distributed extensively in all mammalian organs and tissues.
They have a diverse and numerous biological effects on various pathological and physiological activities in the body, and that is why they are sometimes called local or tissue hormones. In 1980s, the scientists discovered the most common prostanoid in the mammalians and mostly the rats and human beings (Berger, 2007).
According to their findings, they suggest that PGD2 can be a distinctive component of the brain and might be having some essential function in the organ. They found out that when PGD2 cause sleep to rats when it is microinjected in the brains (Piéon, 2003). This was a notable achievement, and they decided to carry on with the study to the molecular mechanism and the physiological significance.
Inoue and Honda from Tokyo Japan first designed the bioassay analysis system for sleep. The analysis of the structure is as follows: through microinjection pump, the chemical PGD2 is injected gradually and constantly through a cannula which is chronically rooted in the 3rd ventricle of a rat . The stages that the rat undergoes to sleep are determined using polygraphic recording of EMG and EEG.
Other aspects like food intake, water intake and brain temperature, are monitored and the general behavior of the rat is recorded using a video recorder under infra-red light. The rats are nocturnal animals that sleep most of the daytime, and remain active during the night. The outcome of the research showed that when the PGD was constantly injected in the third ventricle of a rat, the REM and the NREM sleep improved significantly during injection time.
PGD2 caused the effect since the other PGs were ineffective (Borbély, 2003). The experiment mostly depended on the dose and the little picomolar quantity of PGD2 given to per minute it was enough to cause excess sleep to the rat. The quantity of the PGD2 that required causing sleep corresponded quite closely to the normal concentration inside the brain (Piéon, 2003).
The results indicated that pharmacologically high doses are not necessary, and it can imply that the difference in the concentrations of PGDs which ordinarily occur in the brain have the ability to control sleep under physiological circumstances (Berger, 2007).
The most important aspect is that the PGD2 stimulated sleep was the same as the physiological sleep just as shown by electrophysiological principle and conduct that involves power spectral data. Contrary to PGE2, the PGD2 is never pyrogenic, but in the real sense, it caused little amounts of reduction in temperature as seen to happen throughout the physiological sleep (Ishimori, 2004).
Others experiments, that were carried out, in Japan with monkeys, Mocaca mulatta, indicated clearly that PGD2 could induce natural or physiological sleep (Bayliss, 2006). The sleeping pills and drugs cause quite different sleep from the physiological sleep or the natural one. This shows that PGD2 is a true sleep hormone.
Sleep-wake regulation
The discoveries in the experiments above explain how sleep can be introduced to an animal from the beginning until it gets into a deep sleep. Then the next part is to identify if the same experiment can apply in the process of waking up the animal from the sleep explaining the wake sleep process.
Philos published the brief summary of the experiment in the year 2000. The article observes that the main enzyme that induces sleep is mainly found in the arachnoid membrane and the choroid plexus.
After this enzyme is generated, PGD2 is secreted into cerebrospinal fluid (CSF) and then flows inside the subarachnoid and ventricular spaces. The PDG receptors known as the DPRs are localized on the little area on the ventro-rostral plan of the basal forebrain. PGD2 that circulates in the CFS binds the receptors at the point where the sleep signal is generated (Piéon, 2003).
The signal passes through the parenchyma brain to the ventrolateral preoptic area VLPO), which is a centre for sleep, across the pia membrane (Ishimori, 2004). The process is mediated through adenosine by A2A adenosine receptor. VPLO cast to the tuberomammilary centre (TMN) (Berger, 2007).
The scientists, Oishi and coworkers, found out that adenosine from the TMN cause sleep by hindering the histamnergic structure via A1 receptor (Bayliss, 2006). This implies that PGD2 induce sleep by facilitating the functioning of sleep neurons (Borbély, 2003).
On the same point, wake materials like orexin or PGE2 thruogh the histamine mechanism support an organisms’ wakefulness. According to the scientists, it is their view that the work on wakefulness still requires great attention and it forms the basis of greater basis for more investigation.
Stages of sleep
Sleep has four main stages. It starts from dozing and continuously progresses into a unusually deep sleep.
Stage one
The stage is can be termed as a doing stage. In this stage, five percent of the non-REM is spent. It is the transitional phase of the exact light sleep. The birthing rate, and the muscles start to relax and a person can be easily awakened (Berger, 2007). A person may feel a hypnic jerk during this period, the tendency to fall asleep and come back easily. After the rush of activities, the body starts to get into a slight slumber. The EEG at this stage is low, and the eye movements are slow. The eyes roll slowly as though closing and opening.
Stage two
This is the official onset of a consolidated sleep. A bout forty-five percent of the non-REM sleep is covered in this step (Piéon, 2003). The eye movement stops then the brain waves enlarge. There are two distinct brain waves in this stage, K-complexes and spindles (Borbély, 2003).
A sleep spindle is a design by which EEG waves that consist of a burst of eleven to fifteen hertz wave that last from five to fifteen seconds. A K complex has quite a high voltage of EEG activity. It consists of a sharp downward constituent then followed by a slow upward constituent. This pattern lasts for over five seconds.
Stage three
As the sleep advances deeper and deeper, it becomes extremely difficult to arouse someone at this stage. An individual may spend about twelve percent of the non-REM sleep in stage three. Real slow wave sleep starts with slow and large wave in amalgamate little, faster ones.
Stage four
This stage is normally characterized by extremely deep sleep. It mostly spends round seventy-five percent non-REM sleep, and thirteen percent of this part is spent in the last stage (Berger, 2007). An individual in the last two stages is more difficult to wake than an individual who is in the first two stages (Bayliss, 2006). People who wake up from sleep normally feel disoriented and groggy for some time.
REM sleep
This is the period that a person may experience dreams. During this time, there is an irregular breathing, periodic eye flattering, there is also an irregular heart rate, blood pressure and body temperature. This makes a difference between non-REM and REM sleep stages (Ishimori, 2004).
In other words, the REM is referred to as paradoxical sleep since brain wave activities is almost similar to a wakened state. During this stage, the brain obstructs all signals towards the muscles and they remain immobile so that the dreams cannot be acted out (Piéon, 2003). Most adults spend a round twenty to twenty-five percent of their sleep in REM.
Conclusion
The biological basis of sleep is dated back to more than one hundred years ago. Kuniomi Ishimori and Heni Pieron laid the foundation of sleep through their research done in Japan. The later physiologists identified that sleep can be classified into two main groups. These are the REM and the non-REM (Bayliss, 2006).
All the two parts come in different stages, that is beginning from stage one up to stage four, all the stages follow one another from the beginning of sleep to the time a person wakes up. There is still more room for other scientists to make the research and prove the sleep phenomenon.
References
Bayliss, W.M. (2006). Starling EH. The mechanism of pancreatic secretion. J. Physiol. Chicago: Harvard Publishers.
Berger, H. (2007). Über das Elektrenkephalogramm des Menschen. J. Psychol. Neurol. Chicago: Harvard Publishers.
Borbély, A.A. (2003). Two process model of sleep regulation. Hum. Neurobiol. New York: Macmillan Publishers.
Ishimori, K. (2004). True cause of sleep – a hypnogenic substance as evidenced in the brain of sleep-deprived animals. Tokyo: Igakkai Zasshi.
Piéon, H. (2003). Le probléme physiologique du sommeil. Paris: Masson et cie.
Every human being in day to day life needs some rest from the normal activities by sleeping. Sleep is therefore defined as period that naturally occurs where the body rests from the daily activities and the mind being in a state of unconsciousness. There are said to have five sleep stages, which are divided in to two: the rapid eye movement and the non rapid eye movement during which the dreams occur.
One begins with the preparation to sleep -the waking sleep- where the eyes go on and off. In stage 1 last about five to ten minutes where there is slowing down of muscle activities. At this stage it is easy to awaken someone and he may end up feeling as if he hadn’t slept. During this stage the eyes are closed. In stage 2, one gets a light sleep whereby the body temperature goes down as well as the heart rate. In stages 3 and 4, someone experiences dead sleep, (Andrew, 2005).
However, in stage 4 the sleep is much intense. There is the repeat of stage 3 and 2 after stage 4. Stages 1-4 are referred as the non rapid eye movement (NREM) period. In these stages one dream on memories of the episodes which might have happened during the day or the past days.
The NREM period last up to around 90 minutes where one gets into stage five the rapid eye movement (REM) period. Here the dreams take another shape where the normal realities don’t make sense, for instance one can dream walking on water without sinking. At this stage the heart rate increases and the blood pressure rises. The five stages form a cycle and one may end up having 5 cycles at the end on the night, (Andrew, 2005).
There are theories associated to why we dream, some of them include: to help solving of problems which cannot be solved in normal consciousness, to organize our mind in relation to many information and to cope with different hard situations. We also dream as a result of impulses from the brain which are randomly developed.
There are several consequences related to the disrupted sleep. Disrupted sleep during the night result into the poor working of person during the day where one ends up dozing in the afternoon when supposed to be taking a certain activity, it also disrupts the concentration of the mind. Disrupted sleep has been a high threat to the human health by increasing the risk of diseases such as heart attacks, obesity, and colon cancer among others (Andrew, 2005).
Insufficient sleep may increase the hormones which do cause stress. This leads to the increase in the blood pressure in which many heart attacks are reported to be as a result of increased blood pressure (Pinel, 2009). In the blood vessels there is a lining which is influenced by sleep, and so many cases of strokes as well as the heart attacks have been known to happen in the morning as it’s when the body resumes working with high increased blood pressure.
Diabetes is said to be as a result of poor regulation of the blood in which at the same time people who are known to have insufficient sleep are at the same time reported to have problems in blood sugar regulation (Pinel, 2009).
The body metabolic rate is said to be high at night and thus less sleep leads to poor metabolic rate. This has in turn resulted into many reported cases of obesity especially to women who sleep five hours or less. Insufficient sleep therefore has many negative effects which lead to reduced life span to a person (Davis, 2003).
The bio-psychologist and the psycho-physiologist are said to play a great role in the sleep research. They have researched on the positive effects that the sleep has into a person as well as the negative effects involved when one lacks enough sleep. Out of their research results people are then in position to avoid these effects which are detrimental in to their health. They have a role on explaining the relationship between the sleep and the body biological functioning.
They also have a role in further research on, the sleep and the relationship with the neurological problem or disorders. They are a number of sleep disorders of which the specifics causes have not been known like walking while sleeping. The bio-psychologist have then the role on researching the specific causes of which some of them are believed to be genetic as when the specific cause is known then the specific treatment on the same will be developed (Davis, 2003).
The psycho-physiologists have a role in showing the relationship in psycho-physiological and the radical eye movement period. The science need to be applied for the hallucinations and dreams that people experience with the processes on full conscience. They have also a further role to research of the impact that the disorders such as insomnia to the body functioning which are unknown.
There has been reported cases on psycho-physiological insomnias that are not caused by sleep loss thus they have a further role on researching on the same. Their role however cannot be under looked by the fact that many lives have been saved as a result of their research (Davis, 2003).
References
Andrew, W. (2005). Foundations of Biopsychology. London: Pearson, Prentice Hall.
Davis, S. (2003). Blackwell Handbooks of Research Methods in Psychology. New York: Wiley Blackwell.
Pinel, John P.J. (2009). Biopsychology, 7 ed. Boston, MA: Pearson.