From The Psychology Times, Vol 3, No 3
“From birth to death a normal person spends more time sleeping than doing any other activity,” explained Dr. Denise Sharon, current President of the Southern Sleep Society and Director at the Comprehensive Sleep Medicine Center of the Gulf Coast. “Sleep is a 1/3 of our lives,” she told the Times.
Dr. Sharon’s clinical emphasis is in sleep disorders, a rare specialty for psychologists. She works to help those with obstructive sleep apnea syndrome, restless legs syndrome, narcolepsy, circadian rhythm disorders, insomnia, and other sleep disorders associated with medical or psychiatric disorders.
Dr. Sharon is Associate Professor of Medicine, Sleep Medicine Fellowship Faculty, and Assistant Clinical Professor of Pediatrics, at Tulane University School of Medicine in New Orleans. Sleep is a behavior, she said, and it is an important one for health and safety.
Dr. William Waters, long-time expert in the area of sleep would agree. “The whole country is sleep deprived,” he explained to the Times. “You can’t do sleep deprivation research without feeling a little scared about traveling on the highway at night or early in the morning.”
Dr. Waters developed his interest in sleep during his years as Clinical Director at Louisiana State University throughout the 80s. An ABPP in clinical psychology with a strong psycho- physiological background, Dr. Waters trained psychologists in sleep research and sleep medicine while Director and Full Professor at LSU. His first publication in the area of sleep was also in the 80s. He continues his interest as the Director of the Sleep Disorders Center at Ochsner Clinic in Baton Rouge.
“Sleep deprivation, memory, attention, emotion, cognition … it’s all interlocking,” Dr. Waters said. “For example sleep is really the other side of the attention coin. You can’t actually sleep while attending to something. And you can’t actually attend to something while sleeping. Attention impairs sleep and sleep impairs attention,” he explained.
“There are huge numbers of people who are sleep deprived. And it is a state in which negative emotion tends to prevail, like other strong need deprivation states.”
“It’s not just sleep deprivation,” he said, “but the quality of sleep is very poor for many of those who actually do get enough sleep. For example sleep apnea produces fragmented and light sleep that is not restorative, and causes the same functional decrements that are caused by sleep deprivation, including negative affect.”
According to Harvard Medical investigations have pointed to sleep deprivation as a factor in the 1979 Three Mile Island nuclear accident, the disaster at Chernobyl, and sleep deprivation played a part in the Exxon Valdez oil tanker accident. And the explosion of the space shuttle Challenger revealed critical issues of sleep deprivation.
The Institute of Medicine estimates that between 50,000 and 100,000 deaths are caused each year because of inadequate sleep, and that “drowsy driving” may cause a minimum of 20 percent of all car crashes.
Poor sleep patterns appear connected with a number of chronic illnesses. Researchers are linking inadequate sleep with weight gain and also with a greater risk of diabetes and body mass.
“…And increased morbidity and increased mortality,” noted Dr. Sharon. “If we add intermittent hypoxemia, even mild, to the mix, the result is an inflammatory response that challenges the autoimmune system and contributes to plaque build-up.”
Poor sleep can lead to high stress hormones and research has found that even one night of poor sleep for a person with hypertension can result in elevated blood pressure the next day.
As important as a full night of quality sleep is, the National Sleep Foundation’s 2010 survey, “The Sleep in America Poll,” revealed that 33.7 percent of responders said they did not get the amount of sleep they needed. Only 40 percent said they get a good night’s sleep every night or almost every night.
“Look for an middle-aged, overweight male or female,” said Dr. Waters, “and you are likely to find a problem with quality of sleep because they are likely to have sleep apnea. For psychologists, it is worth noting that sleep apnea will look a lot like depression,” he said.
“The one thing that will reliably destroy sleep is stress,” Dr. Waters told the Times. “No matter what the psychiatrists say, it is all continuous. If you want to take a point on the continuum and call it a disease you can. But stress–the psychophysiological responses–are aimed at getting you to deal with threat,” he said. “And then how likely are you to go to sleep?”
“Keep in mind that negative emotion is a stress response,” he said, “and therefore predictably disrupts sleep, delaying its onset, and making it light and interruptible. In other words, non-restorative.”
Helping a person get the rest and quality night sleep he or she needs was one of the first things that Dr. Sharon enjoyed in this specialty area.
“Coming from psychiatry,” she said, “the first thing I liked about sleep medicine was instant gratification. The majority of our patients [obstructive sleep apnea, narcolepsy, restless leg syndrome] improve immediately after diagnosis and correct treatment with minimal if any side effects.”
She explained a classic example of a bus driver she helped who was struggling with obstructive sleep apnea or OSA. “After diagnosis and a good C-PAP titration,” she said, “he wakes up the next morning and thanks everyone for the best night sleep he has ever had.” “We made the patient happy,” Dr. Sharon said, and we “ensured the safety of tens or hundreds of school kids, other drivers, and pedestrians. Believe me, it’s the best high.”
While Sleep Medicine is considered a medical specialty, psychologists, neuropsychologists, and neurophysiologists had a major role in the development of the field, explained Dr. Sharon.
Dr. Waters told the Times that the field of sleep is perfect for psychologists. “Sleep is the kind of area that clinical psychologists should be doing, it is just made for us,” he said. “We have a whole scientific discipline at our fingertips that is applicable.” He explained that the basic principles of behavior, applied to the treatment of sleep, is a perfect fit.
“Sleep hygiene and stimulus- control therapies are nothing more than applying what we know about sleep related behavior to make the person more likely to sleep,” he said. “Relaxation therapy is what we do to tone down activation. And remember that it is activation, particularly emotional activation, that causes insomnia and reduces the quality of sleep.”
The sleep cycle in most healthy adults begins as the person goes from wakefulness to an orderly set of sleep states. The first cycle is from wakefulness to non-REM sleep, that includes several stages, followed by the first REM period. The two sleep states and the sleep stages continue to alternate throughout the night with an average period of about 90 minutes. A host of difficulties can disrupt the cycle, called fragmentation of the sleep architecture.
“Obviously sleep disorders pose challenges in defining genetics and pathophysiology and developing more and better cures,” said Dr. Sharon, who is currently involved in developing the new edition of the International Classification of Sleep Disorders. She will be reviewing several disorders in the Sleep Related Movement Disorders section for this publication.
“There are many tasks ahead of us,” she noted. “Some relate to education about the importance of sleep to promote adequate development, maintain performance, reduce accidents, morbidity, mortality and overall health costs, as opposed to the on the go 24/7 mentality,” she said. “The importance of ascertaining adequate amounts of sleep in children and teenagers, also, who are among the most sleep-deprived group.”
Researchers at Louisiana Tech in Ruston have a program of research attempting to help unravel some of the complex issues in this area with college students.
“Basically what we’re finding is people that have poor sleep quality tend to consume more food and weigh more over time,” said Dr. Buboltz, Psychology Professor at Louisiana Tech. “Our hope eventually is to give them interventions or strategies to sleep better which would keep them healthier and decrease their weight,” he told the Times.
Dr. Walter Buboltz, Dr. Janelle McDaniel, Rebecca Hoffmann, Eric Robbins, and Barbara Calvert presented “Analysis of food Consumption Behavior and Sleep Patterns in College Students as Measured by Diaries,” at a recent American Psychological Society conference.
The researchers concluded, “College students have a very erratic eating patterns, with some eating regular meals while a large percentage had fairly erratic dietary habits.” And, “Students consumed approximately a whole day’s more of fat during the week than recommended, while at the same time having about a day’s less of calories consumed across the 7 days.”
Dr. Janelle McDaniel, Assistant Professor at LA Tech, com- mented on the study saying, “It’s important to consider the interaction between different factors such as sleep and eating habits when thinking about wellness globally because treating one particular factor may not address underlying conditions.”
“The relationship between sleep and eating habits and food consumption may be more complex than initially believed,” the researchers concluded.
Dr. Buboltz said that the group has “developed an intervention program for college students called the ‘step program’ and it’s basically training students to learn appropriate sleep habits, sleep hygiene and sleep education.”
Sleep hygiene, explained by Dr. Buboltz, is “Doing things that promote sleep, like not drinking coffee past five, not working out at midnight or eating a lot of food before bed, but relaxing before going to sleep.
“What we do is look at the impact of sleep quality and sleep durations, and various outcomes,” Dr. Buboltz said. “We look at how it relates to college adjustment, physical health, mental health, food consumption, and attention.”
Drs. Buboltz and McDainel, and also Lauren Tressler, also presented “Eating Habits and Patterns of College Students: A Preliminary Study, at the American Association of Behavioral and Social Sciences, 14th Annual Meeting in Las Vegas in February this year.
He noted that their goal for these types of studies was “learning about what’s appropriate. Most people don’t know you’re supposed to sleep eight to nine hours a night. Most people don’t know about the amount of caffeine in food. Chocolate is actually worse for caffeine content than Coke! Colleges are bad about having intramural sports events at nine and ten o’clock at night and that prevents them from going to sleep.”
Dr. McDaniel said, “Sleep is a particularly vital factor in college students health.” And for college students even technology can be a crucial element in sleep health. One of the pilot studies that Dr. Buboltz and his team conducted was to examine the relationship between youngsters and their cell phones. “They became little mothers to their cell phones,” he explained. “They became hyper vigilant to answering their cell phones rather than sleeping,” and this can be a habit that can follow one into adulthood.
Future research for the group will be “anything that deals with sleep quality or sleep duration we’re either working with it or planning a study, but we’re mainly focused on its effect on health,” Dr. Buboltz said.
It is a growing and interesting field according to Dr. Denise Sharon. “I got into sleep medicine completely by chance,” she told the Times. She stayed with the field because she enjoyed the “newness” of the area and “the chance to make a difference.”
“When I started I knew everybody or almost,” she said. “The AASM [American Academy of Sleep Medicine] had only about a thousand members … It was easy to get involved and participate and become part of related sleep organizations such as the Southern Sleep Society, which is the oldest regional society.”
Dr. Sharon is now president of the Society. “We are going to have our 34th annual meeting next March,” she said. “The Sleep Research Society, the World Association of Sleep Medicine that tries to promote Sleep Medicine education around the world, the International Restless Legs Syndrome Study Group… It was a welcoming atmosphere to present research, to review papers, to participate in the making, to be recognized for contributions … I easily made numerous friends.”
“Sleep affects major area of life from birth to old age, multi-faceted, new and developing, exciting and friendly colleagues, all but one, treatable conditions with good response. So who in his right mind would not love it?” Dr. Sharon said.
With the overlap between major areas of psychology, psycho- physiology, attention, emotion, Dr. William Waters still finds this area to be perfect for those in psychology and for himself an enjoyable professional activity. “The best clinician you can have is one with an integrated perspective,” he said. And, “It’s fun,” he added “and intellectually satisfying.”
(–Natasha Jordan is a student at ULM, and the Times’ North Louisiana Correspondent)