Sleep Deprivation: The morning after the night before the morning after

I am here on a lecture tour and today I lectured at the Medical School in the city of Khartoum. My topics were Post Partum Hemorrhage, something that has been described previously in these lines and the proper type of vitamin supplementation for women who desired to get pregnant, were pregnant or who had recently delivered a child. But all this is not the topic of my story.

My story starts on New Year’s Eve when I was taken to a large banquet hall by my host and sat at a table occupied by his wife and members of her family. One of the family members was a young doctor who was visiting her family for the holidays and escaping the frigid temperatures of Madison, Wisconsin where she was a fellow in Cardiology having finished her residency in Internal medicine at Johns Hopkins Hospital in Baltimore. We struck up an immediate conversation and it came to pass that she mentioned that she and some of her friends were going to stop by the Hilton at 8AM as was their custom for a breakfast which not only hailed the New Year but paid homage to the fact that the day of the first of January was the independence day of the Republic of Sudan. Happily, I stated that I would join her and we joked about the fact that it was already almost midnight and we were already talking about the fact that breakfast was coming in 8 short hours.

The fateful midnight hour arrived and everyone sang and clapped and the band played on. The music was pleasant and not intrusive, but by 1AM I began to feel tired and asked to be returned to the hotel, even though the party was going full swing and entertainment was promised. Nonetheless, I remembered that if I wanted to be awake and alert, I would need at least 6 hours sleep and by 2AM I was out with a 7:45AM wakeup call. (The sleep was like a log even though it was 6 hours minus 15 minutes.) I should say that this was a lively party with good times being appreciated by all (children and even infants in mothers arms) in the total absence of alcohol as the country of Sudan is dry, even in the hotels.

When the alarm rang, I got up, dressed, threw cold water on my face and proceeded to the Coffee Shop to meet the young lady doctor. She was not there, but this did not surprise me because I later found out that the show went on till 4AM and she stayed till the last minute. What did surprise me was the fact that the lobby of the hotel and the coffee shop was jammed with early morning revelers, half of whom looked like they were walking Zombies. These were young people in their late teens and early twenties. They sat there with glazed eyes shoveling into a full buffet and talking about what they were going to do next.

It then dawned on me. The Zombie crowd had been up all night, deliberately putting themselves into a state of acute sleep deprivation. As I pondered this fact, I remember my brother mentioning to me that he had been awake for 72 hours during the TET offensive of the Vietnam War, but we never discussed it from a physiological point of view. My curiosity was aroused and I went to my usual source, Google, to learn more about this phenomenon, because it is indeed a fact of life that some people and some professions are chronically rather than acutely deprived of sufficient sleep and this too was an appropriate subject to share with readers.

The results of my search are interesting to say the least. To begin with, the phenomenon of sleep deprivation is rampant, and this is not including those individuals who have sleep disorders. Countless others are chronically deprived because of the societal conditions in which we live. Much of it is work related. Whereas years ago this meant working the night shift in a factory or in a hospital, it now includes many other occupations such as taxied drivers and airline personal whose state of alertness is important to the health and safety of others. The annualized costs of chronic sleep deprivation are truly astronomical in terms of lost production, poor health and actual lives lost.

Sleep deprivation must be distinguished from accumulated sleep debt, another and far more easily remedied situation. Here, the individual loses an hour or so each night during the workweek and makes it up with well earned naps on the weekend. However, these persons start the weekend with at least a five-hour debt in terms of sufficient sleep. I have a friend, Professor X of Tel Aviv, who exemplifies this perfectly. He must, and I do mean must, have long naps on Friday and Saturday afternoons to compensate for the loss of sleep that accrues during the working week and when he travels to Europe for long weekends.

The list of medical problems associated with chronic sleep deprivation is long and truly astonishing in the range and breadth of the symptomatology which ranges from aching muscles to hallucinations (both visual and oral) and many, many more. What is even more interesting is the fact that when sleep is deprived on a voluntary basis, as was the case with the young people who sparked my interest in the acute form, it is often induced as a form of recreation, entertainment or to provide a legal “high” without using drugs. As noted above, alcohol is not available in Sudan, but I would have been hard pressed to say that these young people did not look as if they had spent the preceding hours in a bar. When the acute phase extends to 48 hours, hallucinations can occur, as can a heightened sense of creativity. It would appear in the past that mystics often denied themselves sleep for this purpose.

The young people with whom I spoke did not mention that they were tired but rather of what further activities they planned to do. Perhaps the lore of the ancient mystics was still lingering around in Khartoum. I had incurred a slight sleep debt that very same night, so I went upstairs immediately after breakfast and caught my first nap of the New Year. In that regard, I am sure that many readers did the same on the first morning of January.

Is there a message to this column? You bet! Thank goodness that New Year’s Eve only comes once a year. Happy New year Everyone. My next column will be written in New Delhi, India.