Sleep deprivation is pervasive in our fast tempo, 24/7 culture of commerce and daily activities. This article discusses two potentially serious consequences of disrupted sleep or prolonged wakefulness.
The first issue concerns Insomnia, a condition that involves difficulties falling asleep, staying asleep and/or awakening prematurely in the early morning hours. Insomnia is a common source of misery for millions of Americans at one point or another in their lives. For some the problem is chronic, for others, it may be triggered by situational factors. In response to the invisible and relentless COVID-19 virus circling the globe, citizens have become vulnerable to acute stress reactions, which can include sleeplessness, and an overactive mind fueling anxious thoughts, fear or panic. Studies have shown that persistent insomnia, initially fueled by high levels of activation and worry, and the imperative to confront a new normal, can give rise to a full-fledged clinical depression, marked by loss of energy, drive, inability to derive pleasure in life activities, as well as feelings of helpless and hopelessness.
Suicidal thinking is not uncommon in the throes of more serious episodes of Major Depression. In turn, when depression lingers for weeks or months or recurs over time, sleep problems are more likely to occur and Insomnia takes on a life of its own. This might include waking up in the wee hours of the morning, after tossing and turning for hours. According to research spearheaded by Dr. Michael Perlis, behavioral sleep medicine specialist affiliated with the University of Pennsylvania, being awake in the early morning hours after midnight, represents a period of elevated suicide risk. The afflicted person is exhausted, yet cannot achieve sleep. In waking, thoughts of misery and hopelessness become conscious again.
Uninterrupted sleep, including slow-wave sleep, allows the brain to restore its cognitive reserve and build new pathways for problem-solving through pruning of neural networks and synaptic downscaling and preservation of more robust synaptic connections. The sleep-deprived, depressed brain finds it difficult to consider healthy alternatives to stress. In the wee hours, a low point of the day-night circadian cycle, nearing the body temperature nadir for the 24- hour solar period, one’s reasoning capacity and mental faculties are strained and depleted, at precisely the time when the dark emotions of depression may be lurking. There ensues a dangerous uncoupling of healthy, integrated brain functioning that normally involves informed and balanced communication between the pre-frontal lobes of reason, the parietal lobes of association and the limbic system of emotions. This is the time to be vigilant against the onrush of self-destructive thoughts and actions.
The solitary mind at 2 or 3am may not act in the brain’s best interests. While loneliness can afflict people at any time of day, there is something more acutely painful about prolonged wakefulness in the dark, with a bed partner or household of individuals snoozing away, and being unable to restore sleep. Some, desperate for a quick fix, will reach for drugs to remedy the sleep problem and suppress the negative thinking. Because cognitive processes can be clouded in the early morning hours, the choice and quantity of drug, whether it be a prescribed hypnotic or a recreational substance such as alcohol, may not be carefully considered and the downstream (next day) impacts ignored or denied. The ability to access a crisis line is a potential lifesaver, and allows distressed, sleep-deprived individuals in literally their darkest hour to connect with a live human being and in a collaborative fashion, initiate effective decision-making in a support zone of affirmation.
A second risk factor relates to motor vehicle crashes. Research compiled by the National Highway Traffic Safety Administration (nhtsa.gov) has shown that extended wakefulness in a 24-hour day, reaching 18 or 19 hours without rest or slumber, starts to impair judgment and reaction times in ways that are not dissimilar from cognitive and behavioral deficits associated with increasing blood alcohol concentrations. The longer one is awake beyond 18-19 hours at a stretch, the greater the functional equivalence to states of physical inebriation. Needless to say, motor vehicle crash risk rises. You can imagine the functional impact of intoxication with a recreational drug such as alcohol or prescribed anti-anxiety medicine, interacting with a state of prolonged wakefulness or cumulative sleep debt. While caffeine, prescribed stimulants or brief napping can be a useful antidote to drowsy driving for a short period of time, these avenues cannot replace a regular habit of natural, undisturbed sleep for restoring alertness.
Picture a clinically depressed individual already sleep-deprived, driving into the early hours of the morning at freeway speeds. Sleep deprivation can induce involuntary micro-sleeps, very rapid and transient inattentiveness or actual brain sleep, which can lead to profound loss of reaction time and focus. When operating a motor vehicle at 60mph, or any type of dangerous machinery, even a split second of inattentiveness or somnolence can have serious or fatal consequences for the driver and bystanders.
These two risk scenarios drive home the point that sleep is a non-negotiable cornerstone of good physical and mental well-being and a sine qua non of brain health. Fortunately, for the non-depressed individual reducing sleep debt and prolonged wake times are personal choices within reach, and there is plenty of evidence-based research and practice providing a foundation for effective interventions targeting clinical depression as well as Insomnia.
For those needing crisis support 24/7, the National Suicide Hotline is 1-800-273-8255. For more information on sleep disorders and their management, access sleepfoundation.org (National Sleep Foundation) or sleepeducation.org (American Academy of Sleep Medicine) or contact your local primary care provider for additional resources.
Dr. Michael V. DeSanctis, PhD, Licensed Psychologist, National Register of Health Psychology Providers, retired from practice, Diplomate, Board of Behavioral Sleep Medicine; owner Positive Sleep Journeys, PLLC, providing public outreach on behavioral sleep health and training/consultation to healthcare providers.