Woman Sleepwalks Onto Subway Tracks

Stories like this one from yesterday seem far too common these days.  Here is some remarkable surveillance camera video recently released, demonstrating a Boston-area woman ambling slowly forward and right into a subway station pit and onto the subway tracks.

Amazingly, this woman wasn’t seriously injured in the incident, and by report she later told authorities that she had fallen asleep on a nearby bench and that she probably sleepwalked onto the tracks.  According to the clock on the video, this incident took place at 8:41 in the morning.

Here’s just a brief word on sleepwalking, a fairly common phenomenon particularly in children, teenagers, and young adults.  Sleepwalking is a form of non-REM parasomnia–in other words, an unusual movement or behavior occurring during or immediately out of non-REM sleep (i.e., non-dream sleep).  Such events tend to occur more frequently if you are in a position in which you tend to have a lot of deep non-REM sleep (such as if you are sleep-deprived) or if there is something in or around you that causes abrupt arousals from sleep.  In the case of this particular woman, I have not been able to find a lot of specific information in the media pertaining to why this incident occurred, but if she had fallen asleep waiting for her train around 8 or 9 in the morning, chances are probably good that she had been sleep-deprived (otherwise she probably wouldn’t have fallen asleep there in the first place), and being in an environment with lots of loud noises (have you ever been in a T-station in or around Boston?), well, this seems like a set-up for a possible sleepwalking event.

Our modern world is crazy.  Our lives are fast and furious; we work hard, we study hard, we play hard.  But our busy lifestyles don’t make the need for sleep any less important.  Most adults need around 7.5 to 8 hours of sleep per night to feel fully rested.  Ask yourself how often you are making time for that much sleep at night.  My main take-home point for you this afternoon:  getting proper amounts of sleep, and regularly, may prevent a whole host of potential problems during the day, ranging from reduced work productivity to fall-asleep car crashes to unusual behaviors such as sleepwalking.  And perhaps getting proper amounts of sleep each night may even save your life.

 

Sleep well, everyone, and stay safe!

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Fox News’ Tucker Carlson Falls Asleep on Air

 

The other day, Fox correspondent and commentator Tucker Carlson was caught sleeping while taping the show Fox & Friends.  When he awoke he appeared not to be aware that he had been on air during his nap.  Take a look:

I understand that there were media references to narcolepsy (a sleep disorder associated with nocturnal sleep disruption, daytime sleep attacks, and other symptoms) pertaining to Carlson’s on-air snooze, and that he afterwards stated that he had found his nap refreshing.  However, if you listen to the above video carefully, you will hear him suggest that sleep deprivation may have been to blame:  “I sat in for Sean Hannity last night. It went late and all of a sudden I was sitting there and I was just having these happy thoughts and just dozed off.”

Alas, falling asleep on-air is a phenomenon not new to Fox News.  Just for fun, I present to you yet another incident, this time from the Fox affiliate in Austin, Texas:

This sort of thing shows up in the media from time to time:  someone in a televised program dozing on-air.  It also makes sense for morning reporters and anchors particularly to be prone to this problem, because they typically have to awaken so early to go to work.  Everybody’s having a great time with this latest episode with Carlson, too, as you can imagine:  “Tuckered Carlson!” “Fox Snooze!”  Though these incidents are kind of funny to watch, they also are an opportunity for people like me–who work in the realm of sleep medicine–to make some important points about daytime sleepiness.  Here goes:

1.  Daytime sleepiness is much more commonly caused by plain ol’ sleep deprivation than by narcolepsy.  Most adults require around 7.5-8 hours of sleep per night to feel fully rested, and in our American culture many of us do not make time for this much sleep, at least consistently.  How many people do you know that regularly get 7.5-8 hours of sleep each night?  Sleep deprivation may well be the single most common cause of daytime sleepiness in the U.S.  Narcolepsy, though not necessarily a rare disorder, is much less common than sleep deprivation.

2.  A tendency to fall asleep by accident during the day is not equal to or the same as having narcolepsy.  Narcolepsy is a central nervous system disease, of which daytime sleepiness is a cardinal symptom; however, it is a very complex sleep disorder that we in sleep medicine continue to strive to understand through research.  Many other things can cause daytime sleepiness:  sleep deprivation; irregular sleep schedules; insomnia; untreated sleep apnea; the list goes on and on.

3.  If you really DO have narcolepsy, a brief (15-20 minute) nap usually IS refreshing.  This is one of many potentially distinguishing clinical features of narcolepsy; a brief nap in the setting of sleep deprivation alone may or may not be refreshing, and can often cause the napper to feel worse, not better, upon awakening, because only a small amount of the “sleep debt” was “paid back” during that nap.  For my narcoleptic patients, I in fact typically recommend scheduled naps as part of their management regimen.  But just because you find your naps refreshing doesn’t necessarily mean you have narcolepsy either.

Have a great Labor Day, everyone!

Woman Falls Onto Train Tracks After Falling Asleep Standing Up!

Here’s another scary recent incident in the news pertaining to sleepiness.

In Prague, Czech Republic, a woman in a train station appeared to fall asleep while standing and waiting for her train.  Take a look at this.

This video is fascinating.  From a couple different camera angles you witness this woman gradually giving in to the relentless pressure of sleepiness.  She slowly leans forward as slumber starts to overtake her.  She rights herself briefly in an attempt to regain alertness, but she then walks forward a bit and eventually leans in again, knees buckling, until her body weight finally forces her to tumble onto the train tracks.  Miraculously, she lands in the deep groove between the tracks, and  though the train rolls over her she reportedly gets up, dusts herself off, and walks away after the train departs from the station!

According to reports, upon being questioned her following the incident, this woman told law enforcement officers that she was “merely tired.”  She refused a medical evaluation and breathalyzer test.

This is a dramatic example of the inevitable effects of daytime sleepiness, regardless of cause.  You may have untreated sleep apnea or you may be simply chronically sleep deprived, but the bottom line is that a primary response of your body to poor-quality or poor-quantity sleep is that at some point you will be forced to sleep, including in inopportune times or places and in very dangerous situations.  I’ve had patients, for example, who have come to my clinic because they’ve fallen asleep behind the wheel of their 18-wheel trucks, at the controls of their motorcycles on the freeway, in the cab of their cranes, and in front of industrial saws.  No matter how much you try and no matter how bad your insomnia may be, your body will give in eventually and oblige you to sleep.  Remember, sleep is a required biological requirement; you absolutely need your sleep, and your body will make you get it one way or another.

Have a great Independence Day, everyone!

Morgan Freeman Falls Asleep During an Interview

I can’t resist.

The other day actors Michael Caine and Morgan Freeman conducted a live interview with Bill Wixey and Kaci Aitchison from Q13 Fox News right here in Seattle.  The interview centered around their upcoming film, Now You See Me.  But as you now see here in this abridged clip, Mr. Freeman was having a bit of a struggle staying awake while Mr. Caine spoke.

I like in particular how he arouses briefly, nods his head slowly, as if he’s been fully attentive the entire time, and drifts back off.

Here is an online article, which includes Bill Wixey’s post-interview reaction and also the full video interview with Caine and Freeman.  It’s worth watching the entire interview here:  there is much more sleep time than what is seen in the brief clip above.

http://mynorthwest.com/76/2280849/Seattle-news-anchor-puts-Morgan-Freeman-to-sleep

Now, to be fair about this, this soporific faux pas is likely not Freeman’s “fault,” and is probably not due to boredom, as at least one journalist has suggested.  It appears that Caine and Freeman were interviewed from a studio in New York.  I’m guessing Freeman had flown from Los Angeles to New York shortly prior to the interview, and if this was the case he was probably recovering from jet lag.

Remember, there’s a 3-hour time difference between the west coast and the east coast.  Sleepwise, it’s particularly tough to go from the west coast to the east coast, because upon arrival your brain is essentially asked suddenly to go to bed earlier and awaken earlier than usual, setting you up for insomnia and sleep deprivation.  I know this from experience:  I fell asleep at my table and virtually fell out of my chair once during a loud, boisterous classic rock awards banquet shortly upon arriving in London several years ago.

Additionally, in general, the older we get, the less tolerant our bodies become to insomnia, sleep deprivation, and shifts in our usual sleep scheduling.  So I definitely empathize with our nearly 76 year-old Mr. Freeman, who was sitting in a comfortable, quiet environment during the interview, his uncooperative body clock begging for a snooze.

One final comment.  I’m often asked if you fall asleep during the day just because you’re bored.  The answer is no.  However, if you are prone to becoming excessively sleepy during the day (due to sleep deprivation, an untreated sleep disorder, or the like), then your sleepy tendencies will be more likely to express themselves in the form of falling asleep by accident when you are sedentary as compared to when you’re active.  When you’re bored you’re usually sedentary, so in that setting you’re therefore more likely to fall asleep.  This is an important distinction to make; many people don’t get evaluated for their sleep disorders because they believe that falling asleep frequently during the day is normal because they’re bored.

 

Have a good, wakeful day, everyone!

The Perils of Drowsy Driving

It’s 1 a.m.  You debated all day about how good of an idea it would be to drive all night to get to West Palm Beach, but the advantages of taking the chance won out:  you’d beat the traffic, and the time you’d save by getting there by early morning would make the challenge of pulling an all-nighter worth it.  So now you’re on a highway, quite alone and in pitch darkness.  The road is straight and monotonous.  You start to count the mile markers out of boredom.  After an hour and a half, things start to look blurry.  A hazy veil starts to descend slowly over your eyes and upon your brain.  You realize what is happening, and you shake your head violently to become more alert.  You roll down the windows, but the Florida late spring night air bathes your car interior with humid heat.  You crank your car stereo up to eleven.  Passing sign says, “rest stop, 40 miles.”  You push on, propelled by your determination and time.  You sing loudly to the Def Leppard song playing on the only rock and roll station you can find on this desolate stretch of road.  Soon, however, without realizing it, you gradually become silent.  You feel yourself giving in despite yourself.  You suddenly find yourself parked in the rest stop, but for the life of you you cannot recall how you got there.

 

Many of us (myself included) have been in this situation before.  You would not believe the stories I hear from some of my patients, who have fallen asleep behind the wheel of their 18-wheelers, behind the wheel of their school buses, or at the controls of their motorcycles on the freeway.  It should frighten you to know that many many thousands of people in the United States drive drowsy, including right next to you, every day.

Here are some sobering statistics.

According to the National Highway Traffic Safety Administration, over 100,000 police-reported motor vehicle accidents occur in the United States each year due to drowsiness; this number is likely an underestimation of the total number of fall-asleep car crashes in this country, because undoubtedly there are many accidents (particularly single-car crashes) that are never reported.  Due to these 100,000 crashes, roughly 40,000 injuries occur every year, and 1,550 people die per year.

According to an NHTSA-sponsored telephone survey report entitled “National Survey of Distracted and Drowsy Driving Attitudes and Behaviors,” 37% of drivers polled have nodded off for at least a moment or fallen asleep while driving at least once in their lives while driving; 8% have fallen asleep driving within the past six months.  Falling asleep behind the wheel appears most common among drivers age 21-29 and males, and least common among drivers over age 64 and females.

71% of 18-29 year-olds have reported being drowsy while driving.  50% of 30-64 year-olds have reported being drowsy while driving.

It makes sense that people are found to be most likely to fall asleep driving in the early morning hours, particularly 2-7 a.m.  People are also particularly at risk after having driven for long periods of time (3-4 hours or more) or if they are sleep-deprived (i.e., under 6 hours of sleep) the night prior to driving.  Paradoxically, the faster people drive, the statistically more likely they will become involved in a fall-asleep car crash, presumably because unlike in-city driving with all its starts and stops, highway driving is continuous, sedentary, and monotonous, making one predisposed to drowsiness prone to head-bobbing and dozing at exactly the time in which being alert is the most necessary.

You’ve probably heard that drowsy driving is every bit as dangerous as drunk driving.  I would go one step further and say that drowsy driving is in some ways more dangerous than drunk driving, simply because there are just so many drowsy drivers out there all the time, particularly at night, but also during the day.

So, some simple tips to reduce your likelihood of falling asleep behind the wheel:

1.  Get proper amounts of sleep each night, and particularly the night before a trip.
2.  Avoid driving, particularly long distances, late at night if you can possibly help it.
3.  If you HAVE to drive late at night, bring a driving buddy.  Consider coffee or a caffeine-containing energy drink.  Some rest stops have free coffee to prevent drowsy driving, but don’t count on coffee being available to you in this way.  Be prepared.
4.  Take a break frequently, even if you’re not drowsy.  Find rest stops, pull over, get some fresh air, walk about.
5.  Pull over and take a nap if you have to, and lock your car doors.  Better to show up late than to show up dead.
6.  NEVER, EVER operate a vehicle or machinery if you’re drowsy or fatigued.  Period.

 

What About Naps?

Thank you, everybody, for your recent inquiries.  I’m happy to help!

The other day I was asked about daytime naps:  “is it better to take a nap when you are feeling really tired that day or try to go to bed earlier instead and skip the nap?”  In order to best answer the question, it’s important to know what is causing you to want or need the nap in the first place.

 

The science of sleep regulation is quite complex.  Sleep intensity is mediated by what is called the homeostatic mechanism of sleep, the specifics of which are beyond the scope of this blog entry.  Simply stated, the principles of sleep homeostasis dictate that sleep deprivation results in a compensating increase in intensity and duration of sleep, and excessive sleep (such as related to a daytime nap) reduces the inclination for sleep.  Taking a nap during the day implies daytime sleepiness, so let’s explore why one may be sleepy during the day.

One of the most common causes of daytime sleepiness is simple sleep deprivation.  If you’re getting 5 hours of sleep per night, for example, when your body needs 8, then likely you will not need to take a nap during the day any longer if you then gradually increase your sleep time to 8 hours per night, because by satisfying your body’s natural sleep needs consistently you should eventually feel substantially more awake and alert throughout the day.

Another common cause of daytime sleepiness is insomnia.  If you get less sleep at night because you’re awake a lot in bed, an obvious consequence would be feeling fatigued and drowsy during the day.  The problem is that taking a nap during the day can cause or worsen insomnia, particularly if the nap is prolonged and/or taken in the mid-afternoon to early evening; you tend to get a “second wind” and feel more awake and alert later than what you desire, resulting in further sleeplessness at night.

Finally, you could be sleepy during the day due to a problem with the quality (as opposed to the quantity) of your sleep.  Numerous sleep disorders can cause substantial drowsiness during the day even if you get your 8 hours per night:  obstructive sleep apnea, upper airway resistance syndrome, periodic limb movement disorder, and narcolepsy to name a few.  A good general rule to follow:  if you regularly get 7-8 hours of sleep per night and you’re consistently struggling to stay awake during the day when 7-8 hours per night used to satisfy your sleep need in the past, and if the sleepiness can’t be explained by some other factor (like medications or alcohol), you may want to see a specialist like me.

OK, synthesizing this down, then, here are my personal primary clinical concerns about napping:

1.  If you nap because you’re sleep deprived, there is often residual sleepiness between the time you awaken in the morning and the time your nap starts.

2.  If you nap due to insomnia, a vicious cycle can develop:  the nap can cause or worsen the insomnia, which then reduces your nocturnal total sleep time, which then makes you feel more sleepy during the day, which then makes you want to nap more.  In extreme cases people’s bedtime schedules can be completely turned around due to this problem, such that they become essentially nocturnal, sleeping throughout much of the day and remaining awake all night.

3.  Taking a nap to sustain you for the rest of day may “mask” concerns for an occult sleep disorder.

Bottom line here:  if the nap doesn’t cause difficulties falling or staying asleep at night, and if you don’t have substantial daytime fatigue or sleepiness prior to the nap, and if you’re confident you know the reason why you need the nap in the first place (such as staying up too late the night before), then I think there’s probably not much of a problem with taking that nap.  However, if you find yourself unable to stay awake during much of the day, if you are substantially sleepy during the day despite getting proper amounts of sleep, or if you are having mounting insomnia in this setting, there should be further concern about what is happening.

I’ll add several additional points before Sleep Help Desk closes for today.  First, naps can be intentional (i.e., laying down with the intention of taking a nap) or unintentional (such as falling asleep by accident in front of the television).  Second, if you doze off on the couch at 10 p.m. before you go to bed, that’s still a nap!  That late-night nap can cause difficulties falling back to sleep once you do go to bed, so try to avoid dozing off in the evening until you’re in bed intending to sleep.  Finally, to answer the original question posed to me above, I suggest not going to bed too early if you choose to not take the nap.  If you go to bed way earlier than usual, you can still have insomnia even if you’re sleep deprived, because your body clock “wants” regularity nonetheless.  The idea is to gradually increase your total sleep time such that you reliably get proper amounts of sleep every night.

Trivia question:  who is the famous person napping in the photograph above?  Write me with your answer!

Cheers, everyone!  Keep your questions coming!

Is Daytime Sleepiness a Problem?

 

The answer, of course, is yes.  However, it may not necessary feel like a problem to the sleepy person.  Why?  Because if you’re used to feeling a certain way during the day for years, and if there’s no pain or other immediately negative consequence involved, then that way feels tolerable for years and thus becomes normal–to you–because what feels normal is simply what you experience regularly and every day.

Here is a not-uncommon scenario in my clinic.  A man and his wife walk in.  I ask the gentleman if he feels sleepy during the day.  “Not at all,” he may tell me, or he may reply with a more vague “not any more than usual” or “not any more than anyone else.”  Does he tend to doze off if he’s in front of the TV, for example, I ask, or while reading at home?  “No, never,” he replies casually.  This is when the silent eye-rolling from his wife, who cajoled him for months into this visit, changes to an exasperated gasp.  The frustration now is just too much for her.  “He falls asleep all the time,” she tells me, much to the man’s annoyance.  “No I don’t!,” he exclaims, challenging her angrily with his eyes.  “You fall asleep at the dinner table!,” she returns.  “Every night!  Even when we have company!”  The exchange continues in its escalation, both voices now raised to the point in which they can be heard outside the clinic room.  There have been times in which I’ve had to intervene in a mounting spousal fight over this question of sleepiness.  It’s not like he thinks she’s deliberately lying.  He may believe she’s exaggerating, and may accuse her of being prone to exaggeration during this visit.  But the primary problem here is more inscrutable:  the manifestations of daytime sleepiness just don’t seem to be a problem to him like they are for her–what’s wrong with napping when you’re bored, after all–and therefore he doesn’t believe it signals the presence of a medical issue or something that needs to be acted upon or repaired.

There are several problems with this logic.  First, the tendency to drowse and fall asleep by accident, though not necessarily painful in and of itself, can in fact lead to things that are painful, like fall-asleep car crashes.  According to the National Highway Traffic Safety Administration, about 100,000 police-reported car accidents occur in the United States annually due to or associated with driver fatigue or sleepiness.  I’ve seen patients who admitted to me that they’ve fallen asleep behind the wheel of their 18-wheelers, or while driving their motorcycles on the freeway.  Tell me how this is not a dangerous problem.  Secondly, the idea that it’s normal to fall asleep by accident just because you’re sedentary or bored is not based on fact.  If you get proper amounts of sleep regularly and if there are no sleep disorders, you generally shouldn’t be falling asleep easily during the day, even if you’re bored.  Finally, and importantly, the tendency to struggle to stay awake is a symptom of something, not necessarily the problem itself but an indicator that something is wrong, wrong with the quantity of your sleep, the quality of your sleep, or both.

Excessive daytime sleepiness is an incredibly prevalent problem with far-reaching implications.  In 2008 the National Sleep Foundation conducted a survey (called The 2008 Sleep in America Poll).  Of its respondents, 36% nodded off behind the wheel during the previous year; 29% fell asleep at work or drowsed substantially at work; 20% had sex less often or lost interest in sex due to sleepiness; 14% missed family events, work functions, and leisure activities because they were too sleepy or had sleep problems.

The most common cause of daytime sleepiness is simple sleep deprivation.  The vast majority of human adults require between 7.5 and 8 hours of sleep per night regularly to feel awake and alert consistently during the day.  However, as you are probably well aware, many of us tend to get less than that, and often much less than that.  In addition, there are many medical sleep disorders, ranging from obstructive sleep apnea and periodic limb movement disorder to narcolepsy and idiopathic hypersomnia, for which daytime somnolence is an important clinical feature.  If you are struggling to stay awake during the day despite proper amounts of sleep each night, perhaps a sleep disorder needs to be uncovered and managed.

Bottom line:  daytime sleepiness is in fact a real problem, one that can directly and indirectly impact your quality of life.  Consider doing something about it.

Have a great week, everybody!  Cheers!