Sleeping Yankees Fan Brings Up Important Point About Sleepiness

Recently 26 year-old Andrew Rector filed a lawsuit against ESPN, Major League Baseball Advanced Media, and the New York Yankees, claiming defamation stemming from broadcasted video of him fast asleep in the stands during an April Yankees vs. Red Sox baseball game.

 

Here is the video in question:

According to the filed materials, Mr. Rector was subjected to an “unending verbal crusade against the napping plaintiff” and an “avalanche of disparaging words against” him subsequent to the game.

In reporting this story, this morning’s television news programs often asked a question not terribly different from that of the commentators:  “how can anyone sleep through something as exciting as a close Yankees / Red Sox game?”

I’m not writing today to provide legal commentary.  However, this incident does bring up an important issue regarding sleep and our collective perception of sleepiness.

There has long been a widely held belief that you naturally fall asleep simply because you’re bored or inactive.  The corollary concept is that if you fall asleep when you’re not supposed to or when other people usually don’t, such as while at work or at an exciting event, you must be lazy, unmotivated, or dumb.  Over the years I’ve seen many patients whose clinic evaluations were initiated by getting fired, suspended or reprimanded for having fallen asleep on the job or in meetings.

I submit that such notions are ill-conceived and unfair.  If you regularly have proper amounts of sleep and if you are free of medications, substances, or medical conditions causing sleepiness, then you really shouldn’t be struggling to stay awake all day long just because you’re physically or mentally inactive.  It’s more accurate to say that a person who is prone to excessive drowsiness (regardless of the reason) tends to fall asleep by accident if sedentary.  The question then shifts to:  why is that person prone to being drowsy in the first place?

I mean, who knows why Rector was snoozing during the ball game?  Maybe he usually gets up at 3 a.m. to get to work, so the game was past his usual bedtime.  Perhaps he holds down two jobs.  Maybe he spent the previous night caring for a sick child.  Perhaps he has an undiagnosed sleep disorder.  Is it really right to make a judgment of a person’s character or work ethic based on a tendency to fall asleep when others are awake?

How “normal” is it to sleep through something exciting or otherwise stimulating?  In my younger years (prior to practicing sleep medicine), and in the setting of chronic sleep deprivation, I routinely slept through fire alarms, tornadoes, tornado alarms, neighborhood car crashes, earthquakes, and parties next door.  I slept through important lectures, grand rounds, and meetings due to not getting enough sleep.  Your ability to stay awake and your ability to arouse from sleep in response to a stimulus depend on a number of factors, including your age, how much sleep you usually get, how regular your sleep schedules are, how much sleep you happened to get the previous night, and what stage of sleep you happen to be in when the stimulus occurs.

I’m not saying it’s OK to sleep through important events, of course.  Here are my main points today.  If you are finding yourself falling asleep in inappropriate times, places, and circumstances, and particularly if your professional and personal lives suffer as a result:

1.  Work to identify the reason(s) for the sleepiness.  Often an underlying cause may be obvious and right under your nose, like getting 5 hours of sleep each night.  We are creatures of habit, though, so lifestyle choices that lead to chronic sleep deprivation may not feel like problems if you’ve engaged in them for a long time.

2.  If there is a specific lifestyle choice that is causing your sleepiness, make a change, even if the change is uncomfortable or inconvenient.

3.  Strive to get proper amounts of sleep (which for most adults is 7.5 – 8 hours per night) on a regular basis to the extent possible.

4.  Should you remain prone to falling asleep despite proper amounts of sleep and after excluding other potential causes, discuss your sleepiness with your doctor; your drowsiness may suggest the presence of an undiagnosed sleep disorder.  You may want to consider an evaluation at an accredited sleep center.

Stay healthy and awake this summer, everyone!

Final thing:  shout-out to my friend Doug, man, you’re an inspiration.

April Fool’s Day Wake-Up Pranks, 2014

Well, Happy April Fools’ Day once again, everyone!

Last year I posted some funny sleep-related April Fools’ pranks:

https://sleephelpdesk.com/2013/04/01/april-fools-day-wake-up-pranks/

To expand on this tradition I’m posting some more humor today.  I present here some of my more favorite sleep-related practical jokes.  This year I’ve had a hard time finding video sufficiently clean to include in this post.  I’ve done my best to screen for language and out-and-out meanness.  As always, do not try any of these pranks at home.

 

Our first gag comes from Japan, land of crazy, well-orchestrated, and televised practical jokes.  The pranks the Japanese show on television would never float here in the U.S., where people sue other people just for looking at them wrong.  This is way over the top, quite literally.  I would hate to be the guy pranked here.  Check it out.

Here is a guy pretending to be so sleepy that he sleeps standing up, leaning in on other people, and generally freaking people out, especially the last guy.  For the record, falling asleep in public places is quite common, though usually not as dramatically as depicted here; people think of narcolepsy when they hear of people falling asleep in public like this, but actually the most common cause of sleepiness is sleep deprivation, such as from pulling an all-nighter.

Anyone who has seen the Japanese or American versions of The Ring will find this instantly familiar and hilarious.  The women who was pranked seemed to take the joke in her stride.

The classic wake-up prank involves an air horn.  There are hundreds of examples of this form of rude awakening on the web.  Here’s a quick one featuring the Burger King!

I also love rude awakenings in the car, particularly the ones that involve screaming and scaring the pants off of the unsuspecting, slumbering passenger.  You know what I’m talkin’ ’bout.  Here’s a nice example:

And here, at last, is my very favorite sleep-related prank video of the year.  It’s short and silent, but hilarious:  for a brief period of time, this man becomes a guitar hero to all who slumber.  Enjoy!

OK, OK, I have to give you one more.  This is a repeat from last year, but it’s so great I have to post it again.  Have a great day!

“You’re Gonna Hear Me SNORE!”

I hope your holiday season has been great so far!  And it’s not over yet!

I recognize I’m posting this video late–it aired originally during the Thanksgiving holiday–but it’s worth posting now anyway; we’re still in holiday mode, after all, aren’t we?, and lots of people eat turkey at Christmas time!  Jimmy Fallon, Rashida Jones, and Carrie Underwood gave a hilarious musical performance about Thanksgiving traditions on Late Night With Jimmy Fallon.

Please pay particular attention to what Rashida sings 1:29 into the clip.  She parodies Katy Perry’s song “Roar,” singing, “you’re gonna hear me SNORE!”

Drowsing and falling asleep in front of the television or fireplace after a big ol’ hyper-caloric meal are so common, they seem like natural components to our American holiday tradition.  The degree to which L-tryptophan in the turkey triggers an after-dinner snooze is questionable, actually.  However, there are so many reasons for sleep to take you over after a huge holiday meal:  sleep deprivation due to wrapping things up at work; family and friends coming into town; irregular work and sleep schedules; parties keeping you up late; alcohol, particularly when combined with certain medications; underlying medical problems; and undiagnosed sleep disorders.  Untreated sleep apnea, for example, may leave you both sleeping and snoring like a bear in your recliner, disturbing your house guests.

It’s always easier to say than to do, but keeping your sleep schedules as regular as possible and getting proper amounts of sleep during the holidays may well improve your levels of wakefulness and alertness during this time of year and may bring forth even more holiday cheer!  Have a great holiday week, 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!