The torture of sleep deprivation

A couple came to see me as the last stop before initiating divorce proceedings. Since the birth of their son 18 months before, their home had deteriorated into a war zone. Their baby had colic and was a particularly bad sleeper. Typically, the baby would squawk, and mom would jump up to try to settle him before he woke properly. Inevitably, he did wake and then stayed awake for hours. Mom would become tearful and desperate. Knowing this, dad would also jump up when baby stirred because he wanted to support mom.

Both parents were exhausted. Mom was in a constant state of emotional disarray, weepy and angry. Dad was cynical and sarcastic. Both felt that the other was doing less than their fair share. They constantly argued, mainly about sleep training strategies. Also, mom had flu which she couldn’t shake. Dad was making silly mistakes at work, and his anxiety was mounting as he constantly had to put out fires.

Another one of my patients was passionate about an online game called Overwatch. He felt that it was his only joy after a day of work in a frustrating job. His typical pattern was to grab a takeaway on the way home and start playing as soon as he could. He often played until the early hours of the morning. Even when he did try to unplug earlier, he would be plagued by insomnia.

Three patients, all struggling with chronic sleep deprivation. They all recognised their sleep debt and realised that it caused exhaustion. But sleep deprivation affects much more than fatigue. It can make you physically and mentally sick. It is a social problem too. A report released by the AAA Foundation for Traffic Safety suggests that drivers who sleep only five or six hours in a 24-hour period are twice as likely to crash as drivers who get seven hours of sleep or more.

During sleep, the brain makes use of microglial cells to vacuum up waste products so that the brain can function efficiently, just as the body has a lymphatic system to mop up waste. The brain needs sleep periods to enable the microglia to do their work. We need four to six sleep cycles for this to happen effectively (each cycle lasting about 90 minutes). If this does not happen, waste builds up, and the brain ceases to function adequately. The ability to concentrate, remember and learn is impaired, hence the dad’s struggles at his work.

Judgement gets impaired, including judgement about sleep. Sleep deprived people often say “I have adjusted to less sleep”. They have not.

Sleep deprivation wreaks havoc with emotions, a fact well abused in military interrogation techniques. It can leave one feeling tearful, overwhelmed and irrational, like the mom. It can trigger a full-blown depression, like the gamer.

With the couple, we reframed lack of sleep as the problem, not the marriage. We worked out a plan which divided the night up into shifts and a night nurse twice a week. Initially, the mom could not sleep during her time off; she was too attuned to baby’s every grunt. So we needed to use sleeping tablets for a short time. As soon as she got a bit of sleep, her mood greatly improved and she was able to acknowledge how hard her husband was trying. She recovered from her flu. Lack of sleep impairs immunity and can increase the risk of certain cancers. So much so, the WHO has listed shift work as “possibly carcinogenic”.

We simply gave the dad permission to sleep, and he could not keep his eyes open. His ability to concentrate was restored, as was his humour. He became worried about his cumulative lost sleep and increased risk of dementia (insomnia is often one of the first symptoms of dementia, and lack of sleep accelerates memory problems). I was able to reassure him that restoring sleep rapidly restores brain function.

The gamer was trickier to help. His mood was persistently low. I was worried about his isolation and addiction (gaming). His sleep hygiene was terrible.   It was not a surprise that he suffered from insomnia.  We are supposed to wind down before bed, not engage in activating activities. Furthermore, the blue light emitted from screens inhibits melatonin production. Melatonin is an important hormone in sleep regulation. My patient was becoming increasingly isolated, steadily more obese, and his mood was depressed. For these reasons, he needed a hospitalisation to stabilise his mood and set up healthier structures and routines in his life. He still struggles with his addiction at times, but he is careful to prioritise sleep. His mood has improved. His weight has stabilised, partially because of a better lifestyle, partially because his brain is producing leptin and ghrelin again (the “feel full” hormones which aren’t produced with poor sleep).

The reasons for sleep deprivation are varied. The consequences are serious. This is one of those places where patients can heal themselves.

**Details are changed to protect confidentiality.