Ravings of the Loquacious Madman

18 February 2009 by Emma Young

newscientist.com

TAKE anyone with a psychiatric disorder and the chances are they don’t sleep well. The result of their illness, you might think. Now this long-standing assumption is being turned on its head, with the radical suggestion that poor sleep might actually cause some psychiatric illnesses or lead people to behave in ways that doctors mistake for mental problems. The good news is that sleep treatments could help or even cure some of these patients. Shockingly, it also means that many people, including children, could be taking psychoactive drugs that cannot help them and might even be harmful.

No one knows how many people might fall into this category. "That is very frightening," says psychologist Matt Walker from the University of California, Berkeley. "Wouldn’t you think that it would be important for us as a society to understand whether 3 per cent, 5 per cent or 50 per cent of people diagnosed with psychiatric problems are simply suffering from sleep abnormalities?"

First, we’d need to know how and to what extent sleep disorders could be responsible for psychiatric problems. In the few years since sleep researchers identified the problem, they have made big strides in doing just that.

Doctors studying psychiatric disorders noticed long ago that erratic sleep was somehow connected. Adults with depression, for instance, are five times as likely as the average person to have difficulty breathing when asleep, while between a quarter and a half of children with attention-deficit hyperactivity disorder (ADHD) suffer from sleep complaints, compared with just 7 per cent of other children.

Until recently, however, the assumption that poor sleep was a symptom rather than a cause of mental illness was so strong that nobody questioned it. "It was just so easy to say about a patient, well, he’s depressed or schizophrenic, of course he’s not sleeping well – and never to ask whether there could be a causal relationship the other way," says Robert Stickgold, a sleep researcher at Harvard University. Even when studies did seem to point in the other direction, the findings were largely overlooked, he says.

In 1987, for example, Patricia Chang and colleagues at Johns Hopkins University in Baltimore reported a study of 1053 male medical students who had been followed for an average of 34 years after graduation. During that time, 101 of them developed clinical depression and 13 of these committed suicide. It turned out that students who had reported suffering from insomnia were twice as likely to develop depression as those with no trouble sleeping. The team concluded cautiously that insomnia was "indicative of a greater risk" of problems later. Stickgold goes further. He believes the study shows that insomnia can predispose people to depression.

He’s not the only one to be persuaded both by findings such as Chang’s and by the growing realisation that some sleep problems generate symptoms that mimic those of certain psychiatric disorders.

In 2006, Paul Peppard at the University of Wisconsin-Madison and his team studied the relationship between depression and sleep-disordered breathing. In sleep apnoea, the most common form of SDB, a blockage or narrowing of the windpipe causes a steep drop in oxygen levels, temporarily waking the sleeper. The team randomly selected about 800 men and 600 women from a working population and evaluated them in the lab for SDB and depression. There are four categories of SDB and for each increase in a person’s SDB category – from "minimal" to "mild", for example – their odds of getting depressed almost doubled, the team found (Archives of Internal Medicine, vol 16, p 1709). Depression cannot have been the main cause of the poor sleep, since we know SDBs stem from physical factors such as excess fat thickening the windpipe or a large tongue or tonsils relative to the size of the windpipe opening. Instead, this work suggests that sleep disorders lead to the depression.

Indeed, Daniel Buysse, medical director of the Sleep and Chronobiology Program at the University of Pittsburgh, Pennsylvania, has found that treating depressed patients’ sleep problems with a drug such as benzodiazepine can produce a dramatic turnaround in their mood disorder. Buysse does not provide an estimate for the proportion of depressed patients who fall into this category – but he has gone on the record saying that for some patients insomnia seems to cause depression.

Poor sleep may also explain some of the characteristic behaviours associated with other mental illnesses. For example, there is plenty of evidence to suggest that impaired sleep can induce the manic episodes suffered by people with bipolar disorder, according to a review published last May (American Journal of Psychiatry, vol 165, p 830). Stickgold even thinks that it can cause a common problem associated with schizophrenia, namely, the failure to master rote tasks such as how to use a piece of machinery. While healthy people improve overnight on tasks that require such motor skills, Stickgold’s team has found that people with chronic schizophrenia do not. "We have identified a failure specifically of the sleep-dependent component of procedural learning," the researchers write (Biological Psychiatry, DOI: 10.1016/j.bps.2004.09.012). So, in theory, improved sleep should help with this symptom.

It also seems that behavioural problems resulting from lack of sleep may be misdiagnosed as attention-deficit disorder (ADD) and ADHD. In 2005, Clifford Risk, director of the Marlborough Center for Sleep Disorders in Massachusetts, presented a study to the annual meeting of the American College of Chest Physicians. Of 34 adults with sleep apnoea that he investigated, 16 had scores that suggested a moderate or severe impairment of attention. Subsequent treatment for the apnoea led to substantial improvements in attention scores for 60 per cent of these individuals – suggesting that for this sub group, at least, the sleep apnoea caused the difficulties with attention.

Likewise, in an analysis of 83 children with ADHD, David Gozal from the University of Louisville, Kentucky, and colleagues found that a quarter of those diagnosed with mild ADHD suffered from sleep apnoea, compared with just 5 per cent of those with strong ADHD and 5 per cent of healthy controls. "SDB can lead to mild ADHD-like behaviours that can be readily misperceived and potentially delay the diagnosis and appropriate treatment," the team concluded (Pediatrics, 2007, vol 111, p 554). What’s more, a study of children undergoing surgery to remove their tonsils and adenoids (a common treatment for snoring and sleep apnoea) found that before the operation, one-quarter had a diagnosis of ADHD compared to 7.4 per cent of healthy controls. But a year after the operations, half of these children no longer met the criteria for ADHD (Archives of Otolaryngology – Head & Neck Surgery, vol 133, p 974). Mark Kohler from the Women’s and Children’s Hospital in Adelaide, Australia, who has studied links between ADHD and sleep, suspects that some children are being treated with drugs such as Ritalin while their true problem, a sleep disorder, goes unrecognised.

So how does poor sleep lead to behavioural and psychological problems? Some of the links are apparent. For example, every parent knows that tired children usually become hyperactive rather than sleepy. Sleep disruption also bumps up stress hormone levels, which could contribute to daytime anxiety, a component of many psychiatric disorders. More intriguingly, it now seems sleep disruption can fundamentally interfere with the brain’s ability to process emotion and to react to an emotional stimulus in an appropriate way (see "Feeling emotional? Take a nap").

While it is common knowledge anecdotally that a poor night’s sleep is likely to make you more irritable the next day, Walker and his colleagues uncovered key evidence for why this should be so. The team showed a set of increasingly disturbing images to people who had slept normally and people deprived of sleep for 35 hours. In the sleep-deprived group, the gruesome images produced 60 per cent more activity in the amygdala – a primitive, emotionally reactive part of the brain – than in well-rested people. Further scans revealed that in those deprived of sleep the amygdala was failing to communicate with the prefrontal lobe, which normally controls and sends inhibitory signals down to the emotional brain. "The reason we don’t blow our top when someone says something we don’t like is because we have a highly developed prefrontal cortex, which acts as an emotional brake," says Walker. A loss of communication between the amygdala and the prefrontal lobe is one way that sleep loss could create psychiatric symptoms, he thinks. "In a number of psychiatric disorders, such as depression, it has been demonstrated that the frontal lobe’s activity becomes disrupted. There’s also preliminary evidence [of this] for ADHD and post-traumatic stress disorder," Walker says.

In another strand of research, evidence is growing that sleep – and dreaming, REM sleep, in particular – helps the brain to process memories. Disrupt this mechanism, and you could end up with psychological problems such as PTSD.

In August 2008, Stickgold and colleagues reported that when people are presented with pictures of an emotional or neutral object or scene, their memory for these scenes decreases during the day. After a night’s sleep, they forget pretty much everything except the things that roused their emotions, for which their memories stay the same, or even improve (Psychological Science, vol 19, p 781). Cast your mind back, says Walker, and you will appreciate that almost all of your memories are emotional ones. He thinks this is because emotions act as a red flag for important things that we should be remembering. But, crucially, if you recall them now you don’t re-experience the visceral reaction that you had at the time. Somehow, the brain has retained the memory while stripping away the visceral emotion. Both Stickgold and Walker believe this stripping process occurs during REM sleep.

They note that during REM, production of serotonin and noradrenalin shuts down in the brain. Noradrenalin is the neurochemical associated with stress, fear and the flight response; it translates to adrenalin in the body. Serotonin modulates anger and aggression. "You get this beautiful biological theatre during REM sleep, where the brain can go back over experiences it has learned in days past, but can do so in a situation where there are none of these hyping-up neurochemicals," Walker says. So although dreams can be highly emotional, he thinks that they gradually erode the emotional edges of memories.

In PTSD this process seems to fail, so that traumatic memories are recalled in all their emotional detail. It is not clear yet why this happens, but there is evidence that people with PTSD have higher waking levels of noradrenalin and serotonin. This might mean that neurotransmitters cannot be damped down sufficiently during REM sleep for the emotional intensity of the memories to be stripped away, says Walker.

Clearly there is still a lot of work to be done in untangling the ways in which sleep disruption might create psychiatric symptoms. Among the anomalies that need explaining is the fact that antidepressant medications reduce REM sleep and yet can be very effective. Then there is the puzzling finding that many people with depression say they feel happier after a night deprived of sleep (Biological Psychiatry, vol 149, p 471).

Nevertheless, when it comes to exactly how and to what extent sleep disorders could be responsible for psychiatric problems, Walker says: "We’re getting there. Five years ago, that question wasn’t on the radar for anyone – scientists or lay people. The fact that we’re aware of it now and asking those questions means it’s inevitable we’ll find out."

By Jen Angel, YES! Magazine. Posted December 9, 2008

In the last few years, psychologists and researchers have been digging up hard data on a question previously left to philosophers: What makes us happy? Researchers like the father-son team Ed Diener and Robert Biswas-Diener, Stanford psychologist Sonja Lyubomirsky, and ethicist Stephen Post have studied people all over the world to find out how things like money, attitude, culture, memory, health, altruism, and our day-to-day habits affect our well-being. The emerging field of positive psychology is bursting with new findings that suggest your actions can have a significant effect on your happiness and satisfaction with life. Here are 10 scientifically proven strategies for getting happy.

1. Savor Everyday Moments

Pause now and then to smell a rose or watch children at play. Study participants who took time to “savor” ordinary events that they normally hurried through, or to think back on pleasant moments from their day, “showed significant increases in happiness and reductions in depression,” says psychologist Sonja Lyubomirsky.

2. Avoid Comparisons

While keeping up with the Joneses is part of American culture, comparing ourselves with others can be damaging to happiness and self-esteem. Instead of comparing ourselves to others, focusing on our own personal achievement leads to greater satisfaction, according to Lyubomirsky.

3. Put Money Low on the List

People who put money high on their priority list are more at risk for depression, anxiety, and low self-esteem, according to researchers Tim Kasser and Richard Ryan. Their findings hold true across nations and cultures. “The more we seek satisfactions in material goods, the less we find them there,” Ryan says. “The satisfaction has a short half-life — it’s very fleeting.” Money-seekers also score lower on tests of vitality and self-actualization.

4. Have Meaningful Goals

“People who strive for something significant, whether it’s learning a new craft or raising moral children, are far happier than those who don’t have strong dreams or aspirations,” say Ed Diener and Robert Biswas-Diener. “As humans, we actually require a sense of meaning to thrive.” Harvard’s resident happiness professor, Tal Ben-Shahar, agrees, “Happiness lies at the intersection between pleasure and meaning. Whether at work or at home, the goal is to engage in activities that are both personally significant and enjoyable.”

5. Take Initiative at Work

How happy you are at work depends in part on how much initiative you take. Researcher Amy Wrzesniewski says that when we express creativity, help others, suggest improvements, or do additional tasks on the job, we make our work more rewarding and feel more in control.

6. Make Friends, Treasure Family

Happier people tend to have good families, friends, and supportive relationships, say Diener and Biswas-Diener. But it’s not enough to be the life of the party if you’re surrounded by shallow acquaintances. “We don’t just need relationships, we need close ones” that involve understanding and caring.

7. Smile Even When You Don’t Feel Like It

It sounds simple, but it works. “Happy people…see possibilities, opportunities, and success. When they think of the future, they are optimistic, and when they review the past, they tend to savor the high points,” say Diener and Biswas-Diener. Even if you weren’t born looking at the glass as half-full, with practice, a positive outlook can become a habit.

8. Say Thank You Like You Mean It

People who keep gratitude journals on a weekly basis are healthier, more optimistic, and more likely to make progress toward achieving personal goals, according to author Robert Emmons. Research by Martin Seligman, founder of positive psychology, revealed that people who write “gratitude letters” to someone who made a difference in their lives score higher on happiness, and lower on depression — and the effect lasts for weeks.

9. Get Out and Exercise

A Duke University study shows that exercise may be just as effective as drugs in treating depression, without all the side effects and expense. Other research shows that in addition to health benefits, regular exercise offers a sense of accomplishment and opportunity for social interaction, releases feel-good endorphins, and boosts self-esteem.

10. Give It Away, Give It Away Now!

Make altruism and giving part of your life, and be purposeful about it. Researcher Stephen Post says helping a neighbor, volunteering, or donating goods and services results in a “helper’s high,” and you get more health benefits than you would from exercise or quitting smoking. Listening to a friend, passing on your skills, celebrating others’ successes, and forgiveness also contribute to happiness, he says. Researcher Elizabeth Dunn found that those who spend money on others reported much greater happiness than those who spend it on themselves.

For centuries, people have recognized the power of luck and have done whatever they could to try seizing it. Take knocking on wood, thought to date back to pagan rituals aimed at eliciting help from powerful tree gods. We still do it today, though few, if any, of us worship tree gods. So why do we pass this and other superstitions down from generation to generation? The answer lies in the power of luck.

Live a Charmed Life
To investigate scientifically why some people are consistently lucky and others aren’t, I advertised in national periodicals for volunteers of both varieties. Four hundred men and women from all walks of life — ages 18 to 84 — responded.
Over a ten-year period, I interviewed these volunteers, asked them to complete diaries, personality questionnaires and IQ tests, and invited them to my laboratory for experiments. Lucky people, I found, get that way via some basic principles — seizing chance opportunities; creating self-fulfilling prophecies through positive expectations; and adopting a resilient attitude that turns bad luck around.

Open Your Mind
Consider chance opportunities: Lucky people regularly have them; unlucky people don’t. To determine why, I gave lucky and unlucky people a newspaper, and asked them to tell me how many photos were inside. On average, unlucky people spent about two minutes on this exercise; lucky people spent seconds. Why? Because on the paper’s second page — in big type — was the message "Stop counting: There are 43 photographs in this newspaper." Lucky people tended to spot the message. Unlucky ones didn’t. I put a second one halfway through the paper: "Stop counting, tell the experimenter you have seen this and win $250." Again, the unlucky people missed it.
The lesson: Unlucky people miss chance opportunities because they’re too busy looking for something else. Lucky people see what is there rather than just what they’re looking for.
This is only part of the story. Many of my lucky participants tried hard to add variety to their lives. Before making important decisions, one altered his route to work. Another described a way of meeting people. He noticed that at parties he usually talked to the same type of person. To change this, he thought of a color and then spoke only to guests wearing that color — women in red, say, or men in black.
Does this technique work? Well, imagine living in the center of an apple orchard. Each day you must collect a basket of apples. At first, it won’t matter where you look. The entire orchard will have apples. Gradually, it becomes harder to find apples in places you’ve visited before. If you go to new parts of the orchard each time, the odds of finding apples will increase dramatically. It is exactly the same with luck.

Relish the Upside
Another important principle revolved around the way in which lucky and unlucky people deal with misfortune. Imagine representing your country in the Olympics. You compete, do well, and win a bronze medal. Now imagine a second Olympics. This time you do even better and win a silver medal. How happy do you think you’d feel? Most of us think we’d be happier after winning the silver medal.
But research suggests athletes who win bronze medals are actually happier. This is because silver medalists think that if they’d performed slightly better, they might have won a gold medal. In contrast, bronze medalists focus on how if they’d performed slightly worse, they wouldn’t have won anything. Psychologists call this ability to imagine what might have happened, rather than what actually happened, "counter-factual" thinking.
To find out if lucky people use counter-factual thinking to ease the impact of misfortune, I asked my subjects to imagine being in a bank. Suddenly, an armed robber enters and fires a shot that hits them in the arms. Unlucky people tended to say this would be their bad luck to be in the bank during the robbery. Lucky people said it could have been worse: "You could have been shot in the head." This kind of thinking makes people feel better about themselves, keeps expectations high, and increases the likelihood of continuing to live a lucky life.

Learn to Be Lucky
Finally, I created a series of experiments examining whether thought and behavior can enhance good fortune.
First came one-on-one meetings, during which participants completed questionnaires that measured their luck and their satisfaction with six key areas of their lives. I then outlined the main principles of luck, and described techniques designed to help participants react like lucky people. For instance, they were taught how to be more open to opportunities around them, how to break routines, and how to deal with bad luck by imagining things being worse. They were asked to carry out specific exercises for a month and then report back to me.
The results were dramatic: 80 percent were happier and more satisfied with their lives — and luckier. One unlucky subject said that after adjusting her attitude — expecting good fortune, not dwelling on the negative — her bad luck had vanished. One day, she went shopping and found a dress she liked. But she didn’t buy it, and when she returned to the store in a week, it was gone. Instead of slinking away disappointed, she looked around and found a better dress — for less. Events like this made her a much happier person.
Her experience shows how thoughts and behavior affect the good and bad fortune we encounter. It proves that the most elusive of holy grails — an effective way of taking advantage of the power of luck — is available to us all.

From Reader’s Digest

WASHINGTON - Turns out, it is a small world.

The "small world theory," embodied in the old saw that there are just "six degrees of separation" between any two strangers on Earth, has been largely corroborated by a massive study of electronic communication.

With records of 30 billion electronic conversations among 180 million people from around the world, researchers have concluded that any two people on average are distanced by just 6.6 degrees of separation, meaning that they could be linked by a string of seven or fewer acquaintances.

The database covered all of the Microsoft Messenger instant-messaging network in June 2006, or roughly half the world’s instant-messaging traffic at that time, researchers said.

"To me, it was pretty shocking. What we’re seeing suggests there may be a social connectivity constant for humanity," said Eric Horvitz, a Microsoft researcher who conducted the study with colleague Jure Leskovec. "People have had this suspicion that we are really close. But we are showing on a very large scale that this idea goes beyond folklore."

In recent years, the massive databases yielded by cell phone records have been exploited by researchers to better understand human movements and social networks. Stripped of text messages and personally identifiable information, the records indicate users’ location and patterns of contact.

Enter Kevin Bacon
The Microsoft research focused on the popular concept that has inspired games such as Six Degrees of Kevin Bacon and a well-known play by John Guare. A "degree of separation" is a measure of social distance between people. You are one degree away from everyone you know, two degrees away from everyone they know, and so on.

But proof of the theory has been thin.

Its origins lie in the work done in the ’60s by Stanley Milgram and Jeffrey Travers. In an oft-cited 1969 work, they put the figure at 6.2, though they never referred to it as "degrees of separation."

Their finding was based on asking 296 people in Nebraska and Boston to send a letter through acquaintances to a Boston stockbroker.

The subjects were told to send the letter to an acquaintance who could best advance the letter to the target, but most failed: Only 64 of the original 296 letters reached the stockbroker. Of those letter chains that were complete, the average number of degrees of separation was 6.2. The high failure rate, and the possibility that the incomplete chains reflected much more distant relationships, led some to question the results. Also, all of the subjects were in the United States. What would happen if the test was expanded to the planet?

Takes off worldwide
The idea was taken up again, this time on a global scale, by Columbia University researchers in a 2003 report of an e-mail experiment. More than 24,163 volunteers agreed to try to send an e-mail through acquaintances to one of 18 target persons in 13 countries. Only 384 of those 24,163 letter chains were completed. Of those completed chains, the average number of steps was 4, and using statistical techniques, the researchers estimated that the average length in all of the chains was between five and seven steps. Still, it was an estimate.

The Microsoft Messenger project, which was presented at a technical conference in Beijing in April, went further.

"To our knowledge, this is the first time a planetary-scale social network has been available to validate the well-known ’6 degrees of separation’ finding by Travers and Milgram," the researchers said.

For the purposes of their experiment, two people were considered to be acquaintances if they had sent one another a text message. The researchers looked at the minimum chain lengths it would take to connect 180 billion different pairs of users in the database. They found that the average length was 6.6 steps and that 78 percent of the pairs could be connected in seven hops or less.

Some pairs, however, were separated by as many as 29 hops.

"Via the lens provided on the world by Messenger, we find that there are about ’7 degrees of separation’ among people,” they wrote.

Microsoft Messenger use is most intense in North America, Europe and Japan, and in the coastal regions of the rest of the world. While the study sample is huge, there is little way of knowing whether Microsoft Messenger users are as socially connected as the rest of humanity.

Why does it matter that people from around the world are closely tied together? Researchers said that the knowledge might have applications for political organizations, charity efforts, natural disaster relief and missing-person searches.

"They could create large meshes of people who could be mobilized with the touch of a return key," Horvitz said.

It also means that, strictly speaking, six degrees of separation might be just a bit off. It’s closer to seven, at least in their study.

"For a piece of folklore, it wasn’t bad," said Duncan J. Watts, one of the Columbia researchers, now at Yahoo Research. "It was off only in its detail."