Sunday, 5 May 2019

SLEEP (Part 2): Why Do We Need to Sleep? The Science of Sleep & Circadian Rhythm____ A Community Education Feature

Who am I?  Blog Index

(This part was used for a talk at the Burnbank Centre, Hamilton, Scotland in April 2019)

Sleeping seven to eight hours a day is essential for adults.  In Part 1, I have discussed the evidence from recent scientific research about the relevance of sleep for humans and animals with the clear message that sufficient sleep (7 to 8 hours) is not only important for our physical and mental health/welfare, but a lack of good quality sleep has many serious unwelcome consequences (See slide below for a summary).
  (click on the slide to see full page image; press Esc to return to text)

People who sleep too little or too long have increased chances of dying and major cardio-vascular events. It is recommended that adults sleep 8 hours per day but children should sleep somewhat longer depending on their age. 

Along with good diet, clean water, clean air and adequate exercise, sleep is one of the five pillars of good health. 

Electrical Activity of the Brain and Sleep Cycles:  Our brain controls most body functions through electro-chemical signals.  The neurons in the brain are actively talking to each other.  In fact, human brain weighs 1.3 kg (about 2% of the body mass) but is responsible for consuming about a quarter of the base metabolic energy (the brain's energy consumption is ~600 Calories per day). 
Interestingly, the brain uses as much energy when we sleep as it does when we are awake - even more during some periods of sleep.  
When awake, we are interacting with the world around us - thinking and making decisions, and a large amount of input is provided to the brain from objects and events around us. 
When sleeping, the brain is certainly not interacting with the outside world and the question is - what is the brain using the vast amount of energy for? 

Let us first look at the way the electrical activity of the brain is measured and point out the differences & relevance of different types of sleep.
An EEG, electroencephalograph, collects electrical activity from the brain and plots the signal as function of time.  The wavy pattern tells us what is happening in the brain.  One can study signal from individual parts of the brain to learn how active different parts of the brain are at any particular time.

Despite a large amount of descriptive information about the various stages of sleep, the functional purposes of the sleep states are not known. Whereas, most sleep researchers accept the idea that the purpose of non-REM sleep is at least in part restorative, the function of REM sleep remains a matter of considerable controversy.

In the following slides, I shall present typical electrical activity of the whole brain during when you are awake and in different phases of sleep. 
A healthy adult sleeps 7 to 8 hours per day and cycles between different stages of sleep in a consistent manner - generally there are 5 cycles, each lasting 90 minutes. The electrical activity of the brain may be represented on a hypnogram - a record of the stages of sleep as a function of time -  generally plotted in 30 sec intervals.  A typical situation is shown in the slide:
Most slow wave sleep (NREM3) occurs in the first two cycles while REM sleep dominates the last two cycles before waking.

Sleep is also essential for disposing metabolic waste from the brain - this is explained in the next slide

Molecules that Make Us Sleep: There are two ways human body feels sleepy. 
1.  Circadian rhythm causes secretion of hormone melatonin at certain time of the day (at the onset of darkness). Melatonin tells the body that it is time to rest and sleep.  More of this later...
2.  The chemical adenosine acts as a sleep-inducing (hypogenic) molecule. Adenosine is produced by the break up of adenosine triphosphate (ATP) during  energy generation to power bodily functions.  The activity of the neurons and gilial cells causes a build up of adenosine in the brain and this increases the sleep pressure.  After 12 to 16 hours of wakefulness, the level of adenosine and hence the sleep pressure reaches a high value and one has a strong desire to sleep.  During sleep, adenosine is destroyed and after 8 hours of sleep, adenosine levels reach a low value with a correspondingly weaker sleep pressure.  This is shown in the slide:
Adenosine works by attaching itself to receptor sites in the brain to induce sleep pressure.  Substances like caffeine have similar molecular structure to adenosine and are present in tea, coffee, coke and many other food items.  Caffeine attaches to adenosine receptors in the brain and prevents the build up of sleep pressure.  That is why, it is advisable to avoid caffeine 4 to 5 hours before sleeping time in order to ensure a good night sleep.

Circadian Rhythm (Internal Biological Clock): 
Different body functions rise and fall at set times of the day based on your circadian rhythm. Your circadian rhythm controls when you should sleep and when you should be awake (alert and active).

Final Word: Good quality sleep of 7 to 8 hours is absolutely essential for adults - children need more. The benefits are huge ..
The science of sleep is fascinating and, like anything else in the human body, complicated.  I am really curious to learn about the dreams - why do we dream and what is the purpose - as I had said in part 1, evolution does not do anything without a reason - there must be an important function that dreams serve - we just need to find it.  Wait for part 3...

Please pass on the link to friends and family; sleep is an important enough topic to worth shouting about.

Tuesday, 12 March 2019

Air Pollution (Part 2) - Particulate Matter PM10 and PM2.5 - Brake and Tyre Wear are Higher Emitters than Car Exhausts

Who am I?  Blog Index

In Part 1, I had discussed the nature and adverse health effects of outdoor air pollution that is particularly serious in almost all major cities and is responsible for nearly 5 million deaths annually.  In cities, road transport is a major source of air pollutants - particularly particulate matter - the subject of this publication. 
In Central Londonroad transport is responsible for 54% of particulate matter PM10 (all particles less than 10μm diameter) emissions and for 48% of the harmful  oxides of nitrogen.  
The issue of transport in cities is a complex problem - petrol and diesel vehicles are generally blamed for the pollution.  However, under the new low emission legislation, pollution from exhausts has been falling and the main problem in future will be particulate matter generation by brake wear and tyre wear (BWTW), road surface wear and other particulate matter that already exists in the environment and become suspended due to traffic induced turbulence.  Non-exhaust emissions are equally important for electric vehicles (EVs) and it seems that PM emissions will continue to be a serious health hazard in cities until a better way to move people is found

Airborne PM2.5  are capable of bypassing human noses and throats, penetrating deep into the lungs where they deposit harmful chemicals adsorbed on their surfaces. Their presence has been linked to a number of health conditions, including respiratory illnesses (for details, see Part 1).

Experts estimate that by 2030, as the transport sector moves into electric vehicles, 90 per cent of harmful PM2.5 emissions will be caused by microscopic particles eroding from tyres &  brakes and particles airborne from road and surrounding surfaces.

The UK government's clean air strategy plans to develop new standards for tyres and brakes to address toxic non-exhaust emissions. Similar planning is underway in most major economies. At the same time, the size of cities is growing rapidly with 75% of the world population expected to live in urban areas by 2050 with a corresponding increase in road traffic and emission of particulate matter.   

New products and technologies are crucial in achieving clean air in our cities - for example, Bosch has recently launched a new iDisc brake disc with a tungsten carbide coating that emits 90% less brake dust than a conventional cast iron disc. Regenerative braking, most effective in stop/start driving typical of the traffic in cities, in hybrid and electric vehicles (EVs) reduces the need for friction braking greatly, thus cutting down on particulate emissions. More on this later.

In this publication, I look at the non-exhaust particulate emission in more detail and discuss what may be done to improve the quality of outdoor air.  Unlike exhaust emitted particles, there are no standard methods for characterising non-exhaust particulate matter and it is sometimes difficult to compare results of different studies. A good estimate of how much particulate matter (in mg per km of travel) is emitted is provide by the following figure
Concentrating on PM2.5 particles, we note that heavier cars generate greater quantity of particulate matter - that is why large scale adoption of battery electric vehicles (BEVs), which tend to be heavier than internal combustion engine vehicles (ICEVs), will not reduce tyre or road wear.  However, in urban driving, BEVs will almost totally eliminate brake wear due to regenerative braking - for example, BMW i3 does not generate any brake dust for 90% of the time. 
Fuel Cell Electric Vehicles (FCEVs) are much lighter and hold good promise over battery electric vehicles (BEVs) in reducing non-exhaust emissions of PM2.5.

Other measures for reducing PM2.5 emissions could be the use of drones for delivery of parcels in the city and use of Internet to send documents instead of paper.  Both will reduce the number of vehicles on the road.

Greater use of public transport will help too as well as pedestrianisation of central city areas to exclude road traffic.  

Self-driving electrical vehicles (AEVs) will be much lighter than today's BEVs.  As a taxi service, AEVs can be right size for the purpose - for example, for transporting one or two people, a two-seater AEV is all that is required.  Due to their better safety characteristics, AEVs can be made of lighter materials saving on fuel and reducing PM2.5 emissions from tyre and road wear.  Introduction of AEVs will also reduce the number of vehicles in the urban surroundings. 

Most big cities have a subway system where ventilation is not very efficient and the air quality tends to be poorer.  Non-exhaust emissions are the most important source of airborne particulate matter in the subway system, including platforms and trains. Subway PMs are mostly iron and carbon based particles and are generated from rail-wheel-brake interfaces.  Trains and ventilation systems drive the particles along the tunnel and mix them with dust etc. More effective ventilation systems, magnetic filters and platform screen doors will help to reduce the concentration of PMs on the subway platforms.  

Monday, 21 January 2019

Global Greenhouse-Gas (GHG) Emissions by Humans and Animals - An Outreach Feature

Who am I?  Blog Index

Nothing will benefit health and increase chances for survival of life on Earth as much as the evolution to a vegetarian diet.          ...Albert Einstein (quoted)

Greenhouse gases (GHG - mostly carbon dioxide CO2, methane CH4 and nitrous oxide N2O) in the atmosphere trap heat radiated from the Earth and keep it at a comfortable temperature of 14C . Without GHG the Earth will be  about 32 degrees colder with an average temperature of -18C - life would be impossible. During an ice age, the average global temperature only falls by about 7 to 10 degrees.

Since the first industrial revolution, humans have been putting more CO2 and other GHGs in the atmosphere with a sharp increase in the 20th century.  Population numbers have gone up too; the following slides show the steep rise in GHG over the past 100 years.  This has resulted in the Earth warming by about 1C over this period. 

In 2017, total CO2 emissions from fossil fuel and industry were 36.8 billion tons; CO2 stays in the atmosphere for over 100 years. 
Total annual methane emissions had reached 623 million tons in 2016. 
The residency time of methane in the atmosphere is about 12 years.

(Click on a slide to see its full page image, press ESC to return to text

Methane is a potent GHG.  Over a 20 year period, methane has 86 times greater global  warming potential than carbon dioxide. Many publications quote a global warming potential of methane as 26 over a 100 year period. 

We normally attribute the rise in GHGs to increased industrial,  transport and agricultural activity based around the burning of fossil fuels (coal, oil and natural gas).  Most publications do not discuss GHG emissions due to metabolic activity in humans and their livestock, both have increased fourfolds in the past 100 years. 

I shall estimate such metabolic contributions using 'back of the envelope' calculations.  The simple calculations give surprisingly realistic results and help the non-specialist general population to understand this aspect of the science behind global warming.

GHG Emission by Humans and Animals: 
Are we heating the planet as we breathe?

Many news articles mention the role of cattle in emission of the greenhouse gas methane, but it is not widely appreciated that humans and animals also emit significant amounts of CO2 which contributes to the GHG budget and to global warming. I shall estimate these numbers in the following: 

Carbon dioxide emission by humans:  Humans inhale atmospheric air containing CO2 at 0.0004% concentration but exhale air with CO2 at 5% concentration. (I shall use rounded numbers for ease of calculation).
The following slide provides more details:
CO2 is a product of metabolic activity (respiration).  While it is possible to calculate the amount of CO2 emitted by using volume of exhaled air and breathing rate (I have described the calculation at the end of this blog), it is easier (and probably more accurate) to work out the amount of CO2 produced per day by the aerobic respiration reaction in which glucose uses oxygen to produce energy, water and CO2.  
For our purpose, it suffices to say that carbohydrates in the food are broken down to glucose molecules and the reaction may be written as

     Glucose   +   Oxygen    ->    Water  +  Carbon dioxide  +   2886 kJ Energy
    C6H12O6  +   6 O2      →        6 H2+  6 CO2                +       heat 

Essentially, one molecule of glucose uses 6 molecules of oxygen to produce 6 molecules of CO2.  The molar weight of glucose is (calculated from its formula) 180 and that of CO2 is 44.  
This means that 180 gram of glucose burns to produce 6 x 44 = 264 gram of CO2.  
Assuming that we consume 2000 Calories per day and carbohydrates produce 4 Calories per gram, we are burning equivalent of 500 gm of glucose per day in aerobic respiration. 
This will produce 500 x 264 /180 = 733 grams of CO2 per day or 268 kg/year.
Each of us produces this amount of CO2 per year.  The world population is over 7 billion and will produce 1.87 Billion Tonnes of CO2 per year.  This is 5.2% of the total CO2 put into the atmosphere by human activity.

What about Animals?  The main population of animals is comprised of those reared for human consumption - cattle, sheep, pigs, poultry etc.  Their numbers have sharply increased in response to increasing human population and higher demand of meat over the past 50 years or so.

Additionally, there were about 23 billion poultry in the world in 2014.  
Livestock animals exhale CO2 generated in the respiration process - most amount is exhaled by cattle which are much bigger in size than other livestock animals. 

The metabolic energy requirements of a mammal vary as  0.75 power of the body mass, we can calculate for a given body mass how much CO2 per day an animal will produce.  The table shows the amount of CO2 exhaled by livestock animals.  The emissionn of methane is also given.

In conclusion, humans and livestock release 
1.87 + 6.65  = 8.52 billion tons of CO2 in the atmosphere per year. This number has increased fourfold in the past 100 years. Only China emits more CO2 than humans and animals exhale (2015 figures in billion tons per year: China 10.6 and USA 5.2)!

Methane Exhaled by Livestock:   The table above 
gives methane emisssions from various livestock animals.  Meat cattle are the main source of methane.  Exhalation represents about 96% of total methane put into the atmosphere by the cattle - there is a common misunderstanding that cattle emit methane by farting but that only contributes a tiny %.  Most exhaled methane is produced in rumination.

Wiki explains: Ruminants are mammals that are able to acquire nutrients from plant-based food by fermenting it in a specialized stomach prior to digestion, principally through microbial actions. The process, which takes place in the front part of the digestive system and therefore is called foregut fermentation, typically requires the fermented ingesta (known as cud) to be regurgitated and chewed again. The process of rechewing the cud to further break down plant matter and stimulate digestion is  called rumination.   

Currently, we are putting in 623 million tons of methane in the atmosphere every year.  Of this 110.7 million tons ( ~ 18% is emitted by livestock rumination - enteric fermentation or EF).  These numbers have been revised upwards by 11% in 2017 by Wolf et al.  In 2010, EF accounted for 43% of all GHG emission from agricutural activity in the world. 

Remember that biggest increase in methane emissions is due to meat cows and pigs (their numbers have gone up fivefold over the last century); more people are consuming meat that will only make the situation worse.  

Manure Treatment is a serious source of Methane too:
It is not only that livestock exhale methane (product of the rumination process in cattle) but the storage and treatment of manure from the livestock is also a serious source of methane.

Manure is stored in tanks, lagoons where microbial activity causes its deacy.  Anaerobic breakdown produces greater amount of methane and a switch to aerobic decay will reduce the emission of methane.

Final Word:  In this blog, I have used the population numbers and emission of carbon di-oxide and methane by individual animals to calculate the total contribution to GHG emossions that humans and their livestock make.  Additional emission will also come from other animals that I have not considered.  

The warming of the world due to GHG emissions is predicted to reach at least 2 degrees centigrade by the end of the century.  Human and Livestock emissions can be most effectively reduced by population control - while the human population is supposed to stabilise around the 10 billion mark in the next 50 years, livestock population can only decrease if we change our emphasis to eating meat - this is a trend that has a lot of mementum and is unlikely to change in the near future.

Better manure management (using aerobic storage tanks) will help but that is not the major contribution.  Pasture grazed cattle emit less methane but again it is not a practical solution if we all insist on eating meat-rich diet.  

Thanks for reading...

Friday, 11 January 2019

SLEEP (Part 1): Why Do We Need to Sleep Eight Hours per Day? Malaise caused by Impaired, Insufficient Sleep: A Community Education Feature

Who am I?  Blog Index

Sleep is the 3rd pillar of good health, alongside diet and exercise

Early to bed and early to rise, makes a man healthy, wealthy and wise (ref)
Sleep is the best meditation                         ...Dalai Lama

Humans spend about a third of their lives sleeping.  
There has to be an evolutionary reason.  

Why do we need to sleep so much and what advantages we derive from it?  
Or one can turn the question around and ask 
what happens if we do not sleep enough or sleep poorly?

Historically, most people thought of sleep as a dormant, switched-off state of the body - an unproductive time. However, recent research has established the relevance of sleep for humans and animals with the clear message that sufficient sleep (7 to 8 hours) is not only important for our physical and mental health/welfare, but a lack of sleep has many unwelcome serious consequences. 

(Click on a slide to see its full page image. Press ESC to return to text)

It is not only that many adults do not get enough sleep, the quality and regularity of sleep in lot of people is relatively poorMany adults are curtailing their sleep or obtain 'low-quality' sleep  in response to increasing demands and lifestyle changes, such as prolonged working hours, increased environmental lighting, introduction of new communication technologies, which enable living 'round the clock'.  A National Sleep Foundation Survey in five OECD countries found that 20% of the working population sleeps less than 6 hours per 24-hour day. (see also and also).  

In the following sections, I shall present some disturbing findings as to how sleep deprivation (length or irregularity or both) affects our health and well-being. 

Sleep and Productivity:  Rand Corporation Report (2017) estimates that sleep deprivation of workers has serious impact on a country's GDP:

   Country                          GDP Loss 
                              billion US $        % GDP
    USA                         411             2.28
    UK                             50             1.86
    Japan                       138             2.92
    Germany                    60             1.15
    Canada                      21             1.35

Sleep and Mortality:  One might think that sleeping longer than 8 hours or using drugs to help you sleep (hypnotic medication) will be the solution.  That will be a big mistake.  Both choices have been shown to be extremely harmful and significantly increase the odds of premature death. 

Sleep and Traffic Accidents/Sports Injuries: 

Sleeping less than the recommended amount adversely affects neuro-cognitive performance; verbal and visual memory, co-ordination, reaction time are seriously affected. The impairment in these abilities is higher for greater sleep deprivation.  
In adults, sleep deprivation manifests itself as slower than normal reaction time, reduced alertness/concentration, shortened attention span, forgetfulness, poorer memory, involuntary sleeping (microsleep) lasting from a few seconds to a few minutes etc. 

I discuss two examples in the following:

In their 2016/17 report, AAA has published a detailed analysis of police-reported serious vehicle crashes in the USA during the 2005-2007 period. The study indicates that there is a significantly higher crash risk for drivers who slept for less than 7 hours in the past 24 hours; and also for drivers who slept 1 or more hours less than they usually sleep. 

A similar effect of sleep deprivation is observed in incidences of sport injuries in teenagers.

A recent study (March 2019) found that moderate-to-severe insomnia more than tripled the college athletes' risk of concussion, and excessive daytime sleepiness - even just a few days a month - more than doubled it.  The chance of getting a sports-related concussion during the next year was 14.6 times higher for those with both insomnia and excessive daytime sleepiness than for those who were well rested. See also.

Insufficient/poor quality sleep seriously affects the elderly who tend to sleep 6 hours or less.  It is not correct that old people can manage with less sleep  - they also need 7 to 8 hours sleep per day but for various reasons are unable to do so.  This has serious health consequences as we shall discuss in the following sections.

The modern society puts lot of obstacles in young childrens' sleeping patterns.  Using electronic screens (TV and smart phones) near bedtime disturbs the circadian rhythm and can cause difficulty in falling asleep.  To attend school at 9 am, most children wake up by 7 or 8 am - leaving insufficient time to get the recommended sleep of 10 to 11 hours for primary school pupils.  

Physiological Effects of Sleep Deprivation:  The quantity and quality of sleep is important for our physiological health. Sleep deprivation has been linked to many health problems like obesity, cardiovascular disease (CVD),  depression, type-2 diabetes mellitus (DM), ADHD and Alzheimer disease (AD).  I shall discuss some of the evidence in the following:

Sleep and Obesity:  Many studies in animals and humans have found good correlation between sleep deprivation and weight gain.  Essentially, lack of sleep slows the metabolic rate - even a couple of hours loss of sleep can reduce metabolism by 5 to 20%.  Sleep-deprived humans also show increased appetite - particularly, for calorie-rich carbohydrates. When you are sleep deprived, you have more grehlin (hormone that tells you when to eat) and less leptin (hormone that tells you when to stop eating).  More grehlin and less leptin equals weight gain that can lead to obesity. 

Sleep and Diabetes:  Weight gain and obesity are implicated in the rising number of diabetics.  Sleep deprivation increases the likelihood of gaining weight leading to diabetic condition.  
In a study, healthy young men were sleep deprived for 4 hours on six consecutive nights.  Their average blood glucose level increased by 270 mmol/L (or 15 mg/dl) and insulin response to glucose was 30% lower – essentially they became prediabetics (thankfully reversible) after just six days of sleep deprivation. Changes in metabolic and endocrine (hormone production) functions, driven by impaired sleep, predisposes individuals to clinical diabetes.

The following slide suggests that sleep deprivation may be an independent risk factor in the development of diabetes.

Sleep and Hypertension:  Restricting sleep durations has been shown to raise blood pressure and heart rate.  Chronic sleep deprivation can raise the average 24-hour blood pressure with the result that the cardiovascular system operates at a higher blood pressure, thus increasing the risk of hypertension.

Timing of sleep can also disrupt your body-clock (circadian rhythm) and lead to increased blood pressure by disturbing heart function.  

Sleep and CVD:  Current data indicates that people with impaired sleep are at higher risk for cardiovascular (CVD) and cerebrovascular disease (strokes) - regardless of age, weight, smoking and exercise habits. 
The slide shows the situation for adult population:
The association between long duration (9+ hours) and CVD may be explained by other factors - for example, depression, low socio-economic status, unemployment, low level of physical activity and undiagnosed health conditions have been shown to be associated with long duration of sleep. The association between long sleep hours and CVD may be reflecting the role of long sleep as a marker, rather than a cause. A 7-year study of weight reduction, healthy diet and increased physical activity supports the view that long sleep may be an indicator of risk that can be successfully managed.
Sleep is equally important for the young as well.  Adolescents who do not sleep well are at greater risk of developing ailments related to CVD.  Sleep deprived teenagers were observed to have higher cholesterol levels, higher BMI, higher blood pressure  - all indicators of major health issues in later life. 

Sleep and Cancer:  Evidence on the association between sleep duration and cancer risk is controversial, with findings showing inverse, positive, and null effects.  A recent (2018) review of the available information indicated that neither short nor long sleep duration was significantly associated with cancer risk. I refer you to this very extensive study, available online, for more details. 

Sleep and Mental Health:  Sleep and mental health are closely connected. Sleep deprivation affects one's psychological/emotional state and can lead to mental health problems; conversely, people with mental health issues find it difficult to get good quality sleep (Likelihood of  a psychiatric patient to suffer from sleep problems is about 5 times greater than somebody without mental health issues).

The most common sleep problems are insomnia (difficulty in falling or/and staying asleep), sleep apnea (waking up frequently due to disordered breathing like snoring etc) and nacrolepsy (falling asleep suddenly during the day).  Studies have found that, in both adults and children, lack of good quality sleep can directly contribute to  mental health illnesses like depression, anxiety etc. 

The brain basis of a mutual relationship between sleep and mental health is not well understood. Studies suggest that a good night's sleep helps mental and emotional resilience, while chronic sleep disruptions set the stage for negative thinking and emotional vulnerability.

Sleep and Alzheimer Disease (AD):  Incidence of AD, and dementia in general, has increased in the past few decades and the projections do not make comfortable reading.  AD is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks.
At present, there is no cure for AD and the burden of care of AD patients puts large demands on the society.  The infographic from the World Alzheimer Society is quite revealing about the seriousness of the dementia epidemic.  (Click here for the full report). 
The brain of AD patients is found to have many abnormal clumps of proteins (amyloid plaques), tangled bundles of fibrous proteins (tau tangles) and severe loss of connections between nerve cells (dead neurons). 

Hippocampus (essential in forming memories) is affected first.  As neurons die, other parts of brain are affected and by the final stages of AD, the brain tissue has shrunk significantly.  Genetics, lifestyle and environmental factors play a role in AD but the detailed mechanisms are still not well understood.

There are 47 million people living with dementia worldwide with numbers projected to nearly double every 20 years, increasing to 75 million by 2030 and 131 million by 2050!  The cost of dementia is huge - in 2018, the global cost of dementia is estimated at US$1 trillion rising to $2trillion by 2030.

There is mounting belief among research scientists that sleep problems and Alzheimer's pathology may be connected. Multiple studies have shown that people with dementia often experience sleep disturbances, and other studies, using positron emission tomography (PET), have shown build-up of amyloid plaques in the brains of adults and animals who slept poorly or had inadequate sleep. The following shows the possible connections:

The glymphatic system (brain's sewage network) is responsible for removing the metabolic debris that is produced in a functioning brain.  Amyloid protein molecules are part of the debris.  The cleansing of this debris is done in the night when you are deeply asleep. During the non-rapid eye movement (NREM) sleep (more on it in Part 2), glial cell size is reduced by 60% allowing the cerebro-spinal fluid (CSF) to efficiently flush out the amyloid and tau proteins and other stress molecules produced by neurons.  
In sleep deprivation, the cleansing process is inefficient with the result that amyloid proteins collect and form sticky plaques around the neurons and cause them to die.  

In this Part 1, I have listed some of the health implications of sleep deprivation.  There are other issues, e.g. effect on reproductive system, infection rates, immune system etc. where sleep deprivation can have serious negative effects.  A good reference to learn more about this subject is the book entitled 'Why We Sleep' by Matthew Walker.

In part 2, I intend to look at the nature and science of sleep and its relation to the body clock (circadian rhythm). We shall discover that it is not only the duration of the sleep that matters but also the time of the day that we sleep.

Final Word:  In the '24-hour' world, sleep is a precious commodity.  Long distance travel, shift work, school start times, smart phones, TV in bedrooms, long work and commuting hours disturb the body clock and distort the sleep/wake cycles.  Ever stayed in a hospital overnight? The constant traffic in the wards and check-ups make it impossible for the patients to get rest - not helpful for their recovery.  The relevance of sleep in the maintenance and promotion of good health is not appreciated/acknowledged by the modern society  - even health professionals never discuss this issue.  

Collectively, the modern society is sleep-walking into the vicious circle of sleep deprivation and poor physical and mental health. 

A footnote about the studies referred to in this blog.  Most data on sleep duration was self reported by those taking part in the study - this may be problematic sometimes.  Wrist-worn actigraphy bracelets are non-invasive and provide much more reliable information about sleep.

I would love to receive your comments - please send them to 
Also pass the link to this blog to your friends and family...   

Thursday, 27 December 2018

Routines; Habits and Addiction; An Outreach Feature

Who am I?  Index of Blogs.

Routine is a set of behaviours we do regularly, but not automatically, in a particular order.
Habit is a process by which a stimulus generates an impulse to act as a result of a learnt stimulus-response association.                 ...Ben Gardner
40% of daily decision-making processes are unconsciously driven by habits...
Addiction is a primary chronic disease of brain reward, motivation, memory and related circuitry.   ...American Society of Addiction Medicine (ASAM)
[Note the older definition:  Addiction is a state in which an organism engages in a compulsive behaviour, even when faced with negative consequences.]

Our lives are organised around habits and routines.  A recent feature describes how diet, sleep and exercise routines are fundamental to a child's proper development.  Adults need routines too - we do many things at particular times in some definite order - routines give structure to our lives.  We intentionally devise routines because we hope to derive some benefit out of them - to achieve some desirable goal/objective. 
Many of the routines when repeated over time become habits and we carry them out without even thinking about them; the benefit or reward gets hard-wired in our brain. Routines and habits have powerful influence on our health and well-being.  

Routines and habits:  what is the difference? 

Routines:  A set of behaviours we do regularly, but not automatically, in a particular order. 
A routine requires a high degree of intention and effort.  Generally, routines are not thought of as fun or pleasurable but they help us in self-development by focusing on things that are important for our physical, social and emotional well-being. Good routines have a purpose - a why. Examples of routines: Setting alarm for 7 am, preparing a healthy breakfast and doing some exercise; Having dinner with family in pleasant environment; etc.
Routines are powerful because it is only through a well-designed routine that bad/undesirable habits may be changed (broken).

Habit: An acquired mode of behaviour that has become nearly or completely involuntary.  
Habit is behaviour that we do automatically in a regular and repeated way with little or no conscious thought.  We engage in habits because there is some kind of payoff/reward - we get some kind of physical or emotional pleasure that, in some cases, may only be transitory. All habits are not necessarily beneficial. 

Some habits are good - They have positive outcome and enrich life by improving health, relationships, finances - they generally make you feel good and relaxed.  For example, going for a walk after meals, talking to a friend, taking tea-break at 11 am; keeping your place tidy etc.
Habits can be bad too - Some habits have negative outcome and create stress, anxiety, affect your sleep pattern, annoy people around you. For example - picking your nose in public, poor posture (or slouching), watching TV for hours etc. Such habits should be avoided.

How habits form?Habits make up a major part of our behavioural and cognitive livesMany acts (behaviours), after repetitive practice, would transform from being goal directed to automatic habits, which can then be carried out subconsciously and  efficiently. Habits free
up the cognitive load required for routine procedures, and allow the brain to attend to new situations; habits make us utilise our energies more efficiently.   On average one needs about 66 days to form a habit - although sometimes it may take much longer.

Driving a car or riding a bicycle are demanding activities.  Initially, it requires a lot of attention and concentration but with practice, it becomes more or less effortless.  There are occasions when I would drive six or seven miles before realising that I have covered such a distance - it is like being on auto-pilot. This certainly frees the brain to become more efficient and concentrate on dealing with other situations.  Life would be impossible if we had to pay attention to every little part of all the task we do - how to take the next step while walking, or how to use knife and fork at the dinner table etc. Our brains have an “inborn tendency to maximise reward and minimise cost".

Over the past 25 years, numerous studies have linked habit formation with the basal ganglia. We now have a good understanding of how our brain forms habits and which parts are involved in this process. 
The following slide shows the main parts of the brain.

The basal ganglia (BG) are a group of subcortical nuclei that represent one of brain's fundamental processing units.  BG are present in brains of all vertebrates and situated at the base of the forebrain and the top of the midbrain.

The Habit Loop:  Repeated execution of a routine develops into a habit.
Essentially, a routine starts with a trigger - be it alarm at 7 am or nice smell of baking or the clock showing a particular time of the day.  The trigger then causes a behavioural action - getting out of bed or serving yourself a freshly baked cake or having a coffee break at work.  The action leads to a reward - feeling of accomplishment or satisfaction. 

We say that a habit has been formed when encountering a trigger (or cue), the brain involuntarily executes the action anticipating that the reward will be forthcoming.

Experiments with monkeys have demonstrated that, once a habit is formed,  the expectation of the reward is strongly felt as soon as the trigger appears - even before any action happens.  One kind of craves for the reward which - so does the brain believes - is bound to follow the trigger.  If the reward is denied, the subject feels disappointed, angry and can become very upset.  This is particularly evident in case of addiction where an extreme form of reaction may be observed. For example, a smoker must have the cigarette after his meal or a chocoholic denied her favourite treat to go with a nice cup of tea.

How Does the Brain form Habits:  What goes on in the brain during the time when a routine becomes a habit?  The reward from the routine generates a good feeling -- striatum (part of basal ganglia) is central in processing the reward system. In the reward system, via a reinforcement learning process or temporal difference learning, the brain makes a prediction before a reward is delivered; it then compares the reward yield to predicted expectation and, depending on the difference, the brain makes an adjustment leading to a learning curve. 
The brain, thus, begins to expect an appropriate  reward as soon as a trigger is encountered.   

How to Break a Habit:  Old Habits Never Die.

Good habits are useful but sometimes it is good to be able to break a bad habit.  
We can only make a habit latent (mask it) but it will come back to life if proper conditions are present.  Even if you have controlled the habit of not eating chocolates with your coffee, it is very hard to resist the temptation if you happened to be feeling tired and a good opportunity presents itself. 

It is really difficult to break a bad habit.  I must be seriously motivated to do so - first step is that I should be convinced that the particular habit is something I want to eliminate. 

The next step is to study the habit and find the trigger, behavioural pattern and reward - effectively identify the habit loop.
For example, if I prepare a cup of coffee and go for the box of chocolates then coffee is the trigger and action is the process of finding and eating the chocolate.  The reward is obviously the feeling of satisfaction.

It is best to use the same trigger but change the behaviour - may be I should replace the chocolate by a small quantity of nuts and dried fruits - which will still give me a sugar/energy boost and similar reward.  
Essentially, I am forming a new habit; and it takes time to establish a new habit - I need to persevere and remember to go for the nut/fruit mixture. After a couple of weeks, I can start reducing the amount (in small steps) of dried fruits (rich in sugar) and eat only nuts with my coffee.  The next stage will be to reduce the amount of nuts (again in small steps) until I am able to drink coffee on its own. 
The reward system will adjust itself and I should be able to get same pleasure from a cup of coffee that I was able to derive from coffee cum chocolate.  However, my brain will still remember the old habit and the enjoyment that chocolate provided and it will be all too easy to fall back into that routine  - I shall be on guard not to give in to the temptation at the next opportunity.  

Breaking a habit is not an easy process and can not be done in haste.  Forming a new habit takes on average 66 days - breaking one will need similar length of time but also greater motivation. 

Habits and Addiction:  what is the difference?

Habits may be good or bad.  Good habits are desirable and help us to live our lives in a relaxed and efficient manner.  Bad habits are undesirable but they are under our control.  In bad habits, even when a cue/desire is present, we can normally control and stop behavioural actions, and consciously decide to  forgo rewards - we are in control.  

Although initial experimentation with a drug of abuse is largely a voluntary behaviour, continued drug use can eventually impair brain circuits and connectivity  to such an extent that we lose control (prefrontal cortex is responsible for such executive judgements) on our behavioural actions and continue with substance abuse or other addictive activities like eating, drinking, sex, gambling etc. even though it is clear that such actions are causing harm - drug use turns into an automatic compulsive behaviour (addiction).

Studies have shown that impairment begins in the more primitive areas of the brain that process reward; and then moves on to other areas responsible for more complex cognitive functions. The addicted person can experience severe disruption in learning, decision making, cognition and emotional functions.

Addiction is now accepted as a primary disease - not caused by something else, such as a psychiatric or emotional problem.

Addiction:   In the following slides, I shall describe addiction in a more formal way. I feel it is important to understand that addiction is a disease and not just a bad habit that has become much worse. In the following three slides, the information is directly obtained from the public policy statement by the American Society of Addiction Medicine (ASAM) - in my opinion this is the best source for the purpose of this publication (the emphasis - italics and colour text are mine)

Dopamine (DA): The Master Molecule of Addiction
(Ref.)  The brain's reward system uses the neurotransmitter (a molecule that carries signals across the gaps - synapses - between neurons) dopamine (DA) as its major currency to relay information (dopaminergic pathways). All addictive drugs work by triggering exaggerated but transient increases in DA in nucleus accumbens (NAc) located in the ventral striatum of the limbic system.  Such DA surges resemble, and in some instances greatly surpass, the increases triggered by pleasurable stimuli (food, water, sex, gambling etc.).  
Brain imaging studies (PET) have shown that in the NAc, drug induced increases in DA are linked to euphoria (highs) during intoxication.  In awake human trials, greatest changes in DA levels result in the most intense euphoria.

The rate at which a drug of abuse enters the brain determines the speed at which DA increases in NAc and hence the euphoric effect it produces.  The drug has to raise DA abruptly.  
For example, smoked and intravenous cocaine act faster and produce greater high than snorted cocaine (which is faster than oral cocaine). While the fast rate at which cocaine act on the brain plays a major role in its rewarding effects, cociane is rapidly removed from the brain.  This promotes a craving and frequent use leading to rapid addiction to cacaine.
Drugs like MPH (methamphetamine a.k.a. meth) or amphetamines are much less effective when orally administered because of their slow uptake in the brain but are potent drugs when administered intravenously or inhaled.

In the following slides, I shall describe the regions of the brain that are most directly implicated in addiction.  

Final Word:  This blog was meant to be a discussion of routines and habits but expanded into a longer discussion to include addiction.  To keep the article of manageable length, I have missed out some important aspects of addiction, particularly relating to dug dependence, tolerance and treatment.  Addiction can also happen with prescription drugs. 
Teenagers are most susceptible to addiction as their prefrontal cortex is still developing and may be easily manipulated by drug use. Ironically, the society is moving in a direction that young persons feel more alienated and mental illness has been on increase.  This can be a potent factor in experimentation with drugs leading to addiction. 

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