Dr Dingle's Blog / tiredness

Essential Sleep (Part 7). Sleep fatigue and accidents

Essential Sleep (Part 7). Sleep fatigue and accidents

Fatigue

Sleep deprivation also contributes to the physiological state known as fatigue.  A fatigued person is accident prone and judgment impaired.  After approximately 20 hours of no sleep, reaction times are comparable to having a blood alcohol reading of .08.  Staying awake for 24 hours leads to a reduced hand‑to‑eye coordination that is similar to having a blood alcohol content of 0.1. An example of a sleep deprivation accident occurred when a space shuttle mission was aborted 30 seconds before lift‑off because a technician who had worked several consecutive l2hr shifts accidentally released 18,000 pounds of liquid fuel just minutes before the scheduled flight. An investigation of the Challenger space shuttle disaster attributed ground crew fatigue as one of the factors contributing to the disaster. An incident such as this shows the seriousness of the situation and the potential loss of life through human related errors in technical fields. Even operating simple machinery such as forklifts can become extremely dangerous if the operators are not filly alert. Other examples of work related sleep deprivation include a flight which flew 100 miles out over the Pacific before controllers on the ground were able to wake the pilots up using chimes, piped into the cockpit audio. It is common practice for flight attendants to check in on pilots to ensure they do not fall asleep. The Exxon Valdez oil spill occurred on a ship with a crew that had had very little sleep, with the accident happening in the middle of the night.

Pain

45 to 80% of all nursing home residents suffer from chronic pain and this pain is strongly linked to insomnia (Dodla and Lyons, 2006). In Japan a survey conducted by Tanaka and Shirakawa (2004) found that one in five Japanese people suffer from insomnia, and within the elderly population one in three suffer, because of this the Japanese government increased the needs of insomnia patients at community health sites and names insomnia a refactory disease of the 21st centuary. A similar Honk Kong based study found 11.9% of Chinese people living in Honk Kong suffer from insomnia approximately three times a week and the females were 1.6 times more likely to show symptoms of insomnia than males (Li et a!. 2002). 

Accidents, errors and Risk taking

Studies using card games have found that with little sleep, players get stuck in a strategic rut. Sleepy people keep taking risks, even though it’s obviously not working for them.

A study of musicians who practised a new song had improved in speed and accuracy compared with before a night’s sleep. a good night’s sleep can also improve motor performance.

In a study of 1891 male employees compared with those working 6-8 h day(-1) with good sleep characteristics, positive interactive effects for workplace injury were found between long work hours (>8-10 h day(-1) or >10 h day(-1) ) and short sleep duration (<6 h). This study suggests that long work hours coupled with poor sleep characteristics are synergistically associated with increased risk of workplace injury. Greater attention should be paid to manage/treat poor sleep and reduce excessive work hours to improve safety at the workplace (Nakata 2011).

A study looking at the effect of working “standard shifts” (that is, the traditionally accepted long, sleepless shifts) for hospital interns showed that the interns made 36 percent more serious medical errors during a standard work schedule compared to during an intervention schedule that eliminated extended work shifts.  The errors included significantly more serious medication errors and 5.6 times as many serious diagnostic errors.  As a consequence, the overall rates of serious medical errors were significantly higher during the standard schedule than during the intervention schedule (Landrigan, 2004).  Fortunately, most serious medical errors were either intercepted by people who were awake and concentrating or did not result in clinically detectable harm to the patient.  How does this affect you?  It might be all right if you could always go into hospital at the beginning of the shift or be operated on only by doctors who had just started a shift. 

One study found that interns who worked 24-hour shifts made 36 percent more medical errors than those working 16-hour shifts and five times the number of diagnostic errors, and were 61 percent more likely to accidentally cut themselves during procedures.

The study found that the rates of serious medical errors in two intensive care units “were lowered by eliminating extended work shifts and reducing the number of hours interns worked each week.” By asking interns to work less, the hospitals improved their performance.

A number of studies have highlighted the increased number of motor vehicle accidents associated with young adults driving fatigued. It’s conservatively estimated that at least 112 lives could be saved in Australia if fatigue and falling asleep at the wheel were eliminated.

Several studies have highlighted the increased number of motor vehicle accidents associated with young adults driving while fatigued.  Fatigue is estimated to be responsible for 35 percent of road accidents.  It’s conservatively estimated that at least 112 lives could be saved in Australia every year if fatigue and falling asleep at the wheel were eliminated.  In the United States, the National Highway Traffic Safety Administration (NHTSA) reports that fatigue and sleep deprivation contribute to about 100,000 highway crashes each year, causing more than 1,500 deaths annually (Sullivan, 2003).  At a grander level the 1989 Exxon Valdez oil spill off Alaska, the Challenger space shuttle disaster and the Chernobyl nuclear accident have each been attributed to human errors in which sleep deprivation played a role (Grunstein, 2000). 

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Essential Sleep (Part 6). Cognitive decine and the brain

Essential Sleep (Part 6). Cognitive decine and the brain

Late night

Research on 59 participants, those who were confirmed night owls (preferring late to bed and late to rise) had lower integrity of the white matter in various areas of the brain (Rosenberg et al 2014). Lower integrity in these areas has been linked to depression and cognitive instability.

 

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Why We Overeat?

Why We Overeat?

I had a friend a long time ago that used to seesaw with her weight many times over the year. Whenever she got depressed or upset she would eat a lot of rich, high calorie foods that gave her some instant pleasure. Her favourites were chocolate, and Milo by the spoonful, straight from the can. Despite her reasons for binge eating, it didn’t bring any happiness and in fact contributed significantly to her problem. We need to deal with the beliefs that underlie the undesirable eating patterns as part of any dietary program.

Examining emotions and habits during a weight loss journey gives an insight as to why people overeat or have a hard time maintaining weight after losing it. The reasons given for overeating and excess weight gain often have similar root causes including boredom, emotional instability, and stress. Some of these I have already covered but the potential list is pretty long.

The major reasons for overeating include and our appetite includes

  • Busyness
  • Time of day (energy levels)
  • Mood
  • Nervous
  • Stress
  • bored
  • low self esteem
  • hormonal
  • hunger
  • peer/social pressure
  • routine/habit
  • media and advertising
  • low price/convenient
  • mental stimulation
  • too busy
  • Feeling Unloved
  • Anxious or restless
  • Happy
  • Angry or jealous
  • Tired
  • Dissapointed or rejected
  • Depressed
  • Emotional
  • Availability

Or if there are real food cravings, it may require some mineral or nutritional supplementation. For example, some sugar cravings can be significantly reduced with chromium or vanadium supplementation. Sometimes more protein-rich foods need to be eaten.

Lets look at some of the main ones

Busyness and stress are often the underlying factors why we put on weight. One way or another it prevents us from doing what we need and know we should be doing. Too busy to exercise, to busy to eat right or buy the right food, too busy to take the time for ourselves, too busy. Woman are often so busy with looking after the family they constantly justify another little treat and poor eating to get them through another day. While both men and woman often become too busy around their careers. Taking a bit more time for ourselves and focusing on our health and healthy eating can make a big difference to our lives.

Emotional weight gain can be a major problem. Hence why any weight control program needs a lot of emotional support. To much weight on the mind can put on weight in the body. In a study of eating disorders in girls in the 7th to 10th grades, which also applies to us as we age, many of them reported an inability to distinguish between emotional feelings and hunger.  Some of these girls were unable to distinguish between scared, angry and hungry and are able to lump all of these conditions together, which leaves them to overeat whenever they have an emotional feeling.  This is no wonder if you look at how we use foods as rewards and distracters as we grow up. Often when we are feeling upset or anxious we use food as a substitute.

Energy lows can be a major appetite trigger, either directly or indirectly is the amount of energy you have. If you understand your daily energy cycles you can avoid many food cravings and not confuse your levels of energy with poor eating habits. Remember, they are just habits. Most binge eating for example occurs in the low energy times of late afternoon and late evening when energy levels are low. At this low energy time you are also more likely to feel in a low mood so the food further acts as an energy catalyst to get you out of that mood. Only the solution is only a short-term mood changer and often has a negative energy and emotional rebound effect. In support of this one study of dieters found that the average time at which relapse occurred was late afternoon at 4.34 pm, about 4 hours after their last meal when they were moderately hungry and their energy levels were low. The majority of cases for temptation and relapse were characterised by upset including anger and by depression or tiredness.

On the other side of the coin research is increasingly showing that how we feel is also affected by what we eat. Research shows links between depression and nutritional deficiencies.  The research also shows that the deficiencies do not have to be excessive to depress the mood. So it can become a vicious circle of food-mood-food. Dieting and food restriction can also play havoc with our moods. In a review of dieters the research concluded that negative moods particularly depression increased eating amongst the dieters. In another study of people who were at least 30% over-weight and ate only a fasting supplement of 420 calories per day over a 10 week period, they most commonly violated their diets in the second month at a time when they were feeling fatigued. Using brain imaging machine when you fast or deprive yourself of food (as in a diet), your brain sees high calorie foods as being far more pleasurable. The cravings and temptation to eat unhealthily, will be far more intense. This is what they found in the short term, at least. It appears The orbifrontal cortex is responsible for how the brain perceives the “value” of a food—or how pleasurable it will be to eat.

There is no doubt the negative effects of low moods and energy have on weight management. For many people when these two are low up goes the weight. Fortunately, for the majority of people, physical activity is the most effective way to raise energy and reduce tension. It produces rapid and reliable results that can change moods immediately. Overwhelming scientific evidence shows that even moderate physical activity has the ability to increase your energy, unlike the energy drinks which actually make you feel more drained. In an experiment where one group was exercising by walking and a control group sat quietly reading over materials there was a significant change in mood that was significant and unmistakable with the walking group. Research has highlighted that 15 minutes of walking produces slightly more energy than 5 minutes but even 5 minutes of brisk walking has a significant effect. After just a 10 minute brisk walk there were still statistically significant effects 60 minutes later and 120 minutes later a week energy increase was still evident. A brisk walk therefore energises the person for somewhere between 30 to 90 minutes afterward.

In a study on unhealthy snacking researchers identified six distinct motives for snaking including opportunity induced eating, coping with negative emotions, enjoying a special occasion, rewarding oneself, social pressure, and gaining energy. Sound familiar? While Enjoying a special occasion and opportunity induced eating were most important. For all reasons except to enjoy a special occasion, younger people reported a higher score. Women indicated a higher score than men on coping with negative emotions, enjoying a special occasion and gaining energy. People who diet to a stronger extent reported a higher score for snacking because of social pressure, to reward oneself and to cope with negative emotions, with the latter also being related to a higher BMI.

Other studies have also made a link between emotions and snacking. One study showed movie-goers watching tearjerkers ate between 28% and 55% more popcorn both in the lab and in a mall theatre. Previous studies have shown that humans who play violent video games show clear signs of distress (ie, negative stress), comprising higher blood pressure as well as reports of less fullness and a tendency to prefer sweet food. Studies suggest that watching scenes of an action movie may cause distress, a condition that can increase food intake in the absence of hunger. One study found action and adventure movies also lead television viewers to eat more calories – but only if the foods are within arm’s reach. With action movies, people seem to eat to the pace of the movie. In contrast, watching an engaging comedy clip has been linked with decreasing tiredness, sadness, irritation, anxiety, and restlessness, while increasing relaxation and joy. Thus, watching a comedy clip may cause eustress (ie, positive stress), which, owing to its high rewarding property, may reduce an individual’s concomitant drive to eat. While another study found that female students ate less grams when watching a comedy program compared with food intake when watching a television (TV) documentary.

Our eyes lie

Another major factor in overeating is the supersize me phenomena. Portion size is a key environmental driver of energy intake, and larger-than-appropriate portion sizes increase the risk of weight gain. Unfortunately the size of food packaging and portions has steadily increased over the past 30 years and these super sized food portions play a major role in weight gain. Simply people who sit down with bigger portion sizes of food are more likely to be overweight and obese while those who maintain a small portion size lower their weight. Whether it is from our parents telling us to eat all our food on the plate or our hunter-gatherer starvation mentality once it is on our plate we tend to eat it and as a result over eat. For instance, one study reported that 54% of American adults generally claim that they attempt to eat until they “clean their plates”. Interestingly very early studies showed this when participants who drank soup through a tube drank less when they had visual contact with the soup than when they did not. Literally a person's eyes may influence how much they consume, leading them to be less influenced by physiological cues of satiation. As a result, their estimate of how much they have consumed and how full they are may have to do more with what they believe they saw themselves eat and less with how much they actually ate. In a study of fifty-one men and women were served lunch of different portion sizes subjects consumed 30% more energy (676 kJ) when offered the largest portion than when offered the smallest portion. Larger portions led to greater energy intake regardless of serving method and subject characteristics. In one study after a 3 month intervention subjects who regulated their portion size had a greater weight change from baseline to the end of the 3-month intervention period loosing 3.7 kg compared to 0.1 kg in the control group showing that portion control is effective to reduce body weight in overweight and obese diabetic subjects.

It is time to have a think on why we overeat and puts some steps in place. Simple strategies like keeping a food mood diary can help you identify any common factors in overeating. While serving food on small plates can make a big difference to how much you eat each meal. Time to downsize our meal sizes.

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