Poking at a personal scale of sleep dep

[azurelunatic]

Got linked to http://www.misstreated.org/blog/2016/3/24/five-reasons-fatigue-isnt-like-normal-tiredness-proving-most-people-dont-get-it via some of the usual suspects.

There's a fatigue scale at the destination; since it's an image I'll transcribe it here.

FATIGUE SCALE
10. Can barely move. Can't talk.
9. Can barely move. Can talk.
8. Can move, but can't do much more than watch TV.
7. Can watch TV and play a game on my phone simultaneously.
6. Can do work on my computer lying in bed.
5. Can get around the house, but definitely couldn't go out.
4. Can run a light errand.
3. Can get in my 10,000 steps for the day, making my fitbit happy.
2. Can do three or more activities in a single day.
1. GOING CLUBBING!
From www.misstreated.org, MissKatieErnst

Reading that makes me think of some of my own struggles around sleep, which are not quite the same beastie. I have had problems with tiredness more than fatigue, specifically. The numbering system is a combination of severity and misery.


10. By all rights I should be asleep, but there is something chemically prohibiting me from reaching that state (caffeine poisoning, adrenaline spike). I am probably angry, miserable, nauseated, with a high likelihood of auditory and peripheral vision hallucinations. I am not functional.
9. I have been awakened in the middle of a sleep cycle. I am angry and possibly terrified. I may be hallucinating. If I am capable of speech, the words aren't likely to form coherent concepts even if they're intelligible. Memory writing is impaired; I am existing in a very bad dream state. I may or may not exhibit PTSD symptoms, and may or may not acquire new trauma. If I am functional, it is by accident. (Equivalent BAC 0.16-0.20)
8. There will be bad consequences if I cannot be awake for this thing, but I cannot safely drive. I can still sort of function if I take the bus or someone else drives me. Cognitive impairment, emotional fragility, nausea. I am unable to tell whether I actually experienced something, or whether I slipped into a dream state. I may not have the presence of mind to cancel my plans and go back to bed. (Equivalent BAC 0.08-0.20)
7. I have chosen to force myself awake/force myself to stay awake for this because there will be bad consequences if I do not. Cognitive impairment, emotional fragility, nausea. (Equivalent BAC 0.04-0.09)
6. I'm in bed. If I can sleep within the next 15 minutes, everything will be okay. Unfortunately, I know I won't be able to. Tomorrow's going to be a #7 or a #8, depending on how long it takes! Yay!!!
5. It is an appropriate time for sleep for NORMAL people and I am miserably exhausted, but if I go to sleep now I will get 3-5 hours of sleep and then I will be WIDE AWAKE and will have fucked up my sleep schedule for a week or more. I do not have to be functional, merely stay awake until an appropriate bedtime for my own sleep schedule.
4. Micronaps. (Not while driving. Micronaps while driving is a clear #8.)
3. I badly need to sleep and it is an appropriate time for my own sleep schedule, but the sequence of events to get myself actually into bed is not something that I have enough executive function to operate, even though I am sitting upright and reading/talking/typing/playing computer games. I may remain awake for another 0.5 to 4 hours attempting to get to bed to get to sleep. I may even produce useful work while in this state. Tomorrow will be a 2, a 7, or an 8, depending on when I have to be awake.
2. I guess I'm awake? (Equivalent BAC 0.02)
1. Awake, alert, and ready to function.


Before this past September, I rarely ever attained 1. I exist in 3, 5, and 6 regularly, even now.

All my jobs except for Virtual Hammer and the back-room stuff at Survey Hell had me in #7 pretty much every day (because I started later at those two, letting me sleep enough regularly). 2nd Thursday at Virtual Hammer was #7, pretty much always, although discovering the Quiet Room and taking a nap after the morning meeting let me reset to #2. Being within walking distance of Survey Hell as a phone goon let me go to work in a state of #8 pretty regularly, and I was still calling out sick enough to screw up my attendance record due to just not being able to function. 1996 was full of #9. I've only hit #10 a few times, but they were memorable.

Comments

[wibbble]

I micronap constantly. Modafinil is a lifesaver, probably literally when I'm driving.

[niqaeli]

This does not quite apply to me, but ye gods I am glad someone else went... okay, yes, I totally get and agrees with where you are coming from but you may also be VASTLY UNDERESTIMATING WHAT SEVERE SLEEP DEBT IS LIKE. When my sleep debt gets bad enough it -- I don't have the words to describe it while typing on a phone. It is not a normal tired. A weekend sleeping it off will NOT set me right; it'll pay off only partial interest and leave the debt intact, leaving me able to stagger along again like a determined zombie. And then it'll be back to life, to rack up more interest and/or more principal debt!

I only survived graveyard because I'd already had years managing a non-diurnal schedule with occasional insomnia while functioning within a diurnal society. I already knew how to cope with severe sleep disturbances and didn't have to learn on the fly. (Graveyard is violently worse for me than diurnal, because I have DSPS such that my natural hard bedtime is 2-3am, i.e., right in the middle of graveyard shift.)

So yeah, *hands*. I feel like a scale of sleep functionality is useful because the vast majority of the world have no idea what severe sleep disturbances look like. Or feel like. Because, on top of the general misery, my pain levels go through the ROOF when I am sleep-deprived. Which... I'm not sure when the last time I wasn't, at least a little. 2-3/10 is my baseline, as it were. Also, fun fact: my pain levels spiking can trigger the insomnia! Yaaaaay feedback loops.

[azurelunatic]

Do you get the thing where you could totally put another 2-6 hours against the sleep debt but your body says "oh fuck no lying down is now the most painful thing in the world"? Even though you could sleep? I resent it so much when that happens.

[azurelunatic]

Unfortunately, if I manage to stay awake through 5, it has a good chance of going into 3.

[ankaret]

I am living with someone who does the 'may or may not be in dream state' thing (usually due to low blood sugar and, thank fuck, now he has an insulin pump so that is much better controlled) and I had no idea it happened to anyone else. I've been flatly told 'that doesn't happen' by doctors.

So here I am with an unhelpful message of 'ugh, it sucks that that happens to you too' combined with 'external validation of my reality! thank you!'.

[azurelunatic]

For me it is now rare but super unpleasant.

[ankaret]

I am glad it's rare at least. The worst I get is confusion when waking up from super vivid Citalopram dreams, and that's bad enough.

[niqaeli]

I do, sometimes! It's awful. I am fortunate that these days we have a fombag (beanbag with shredded memory foam stuffing) in our bedroom and usually even when laying down is painful, I can find a position on the fombag such that I can sleep.

[azurelunatic]

Generally it was when I was seated at work and micronapping. I think it would have been more accurately hypnagogic hallucinations, but that led to situations like me saying, out loud: "No sir, the fleas on the cat in your doghouse do not count as teenagers between the ages of 11 and 17."

I have no idea whether the guy who said "No, unless the fleas on the cat in my doghouse count?" was real or a dream, but either way, that would have been the appropriate answer. Unless of course he was a dream and it was an answering machine that I was talking to.

[azurelunatic]

Micronaps are the worst.

[sithjawa]

Ohhh man. This reminded me that often in college after staying up too long, I would get to the "too tired to sleep" state. THAT STATE BLOWS.

I do bristle a bit at OP's assertion that "fatigue is worse than being tired," which you can probably relate to. Fatigue is different than being tired, and OP gets severe fatigue and doesn't get severely tired.

The cognitive effects of your 9 sound worse than your 10.

My personal scale would look something like:

10. Basically dreaming while awake. May incorrectly believe I can function. May believe many false things. Hallucinations can't really be isolated by sense; my brain is just living in a different reality than my body. In the most dangerous mode, I'm entirely capable of moving around, performing tasks, and even holding conversations - but the thought processes behind them are entirely nonsensical. Danger: Potential to get in the car, figure out how to turn it on, and drive at top speed into a street light. Equivalent of a multi-drug overdose.

9. Extremely out of it. Edge of dream state. No longer experiencing the mental sense of being tired. Peripheral sensory hallucinations (auditory, visual, tactile). Mostly coherent, or at least, I believe I am at the time. However, prone to sudden and unpredictable microsleeps, vision cutting out, and the like. Judgement, reflexes, and perception impaired. Danger: Potential to believe I'm safe to drive, when in fact I will quite likely microsleep and drive into someone.

8. "Too tired to sleep." Extreme sense of mental fatigue, difficulty keeping eyes open. Cognitive impairment, but at least I'm aware of it. May want to lie somewhere and stare at a wall, or may be hyperactive, unable to sit still, while simultaneously experiencing severe tiredness. Less likely to think I'm safe to drive, but still possible. Danger: Due to being too tired to sleep, when opportunity for sleep comes, may not be able to get any sleep (or maybe only 1-2 hours) before the next Important Thing.

7. Between 6 and 8 with a grab bag between them. Edge of "too tired to sleep." Paranoia likely due to uncertainty about whether I'll be able to get sleep and recover.

6. Extremely tired. Strong desire to sleep. Cognitive impairment, irritability or emotional fragility. Stomach pain common. Difficulty thinking about complex things, attempting to do so may cause sobbing uncontrollably. For 7 and less, sleep is more likely to actually be possible, except when complicated by insomnia. Insomnia: When attempting to sleep, may discover once I lie down and close my eyes that it's impossible or that I'm suddenly not tired any more (until I get up again, at which point I'm immediately super tired again).

5. Tired. Should probably be asleep. Desire to sleep, but easily overridden by something interesting. Cognitive impairment, reflex impairment, irritability or emotional fragility. Stomach pain possible if caused by chronic sleep dep rather than a single late night. Not really safe to drive, but only due to reflex and decision making impairment - no hallucinations, no vision cutting out, no microsleeps. This is the state I'm usually in if I don't get enough sleep for a week or so and then get like 10 hours one night - a second night is necessary before I'm really functional.

4. Somewhat tired - residual sleep dep or staying up past bedtime. Mild cognitive impairment - it's possible to push through, but doing so is physically painful. Head feels like it's stuffed with cotton. Desire to take a nap. Some irritability. Current state after a few weeks of almost but not quite getting my requisite 7.5h of sleep a night.

3. Mild residual sleep dep. Some irritability. Mild headache. Occasional/mild cognitive impairment. Low end of the scale I experience when having insomnia.

2. Awake, no serious symptoms, but not really 100% alert. Other people may notice; I probably don't. May hear "you look tired" a lot. May take a long time to respond to questions. Obviously there's cognitive impairment, but it isn't severe enough that I actually notice it until other people point it out.

1. Awake, ready to do all the things.

0. Let's rewrite all the code, run five miles, organize a meeting, and uhh maybe I shouldn't have had that chocolate covered coffee bean.

-1. HI HI HI I HAD A COFFEE HI WOULD YOU LIKE TO REFACTOR THE CODE WITH ME I LIKE TURTLES THAT IS A NICE SHIRT DO YOU LIKE TECHNO MUSIC I LIKE TECHNO MUSIC

-2. (is doing jumping jacks and singing at top of lungs in room by self because all others have fled building)

[sithjawa]

For me it mostly happens if I am "awake" during the time that I would normally be asleep. Brain decides it's gonna catch some REM on the fly.

Which thinking about makes it a little D: that it was happening to you during times you would normally be awake (at work).

[sithjawa]

Should add that for me, 5 and below are helped by caffeine. 6 and above are not.

[azurelunatic]

Well. "would normally be awake" here is, er.

Have you met my sleep schedule?

Anything before, say, 5-8pm is fair game for a nap. Especially if awakened at or before 7am. In order to go to school. In the morning.

[sithjawa]

You have a point. I have met your sleep schedule. I would not want to meet it in a dark alley.