Sleeping on a problem: the impact of sleep disturbance on intensive care patients - a clinical review

Sleep disturbance is commonly encountered amongst intensive care patients and has significant psychophysiological effects, which protract recovery and increases mortality. Bio-physiological monitoring of intensive care patients reveal alterations in sleep architecture, with reduced sleep quality and continuity. The etiological causes of sleep disturbance are considered to be multifactorial, although environmental stressors namely, noise, light and clinical care interactions have been frequently cited in both subjective and objective studies. As a result, interventions are targeted towards modifiable factors to ameliorate their impact. This paper reviews normal sleep physiology and the impact that sleep disturbance has on patient psychophysiological recovery, and the contribution that the clinical environment has on intensive care patients' sleep

Sleep, Health, and Aging

As people grow older, getting a good night's sleep remains essential to maintaining good health. Insomnia is a common complaint in older adults, and although occasional sleep complaints may not be associated with age, chronic sleep difficulties are experienced more often by older adults than by younger adults

Antidepressant suppression of REM and spindle sleep impairs hippocampus-dependent learning and memory but fosters striatal-dependent strategies

REM sleep enhances hippocampus-dependent associative memory but has little impact on striatal-dependent procedural learning. Antidepressant medications like desipramine (DMI) inhibit rapid-eye-movement (REM) sleep but it is little understood how antidepressant treatments affect learning. We found that DMI strongly suppressed REM sleep in rats for several hours and impaired reconsolidation of a familiar maze and consolidation of moved baited positions (reversal learning) in a sleep-dependent fashion. Unexpectedly, DMI also reduced the spindle-rich transition-to-REM sleep state (TR) and spatial memory changes were more related to TR than to REM sleep. Working memory was unaffected, but overnight reference memory was significantly impaired and subjects increased reliance on non-hippocampal strategies. Procedural memory performance was positively correlated with increases in non-REM sleep after DMI serving to offset memory declines, partially preserving performance. Our results suggest that familiar memories are re-consolidated during REM sleep, reversal memories consolidated during TR, and procedural memories consolidated during non-REM sleep

Theorizing Billable Hours

This article looks at the ethical and diversity implications of high billable hour requirements. While corporate counsel have increasingly demanded a diverse legal workforce and emphasized the need to lower the costs of outside counsel, law firms have not responded to these concerns in a manner that is producing results. Instead, women continue to drop out of law firm practice at higher rates than their male counterparts and the costs of legal services remain high. High billable hour requirements exacerbate both these problems and have implications as well for ethical lawyering. Using data from a variety of disciplines, the article shows that not only do high billable hour requirements make large law firms difficult places for women to succeed, but they also foster work environments that are inefficient and therefore cost clients more. This has implications on a lawyer’s ethical duty not to discriminate based on sex and not to charge an unreasonable fee, and also increases the potential of lawyers making mistakes. Studies of lawyers suggest that high billable hour requirements exacerbate the difficulties women have in practice, especially for those women who have family responsibilities. This leads to high dropout rates from law firm practice that hurt both law firms and their clients. Lowering billable hours will increase the possibility that women will succeed in these workplaces while making lawyers more efficient. Using studies of sleep deprivation and sleep restriction, this article explores what clients are getting for their money from sleep-deprived high billable hour lawyers. It is clear that both sleep deprivation and chronic sleep restriction impair the average person’s ability to function on many levels—including neurocognitive performance that has important implications for lawyering. In addition, studies of workplace productivity have shown that limiting working hours can actually increase productivity. Thus, limiting hours logically should produce more efficient and ethical lawyering while making law firms more feasible work environments for women

Theorizing Billable Hours

This article looks at the ethical and diversity implications of high billable hour requirements. While corporate counsel have increasingly demanded a diverse legal workforce and emphasized the need to lower the costs of outside counsel, law firms have not responded to these concerns in a manner that is producing results. Instead, women continue to drop out of law firm practice at higher rates than their male counterparts and the costs of legal services remain high. High billable hour requirements exacerbate both these problems and have implications as well for ethical lawyering. Using data from a variety of disciplines, the article shows that not only do high billable hour requirements make large law firms difficult places for women to succeed, but they also foster work environments that are inefficient and therefore cost clients more. This has implications on a lawyer\u27s ethical duty not to discriminate based on sex and not to charge an unreasonable fee, and also increases the potential of lawyers making mistakes. Studies of lawyers suggest that high billable hour requirements exacerbate the difficulties women have in practice, especially for those women who have family responsibilities. This leads to high dropout rates from law firm practice that hurt both law firms and their clients. Lowering billable hours will increase the possibility that women will succeed in these workplaces while making lawyers more efficient. Using studies of sleep deprivation and sleep restriction, this article explores what clients are getting for their money from sleep-deprived high billable hour lawyers. It is clear that both sleep deprivation and chronic sleep restriction impair the average person\u27s ability to function on many levels--including neurocognitive performance that has important implications for lawyering. In addition, studies of workplace productivity have shown that limiting working hours can actually increase productivity. Thus, limiting hours logically should produce more efficient and ethical lawyering while making law firms more feasible work environments for women

Theorizing Billable Hours

This article looks at the ethical and diversity implications of high billable hour requirements. While corporate counsel have increasingly demanded a diverse legal workforce and emphasized the need to lower the costs of outside counsel, law firms have not responded to these concerns in a manner that is producing results. Instead, women continue to drop out of law firm practice at higher rates than their male counterparts and the costs of legal services remain high. High billable hour requirements exacerbate both these problems and have implications as well for ethical lawyering. Using data from a variety of disciplines, the article shows that not only do high billable hour requirements make large law firms difficult places for women to succeed, but they also foster work environments that are inefficient and therefore cost clients more. This has implications on a lawyer\u27s ethical duty not to discriminate based on sex and not to charge an unreasonable fee, and also increases the potential of lawyers making mistakes. Studies of lawyers suggest that high billable hour requirements exacerbate the difficulties women have in practice, especially for those women who have family responsibilities. This leads to high dropout rates from law firm practice that hurt both law firms and their clients. Lowering billable hours will increase the possibility that women will succeed in these workplaces while making lawyers more efficient. Using studies of sleep deprivation and sleep restriction, this article explores what clients are getting for their money from sleep-deprived high billable hour lawyers. It is clear that both sleep deprivation and chronic sleep restriction impair the average person\u27s ability to function on many levels--including neurocognitive performance that has important implications for lawyering. In addition, studies of workplace productivity have shown that limiting working hours can actually increase productivity. Thus, limiting hours logically should produce more efficient and ethical lawyering while making law firms more feasible work environments for women

Theorizing Billable Hours

This article looks at the ethical and diversity implications of high billable hour requirements. While corporate counsel have increasingly demanded a diverse legal workforce and emphasized the need to lower the costs of outside counsel, law firms have not responded to these concerns in a manner that is producing results. Instead, women continue to drop out of law firm practice at higher rates than their male counterparts and the costs of legal services remain high. High billable hour requirements exacerbate both these problems and have implications as well for ethical lawyering. Using data from a variety of disciplines, the article shows that not only do high billable hour requirements make large law firms difficult places for women to succeed, but they also foster work environments that are inefficient and therefore cost clients more. This has implications on a lawyer’s ethical duty not to discriminate based on sex and not to charge an unreasonable fee, and also increases the potential of lawyers making mistakes. Studies of lawyers suggest that high billable hour requirements exacerbate the difficulties women have in practice, especially for those women who have family responsibilities. This leads to high dropout rates from law firm practice that hurt both law firms and their clients. Lowering billable hours will increase the possibility that women will succeed in these workplaces while making lawyers more efficient. Using studies of sleep deprivation and sleep restriction, this article explores what clients are getting for their money from sleep-deprived high billable hour lawyers. It is clear that both sleep deprivation and chronic sleep restriction impair the average person’s ability to function on many levels—including neurocognitive performance that has important implications for lawyering. In addition, studies of workplace productivity have shown that limiting working hours can actually increase productivity. Thus, limiting hours logically should produce more efficient and ethical lawyering while making law firms more feasible work environments for women

Cognitive performance is related to central sensitization and health-related quality of life in patients with chronic whiplash-associated disorders and fibromyalgia

Background: A growing body of research has demonstrated that impaired central pain modulation or central sensitization (CS) is a crucial mechanism for the development of persistent pain in chronic whiplash-associated disorders (WAD) and fibromyalgia (FM) patients. Furthermore, there is increasing evidence for cognitive dysfunctions among these patients. In addition, chronic WAD and FM patients often report problems with health-related quality of life (QoL). Yet, there is limited research concerning the interrelations between cognitive performance, indices of CS, and health-related QoL in these patients. Objectives: (1) Examining the presence of cognitive impairment, CS, and limitations on health-related QoL in patients with chronic WAD and FM compared to healthy controls. (2) Examining interrelations between performance-based cognitive functioning, CS, and self-reported health-related QoL in these 3 study groups. Study Design: A case-control study was conducted. Setting: The present study took place at the University Hospital Brussels, the University of Brussels, and the University of Antwerp. Methods: Fifty-nine patients (16 chronic WAD patients, 21 FM patients, and 22 pain-free volunteers) filled out the Short Form 36 item Health Survey (SF-36), a self-reported psychosocial questionnaire, to assess health-related QoL. Next, they were subjected to various pain measurements (pressure hyperalgesia, deep-tissue hyperalgesia, temporal summation [TS], and conditioned pain modulation [CPM]). Finally, participants completed a battery of performance-based cognitive tests (Stroop task, psychomotor vigilance task [PVT], and operation span task [OSPAN]). Results: Significant cognitive impairment, bottom-up sensitization, and decreased health-related QoL were demonstrated in patients with chronic WAD and FM compared to healthy controls (P < 0.017). CPM was comparable between the 3 groups. Cognitive performance was significantly related to central pain modulation (deep-tissue hyperalgesia, TS, CPM) as well as to self-reported health-related QoL (P < 0.05). Decreased cognitive performance was related to deficient central pain modulation in healthy controls. Further, significant correlations between decreased cognitive performance and reduced health-related QoL were revealed among all study groups. Additionally, FM patients showed correlations between cognitive impairment and increased health-related QoL. Remarkably, impaired selective attention and working memory were related to less TS, whereas impaired sustained attention was correlated with dysfunctional CPM in FM patients. Limitations: Based on the current cross-sectional study no firm conclusions can be drawn on the causality of the relations. Conclusion: In conclusion, this paper has demonstrated significant cognitive deficits, signs of CS, and reduced health-related QoL in chronic WAD and FM patients compared to healthy individuals. Significant relations between cognitive performance and CS as well as health-related QoL were demonstrated. These results provide preliminary evidence for the clinical importance of objectively measured cognitive deficits in patients with chronic WAD and FM

Confidence in Judgment Among the Chronically Sleep-Deprived

Research has demonstrated that acutely and chronically sleep-deprived individuals are hindered in their performance on cognitive tasks, with pronounced effects on working memory tasks (Durmer &amp; Dinges, 2005). However, little research has been done to examine the effects of sleep deprivation on metacognitive performance. Here, we test whether chronic sleep deprivation affects calibration scores during a working memory task and whether this is dependent on whether participants complete an easy or hard task. Participants aged 18-65 (N = 33) completed a practice mental arithmetic task and made confidence judgments on their expected performance before completing a subsequent 10 mental arithmetic tasks. Results showed that participants were equally calibrated regardless of sleep quantity or task difficulty. These findings could suggest that people can accurately assess their cognitive performance when chronically sleep-deprived, though more research is needed to know whether these findings are accurate. The implications and limitations of the study will be discussed, and directions for future research are proposed.&nbsp