Mental health debates without the stress

If you work in mental health, you could do much worse than reading the editorial in today’s Lancet Psychiatry about unpleasant debates and how to avoid them.

Unfortunately, debates in mental health tend to get nasty quite quickly – but I’ve seen no part of the debate spectrum which has a monopoly on bigotry or a blessed surplus of consideration.

But instead of throwing up their hands in despair, the editorial team wrote some sensible guidance on bringing some respect to moving mental health forward.

The first is to assume the best of one’s opponent: that their argument proceeds not from self-interest, financial interest, or wilful ignorance, but from genuine curiosity and a desire to improve the lives of people with mental health problems. There is a view that so-called punching up to perceived figures of authority is justifiable and necessary, but punching up is still punching someone. There is always potential in the discussion of mental health issues to trigger distress, as everyone, patient or professional, has an unseen personal history and sensitivity.

Second, it is worth questioning whether one line of investigation or treatment necessarily diminishes the other. Although a holistic medical perspective on mental distress is useful, alternative types of assistance might also be of value. Such services need to be taken seriously, evaluated thoroughly, and, when appropriate, considered for public funding. Perhaps some arguments about which model of research or practice should be prioritised would be better resolved by a united campaign for better funding across the board.

Third, as Sun Tzu advised, know your enemy. Do not dismiss biological data as an irrelevant folly, nor philosophical and sociological analysis as a form of obscurantism. Take some time to consider your opponent’s intellectual discipline, and how his or her work might be criticized on its own terms. This might be a long, difficult, and tedious process, but it is what patients, and the public, deserve.

The final point is to ensure that those whose voices are not listened to enough are given the space and opportunity to be heard. Their numbers include individuals such as mental health nurses and social workers, who provide a large amount of care but who are given little time compared with psychologists and psychiatrists. Most important, the voices of patients must be “airtime” respected in all their diversity. If a new form of mental health care is to be built, all involved would do well to remember the three principles of James Madison, President of the USA and father of its constitution: compromise, compromise, compromise.

A tip of the hat to you.
 

Link to Lancet Editorial ‘Duel diagnosis’ (via @PsychiatrySHO)

Agents, social encounters and hallucinated voices

I’ve written a piece for the new PLOS Neuro Community about how the social aspects of hallucinated voices tend to be ignored and how we might go about making it more central in psychology and neuroscience.

It came about because the PLOS Neuro Community have asked authors of popular papers to write a more gentle introduction to the topic, so the piece is based on a PLOS Biology paper I wrote last year.

I’ve met a lot of people who hear hallucinated voices and I have always been struck by the number of people who feel accompanied by them, as if they were distinct and distinguishable personalities. Some experience their hallucinated entourage as hecklers or domineering bullies, some as curious and opaque narrators, others as helpful guardians, but most of the time, the voice hearer feels they share a relationship with a series of internal vocal individuals.

The piece discusses psychology and neuroscience but in the post, I also mention some work I’ve been doing with philosopher of mind Sam Wilkinson. As luck would have it, Sam just published a post about what we’re working on, on the excellent Imperfect Cognitions blog.

It looks at hallucinated voices and the representation of agency and agents. If you’re not used to these terms they can be slightly opaque but they refer to how the mind and brain represents autonomous individuals – be they human, animal, presumed or imaginary – and how that might relate to the experience of having hallucinated voices.
 

Link to A Social Visit with Hallucinated Voices.
Link to The Representation of Agents in Auditory Verbal Hallucinations.

Talk, 28 Oct 2014: The power of reason

I am giving a talk on 28th October at Off the Shelf, Sheffield’s festival of words. Here is the blurb:

Is it true that “you can’t tell anybody anything”? From pub arguments to ideology-driven party political disputes it can sometimes people have their minds all made up, that there’s no point trying to persuade anybody of anything. Popular psychology books reinforce the idea that we’re emotional, irrational creatures, but Tom Stafford argues against this bleak portrait of human irrationality. He has investigated the psychological science of persuasion by rational argument, interpreting old studies and reporting some new ones which should give hope to those with a faith in reason. Tom tells you how to most effectively change someone’s mind, when people are persuaded by evidence (and when they aren’t) and why evolution might have designed our thinking to work best in groups rather than on our own.

sleep_of_reason

Mostly I’ll be picking up on ideas I outlined in my Contributoria piece: What’s the evidence on using rational argument to change people’s minds? Tickets are £7.50/£6 (cons), the venue is the Showroom Cinema, Paternoster Row, S1 and we start at 7pm (I talk for 45 minutes then there is time for questions). Book tickets by calling the Showroom on 0114 275 7727 or go to showroomworkstation.org.uk The full festival programme is available as a PDF.

Psychoactive plants in season at Kew Gardens

The Royal Botanical Gardens at Kew, or London’s Kew Gardens if you’re not from the 1800s, has a fantastic season of events on the science of psychoactive plants that starts on 20th September.

It covers everything from coffee to opium to magic mushrooms and discuss the pharmacology, public policy and ethnobotany of intoxicating plants.

There are a number of installations, exhibitions and events that you can access by paying to get into the gardens as normal, as well as some dedicated talks that require specific tickets.

The full details of the daily talks and films haven’t been announced yet but a few highlights from the published programme seem to be a talk on plant intoxicants in history and culture with the ever-interesting Mike Jay, a living display of mind-altering plants, and a talk on the neuroscience on intoxicating plants.

If you’re going to visit the gardens it’s worth taking a day for it as the tickets are a bit pricey (£15) but as the place is so huge you get good value if you’re there long enough to see plenty of it.
 

Link to details of Kew’s Intoxication season.

Implicit racism in academia

teacher-309533_640Subtle racism is prevalent in US and UK universities, according to a new paper commissioned by the Leadership Foundation for Higher Education and released last week, reports The Times Higher Education.

Black professors surveyed for the paper said they were treated differently than white colleagues in the form of receiving less eye contact or requests for their opinion, that they felt excluded in meetings and experienced undermining of their work. “I have to downplay my achievements sometimes to be accepted” said one academic, explaining that colleagues that didn’t expect a black woman to be clever and articulate. Senior managers often dismiss racist incidents as conflicts of personalities or believe them to be exaggerated, found the paper.

And all this in institutions where almost all staff would say they are not just “not racist” but where many would say they were actively committed to fighting prejudice.

This seems like a clear case of the operation of implicit biases – where there is a contradiction between people’s egalitarian beliefs and their racist actions. Implicit biases are an industry in psychology, where tools such as the implicit association test (IAT) are used to measure them. The IAT is a fairly typical cognitive psychology-type study: individuals sit in front of a computer and the speed of their reactions to stimuli are measured (the stimuli are things like faces of people with different ethnicities, which is how we get out a measure of implicit prejudice).

The LFHE paper is a nice opportunity to connect this lab measure with the reality of implicit bias ‘in the wild’. In particular, along with some colleagues, I have been interested in exactly what an implicit bias, is, psychologically.

Commonly, implicit biases are described as if they are unconscious or somehow outside of the awareness of those holding them. Unfortunately, this hasn’t been shown to be the case (in fact the opposite may be true – there’s some evidence that people can predict their IAT scores fairly accurately). Worse, the very idea of being unaware of a bias is badly specified. Does ‘unaware’ mean you aren’t aware of your racist feelings? Of your racist behaviour? Of that the feelings, in this case, have produced the behaviour?

The racist behaviours reported in the paper – avoiding eye-contact, assuming that discrimination is due to personalities and not race, etc – could all work at any or all of these levels of awareness. Although the behaviours are subtle, and contradict people’s expressed, anti-racist, opinions, the white academics could still be completely aware. They could know that black academics make them feel awkward or argumentative, and know that this is due to their race. Or they could be completely unaware. They could know that they don’t trust the opinions of certain academics, for example, but not realise that race is a factor in why they feel this way.

Just because the behaviour is subtle, or the psychological phenomenon is called ‘implicit’, doesn’t mean we can be certain about what people really know about it. The real value in the notion of implicit bias is that it reminds us that prejudice can exist in how we behave, not just in what we say and believe.

Full disclosure: I am funded by the Leverhulme Trust to work on project looking at the philosophy and psychology of implicit bias . This post is cross-posted on the project blog. Run your own IAT with our open-source code: Open-IAT!

Freaky brain tongue graffiti

You wait all year for neuroscience themed graffiti and then two come along in a week. This was found on Carrera 31 in Medellín yesterday morning.

It turns out that over the years I’ve managed to collect a fair amount of brain-themed graffiti for Mind Hacks, which you can browse at your pleasure here.

And with that, I leave the booming, buzzing confusion of Medellín and head back to the sustained attention of London.

Taste illusions

I’ve just found a 2008 review article on the multisensory perception of flavour that is full of fascinating examples of taste illusions and demonstrates the surprisingly complexity of the gustatory system.

The following is one of my favourites. The article first makes the interesting observation that the majority of odour names refer to objects and most non-object odour names like ‘acrid’ and ‘pungent’ actually refer not to smell but to felt sensation.

Another manifestation of the object-based nature of olfactory perception is the constant error made, when eating, of attributing to taste what really belongs to the sense of smell. The error of localizing the odors coming from food as originating in the mouth has been termed the olfactory illusion. It has been compared to the ventriloquism effect, that is, the influence of visual cues on the identification of the location of a sound source. Green (2001) has provided a similar explanation for the fact that although flavor is perceived by receptors on the tongue, in the nose, and even in the eyes, the brain interprets the overall sensation as originating from within the mouth. According to Green, all of the sensory information is localized in the mouth in order that we associate this information with the food being consumed, in the same way that we typically use both touch and vision to localize a point on our bodies.

The paper is by psychologists by Malika Auvray and Charles Spence and it’s sadly locked – but someone has handily a put a pdf online.
 

Link to journal hosted locked article (via @velascop)
pdf of full text.

Brain digger in Medellín

A digger scooping the brain of a blue man, found earlier this week in Medellín, on Calle 67, just by the metro station Hospital.

The text translates as ‘changing forests for cement’ but has been scratched on after the original artwork, presumably by someone who isn’t familiar with the industrial brain digger industry and its interest to Colombian graffiti artists.

A torrent of accidental poems

CC Licensed photo by Flickr user Jonathan Reyes. Click for source.Neurology journal Neurocase has an interesting study of a women who started compulsively writing poetry after having brief epileptic amnesia treated with the anti-seizure drug lamotrigine.

A 76-year-old woman reported having a poor memory and short periods of disorientation and was eventually diagnosed with transient epileptic amnesia – brief recurrent seizures that lead to short periods where affected people can’t lay down new memories.

Several months after starting lamotrigine [a common and widely used anti-seizure drug], the patient suddenly began to write original verse. Whereas poetry had never previously been among her pastimes, she now produced copious short poems (around 10–15 each day) on quotidian topics such as housework or about the act of versifying itself and sometimes expressing her opinions or regret about past events. These poems often had a wistful or pessimistic nature but did not have a moral or religious focus. Her husband characterized them as “doggerel” because they were generally rhyming and often featured puns and other wordplay.

My poems roams,
They has no homes
Yours’, also, tours,
And never moors.

Why tie them up to pier or quay?
Better far, share them with me.

Prose – now, that’s a different matter.
Rather more than just a natter.
Prose is earnest, prose is serious
Prose is lordly and imperious
Prose tells you, loud, clear, that
Life – life is dear.

This versifying had a compulsive quality: she spent several hours per day writing poetry and became irritated if attempts were made to disengage her. However, she appeared to derive pleasure from the activity and there was no evidence of associated distress. She did not produce prose passages, diaries, or other examples of hypergraphia, nor did she develop new interests in other “creative media,” such as visual arts or music.

When reassessed 6 months after the onset of versifying this apparent compulsion had diminished, but she continued to produce occasional poems. She had also developed a more general fondness for wordplay, frequently using puns in speech, making humorous word associations, and identifying word patterns in everyday objects such as car license plates. Throughout this period there were no associated mood symptoms, features of a thought disorder, or other changes in her behavior or cognition to suggest hypomania or another generalized neuropsychiatric disturbance.

The article mentions the exclusion of hypomania and thought disorder because these are two other phenomena that appear as compulsive rhyming or punning in speech.

The article also mentions some similarities between the compulsive poem writing and hypergraphia – compulsive and copious writing that is a well-known although not particularly common symptom of epilepsy.

The difference in this case, however, is that hypergraphia often appears as meaningless, rambling or disorganised, and this particular patient produced competent, if not particularly high quality poems.

One of the most interesting implications of these cases is that rhyming, punning and poetic speech, which we normally think of as something that needs specific conscious effort and attention, can appear spontaneously to the point of overwhelming our normal forms of communication.
 

Link to open-access scientific article.
Link to DOI of same.

Round trip ticket to the science of psychedelics

The latest edition of The Psychologist is a special open-access issue on the science and social impact of hallucinogenic drugs.

There’s an article by me on culture and hallucinogens that discusses the role of hallucinogenic drugs in diverse cultures and which also covers how cultural expectations shape the hallucinogenic experience – from traditional Kitanemuk society to YouTube trip videos.

The other articles cover some fascinating topics.

Neuroscientists Robin Carhart-Harris, Mendel Kaelen and David Nutt have a great article on the neuroscience of hallucinogens, Henry David Abraham discusses hallucinogen persisting perception disorder or post-trip flashbacks, and there’s also piece that talks to a researcher, participant and clinician on the use of psilocybin to alleviate cancer anxiety, while Keith Laws discusses an intense painting and its psychedelic aspects.

There’s also an excellent piece on the influence of psychedelic drugs on literature from Dirk Hanson – long-time writer of the essential drug blog Addiction Inbox, and Mo Costandi (who you may know from the Neurophilosophy blog) has written a fantastic retrospective of the use of psychedelics in psychiatry.

Overall, a fascinating read and well worth checking out.
 

Link to special issue of The Psychologist on hallucinogens.

Disco biscuits

This is a video of Professor Stephen Stahl, author of Stahl’s Essential Psychopharmacology, doing a DSM-5 themed version of Stayin’ Alive by the BeeGees.
 

After working out that, no, no-one has dropped acid in your morning Red Bull, you may notice that the professor busts some pretty respectable moves.
 

Link to video on YouTube (via @AllenFrancesMD)

How to speak the language of thought

We are now beginning to crack the brain’s code, which allows us to answer such bizarre questions as “what is the speed of thought?”

When he was asked, as a joke, to explain how the mind works in five words, cognitive scientist Steven Pinker didn’t hesitate. “Brain cells fire in patterns”, he replied. It’s a good effort, but all it really does is replace one enigma with another mystery.

It’s long been known that brain cells communicate by firing electrical signals to each other, and we now have myriad technologies for recording their patterns of activity – from electrodes in the brain or on the scalp, to functional magnetic resonance scanners that can detect changes in blood oxygenation. But, having gathered these data, the meaning of these patterns is still an enduring mystery. They seem to dance to a tune we can’t hear, led by rules we don’t know.

Neuroscientists speak of the neural code, and have made some progress in cracking that code. They are figuring out some basic rules, such as when cells in specific parts of the brain are likely to light up depending on the task at hand. Progress has been slow, but in the last decade various research teams around the world have been pursuing a far more ambitious project. We may never be able to see the complete code book, they realised, but by trying to write our own entries, we can begin to pick apart the ways that different patterns correspond to different actions.

Albert Lee and Matthew Wilson, at the Massachusetts Institute of Technology (MIT) first helped to set out the principles in 2002. It progresses like this. First, we record from the brain of a rat – one of our closer relatives, in the grand tree of life – as it runs a maze. Studying the whole brain would be too ambitious, so we can focus our recording on an area known as the hippocampus, known to be important for navigation and memory. If you’ve heard of this area before it is probably because of a famous result which showed that London taxi drivers developed larger hippocampi the longer they had spent navigating the streets of England’s sprawling capital.

While the rat runs the maze we record where it is, and simultaneously how the cells in the hippocampus are firing. The cell firing patterns are thrown into a mathematical algorithm which finds the pattern that best matches each bit of the maze. The language of the cells is no less complex, but now we have a Rosetta Stone against which we can decode it. We then test the algorithm by feeding it freshly recorded patterns, to see if it correctly predicts where the rat was at the point that pattern was recorded.

It doesn’t allow us to completely crack the code, because we still don’t know all the rules, and it can’t help us read the patterns which aren’t from this bit of the brain or which aren’t about maze running, but it is still a powerful tool.  For instance, using this technique, the team was able to show that the specific sequence of cell firing repeated in the brain of the rat when it slept after running the maze (and, as a crucial comparison, not in the sleep it had enjoyed before it had run the maze).

Fascinatingly, the sequence repeated faster during sleep around 20 times faster. This meant that the rat could run the maze in their sleeping minds in a fraction of the time it took them in real life. This could be related to the mnemonic function of sleep; by replaying the memory, it might have helped the rat to consolidate its learning. And the fact that the replay was accelerated might give us a glimpse of the activity that lies behind sudden insights, or experiences where our life “flashes before our eyes”; when not restrained, our thoughts really can retrace familiar paths in “fast forward”. Subsequent work has shown that these maze patterns can run backwards as well as forwards  – suggesting that the rats can imagine a goal, like the end of the maze, and work their way back from that to the point where they are.

One application of techniques like these, which are equal parts highly specialised measurement systems and fiercely complicated algorithms, has been to decode the brain activity in patients who are locked in or in a vegetative state. These patients can’t move any of their muscles, and yet they may still be mentally aware and able to hear people talking to them in the same room. First, the doctors ask the patients to imagine activities which are known to active specific brain regions – such as the hippocampus. The data is then decoded so that you know which brain activity corresponds to certain ideas. During future brain scans, the patients can then re-imagine the same activities to answer basic questions. For instance, they might be told to imagine playing tennis to answer yes and walking around their house to answer no – the first form of communication since their injury.

There are other applications, both theoretical science, to probe the inner workings of our minds, and practical domains such as brain-computer interfaces. If, in the future, a paraplegic wants to control a robot arm, or even another person, via a brain interface, then it will rely on the same techniques to decode information and translate it into action. Now the principles have been shown to work, the potential is staggering.

If you have an everyday psychological phenomenon you’d like to see written about in these columns please get in touch @tomstafford or ideas@idiolect.org.uk

This is my BBC Future column from monday. The original is here

Brain scanning the deceased

I’ve got an article in The Observer about how, a little surprisingly, the dead are becoming an increasing focus for brain scanning studies.

I first discussed this curious corner of neuroscience back in 2007 but a recent Neuroskeptic post reminded me of the area and I decided to check in on how it’s progressing.

It turns out that brain scanning the dead is becoming increasingly common in research and medicine and the article looks at how the science is progressing. Crucially, it’s helping us better understand ourselves in both life and death.

For thousands of years, direct studies of the human brain required the dead. The main method of study was dissection, which needed, rather inconveniently for the owner, physical access to their brain. Despite occasional unfortunate cases where the living brain was exposed on the battlefield or the surgeon’s table, corpses and preserved brains were the source of most of our knowledge.

When brain scanning technologies were invented in the 20th century they allowed the structure and function of the brain to be shown in living humans for the first time. This was as important for neuroscientists as the invention of the telescope and the cadaver slowly faded into the background of brain research. But recently, scrutiny of the post-mortem brain has seen something of a revival, a resurrection you might say, as modern researchers have become increasingly interested in applying their new scanning technologies to the brains of the deceased.

It’s a fascinating area and you can read the full article at the link below.

UPDATE: I’ve just noticed two of the links to studies have gone AWOL from the online article. The study that looked for the source of a mysterious signal by scanning people, cadavers and dummies and found it was a scanner problem was this one and the study that used corpses to test in-scanner motion correction was this one.

 

Link to Observer article on brain scanning the dead.

Spike activity 15-08-2014

Quick links from the past week in mind and brain news:

An important editorial in Nature describes the pressing problem of how research is not being turned into practice for treating children with mental health problems caused by armed conflict.

Not Exactly Rocket Science covers a swarm of self-organising autonomous robots that have the potential to rise up, rise up and threaten humanity with their evil buzzing. To the bunkers!

A Malaysian language names odors as precisely as English does colors. Interesting finding covered by Discover Magazine.

New York Magazine has a piece on the social psychology of how the presence of militarised police can increase aggression.

The Demographics of Genocide: Who Commits Mass Murder? Interesting piece in The Atlantic.

The Neurocritic has a fascinating interview with Jan Kalbitzer, the man behind the ‘Twitter psychosis’ case study, who discusses the media reverberations of the article.

Excellent Wired profile of Yann LeCun, AI guru begind Facebook’s, tweaked deep learning revolution.

Science News has an interesting piece on how the explosion of baby monitoring technology feeds ‘paranoia parenting’.

The new president of the Royal College of Psychiatrists gives his first interview in The Guardian and lays down some hard truths about mental health treatment.

One death too many

One of the first things I do in the morning is check the front pages of the daily papers and on the day following Robin Williams’ death, rarely have I been so disappointed in the British press.

Over the years, we have gathered a lot of evidence from reliable studies that show that how suicide is reported in the mass media affects the chances of suicide in the population – likely due to its effect on vulnerable people.

In other words, sensationalist and simplistic coverage of suicides, particularly celebrity suicides, regularly leads to more deaths.

It seems counter-intuitive to many, that a media description of suicide could actually increase the risk for suicide, but it is a genuine risk and people die through what is sometimes called suicide contagion or copycat suicide.

For this reason, organisations from the Samaritans, to the Centre for Disease Control, to an international panel of media organisations, have created explicit suicide reporting guidelines to ensure that no one dies or is harmed unnecessarily because of how suicide is reported.

The guidelines include sensible advice like not focusing on the methods people use to harm themselves, not oversimplifying the causes, not overly focusing on celebrity suicide, avoiding sensationalist coverage and not presenting suicide as a tool for accomplishing certain ends.

This advice keeps people safe. Today’s coverage does exactly the opposite, and many of the worst examples of dangerous reporting have been put directly on the front pages.

It is entirely possible to report on suicide and self-harm in a way that informs us, communicates the tragedy of the situation, and leaves us better off as a result of making these events more comprehensible.

This is not about freedom of the press. The press can report on what they want, how they want. There are no laws against bad reporting and neither would I want there to be but you do have a personal and professional responsibility to ensure that you are not putting people at risk by your need to sell copy.

You also have to look yourself in the mirror every morning, and by the front pages of many of today’s daily papers, I’m sure there are more than a few editors who had to divert their gaze while standing, momentarily shamed, in front of their own reflections.

Drugs in space and sleepless in the shuttle

A fascinating study published in today’s Lancet Neurology reports on sleep deprivation in astronauts but also describes the drugs shuttle crew members use to keep themselves awake and help them fall asleep.

The study looked at sleep data from 64 astronauts on 80 space shuttle missions along with 21 astronauts on 13 International Space Station missions, and compared it to their sleep on the ground and in the days before space flight.

Essentially, in-flight astronauts don’t get a great deal of shut-eye, but what’s surprising is the range and extent of drugs they use to manipulate sleep.

Mostly these are the z-drug class of sleep medications (of which the best known is zolpidem, branded name Ambien) but also include benzos, melatonin and an antipsychotic called quetiapine.

Here are the sleep-inducing drugs with my comments in square brackets:

Zolpidem and zolpidem controlled release were the most frequently used drugs on shuttle missions, accounting for 301 (73%) and 49 (12%) of the 413 nights, respectively, when one dose of drug was reported. Zaleplon use was reported on 45 (11%) of 413 nights.

Other sleep-promoting drugs reported by shuttle crew members during the 413 nights included temazepam [sedative anti-anxiety benzodiazepine - similar to Vallium] on 8 (2%) nights, eszopiclone on 2 (<1%) nights, melatonin [hormone that regulates circadian rhythms] on 7 (2%) nights, and quetiapine fumarate [antipsychotic] on 1 (<1%) night.

The paper also notes concerns about the astronauts’ use of zolpidem and similar z-drug medications because they can affect mental sharpness, coordination and can lead to unusual and complex ‘sleep-behaviours’.

Interestingly, it seems astronauts tend to use these drugs in a rather ad-hoc manner and the consequences of this have clearly not been well thought through.

As the Lancet Neurology paper notes:

This consideration is especially important because all crew members on a given mission might be taking a sleep-promoting drug at the same time…. crew members reported taking a second dose of hypnotic drugs—most commonly zolpidem—often only a few hours before awakening. Although crew members are encouraged to try such drugs on the ground at home at least once before their use in flight, such preparations probably do not involve multiple dosing or dosing with two different drugs on the same night.

Furthermore, such tests do not include any measure of objective effectiveness or safety, such as what would happen in the case of abrupt awakening during an in-flight night-time emergency… sleep-related-eating, sleep-walking, and sleep-driving events have been reported with zolpidem use, leading the FDA to require a so-called black-box warning on all hypnotic drugs stating that driving and performance of other tasks might be impaired in the morning after use of such drugs:

“A variety of abnormal thinking and behavior changes have been reported to occur in association with the use of sedative/hypnotics…. Complex behaviors such as ‘sleep-driving’…have been reported. Amnesia, anxiety, and other neuropsychiatric symptoms may occur unpredictably.”

However, use of sleep drugs was reported on more than half the nights before extravehicular activities were undertaken.

Information on stimulant use by astronauts is hidden in the appendix but caffeine was widely used in space, but less than when on the ground – although possibly due to coffee shortages, and modafinil was used occasionally.

Caffeine was widely used throughout all data collection intervals by both shuttle and ISS crewmembers, though supply shortages sometimes led to coffee rationing and reduced consumption aboard ISS. All but eight shuttle mission crewmembers (72/80, 90%) and all but one ISS crewmember (20/21,95%) reported using caffeine at least once during the study…

Given the 3-7 hour half-life of caffeine and the sleep disturbances associated with its use, caffeine may have contributed to or enabled the sleep curtailment observed in this population. However, there is no evidence that caffeine accounts for the reduced sleep duration observed during spaceflight, as caffeine consumption was, if anything, reduced during spaceflight.

The wakefulness-promoting medication, modafinil, was reportedly used on both shuttle (10 reported uses) and ISS missions (2 reported uses). The use of this wakefulness-promoting medication was reported more frequently in post-flight debriefs.

There’s also an interesting snippet that gives the most common reason for sleep disturbance in space:

Nocturnal micturition is common in this age group and was the most reported reason for disruptive sleep both on Earth and inflight

Not stress, not being surrounded by equipment, not a lack of home comforts, but ‘Nocturnal micturition’ or wetting yourself in your sleep.

This is possibly more likely in space due to the fact that bodily cues for a full bladder work less effectively in zero gravity, but one major factor in astronauts wetting themselves was that it a better alternative than waking sleeping colleagues by going to the toilet.

The paper notes that this is why many astronauts wear ‘maximum absorbency garments’ – essentially giant nappies – while they sleep.
 

Link to locked Lancet study on sleep in astronauts.

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