Effect of Sleep Deprivation

Chapter II

Review of Related Literature and Studies

This chapter includes the review related literature and studies which may

give a hint to the researchers and perused to give a light on the topic under the study.

Review of Related Literature

Local literature

According a newspaper article written by Tacio, H.D. entitled Getting a Good

Night’s Sleep, states that in many cases, staying up too late is the culprit of reduced

morning energy and fatigue. In one experiment, children were asked to go to bed later

than normal for a week, and then were asked to spend no fewer than 10 hours in bed for

another week and during the week of later bedtimes, teachers rated these kids as having

more academic problems and more attention problems without knowledge of

the research. According to the 2016 Healthy Living Index Survey, Filipinos have one of

the highest rates of sleep deprivation in Asia; 46% of Filipinos do not get enough sleep

while 32% said they sleep for less than six hours.

Lack of sleep boosts levels of Alzheimer's proteins: study Philippines News

Agency According to their study Persistent high levels of the Amyloid beta protein can set

off a cascade of brain changes leading to dementia.

One major phenomenon that has been gradually eroding the health of the

Philippines is lack of sleep. From the effects of unbearable traffic to the explosion of the

business process outsourcing industry to the geometric rise of Internet usage nationwide,

millions of Filipinos are choosing to sleep less and less, with dangerous effects. We seem

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to think that staying awake to finish work is the lesser evil. By Bill Velasco (The Philippine

Star)

According to the Philippine Daily inquirer, the 24-hour cycle programs us to have

peaks and dips for body temperature, blood pressure, the production of certain hormones

and the functioning of many of our vital systems. Crucial here is the sleep we get,

sleepiness and alertness being functions as well of the circadian rhythm. Sleep allows the

body to perform maintenance and tune-up work and if we don’t get enough sleep, our

bodies fail to function properly and, in the long run, there are even increased risks for all

kinds of illnesses from obesity and diabetes to cancer and Alzheimers.

The sleep crisis has worsened with modern societies because of the way the

circadian rhythm is disrupted. There are the longer work and school days, with so much

take-home work. Technologies have abolished the night with artificial light, and our

waking hours are prolonged with television, phones and tablets, not just because we work

(and play) with them but because they emit a blue light that induces more wakefulness.

MANILA, Philippines - Lack of sleep does more than give you eye bags. New research

has found that getting less than the recommended 7 to 9 hours of sleep may affect even

your genes. A study published in Proceedings of the National Academy of Sciences of

the United States of America revealed that one week of not getting enough sleep alters

gene expression in human blood cells, changing the activity of over 700 different genes.

(Rappler)

Foreign Literature

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 Effect of Sleep Deprivation

The Journal Scientific Reports, says college students who did not go to bed or

wake up at consistent times every day were more likely to have lower grades. They

conducted a research over 61 students from Harvard College who kept online diaries of

their sleep schedules for 30 days. The Researchers identified two groups: regular

sleepers, or those who went to bed and woke up about the same time every day, and

irregular sleepers, who had different sleep patterns every day. For Andrew Phillips, lead

author of the study and associate professor of medicine at Harvard Medical School, said

the findings show that irregular sleepers have a delayed release of the sleep hormone

melatonin.

Sandra Tamm, in her doctoral thesis, based at the Department of Clinical

Neuroscience of the Karolinska Institutet, in Stockholm, Sweden, set out to explore

precisely the ways in which sleep loss can alter our emotional perceptions and

engagements. In her work, Tamm conducted no fewer than five studies, each of which

set out to assess a different aspect of the relationship between sleep deprivation and

emotional perception:

The first study investigated the impact of poor sleep on emotional contagion (a

person's ability to mimic and respond to someone else's emotions).

The second looked at sleep deprivation's effect on a person's ability to empathize

with someone else's pain.

The third examined the relationship between sleep restriction and emotional

regulation (a person's ability to control their own emotional reactions).

The fourth looked at sleep restriction and brain network connectivity.

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The fifth assessed the impact of seasonal allergy (which is a risk factor for sleep

loss) on brain inflammation, aiming to identify a mechanism that could lead to sleep

deprivation.

The Medical News Today Knowledge Center give some key points about sleep

deprivation on their article. They examines the consequences of sleep deprivation, along

with what can be done to treat and prevent it.

Sleep loss alters normal functioning of attention and disrupts the ability to focus on

environmental sensory input

Lack of sleep has been implicated as playing a significant role in tragic accidents

involving airplanes, ships, trains, automobiles and nuclear power plants

Children and young adults are most vulnerable to the negative effects of sleep

deprivation

Sleep deprivation can be a symptom of an undiagnosed sleep disorder or other

medical problem

When you fail to get your required amount of sufficient sleep, you start to

accumulate a sleep debt.

According to a Book written by Carskadon, M.A., Adolescent Sleep Patterns

Biological, Social, and Psychological influences. Although the prevalence varies, many

adolescents and young adults are reported to have an irregular sleep schedule and a

tendency to have a delayed sleep phase. A remarkable degree of problems associated

with sleeping and poor sleep quality have been observed in university students or many

Western countries. However. To the researcher’s knowledge, the data regarding sleep

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patterns and habits in Asian countries is limited. It is necessary to investigate this issue

within the Asian population because sleep habits are affected by ethnicity, social factors,

and culture.

A team of scientists at the University of Rochester recently discovered that during

sleep, the brain purges itself, flushing out its own chemical waste through a hidden

network of channels that resemble a plumbing system. These pipes simulate opening up

during sleep. In addition, researchers think that this cleansing process uses up a lot of

energy, which may explain why the brain waits until bedtime to take out its own trash.

Also, your body saves the energy it uses to see while you are sleeping, which possibly

adds needed fuel to this process. The American Academy of Sleep Medicine also

revealed that growth hormone is released in children while they are asleep. Of course,

there is still some debate as to which is the optimum time to sleep, some suggest 10 p.m.

to 2 a.m., and others say midnight to 6 a.m. is best.

According to Carskadon, M.A. and Wolfson A.R.’s study that assesses the relation

between sleep patterns, sleep quality, and school of performance of adolescents

attending middle school, high school, and/or college, that the findings strongly indicate

that shortened total sleep time, erratic sleep or wake schedules, late bed and rise times,

and poor sleep quality are negatively associated with academic performance for

adolescents from middle school through the college years. The study specifically looked

at the sleep/wake patterns and usual grades of students, school start time and

phase preference in relation to sleep habits and quality and academic performance, and

sleep patterns and classroom performance.

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According to Curry, J.’s book understanding the impact of irregular Sleep Pattern,

Some behaviors or activities are detrimental to normal sleep have been suggested. These

“inadequate sleep hygiene” behaviors include irregular sleep schedules, frequent or

prolonged daytime naps, excessive alcohol consumption before bedtime,

absentmindedness, slower mental capacity, and staying on one-s bed for

non3sleep3relatedactivities. Accordingly, adequate sleep hygiene is considered to be an

important adjuvant for treating patients with insomnia or other sleep disturbances.

However, in the case of normal subjects, who are unaffected by these pathological

conditions, the association between sleep hygiene and sleep itself is surprisingly

inconsistent.

According to an article in Time magazine entitled Let your Kids Sleep more for

better Grades written by Locker, M. states that a new study shows that a good night’s

sleep can translate to improved academic performance. Researchers at McGill University

and the Douglas Mental Health University Institute in Montreal found that children who

had a better quality sleep performed better in math and languages.

Judith A. Owens (2010) in her study about ‘Impact of Delaying School Start Time

on Adolescent Sleep, Mood and Behavior’ concludes that a modest delay in school start

time was associated with significant improvements in measures of adolescent alertness,

mood and health. The results of this study support the potential benefits of adjusting

school schedules to adolescents sleep needs, circadian rhythm, and developmental stage.

This study is closely related to our current study. The study includes some improvements

of the adolescent alertness, mood and health that may affect when a person is sleep

deprived. This may help to solve the delaying school start time for the students.
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 Effect of Sleep Deprivation

The Journal Scientific Reports, says college students who did not go to bed or

wake up at consistent times every day were more likely to have lower grades. For the

study, 61 students from Harvard College kept online diaries of their sleep schedules for

30 days. Researchers identified two groups: regular sleepers, or those who went to bed

and woke up about the same time every day, and irregular sleepers, who had different

sleep patterns every day. There were several differences between regular and irregular

sleepers, including significant differences in grade point averages. Using a unique scoring

index from zero to 100 to calculate a student's sleep regularity, students with very irregular

sleep patterns were given lower scores close to zero, while more regular sleepers were

given higher scores close to 100. The researchers found that for every score increase of

10 on the regularity index, the student had an average increase of 0.10 in their GPA.

Andrew Phillips, lead author of the study and associate professor of medicine at Harvard

Medical School, said the findings show that irregular sleepers have a delayed release of

the sleep hormone melatonin.

Review of Related Study

The National Center on Sleep Disorders Research estimates that between 50 and

70 million Americans are affected by a sleep-related problem [1]. In the 2008 Sleep in

America poll by the National Sleep Foundation, 65 percent of respondents reported

having experienced a sleep disturbance at least a few nights a week in the prior month,

and 44 percent reported sleep problems occurring every night or almost every night.

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A national survey of medical school course directors in 1993 found that the

average medical school curriculum devoted fewer than 2 hours to sleep and sleep

disorders over the four years of medical education

Possible effects of sleep deprivation and fatigue on the performance and well-

being of residents have received little scientific examination until recently. This article is

a review of the studies on this topic published since 1970. All those studies that dealt with

residents' moods and attitudes demonstrated deleterious effects of sleep deprivation and

fatigue. The implications of this finding for patient care deserve exploration. Residents'

acuity on performance tests requiring prolonged vigilance tended to deteriorate with acute

sleep loss, while their performances on most brief psychomotor tests measuring manual

dexterity, reaction times, and short-term recall were not adversely affected. The data

presently available suggest that sleep-deprived or fatigued house officers can

compensate for sleep loss in crises or other novel situations. However, sleep-deprived

residents may be more prone to errors on routine, repetitive tasks and tasks that require

sustained vigilance, which form a substantial portion of residents' workload. The authors

concur with the recommendation of the Executive Council of the Association of American

Medical Colleges that the total working hours for residents should not exceed 80 hours

per week averaged over four weeks.

Sleep is an ancestral and primitive behavior that is shared across the planet by

over a billion people on a daily basis. Its underlying mechanisms, interactions, and long-

term effects are still poorly understood. Sleep patterns of quantity and quality are affected

by a variety of cultural, social, psychological, behavioral, pathophysiological, and

environmental influences and have shown secular trends alongside changes in the
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modern society requiring longer hours of work, more shift-work and 24-7 availability of

commodities, curtailing the duration of sleep to fewer hours per day across westernized

populations.1 This has led to increased reporting of fatigue, tiredness, and excessive

daytime sleepiness.2 Lack of sleep also exerts deleterious effects on a variety of systems

with detectable changes in metabolic, endocrine,3,4 and immune pathways.5 Over the last

few decades there has been growing evidence to suggest that too little sleep and too

much sleep are associated with adverse health outcomes, including total mortality,

cardiovascular disease, type 2 diabetes, hypertension and respiratory disorders, obesity

in both children and adults, and poor self-rated health. The relationship between duration

of sleep and mortality has been often described as a U-shaped association, although

other studies have not found such a uniform effect or have found no association. It is

believed that different mechanisms may underlie such associations at either end of the

distribution of sleep duration. Given the variety of studies, the large differences in the

types and sizes of populations examined, the duration of follow-up, and the size of the

effects, it is difficult to draw immediate conclusions on the consistency of the associations

at either end of the distribution of sleep duration and at its effect size. The latter is

important in public health to ascertain the likely impact at population level, if amenable to

modification. The aims of this study were to (a) systematically review published

prospective population-based studies, (b) carry out a meta-analysis to assess whether

the global evidence supports the presence of a relationship between either short or long

duration of sleep and all-cause mortality, and (c) obtain a quantitative estimate of the risk

to assess the consistency and potential public health relevance. A meta-analysis allows

the combination of the results of different studies, increasing the overall statistical power

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and the precision of estimates while controlling for bias and limiting random error.(Sleep

Duration and All-Cause Mortality: A Systematic Review and Meta-Analysis of Prospective

Studies)

“Lack of sleep should no longer be considered a traditional adolescent rite of

passage because it can have serious consequences” (McCann, 2008).

Students should not make it a habit to stay up late at night. Porpova (2013) claims that

chronic sleep deprivation in adolescents reduces the brain’s capacity to learn new

information and can lead to emotional issues like depression and aggression. Also, an

article of Hackethal (2013) has shown that sleep deprivation might affect the frontal lobes

of the brain which controls decision-making functions. Even teenagers still need to get

enough sleep to avoid suffering the consequences of being sleep deprived.

Theoretical Framework

Any Theory

Any theory of sleep must account for several universal characteristics of sleep, including

that sleep is:

Found in all mammals and birds, plus probably in reptiles and some amphibians cannot

be replaced by waking rest.

- is homeostatic and circadian

- is characterized by physiological and brain states that are not otherwise obtainable

easily includes unconsciousness/reduced sensitivity to external stimuli

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- has two distinct components...REM & NREM (active & quiet), each with its own distinct

physiological and brain states.

The Brain Needs the Downtime That Comes With Sleep

Supporting Evidence

James Horne: Many of the effects of sleep deprivation are brain-based. For example,

consider some of the effects shown by Randy Gardner: irritability, difficulty recognizing

objects only by touch, memory lapses, difficulty concentrating, hallucinations, and

difficulty naming common objects, fragmented thinking and paranoia.

J. Allan Hobson: neurons that are highly active when awake may deplete their supplies

of neurotransmitters and need time to recover, while those not often used when awake

need the chance to be stimulated on a regular basis.

Kavanau: memory circuits and synapses need to be periodically activated or they

weaken...that maybe why the sleep reduction in old age is correlated with memory loss.

PBS Nova: sleep is the time when the brain processes/edits information from the previous

day.

Restoration Theory (Oswald, 1966)

According to Oswald (1966), the function of sleep is to restore the body during periods of

inactivity so that adequate biological functioning is ensured. The tissues of the brain and

body are repaired and the chemicals needed for proper functioning are replenished.

Specifically, Oswald claims that:

NREM sleep restores biological processes that have deteriorate during the day;

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REM sleep replenishes and renews brain processes through the process of protein

synthesis.

Evidence for Restoration Theory

Many animal studies of sleep deprivation support the ideas of the restoration theory

because they show that biological functioning deteriorates if an animal is deprived of

sleep. However, the results of human studies are not as clear cut and do not seem to

support the idea that biological functioning is upset if a human is deprived of sleep.

Conceptual Framework

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