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The Medicine Cabinet-Ask the Harvard Experts: Restless legs might improve with nutritional changes

May 28th, 2014 Raquel Rothe

By Robert Shmerling. M.D., Tribune Content AgencyPremium Health News Service

4:30 a.m. CDT, April 30, 2014

Q: I have restless legs syndrome. Can diet help?

A: We don’t know what causes restless legs syndrome, but we do know that it causes unpleasant or painful sensations in the legs. This could include tingling, pulling, or crawling, along with an urge to move the legs.

A number of medications can help. However, treatment recommendations do not usually include changes in diet. Therefore, many doctors would answer “no” to your question. However, there are some associations that might be considered.

Iron deficiency is a risk factor for restless legs syndrome. So if blood tests show iron deficiency, eating iron-rich foods might help. Examples include red meat, leafy green vegetables and iron-fortified cereals. But most doctors would simply recommend an iron supplement. (And your doctor may recommend testing to determine the cause of iron deficiency.)

A few studies have found that celiac disease is more common among people with restless legs syndrome. For people with both celiac disease and restless legs syndrome, eliminating gluten from the diet might improve symptoms of both conditions. However, this possibility has not been well-studied.

A study of more than 18,000 men found no connection between restless legs syndrome and an “unhealthy diet.” (This would be a diet that increases the risk of diabetes, heart disease and other chronic illness.) But this study did not include a detailed analysis of the impact of specific foods on restless legs syndrome.

Caffeine and alcohol may affect sleep quality. Poor sleep quality can make symptoms of restless legs syndrome worse. If you’re willing, it may be worth a trial of cutting back and then eliminating both from your diet.

If you have restless legs syndrome, current evidence suggests that dietary changes are unlikely to have a major impact on your symptoms. But research regarding the connection is limited. Future research could change that.

Until then, watch your caffeine and alcohol intake. And talk with your doctor about getting a blood test for iron deficiency and perhaps for celiac disease.

(Robert H. Shmerling, M.D. is a practicing physician in rheumatology at Beth Israel Deaconess Medical Center, Boston, Mass., and an Associate Professor in Medicine at Harvard Medical School.)

(For additional consumer health information, please visit http://www.health.harvard.edu.)

(c) 2014 PRESIDENT AND FELLOWS OF HARVARD COLLEGE. ALL RIGHTS RESERVED. DISTRIBUTED BY TRIBUNE CONTENT AGENCY, LLC.

Can Naps be Harmful?

May 13th, 2014 Raquel Rothe

By Lori Sichtermann

It’s well documented that taking the occasional mid-day nap can have a positive effect on one’s health.  A brief power nap can reduce sleepiness, improve cognitive functioning such as problem solving and decision making, and improve one’s reaction time. An afternoon snooze also can enhance short-term memory and mood, Dr Nicole Lovato, nap scientist at the School of Psychology, Flinders University, South Australia, told NapNow.net.au.

Yet, as refreshing as a siesta may seem, recent results from a 13-year study conducted by researchers at the University of Cambridge reveal that those who napped more than an hour or more each day  were 32% more susceptible to early death.

After analyzing the health and outcome of nappers and non-nappers, investigators found the frequent nappers –  those who napped for more than two hours every day  –  had a greater risk of death by heart disease, cancer, and respiratory illness.

Because the results of these findings remained the same even after the researchers adjusted for age, sex, educational level, body mass index, physical activity level, smoking, alcohol intake, and other preexisting conditions, investigators with the study believe the results demonstrate a link between chronic napping and undiagnosed health problems. In fact, a growing tome of research has reported associations between napping and increased risk of several medical problems, including type 2 diabetes and high cholesterol.

According to Lovato, who was not involved in the study, many individuals with co-existing medical and sleep problems, such as diabetes and sleep apnea, also experience excessive levels of daytime sleepiness. As a result, she says, the connection between extensive naps and chronic disease is likely due to medical issues that contribute to daytime sleepiness, which is in turn relieved by napping. She specifically notes diabetes as a disease that induces tiredness, which may encourage napping.

Although there is evidence that links chronic napping to more serious health issues, Lavato is quick to say that more research is needed. She notes that the majority of these types of studies are cross-sectional in nature, so they are not designed to establish whether napping can actually cause medical problems.

“Experimental and prospective studies are needed to assess the casual direction between medical issues and napping,” she told NapNow.net.au. “Essentially, is napping causing the health problem or is the health problem causing napping?”

According to a report on the topic published by Health.com, not all naps are bad or indicate poor health. In fact, a number of previous studies have found that naps can actually help with certain medical conditions, such as depression, anxiety, and even lower blood pressure. James Wyatt, PhD, director of the Sleep Disorders Service and Research Center at Rush University Medical Center, Chicago, told Health.com that those who suffer from narcolepsy or shift-work syndrome can actually benefit greatly from regular daytime naps.

Experts on the topic of naps say 30 to 45 minutes is best when it comes to catching some mid-day Zs. However, individuals are well-advised to listen to their bodies. If one is consistently feeling tired and in need of frequent naps, it may be a good idea to seek medical attention.

- See more at: http://www.sleepreviewmag.com/2014/05/naps-harmful/#sthash.bUf8n7fg.dpuf

Omega-3 Linked to Better Sleep

March 25th, 2014 Raquel Rothe

Higher levels of omega-3 DHA, the group of long-chain fatty acids found in algae and seafood, are associated with better sleep, according to a randomized placebo-controlled study by the University of Oxford.

The researchers explored whether 16 weeks of daily 600 mg supplements of algal sources would improve the sleep of 362 children. The children who took part in the study were not selected for sleep problems, but were all struggling readers at a mainstream primary school. At the outset, the parents filled in a child sleep questionnaire, which revealed that four in 10 of the children in the study suffered from regular sleep disturbances. Of the children rated as having poor sleep, the researchers fitted wrist sensors to 43 of them to monitor their movements in bed over 5 nights. This exploratory pilot study showed that the children on a course of daily supplements of omega-3 had nearly 1 hour (58 minutes) more sleep and seven fewer waking episodes per night compared with the children taking the corn or soybean placebo. The findings are due to be published in the Journal of Sleep Research.

The two-phased study looked at sleep in 362 healthy 7-9 year old UK schoolchildren in relation to the levels of omega-3 and omega-6 long-chain polyunsaturated fatty acids (LC-PUFA) found in fingerstick blood samples. Previous research has suggested links between poor sleep and low blood omega-3 LC-PUFA in infants and in children and adults with behavior or learning difficulties. However, this is the first study to investigate possible links between sleep and fatty acid status in healthy children.

At the start of the study, parents and carers were asked to rate their child’s sleep habits over a typical week (using a three-point scale). Their responses to the well-validated Child Sleep Habits Questionnaire indicated that 40% of the children had clinical-level sleep problems, such as resistance to bedtime, anxiety about sleep, and constant waking in the course of the night.

The study finds that higher blood levels of the long-chain omega-3 DHA (the main omega-3 fatty acid found in the brain) are significantly associated with better sleep, including less bedtime resistance, parasomnias, and total sleep disturbance. It adds that higher ratios of DHA in relation to the long-chain omega-6 fatty acid AA (arachidonic acid) are also associated with fewer sleep problems.

Lead author Professor Paul Montgomery of Oxford University says in a release: “To find clinical level sleep problems in four in ten of this general population sample is a cause for concern. Various substances made within the body from omega-3 and omega-6 fatty acids have long been known to play key roles in the regulation of sleep. For example, lower ratios of DHA have been linked with lower levels of melatonin, and that would fit with our finding that sleep problems are greater in children with lower levels of DHA in their blood.”

Co-investigator Dr Alex Richardson of Oxford University says: “Previous studies we have published showed that blood levels of omega-3 DHA in this general population sample of 7-9 year olds were alarmingly low overall, and this could be directly related to the children’s behaviour and learning. Poor sleep could well help to explain some of those associations.

“Further research is needed given the small number of children involved in the pilot study. Larger studies using objective sleep measures, such as further actigraphy using wrist sensors, are clearly warranted. However, this randomised controlled trial does suggest that children’s sleep can be improved by DHA supplements and indicates yet another benefit of higher levels of omega-3 in the diet.”

- See more at: http://www.sleepreviewmag.com/2014/03/omega-3-better-sleep/#sthash.TEJ9eyBI.dpuf

American Heart Month Means Time to Get in Shape

February 6th, 2014 Raquel Rothe

María Simón

Celebrity fitness trainer, volunteer

So it’s February, and although resolutions are beginning to fade, they’re still there, shining dimly in the background of your mental to-do list. The determination to get back in shape is still alive, but already unforgiving schedules, nagging colds, and less-than-optimal weather conditions have gotten in the way.

Whatever you do, don’t give up… February is here to the rescue! What better time to get back on the wagon than during American Heart Month! Whether your goal is to lose weight, lower your blood pressure or simply become more active, the path is clear and, contrary to what the negative voices in our heads are saying, these goals are attainable.

I’m all for vanity as a great motivator to get healthy, but let’s not lose sight of the most important goal: to live longer and stronger. Heart disease is the leading cause of death in women, even more than all cancers… combined! Obviously, excess fat is a contributing factor, and dropping a few pounds greatly improves heart health. Nevertheless, losing weight shouldn’t be the only focus. After all, in case you haven’t heard, strong is the new skinny! It is important to be informed and have realistic goals.

Research by the American Heart Association has shown that visceral (abdominal) fat is directly related to higher incidences of heart health issues. But before you throw yourself to the floor in a frantic attempt to do as many crunches as humanly possible, know that six-pack abs are no more healthier than those with reasonable height-to-weight ratios. The American Heart Association recommends a waist circumference that is less than 35 inches for women. However, this is relative to height. Therefore, a waist circumference that is less than half of one’s height is another guideline toward procuring a healthy size, as opposed to going by the air-brushed model on the cover of your favorite magazine.

By now, we’ve been bombarded with every lose-weight-quick diet tip and get-flat-abs-quicker exercise routine. Fitness professionals, like myself, are forever searching for exciting exercise combinations in order to motivate our clients. But between you and me, the truth is, simple is best. Sometimes, just finding the time (and a wearable sports bra) is complicated enough.

The American Heart Association recommends at least 30-45 minutes of any exercise to achieve a healthier lifestyle. The keyword here is “any.” You don’t have to be drenched in sweat and feel like you’re about to die in order to have accomplished a good work-out, but if you’re determined, a lot can be done in just 30 minutes.

Start with a casual warm-up, jogging in place for a minute, increase to sprinting for another minute, and add jumping jacks for yet another minute. You can go back to sprinting, then jogging to bring your intensity down before stopping. Add some arm circles and leg swings for dynamic stretches while keeping your heart rate somewhat elevated.

Now that you’re all warmed up, let’s use your home as a gym. The bottom two steps of any stairway can be used as a “stepper” to do alternating step-ups, adding knee raises to work the quadriceps and then heel lifts to work the hamstrings and glutes. Use a dining room chair for tricep dips, and you can even sit in the chair, hold on to your seat (literally), bring your knees into your chest and extend your legs for a great abdominal workout.

Finally, take it to the floor and add some planks to the mix, going from elbows to hands to make it a little more interesting (if not entertaining) for an effective core and upper body exercise. Spend a couple of minutes at each of your homemade stations, take a one-minute water break, and repeat three times. End your at-home exercise routine by holding a few static stretches and you are good to go!

Find out more information about Health Benefits of Weight Training for Women,Abdominal Exercises that Strengthen Your Core and other heart-healthy routines by visiting Go Red For Women.

This blog post is part of a series produced by The Huffington Post andlesscancer.org, in recognition of both World Cancer Day and National Cancer Prevention Day (both Feb. 4), and in conjunction with lesscancer.org’s panel oncancer in Washington that day. To see all the other posts in the series, clickhere. For more information about lesscancer.org, click here

Sleep apnea may hold hidden dangers for women

November 5th, 2013 Raquel Rothe

A new study on sleep apnea reveals there could be some hidden dangers – particularly for women who have the condition – where breathing is interrupted during sleep. Women with sleep apnea may appear healthy, but they have subtle symptoms so their sleep problem is often misdiagnosed.

Now, new research, led by the University of California Los Angeles (UCLA) School of Nursing, shows that the body’s autonomic responses, which normally control blood pressure, heart rate, sweating and other basic functions, are not as strong in people with obstructive sleep apnea, and even less so in women.

Obstructive sleep apnea is a serious condition that happens when the person is asleep, sometimes hundreds of times a night. When it occurs, blood oxygen drops and eventually damages many cells of the body.

There are over 20 million adult Americans living with the condition, note the researchers, who explain that it is linked with several serious health problems and also early death.

Women are much less likely to be diagnosed with obstructive sleep apnea than men.

Lead researcher Dr. Paul Macey says:

“We now know that sleep apnea is a precursor to bigger health issues. And for women in particular, the results could be deadly.”

Early detection and intervention needed

Dr. Macey and his colleagues describe their work in a recent online issue of PLOS ONE.

For their study, the team recruited 94 adult men and women, comprising 37 newly diagnosed, untreated obstructive sleep (OSA) patients and 57 healthy volunteers to act as controls.

The three groups had their heart rates measured as they went through three different physical challenges:

  • The Valsalva maneuver – where they had to breathe out hard while keeping the mouth closed
  • A hand-grip challenge – where they had to just squeeze hard with one hand
  • A cold pressor challenge – where the right foot is inserted into near-freezing water for a minute.

The team notes the main results:

“Heart rate responses showed lower amplitude, delayed onset and slower rate changes in OSA patients over healthy controls, and impairments may be more pronounced in females.”

Dr. Macey adds:

“This may mean that women are more likely to develop symptoms of heart disease, as well as other consequences of poor adaptation to daily physical tasks. Early detection and treatment may be needed to protect against damage to the brain and other organs.”

The team now intends to investigate if the usual treatments for OSA, such as continuous positive airway pressure (CPAP), help to improve the autonomic responses.

CPAP is where a machine helps the OSA patient breathe more easily while asleep.

Funds from the National Institutes of Health and the National Institute of Nursing Research helped finance the study.

In another study published recently, researchers from Brigham and Women’s Hospital in Boston, MA, found that sleep apnea is linked to early sign of heart failure.

Written by Catharine Paddock PhD

Couples Who Sleep Apart are Healthier?

February 26th, 2013 Raquel Rothe
By Irmina Santaika
“Want the dream marriage? Then sleep in separate beds”dailymail.co.uk, 2009 August 1, 2012, L ifestyle My Joy Online The secret to a long and happy marriage could be having separate beds, an expert on sleep claims.
Not only will a couple escape arguments over duvet-hogging and fidgeting, but they will have a proper night’s rest.
This will have a huge impact on both their health and the relationship as poor sleep increases the risk of stroke, heart disease and divorce, said Dr Neil Stanley.
The consultant, who set up sleep laboratories at Surrey University, said: ‘Poor sleep is bad for your physical, mental and emotional health. There is no good thing about poor sleep.
‘If you sleep perfectly well together, then don’t change. But don’t be afraid to relocate.’ If a husband or wife snores, twin beds might not be an option either, and they should sleep in separate bedrooms, he told the British Science Festival.
Dr Stanley, who follows his own advice and sleeps in a different room to his wife, said that double beds are just not conducive to a good night’s sleep.
He said the tradition of the marital bed began with the industrial revolution, when people moved into cities and found themselves short of living space.
Before the Victorian era it was not uncommon for married couples to sleep apart.
He said that now the British way is to have a 4ft 6in double bed. ‘A standard single bed is 2ft 6in or 3ft, that means you have nine inches less sleeping space in bed than your child does in theirs.
‘You then put in this person who makes noise, punches, kicks and gets up to go to the loo in the middle of the night, is it any wonder you are not getting a good night’s sleep?’ He added:
‘Poor sleep increases the risk of depression, heart disease, stroke, respiratory failure and increases the risk of divorce and suicidal behaviour.’
A recent large- scale Japanese study concluded that seven and a half hours of sleep a night is optimal for good health.
A third of British adults regularly have fewer than five hours. Dr Stanley’s advice follows studies at Surrey University on the impact of tossing and turning on sleeping partners.
When one partner moves in his or her sleep, there is a 50 per cent chance the other will also change position.
Despite this, couples are reluctant to sleep apart, with just 8 per cent of those in their 40s and 50s bedding down in different rooms.
Separate bedrooms are much more common in old age, with more than 40 per cent of those aged 70-plus sleeping apart.
This could be because long-established couples feel more secure in their relationships.
They may also find it easier to bring up the touchy topic of one moving out of the marital bed and could also be more likely to have a spare room than a younger couple.
Dr Stanley said the argument that it is comforting to sleep beside someone else holds little water.
He said: ‘Sleep is the most selfish thing we can do. People say that they like the feeling of having their partner next to them when they are asleep. But you have to be awake to feel that.
‘We all know what it is like to sleep in a bed with somebody and have a cuddle. ‘But at one point you say, “I’m going to go to sleep now”.
‘Why not at that point just take yourself down the landing?
‘Intimacy is important for emotional health. But good sleep is important for physical, emotional and mental health.
‘Getting a good night’s sleep is something we should all aspire to.

What is Cholesterol?

February 15th, 2012 Raquel Rothe
Cholesterol is a soft, waxy substance found in every cell of your body.
1
It’s essential for normal body
function, but your body produces all the cholesterol it needs, so cholesterol in your diet is deposited
in your blood vessels. Eventually, this surplus can lead to narrowing of the arteries, stroke and heart
disease.
2
In fact, high blood cholesterol is a major risk factor for heart disease, the leading cause of
death in the U.S. Depending on race, between 40 and 51 percent of American adults have high blood
cholesterol.
3
Get Healthy. Stay Healthy.
What is Cholesterol?
LDL vs. HDL cholesterol
4
Cholesterol is carried through the bloodstream by particles called lipoproteins, which are made up of cholesterol on the
inside and protein on the outside. There are two main types of lipoproteins:

Cholesterol is a soft, waxy substance found in every cell of your body.

1- It’s essential for normal body

function, but your body produces all the cholesterol it needs, so cholesterol in your diet is deposited

in your blood vessels. Eventually, this surplus can lead to narrowing of the arteries, stroke and heart

disease.

2- In fact, high blood cholesterol is a major risk factor for heart disease, the leading cause of

death in the U.S. Depending on race, between 40 and 51 percent of American adults have high blood

cholesterol.

3-Get Healthy. Stay Healthy.

4-What is Cholesterol?

LDL vs. HDL cholesterol

Cholesterol is carried through the bloodstream by particles called lipoproteins, which are made up of cholesterol on the

inside and protein on the outside. There are two main types of lipoproteins:

Low-density lipoproteins (LDL) are the major type of lipoprotein carrying cholesterol through the body. LDL cholesterol builds up on the walls of your arteries and can lead to coronary artery disease, heart attack and stroke.

High-density lipoproteins (HDL) carry excess cholesterol back to the liver to remove it from the body. HDL cholesterol is what’s referred to as “good cholesterol.

Do 5 Easy Things Now to Extend Your Life, what do sleep and sex have to do with it?

September 29th, 2011 Raquel Rothe

The 10 Things You Should Hate About The Loss of Sleep

September 20th, 2010 admin

Did you know that the lack of sleep can make you grumpy and foggy? You may not realize what it can do to your life, memory, sex, looks and even the ability to loss weight, these are all serious-and surprising effect of sleep loss.
Sleepiness Causes Accidents-Some of the biggest disasters in recent history were caused by sleep deprivation: the 1979 nuclear accident at Three Mile Island, the massive/destructive Exxon Valdez oil spill, the 1986 nuclear meltdown at Chernobyl are just a few. Sleep loss is a big public safety hazard every day on the roads we travel. Drowsiness can slow reaction time as much as driving drunk; many studies have proven this and the National Highway Traffic Safety Administration estimates that fatigue is a cause in 100,000 auto crashes with 1,500 crash-related deaths a year in the U.S.
The loss of sleep dumbs you down-Sleep plays a critical role in thinking and learning. Lack of sleep hurts these cognitive processes in many ways. First, it impairs attention, alertness, concentration, reasoning, and problem solving so this makes it more difficult to learn efficiently. Secondly during the night, various sleep cycles play a role in “consolidating” memories in the mind. If you don’t get enough sleep, you won’t be able to remember what you learned and experienced during the day.
Serious health problems can lead to sleep deprivation-Sleep disorders and chronic sleep loss can put you at risk for:
Heart disease
Heart attack
Heart failure
Irregular heartbeat
High blood pressure
Stroke
Diabetes
According to some estimates, 90% of people with insomnia — a sleep disorder characterized by trouble falling and staying asleep — also have another health condition.

4. Lack of Sleep Kills Sex Drive-Sleep specialists say that sleep-deprived men and women report lower and libidos less interest in sex. Depleted energy, sleepiness, and increased tension may be largely to blame. For men with sleep apnea, a respiratory problem that interrupts sleep, there may be another factor in the sexual slump. A study published in the Journal of Clinical Endocrinology & Metabolism in 2002 suggests that many men with sleep apnea also have low testosterone levels. In the study, nearly half of the men who suffered from severe sleep apnea also secreted abnormally low levels of testosterone during the night.

5. Sleepiness Is Depressing-In a 1997 study by researchers at the University of Pennsylvania, people who slept less than five hours a night for seven nights felt stressed, angry, sad, and mentally exhausted. Over time, lack of sleep and sleep disorders can contribute to the symptoms of depression. The most common sleep disorder, insomnia, has the strongest link to depression. In a 2007 study of 10,000 people, those with insomnia were five times as likely to develop depression as those without. In fact, insomnia is often one of the first symptoms of depression. Insomnia and depression feed on each other. Sleep loss often aggravates the symptoms of depression, and depression can make it more difficult to fall asleep. On the positive side, treating sleep problems can help depression and its symptoms, and vice versa.

6. Lack of Sleep Ages Your Skin-Most people have experienced sallow skin and puffy eyes after a few nights of missed sleep. But it turns out that chronic sleep loss can lead to lackluster skin, fine lines, and dark circles under the eyes. When you don’t get enough sleep, your body releases more of the stress hormone cortisol. In excess amounts, cortisol can break down skin collagen, the protein that keeps skin smooth and elastic. Sleep loss also causes the body to release too little human growth hormone. When we’re young, human growth hormone promotes growth. As we age, it helps increase muscle mass, thicken skin, and strengthen bones. “It’s during deep sleep — what we call slow-wave sleep — that growth hormone is released,” says Phil Gehrman, PhD, CBSM, assistant professor of psychiatry and clinical director of the Behavioral Sleep Medicine program at the University of Pennsylvania in Philadelphia. “It seems to be part of normal tissue repair — patching the wear and tear of the day.”

7. Forgetful? Sleepiness Makes You this way-If you are trying to keep your memory sharp? Try getting plenty of sleep. In 2009, American and French researchers determined that brain events called “sharp wave ripples” are responsible for consolidating memory. The ripples also transfer learned information from the hippocampus to the neocortex of the brain, where long-term memories are stored. Sharp wave ripples occur mostly during the deepest levels of sleep.

8. Losing Sleep Can Make You Gain Weight-When it comes to body weight, it may be that if you snooze, you lose. Lack of sleep seems to be related to an increase in hunger and appetite, and possibly to obesity. According to a 2004 study, people who sleep less than six hours a day were almost 30 percent more likely to become obese than those who slept seven to nine hours. Recent research has focused on the link between sleep and the peptides that regulate appetite. “Ghrelin stimulates hunger and leptin signals satiety to the brain and suppresses appetite,” says Siebern. “Shortened sleep time is associated with decreases in leptin and elevations in ghrelin.” Not only does sleep loss appear to stimulate appetite. It also stimulates cravings for high-fat, high-carbohydrate foods. Ongoing studies are considering whether adequate sleep should be a standard part of weight loss program. So if we are gaining sleep, we should be losing weight.

9. Lack of Sleep May Increase Risk of Death-In the “Whitehall II Study,” British researchers looked at how sleep patterns affected the mortality of more than 10,000 British civil servants over two decades. The results, published in 2007, showed that those who had cut their sleep from seven to five hours or fewer a night nearly doubled their risk of death from all causes. In particular, lack of sleep doubled the risk of death from cardiovascular disease.

10. Sleep Loss Impairs Judgment, Especially About Sleep! Lack of sleep can affect our interpretation of events. This hurts our ability to make sound judgments because we may not assess situations accurately and act on them wisely. Sleep-deprived people seem to be especially prone to poor judgment when it comes to assessing what lack of sleep is doing to them. In our increasingly fast-paced world, functioning on less sleep has become a kind of badge of honor. But sleep specialists say if you think you’re doing fine on less sleep, you’re probably wrong. And if you work in a profession where it’s important to be able to judge your level of functioning, this can be a big problem. “Studies show that over time, people who are getting six hours of sleep, instead of seven or eight, begin to feel that they’ve adapted to that sleep deprivation — they’ve gotten used to it,” Gehrman says. “But if you look at how they actually do on tests of mental alertness and performance, they continue to go downhill. So there’s a point in sleep deprivation when we lose touch with how impaired we are.”

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