Worth It?

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// WEEKEND

Cathy Huang ’15 usually sleeps from 10 p.m. to 6 a.m. She makes sure to schedule her other commitments around her eight hours.

She realizes that’s “not normal.”

When Huang first came to Yale, she found herself staying up late much more often than she had in high school and gradually consuming more caffeine. Part of it was the nocturnal lifestyle college seemed to demand. Part of it was the culture of meeting people for coffee, working in coffee shops.

Huang can list off the effects drinking caffeine has on her: “My palms sweat, my heart starts racing, my mental to-do list just starts forming without my consent in my head. I have a really hard time enjoying things just to enjoy them. I feel really intense.”

After a “bad” beginning to her sophomore year, Huang began seeing a counselor at Yale Mental Health and realized there was a correlation between her negative moods and not sleeping enough — and with having to use coffee to keep awake.

Now she’s back to her high school schedule. She has tried bringing friends around to her way of thinking, but hasn’t had much success so far.

After all, there’s a prevailing sense on campus that, in the words of a recent Red Bull campaign, “Nobody ever wishes they’d slept more in college.”

And we don’t have to. We don’t have to drink Red Bull either: We’ve got options. Reading “week” starts tomorrow, and from what I can tell through conversation osmosis, everybody is basically fucked. A News survey conducted earlier this week shows that more than 70 percent of students feel “somewhat” or “very” stressed about the upcoming finals period.

Over the next 10 days, Yale’s student body will deal with the end of year crunch by consuming stimulants including coffee, tea, energy drinks, 5-hour energy shots and prescription stimulant drugs intended for the treatment of Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD).

“I’m not classically against drugs,” said Hedy Kober, an assistant professor of psychiatry and psychology at the Yale School of Medicine. “But everybody who takes drugs has a responsibility to know exactly what they’re taking and what they’re doing [to their brains and bodies].”

***

According to a 2005 New Scientist article reassuringly titled “Coffee: The demon drink?”, 90 percent of adults in North America consume caffeine daily in some form, and the Internet of 2013 seems to pretty much agree with that number.

I’m not sure if that’s us already, or just future us. But we’re getting there.

The longer we stay awake, the more our brains produce a chemical called adenosine, which makes us want to go to sleep. While sleeping, we make less and less adenosine, so that in the morning we wake up feeling less tired than when we went to bed. Caffeine is primarily an “adenosine antagonist,” Kober explained: Technically it is a “sleepiness-reducing” agent rather than an “energy-producing” agent, though feeling less sleepy may leave us more energetic.

Caffeine also increases the action of dopamine and norepinephrine, neurotransmitters associated with, among other things, energy and euphoria. But this is a secondary action. What caffeine mostly does is stop the brain from following through with its natural sleep-promoting processeses.

All of which makes me pretty nervous. I’ve been dealing with the opposite problem on and off for most of the last eight years. During peak angst times (grades six through 12), I’m pretty sure 3/4 of the emotions I experienced were produced by insomnia. It’s hard not to feel Kierkegaardian levels of Despair when you’re consistently the only one awake in your house during the witching hours.

Drinking caffeine has, until recently, been unthinkable. Once, in sixth grade, I tried a cappuccino. I didn’t sleep for a full day and a half. At home, my parents still get mad at me for eating so much as a piece of dark chocolate after 7 p.m.

John Sununu ’15 has always had coffee in his house and in his life. Starting around age 12, he began to sample some himself. It made him feel grown up.

His freshman year of high school, Sununu first started drinking coffee in the evenings to help him make it through late nights of studying. By junior year, Sununu realized he was drinking between seven and eight caffeinated beverages a day. He decided it was time to stop.

“I was alone and irritable and interning, and detoxing cold turkey,” Sununu recalled. “I was really fidgety and always falling asleep in the middle of important things, which is not good when you’re interpreting.”

Sununu went back to drinking coffee after the summer, but feels he has a healthier relationship with it now that he knows he could quit if he really needed to. Still, he added:

“It’s just easier to have a little extra energy — or a lot of extra energy.”

For most of this year, even if I’d slept nine hours out of the past 48, it didn’t occur to me try anything stronger than weak green tea. But I’ve started to think about experimenting. First, though, I decided to seek out a few of the uncaffeinated 10 percent, and see what they had to say.

For Kerri Lu ’14, coffee just doesn’t work. She gets about 20-30 minutes of nervous energy before she crashes and falls asleep. The same thing happened when she tried 5-hour Energy, but she admitted she wasn’t brave enough to pound the whole thing at once. Lu more or less summed up the concerns seven other students interviewed cited about the product when she said she was worried it would make her heart “explode.”

“It scares me, because I think I would really enjoy drinking [5-hour Energy] to stay awake,” Lu said. “I would probably resort to those things if they helped me physically.”

But for at least a small portion of Yale’s student body, whether or not coffee would help doesn’t matter. What does is maintaining a sense of spiritual responsibility over what does — and doesn’t — go into the body. The Church of Latter Day Saints’ health code requires Mormons to abstain from consuming “harmful and addictive substances,” said Russell Ault ’14. The church explicitly forbids alcohol, tea, coffee and tobacco.

“Mormonism has a strong emphasis on agency,” Glorianna Tillemann-Dick ’14 said. “Developing an addiction reduces agency because we feel the need to partake in the same specific substances.”

Glorianna and her sister, Mercina Tilleman-Dick ’14, have different approaches to living through the prohibition. Mercina allows herself the very rare Diet Coke, but generally plans her schoolwork so as to avoid needing to stay up too late.

Glorianna pulls all-nighters fairly regularly but keeps herself up with lots of water and small naps. When done naturally, it’s hard to feel that it’s “no big deal” to stay up all night, Glorianna added. By allowing herself to feel the physical consequences of her decision without the aid of stimulants, she keeps the emphasis on her own agency — and what she describes as her failure to plan her time better.

Huang would prefer to email a teaching fellow and tell them she’ll be turning a problem set in late rather than compromise her health in the long run.

But when it comes to sleep, she said, “I think we’re the few and the proud here.”

***

When Rachel* found herself left with a single night to cram for a final her freshman year at Yale, a friend asked her if she wanted some Adderall. She needed to stay up all night, and coffee had always made her feel jittery. The Adderall kept her awake, and she felt like she was getting a lot done.

According to a 2009 study by the Substance Abuse and Mental Health Services Administration, full-time college students 18-22 are twice as likely to use unprescribed Adderall as their non-full-time student counterparts. The report underscores Adderall’s role as a ‘study drug’ on campuses across the nation.

Sadie*, another sophomore girl, has used un-prescribed Adderall as a study aid on several occasions. She drinks coffee at other times to keep herself awake, but said that it doesn’t give her anything close to the increase infocus and motivation she feels when on Adderall.

Otherwise, Sadie said, taking it doesn’t make her feel much different.  She has never experienced any negative side effects and doesn’t know anybody who has. She said she knows a broad spectrum of users on campus.

And with reading and finals period ahead, she is asking around for more Adderall.

“But it’s not 100 percent necessary,” Sadie maintained. “I can organize my [work] so I don’t need it. It’s not like I plan to use it … If I can find some, I’ll use it, but I’m not going to seek it out unless the people I usually go to have it.”

She can get it from friends who have it prescribed to them or others who have obtained it from someone else with a prescription. Prices vary with the dose of the pill she’s buying.

Sununu also knows students at Yale who use the drug regularly.

“On the whole, [stimulants like Adderall are] relatively easy to access, and college kids have grown used to the idea that if they need to access them they can,” he said.

But he is not prepared to condemn his classmates’ Adderall use outright: “I don’t want to judge anyone for their personal decisions. As long as people stay healthy and safe, I think it’s their prerogative to do what they need to do.”

Sadie said that the only people at Yale she would peg as not using Adderall would be those who already devote so much time to school work that they would not need the extra boost.

Adderall and many other ADD/ADHD medications are part of a category of stimulants called amphetamines, which keep you awake by entirely different means than caffeine does. They do not bind onto adenosine. Instead, like other stimulant drugs such as cocaine, amphetamines work primarily on dopamine and norepinephrine, which also have roles in promoting wakefulness. Amphetamines are extremely close relatives of the methamphetamines (see: Breaking Bad).

Students don’t think of them that way. Sadie doesn’t see developing an addiction to Adderall as a concern, given the infrequency and low doses of her consumption. And she added that she finds students see Adderall as ‘less illegal’ than other drugs, since “no doctor is ever going to prescribe you cocaine.”

“Adderall is not generally viewed as a party drug — it’s viewed as a drug for college students that have to get their shit done,” Sadie said.

Part of the reason Adderall may seem less intense than other drugs has to do with the method of taking it rather than its chemical composition. When taken in pill form, part of the pill is degraded in the stomach, and the effects are felt more gradually. If snorted, some of the drug would get lost in the nose, but what was ingested would go to the brain much more quickly, Kober said. She added that the effects of snorting Adderall would be more akin to snorting something like crystal meth. And the faster the drug enters the brain, the greater the chance of one’s forming an addiction.

Kober said because the drug is relatively new, the medical world lacks research on whether taking these stimulants in college will harm you in the long run. But researchers also don’t know that it doesn’t.

Robert Malison MED ’87, a professor of psychiatry at the School of Medicine who studies stimulant use and addiction, said the best current research demonstrates that one in 10 people who try Adderall or similar amphetamines will develop an addiction. That might sound like good news: it means that 90 percent probably won’t. But it’s a gamble students should at least know they are taking, Malison feels.

He is worried about students’ growing use of such stimulants. To illustrate its risks, he brought up the example of the methamphetamine craze that has swept over Thailand in the past decade. It began with over-the-counter capsules, which he said were used primarily by university students and truck drivers to stay up through the night.

The pills have now crossed over into all parts of Thai society. Malison recounted how on a research visit to Thailand, he saw eight and nine-year-olds in hospitals for addiction. And while they used to be called “diligence pills” they are now commonly called “crazy pills”: once users become addicted, the pills can make them psychotic.

Malison sees the rise of Adderall in the States as having “all the hallmarks of our country’s next stimulant epidemic.”

He is interested in further studying how the kind of sleep loss Yale students report can make individuals more vulnerable to addiction and said correlative (though not causal) studies have shown a link between the two.

“If you’re going without sleep for weeks, you’re most likely to feel those benefits and euphoric effects. We know young people are sleep deprived,” Malison added. “It’s fertile soil for the use of stimulants to plant themselves in. Mood changes evaporate on stimulants.”

When we lose sleep, our cognitive performance declines, said Dr. Vahid Mohsenin, director of the Yale Center for Sleep Medicine. Malison said some of the positive effects these stimulants have on cognitive function would likely be far more modest if users were sleeping enough in the first place.

The one time Rachel took Adderall, she experienced some of the euphoric effects Malison described.

“I was just intensely content and happy; I felt like everything was going to work out,” she said. “[When sober] I realized it was a fake, temporary feeling.”

But Rachel found herself crashing by the time of her final and had to drink two cups of coffee in the morning to stay awake. The exam didn’t go well, and she felt unable to eat or function normally for the rest of the day before passing out at 6 p.m. Looking back on the experience, she’s not at all sure that taking the drug had helped her study more than she would have on her own.

“At the time I was like, ‘Wow, I definitely need to take this all the time!’” she said. “After, I was like, ‘No way. I don’t want to do that to my body ever again.’”

***

So, to recap: the less you sleep, the more likely you are to resort to stimulants, such as amphetamines, and the more likely you will be to experience positive effects from taking them that can then lead to addiction — and which you might not experience if you had just slept more in the first place.

So why aren’t we just sleeping more?

Different animals sleep very different amounts, Mohsenin said. Horses and donkeys only need to sleep for about 3 hours a day. Large cats do about 16.

“Humans have been programmed for 7 to 8 hours,” Mohsenin said. “It’s all hard-wired.”

That is about one third of all of the hours we have each day. That means we’re supposed to be spending a third of our lives asleep, which sounds a little excessive. And four students interviewed agreed that at least part of what’s keeping us awake isn’t papers or problem sets: it’s FOMO, or fear of missing out.

Kevin Ho ’12 SPH ’13 said everyone at Yale loves sleep. But when it comes down to it, they just value other things more. According to the News survey, 60 percent of students sleep an average of 6 hours or less per night.

“The opportunity cost of sleeping at Yale is higher than at other places.” Ho said — there’s just so much else to do with your time. “We have the rest of our lives to sleep.”

And anyway, we are young! We’ll bounce back! And we all like to have a good battle story or two at the very end of the year. Last semester, I took five exams and turned in a term paper in the span of four days. On day five, I took a two-hour final about fish after sleeping two and a half hours. I later described the experience as both “harrowing” and “epic.”

Mohsenin said that a normal sleep pattern would mean that our internal sleep-producing forces are aligned with the external cycles of light and darkness. When these fall out of alignment, a range of things can happen, including increased insulin resistance—which is what leads to diabetes—and increased risk for stroke.

But sleep remains one of the few things we are collectively not that afraid of missing out on.

Science is telling us we’re wrong, but Science also tells us a lot of things. Whether wine/chocolate/tobacco/organ meat are recommended to us as healthy or carcinogenic can vary wildly from one decade to the next, and we don’t always listen. We’ve all heard the new studies saying the brain doesn’t finish developing till well into our 20s, that we shouldn’t be binge drinking so young. Many of us just don’t seem to care.

***

I remember hearing a particular verse read during Wednesday Lenten services at my Russian Orthodox church back home. It turned out to be Psalm 127:2, and of all the verses intoned by candle-light, it’s the only one I can recount almost from memory: “It is in vain that you rise up early and go late to rest, eating the bread of anxious toil; for He gives to His beloved sleep,”

Of course, if you look through the Bible hard enough, it seems you can find instructions telling you to do pretty much everything (lots of stoning to death).

In offices at the Joseph Slifka Center for Jewish Life, I asked for interpretations from two people who have spent considerably more time studying the text than I have: Rabbis Noah Cheses and James Ponet ’68. Cheses is young and soft-spoken. Ponet has gray hair but a lively and intense manner of speaking. He said he would offer me tea if he had more time.

Ponet explained that part of the idea of the “ever-watchful God” is that it gives us, people, permission to go to sleep. But especially in ego-driven environments like Yale, it’s hard to let go of the idea of constantly exerting control over bodies and minds.

“We feel a certain shame at limitations; we seek to show we aren’t bound by them,” Ponet said. “Sleep seems to be a thief that steals time.”

When the promise of control provided by caffeine didn’t work out for Lu, she had to come to terms with the fact she couldn’t push herself infinitely. She said that learning her own limits has been a college-long struggle for her, one that’s ongoing. “[By using stimulants] people think they can control nature and not subject themselves to the limitations of physiology, of their humanness,” Cheses said. “It’s the illusion of control.”

Ponet thinks there is room for us to think of sleep as more than just a physical weakness to be overcome. He linked the origin of the expression “I’m going to sleep on it,” to the sayings, “I’m going to pray on it,” or “I’m going to give it to God,” explaining that they all point to the fact that there are some things we can only understand with the unconscious mind. He also cited the many instances of revelatory dreams to be found in the Bible.

“There’s a connection between effort and attainment of truth in life,” Ponet said. “But that’s not always the case. There are gifts, miraculous insights. There are times exhaustive efforts prevent us from seeing what’s there already.”

On some special days in the Jewish calendar, one is asked to stay up all night long learning and studying the Torah. Cheses said these practices originate from around the time when coffee began to spread out of Northern Africa during the 15th century. But such celebrations are viewed as “exceptional evenings, when you’re intentionally going above and beyond nature,” he said. From a pastoral perspective, he counsels students to sleep.

“When they don’t sleep, they don’t have full access to their emotions, and they make dumb decisions because they are not fully aware of themselves,” Cheses said.

Ponet admitted, though, that he does find something special in the experience of being up and lucid at 11, 12, 1, 2.

I know what he means. Even in my insomnia years, I sometimes felt the exhilaration of being awake and reading long after midnight. It meant hearing things no one else around was hearing, being the only one to see and notice all the different kinds of darkness. Right up until this year, I wouldn’t take back any of the all-nighters I’ve pulled, however reluctantly.

But sleep has never been the enemy for me. Until, suddenly, it was. This semester, I planned my schedule knowing there was no way I could get more than 6 hours a night for most of the week, and would often have to make do with less. What worries me is that that this didn’t concern me. Since I came to Yale, I have gone from thinking of sleep as something with obvious, intrinsic value to seeing it as an inconvenience at best.

Common phrases like “I’ll sleep when I’m dead,” make us think of sleep as opposed to life. Sleep is not-doing. When we sleep, we give up acting on ourselves and on the world around us. We wake up with nothing tangible to show for it, except, hopefully, a reduction in the amount of adenosine floating around in our brains.

We won’t always live by semesters, with papers and p-sets to make us stay up. Yet 90 percent of us will go on drinking caffeine daily. And I think part of it has to do with the way we view sleep, and our bodies: as tools to control instead of to take care of, by drinking a cup of something or by taking a pill.

Red Bull says no one ever wishes they had slept more in college. It’s up to us to decide whether we’re going to believe them.

***

I wrote almost this entire article after midnight on a single night. When my friend went to G-Heav at around 2 a.m., I made a decision, and asked him to bring me a cup of coffee.

I could instantly taste the difference. It was sharper, more metallic than the decaf I’d been having for my entire life.

Within 20 minutes, I no longer felt like I was going to fall asleep, and I didn’t crash for a good few hours after drinking less than half the cup. So unlike Lu, I know it works for me now. I also felt surprisingly cheerful, more optimistic. I stayed focused for three more hours, but found myself more hung up on small details of word choice and grammar, however hard I tried to force myself to look at the big picture.

I also started to feel other things. I became weirdly, intensely aware of my heartbeat, which seemed to be getting faster and faster. My hands were shaking. After a while, everything was shaking. Still, I couldn’t believe how awake I was. I began to question why I hadn’t been doing this all along. I also thought about how, if I did choose to start drinking caffeine, I would probably never feel it quite like this again.

I thought of something Kober had told me. The other things it’s possible to experience when you take stimulants, such as increased jitters and anxiety, aren’t really side effects. They are just other effects. Stimulating our central nervous systems might mean less sleepiness, but it also means more of everything else, whether we want it or not.  As Huang put it, I felt “really intense.”

Around 5:30 a.m., the effects began to wear off. I was surprised to find out it was light outside.

I walked back to my room.

By 6:30 a.m., I was asleep.

*Name changed for anonymity.

 

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