All In The Mind

In his book Faster, James Gleick writes, "The mere presence of an alarm clock implies sleep deprivation and what bedroom doesn't have one?". Going without your full quota of shut-eye in this globalised 24/7 world of ours has become almost compulsory. As we head for shift work nirvana, are we facing a pandemic of fatigue? Could science do away with the need for sleep altogether? World renowned sleep expert David Dinges reckons too little sleep is getting in the way of healthy wakefulness...Prop your eyes open with matchsticks, and tune in.

Transcript

Natasha Mitchell: Hello, Natasha Mitchell on this side of your radio with this week's edition of All in the Mind, thanks for tuning in.

Are you feeling a little sleep deprived these days? Well join the club - as James Gleick writes in his 1999 book Faster, "The mere presence of an alarm clock implies sleep deprivation and what bedroom doesn't have one?"

It's a sobering reminder that all is not well in the land of slumber.

Lily: I took up a job which required me to start work at midnight so my shift actually started a midnight but I'd probably turn up to work a little bit earlier so I'd start at 10pm and went until about 6 in the morning and that was when I became severely sleep deprived and unhinged.

I'm not really a night owl and I think this is really a key thing, I am really physiologically a person who wants to be in bed by 10pm, 1030pm but at the time I really needed the job so you know I was weighing it up all the time in my head thinking I really want to quit, I just can't do this, this is hell but I think there was an attitude of listen, you are lucky to have this because you know it's a globalised world as my boss used to say, you know it's a 24 hour world and we need people to work these shifts and you know, there's a lot of other people who would love this job. It was really fairly traumatising.

David Dinges: Why did humans come up with all these crazy systems if it's not biologically healthy or it's not the way we're programmed. For me the parallel of that is why didn't the fish go to the moon. It's the fact that we have this big pre-frontal cortex in our brain that cooks up this control of time and allows us to be creative and inventive, and...

Natasha Mitchell: And ultimately self-destructive.

David Dinges: Well it wants us - it also has all these schemes for keeping us up and keeping wakefulness and consciousness going. The lower part of the brain where all these control systems are for putting you to sleep says 'I don't think so!'. And in a sense we're at odds with ourselves, our own brain is at odds with itself. The top part wanting to be awake and enjoy and use the internet and fly and work shifts and the bottom part saying no, when it's dark on this planet you sleep, and when it's light you are awake. And what we do then in modern societies is we put all of our technological energies into pharmaceutical agents, technologies to try and beat the biology, to control it.

If you're looking around for a resource to use in time - there's this thing called sleep sitting out there - so why not nibble away at that? Take an hour here and an hour there of sleep time to do that extra activity you wanted to do or to live life more fully, or work two jobs and gain more income. What is remarkable is how endemic this is to modern industrialised cultures. There is this terrific sense that sleep is a resource that we can draw on for more wake time, unfortunately that ignores the fundamental biological imperative of sleep that is so essential for our healthy wakefulness.

Natasha Mitchell: Professor David Dinges, a world renowned expert on sleep loss and fatigue who was recently in Australia as a consultant with VicRoads. And before him, recovering shift worker Lily, and more from both of them later.

Today on the program the question are we experiencing a pandemic of fatigue and could science make regular sleep unnecessary in the quest for shift work nirvana?

Reading from Manhole 69:
None of you realise it yet, but this is an advance as big as the step the first ichthyoid took out of the protozoic sea 300 million years ago. At last we've freed the mind, raised it out of that archaic sump called sleep, it's nightly retreat into the medulla. With virtually one cut of the scalpel we've added twenty years to those men's lives. For the first time Man will be living a full twenty four hour day, not spending a third of it as an invalid, snoring his way through an eight hour peep show of infantile erotica.

Natasha Mitchell: An except from J.G. Ballard's 1957 sci-fi story, Manhole 69 in which a scientist undertakes a sinister experiment on three subjects in an effort to remove their need for sleep altogether. But could this be close to fact than fiction?

Dr Paul Martin is author of Counting Sheep - the science and pleasures of sleep and dreams. And he despairs at what he describes as a growing and deep-seated prejudice against sleep. Especially for those in public life, functioning on almost no sleep seems to have become a sign of machismo and in recent history there's been a tendency to celebrate those who have achieved the extraordinary things with very little rest.

Paul Martin: There is an awful lot of mythology in this area as well. You know, the idea of people who can function superbly on three or four hours sleep a night, you know Mrs Thatcher was always held up in this country as an example of that.

If you actually look into it you find that many of these people actually spent more time asleep that they claimed. And if they weren't doing that they were napping. There's been throughout history, again, this rather sort of critical attitude towards sleep.

Dr Samuel Johnson a long time ago put it I think very clearly, he went around like a lot of people preaching that people should get up early and go to bed late and one of his most popular quotes in his time was "preserve me from unseasonable and immoderate sleep". But you know when he was off his guard talking to James Boswell it all came out and there's a quote in the book which I just love from Johnson where he says, "people are more influenced by what a man says because they are blockheads. I have all my life long been lying til noon, yet I tell all young men, and tell them with great sincerity that nobody who does not rise early will ever do any good".

Natasha Mitchell: So he was having us on?

Paul Martin: Yeah, they were because you know it was seen as a right and proper thing you know, just like in the 80s you know, greed is good, lunch is for wimps, so I think he thought that sleep is a waste of time, we should be out partying or working and not wasting our hours in bed. And I think this is a very ill conceived view.

Natasha Mitchell: In some countries the great tradition of the afternoon siesta is under threat or has even been banned. Cheating sleep has become almost an economic necessity.

David Dinges is Professor of Psychology and Psychiatry and Head of the Division of Sleep and Chronobiology at the University of Pennsylvania.

And he's estimated that only around 10% of us can in fact consistently cope with less than 8 hours of kip a night. The rest of us who are having less than this are accumulating a chronic sleep debt. That's a frightening thought.

David Dinges: Yes, the truth of the matter is whenever someone reads an article or listens to an interview like this where I say something like that I get hate mail afterwards from people. It's not really hate mail it's just that they're annoyed that I would suggest that if they've been a lifelong you know five or six hour sleeper how dare me suggest that they might not be all they can be. And I really don't mean to suggest that there are not genetically short sleepers, they don't need eight hours a night, but they are actually relatively rare in my estimate and in fact, most of us are really working off of the average sleep need of about eight hours a night but we're chronically reducing it and what we've been able to do in the last few years my colleagues at my laboratory is do a series of Herculean studies where people live in a laboratory for two to three weeks at a time and we give them dosages of sleep to live on.

We've been able to unequivocally establish that there is such a thing as a sleep debt and it does in fact lead to growing cognitive impairment, difficulties in remembering, a tendency to lapse, difficulties with attention and that there doesn't seem to be anyone in the populations we've studied who's complete immune to that.

And in all cases what we find are these astonishing dose response curves - that is functioning steadily degrades. So if you're living on four hours sleep a night and by the seventh night of that your impairment level is equivalent to someone who's been awake for two nights, 60 some hours. So these deficits become quite severe and they don't seem to attenuate over time.

What does seem to change over time in a different way are your feelings about all this. People tend to start claiming that they've adapted to it and so they become deluded in believing they're fine when in fact their cognitive function's quite eroded.

Natasha Mitchell: And what's happening to them physiologically, you've made some interesting measurements around the immune system and its ability to cope with, or not as the case may be, with sleep deprivation?

David Dinges: Well we see evidence of the molecular markers of inflammation occurring, their monocyte levels begin to go up, their cytokine releases increase in plasma and finally, very recently, we have evidence that a molecule that's a marker for risk factor for cardiovascular disease goes up.

So there are physiological changes, there not in the direction one would hope for, they're bad, but we don't know yet how clinically significant they are. It looks like you do in fact need your full quota of sleep and that many people are chronically under-sleeping. I think the reason they get away with it is because of the weekend.

Natasha Mitchell: Ah, right.

David Dinges: They oversleep on the weekend.

Natasha Mitchell: But is that enough to catch up and cancel your sleep debt, just little sleeps during the week and a big whopping sleep on the weekend, I know that certainly is how I manage my sleep deprivation issue?

David Dinges: That's a very important question and I have to tell you there's been astonishingly little research worldwide on the role of recovery sleep. How many nights of extended sleep do you need to recover from a sleep debt? There is enough evidence to say you need more than one night and it looks like you may need more than two in some studies, in some populations.

Natasha Mitchell: David Dinges, and you're listening to All in the Mind on ABC Radio National and internationally on Radio Australia and the web - I'm Natasha Mitchell.

Lily: You just feel absolutely wretched and if you're driving home and you're watching everyone going for their morning jog and getting up and going to work and it's like 6-30 in the morning and you know, it's a beautiful sunrise or the sun's just come up, you just feel like death like this bizarre sort of vampire type person going 'oh, I'm this ghoulish creature crawling home to bed' when everyone else is you know up and alive and you just feel so out of sync with the rhythm of the world.

Natasha Mitchell: Well when it comes to not getting the full quota of shuteye shift workers are perhaps the most deprived of all. As Lily can testify flying in the face of your biological clock isn't easy and there's now even a condition called shift worker syndrome to describe the set of debilitating systems that come with working strange hours.

Natasha Mitchell: Well you're doing some interesting work with both NASA and also various military agencies including the Air Force in the United States and here are examples of very extreme cases of sleep deprivation. I was interested to read one major military research agency in the USA has written about its focus on sleep research and they are pouring quite a bit of money into this. They wrote that "In short, the capability to operate effectively without sleep is no less than a 21st Century revolution in military affairs". Now you're involved in this research, what sorts of scenarios do people find themselves in terms of depriving themselves of sleep in these professions?

David Dinges: Well what you find is when you look at any of these very complex systems people need to be awake around the clock to operate the system. In the 1970s in the United States we got some very, very large complex systems with high lethal potential. We got nuclear power plants which I know you don't have in Australia but we have them here, we got super-tankers, these giant tankers that hold oil and we got wide bodied aircraft. In other words we got these very large, heavily automated systems and if something went wrong they could be quite lethal to people or to the environment. And at that point you started to see terrific pressure for people to be awake and monitor these systems 24/7 and the practice of military operations really since World War II also evolved in this direction and in fact, began exploiting the night.

Natasha Mitchell: So sleep deprivation has become a tactical necessity?

David Dinges: Well in a sense it has and well, I'm certainly not doing classified research and don't sit around condoning the human predilection towards a military conflict. The reality is that cultures and societies still engage in this and they use the night, they use the clock and so does the Space program only not for war in that case you've got people orbiting the planet.

Natasha Mitchell: So what's your work with NASA trying to achieve?

David Dinges: Well the same sort of thing. How do you keep people healthy and behaviourally effective to the point of being safe when they can't get normal biological cues for when they should sleep and wake and when they can't get enough sleep for whatever reason.

Natasha Mitchell: Part of your work in this field of trying to keep people awake healthily which is slightly ironic given that you've spent all this time in your research life actually establishing that sleep deprivation is physically bad for you. But part of this work exploits a drug that is available in the USA called Modafinil and it's a so-called wakefulness-promoting drug. This has been around for some time I take it but its use today is especially triggering some tricky issues, particularly the question of could science make sleep almost unnecessary? What exactly is Modafinil?

David Dinges: Well no one knows for sure the precise way on which Modafinil works in the brain but it was discovered in France by a pharmaceutical company in the 1970s and what makes it so interesting is unlike traditional stimulants like amphetamines which can be addicting and dangerous and have very nasty side effects in agitating you and disturbing your sleep, Modafinil seems to promote wakefulness without do many of those very nasty things.

Natasha Mitchell: What is it?

David Dinges: Well it's a drug that seems to effect areas of the brain that are fundamental for just creating natural, what looks like natural wakefulness, that is wakefulness without agitation, wakefulness that feels somewhat effortless. It is a stimulant and the Food and Drug Administration of the United States has approved it for the treatment of the debilitating sleepiness that occurs with a very nasty sleep disorder called narcolepsy.

Natasha Mitchell: And this is where people find it very difficult to stay awake?

David Dinges: Correct, and I want to acknowledge that the company funds some of my research but my comments now have nothing to do with what they fund or not. But there has been no really good effective way to treat sleepiness pharmacologically. And for that reason scientists are very excited about it, clinicians are excited. But the proof's in the pudding. What is particularly important I think is that the public needs to understand this may be the first of many compounds.

Natasha Mitchell: But I understand that a major concern then with a product like Modafinil and I should point that it's not available in Australia as yet but it is being slated for approval - But I understand a major concern with Modafinil is that people like shift workers or people who just want to stay up all night and party over a couple of days are equally attracted to this product. Clearly this is a major concern?

David Dinges: Well that's right and you know it's very, very important to discriminate here a medicine that's controlled and should only be used under physician's directions for specific symptoms or disorders that it's indicated for and a recreational drug. And this is not a recreational drug and what needs to be discussed is where does lifestyle preference stop and medical intervention begin and we've got to be very careful here. I think though the temptation will be terrific, it's not just another caffeine coming, you know the use of caffeine is exploding in the world in this country, the United States, we have 150 million people taking caffeine daily, we have caffeine in all of the beverages, or many of the beverages that our children are drinking, our pre-teens and teens, we have larger dosages of caffeine than ever before.

Natasha Mitchell: The panacea, the collective panacea for sleep deprivation.

David Dinges: Well you know caffeine is a stimulant, it does bind adenosine receptors in the brain and it will promote wakefulness up to a point. The problem is you develop tolerance to it so you can't get as much effect from it any more, if you drink too much of it too regularly, and it also produces if you take high dosages of it, it can produce changes in thermo-regulation, in stress hormone levels etc. And that's one of the reasons I'm concerned relative to Modafinil, the way people clamour for it now to deal with the sleep debts suggests that they'll clamour for whatever the next thing is that comes along.

Society may decide that in certain circumstances it's OK to have a relatively scientifically proven, safe drug to promote wakefulness when a pilot of a military aircraft or somebody absolutely positively has to be awake. But on the other hand where do we draw the line, how do we decide what the limits are to occupational use and I think we have to be very careful here. We also don't know what the long term consequences are of promoting wakefulness in the face of a sleep debt.

Natasha Mitchell: What are the limits of a product like Modafinil, I mean for how long can it be sort of a quasi-replacement for sleep.

David Dinges: Those studies have been done but within the range of the scientific literature that exist and there are hundreds of studies on this drug now, it doesn't completely substitute for sleep. This is not a drug that makes sleep go away, what it does is make it easier to stay awake but only up to a point. Now some of the studies that we're doing for the United States Air Force tried to understand how far can you go with it. And those studies aren't completed yet so I can't give you the final answer but studies like that in our laboratory and in other laboratories will ultimately define it's limits but it definitely has limits. I already know that if you take it in too high a dosage you are more likely to get side effects like headaches and other problems. So clearly this is not going to be the absolute substitute for sleep but there may be other drugs coming out down the line as more and more of the brain mechanisms that regulate sleep and waking become known and become targets for biotechnology.

Natasha Mitchell: I'll put this question to you then. In light of some of the work that the military is doing around the world, could science make sleep almost unnecessary - is this a brave new world of sleep deprivation?

David Dinges: Well let me put it to you this way, that question which may have seemed impossible 50 years ago is now being asked.

That is a remarkable scientific question and I was in a room with my colleagues to discuss an initiative in this area and we were, it was a very bizarre meeting because at first someone would crack a joke and we would laugh hysterically at the absurdity of it and then we would talk very seriously for about 30 minutes on various genetic molecular systems in science and other approaches to it...pharmacologic, and then we would laugh hysterically again at it and it really highlighted the impudence of humans asking such a question. It is definitely futuristic, it's not yet a brave new world because the truth is no one's done it.

Natasha Mitchell: Professor David Dinges there from the University of Pennsylvania.

And finally, just in case you're yet to be convinced that sleep deprivation sucks, science writer Dr Paul Martin is eager to remind us of the great joys of sleep, the pure bliss of bunking down for the night, or whenever the hell you want to.

Paul Martin: Not only is sleep something you have to do, it's something you can also potentially extract a lot of pleasure from and I think a lot of people are missing out on that. Again if are like this perhaps an analogy here with say eating. In the UK in the post war period, eating was by and large something people did in order to sort of stay alive, the food wasn't regarded as important, the quality of food was poor, people sort of shovelled it in to keep the boilers going but it wasn't seen as a particularly pleasurable activity. Nowadays you know, TV is full of cooking programs, we have a much more gourmet attitude towards food and eating. It is seen as a form of entertainment, a sort of pleasure as well as simply a biological necessity. I think our attitudes towards sleep has been mired in that kind of 1950s you know canteen food era where people climb into bed late at night exhausted, they shut their eyes, go into oblivion, they fall asleep very rapidly because they're tired. They are woken up the next morning by an alarm clock, and because they're woken abruptly they don't remember their dreams. We all dream every night, arguably we dream throughout the night but if you don't remember it when you wake up you're not conscious of it. So sleep is just this sort of period of oblivion that happens - that we're not conscious of at the time.

Natasha Mitchell: We've become excessively utilitarian perhaps about our sleep?

Paul Martin: Absolutely, whereas for example, napping in the day, dozing and in particular becoming better at connecting the dreams and enjoying the dream experience those who do it, do get a lot of pleasure from it.

Reading Manhole 69: Sometimes Neill's aggressiveness surprise him; it was almost as if he regarded sleep itself as secretly discreditable, concealed vice. What I really mean is that for better or worse, Lang, Gorrel and Avery are now stuck with themselves. They're never going to be able to get away, not even for a couple of minutes, let along eight hours. How much of yourself can you stand? Maybe you need eight hours off a day just to get the shock of being yourself. What happens if they get fed up with themselves?

Natasha Mitchell: A brave new word of sleep deprivation from J.G. Ballard's 1957 Sci Fi story Manhole 69. And Paul Martin's latest book is called Counting Sheep, the science and pleasures of sleep and dreams. And it's published by Harper Collins. Thanks today to producer David Rutledge and Studio Producer Jenny Parsonage.

You can check into our website for transcripts and audio of the program at abc.net.au/rn and just click your way to All in the Mind.

Next week our Science Week public forum, the Nature of Evil, I'm Natasha Mitchell, feeling like a nap and proud of it.

Guests

Dr Paul Martin
Science writer and behavioural biologist

Professor David Dinges
Professor of Psychology in Psychiatry Chief, Division of Sleep and Chronobiology Director, Unit for Experimental Psychiatry University of Pennsylvania School of Medicine Department of Psychiatry Philadelphia, PA 19104-6021
mailto:dinges@mail.med.upenn.edu

Further Information

Professor David Dinges website

Australasian Sleep Association Inc

Sleep Research Society (USA)

Publications

Title: Counting Sheep - The Science of Pleasures of Sleep and Dreams
Author : Paul Martin
Publisher: HarperCollins Publishers (2002)
ISBN: 0 00 257066 1

Title: Faster: The Acceleration of Just About Everything
Author : James Gleick
Publisher: Little, Brown and Company (1999)
ISBN: 0 316 88335 2

Title: Manhole 69
Author : J. G Ballard
Publisher: Jonathan Cape (1967)
Collection of short stories first published in 1967