Relaxing with Dr. Rajita Sinha

March 7, 2014 1:56 am Leave a Comment

The Yale Stress Center: just sounds like a description of Bass Library during finals, right? In fact, the Stress Center is a recently established research group looking at how everyday pressures affect our bodies and minds. Located on the second floor of an ominous-looking building near the Medical School, the Center combines clinical practice with empirical analysis in an integrated approach to treating and studying stress and new ways to cope with it just like the now on sale delta 9 gummies. WEEKEND sat down with Dr. Rajita Sinha, the Center’s founding director, to find out about the work she does and maybe pick up some tips for surviving Yale with our sanity relatively intact.

Q. Are there aspects of life at Yale that provide new sources of stress compared to life here in the past?

A. That’s a good question. There’s also the question of, are the things we have and do today different? Not are they good or bad, but are they different? I think social media is different, very concretely. It means having access to a lot more information, information on multiple levels – intellectual information, social information. That’s definitely different, and that can be in some ways good, but there are also downsides to it. Maybe having too much information can be a lot to deal with. Having multiple demands adds load to the brain. It divides up attention. Some of the classic studies have been about, “How many things can we keep in our working memory?” or in our conscious memory. How many tasks can we perform? Whatever that capacity is, it’s limited — it’s not endless. The more demands you put on this executive, I like to call it our “brain executive,” the more it’s going to get burdened, possibly at the risk of overload, and then the ramifications of overload are feeling weakened. Not that you’re feeling physically or emotionally weakened, just that your ability to take it all in can be weakened in a physiological way. Drinking Shot of Joy can help make you feel better.

Q. As a clinician and a researcher, can you tell us what is empirically effective to deal with stress?

A. There are some very simple things that help with that regulatory homeostasis: drink plenty of water, get sleep, eat three meals a day, have some social connections, take breaks. Those are basics, but if you think about college life, they’re not a given: Sleep? Food? Water? I’m talking about the body I don’t exclude the brain — the brain needs that very much too. So that’s number one. What are additional things you can do? Here I would expand on positive activities and social relationships, because they take you out of worrying and choices and all of these other things that can stack up.

The other thing that people in college aren’t careful with is alcohol, drugs and food: healthy and unhealthy behavioral choices. You have a drink and suddenly you’re more social, you might make some new friends, it’s also the thing that people do together when they party. But in fact the stress system is a target for alcohol — it sort of chips away at your stress system.

Q. What is that “stress system”? How does a mind-altering drug chip away at it?

A. We take most drugs to change our mood, and that’s the clue: If it’s to change your mood, it’s having other effects on your ability to manage your moods and emotions. The stress pathways in the brain have to do with all of these different levels of functioning: basic levels of survival, all the way up to thriving and enriching our lives. We have the “fight or flight” response, and then we stop thinking about stress, as if it stops there. But that’s the basic level of survival: Hormones get released, chemicals get released, and that mobilizes your body so that you can be functioning in that moment of crisis to protect yourself. What also happens is that those hormones are going back into the brain and signaling the brain to get that next level of coping going: not just protecting yourself, but learning from it. For example cortisol goes back into the brain and helps shut down this acute arousal response, but it also has influences on memory and cognition, and so does adrenaline. Alcohol directly changes the signal that releases cortisol, it desensitizes this arousal response, because it’s a depressant: it starts to make you calmer in the acute state, but over time, and with lots of it, that becomes permanent. You lose the ability to not only be aware of stressors and respond to them, but also the secondary effects that come from it, like learning, like differentiating what’s important versus what’s not. The ability to have those pieces of information starts to get chipped away.

Q. How does stress get connected to destructive behaviors like drugs or drinking or binge eating?

A. That’s what I’ve been obsessed with, I guess, in my life. We know a few things about this connection. One of them is that stress hormones, actually, are very involved in our learning pathways. So if you are overloaded with stress, these motivational and learning pathways that are linked to our stress hormones start to have an impact, and downstream effects. If you start to have lower motivation under stress, you might want to have a pick-me-upper. And rather than taking good care of your brain, it’s sometimes easier to have a couple of drinks. There’s also some evidence that the amount of reinforcement you feel from a drug that feels pleasurable is different if you’re stressed versus not stressed. And then there are these direct effects of stress hormones on dopamine, which the mainstream media will often talk about as the “reward chemical.” Those are some of the links that we’ve studied: this dopamine pathway or “reward pathway” also goes all the way up to our frontal executive and helps us think and manage cognitive tasks. So these are very intricately linked, and what’ we’ve discovered is that there isn’t much of a difference, at least in the neurochemical pathways, between what’s involved in motivation and learning and what’s involved in stress and stress regulation.

Q. You helped found the Stress Center as a director. How did you end up putting something together like this, both clinical and research-based?

A. My work has been in stress and emotions for a long time, and how stress affects behavior and choices, the link between stress and addictive behaviors. NIH [the National Institute of Health] was interested in complex biomedical and behavioral problems that don’t get solved with more traditional ways of studying, and what they asked for was to set up consortia: bringing teams of people with different expertise to solve complex problems. We put together a consortium here at Yale, with two other universities as collaborators, with leading scientists to target the links between stress and these addictive behaviors of alcohol, nicotine and comfort food, because those are three of the main behavioral causes of chronic diseases, and we felt the brain mechanisms had been ignored. It was all research from basic science, animal studies all the way to human-based studies and population studies. But what we found was that people who were calling in to participate in our studies were saying, ‘What can you do about it? Can you help us with our stress? Can you teach us what to do?’ And in fact we were developing new interventions as well as looking at things that had worked in the past. I’d found that people were not paying attention to thinking about health from an integrated perspective, integrating brain issues and body issues.

In terms of medical treatment, we’ve divided the body into different pieces, and of course there’s importance for specialists, but wouldn’t it be good to have a place somebody could come and have a team approach to what’s going on with them? Could that perspective open up a different way of thinking about health, and well being, and addressing people’s problems? A lot of times in chronic disease, there are multiple causes, and those issues are related to stress, so it made sense to start with the concept of stress and all of its multiple effects in the brain and body, to construct what we call ‘clinical and preventive services’ that would link to the research, and there would be a really nice back-and-forth between research and clinical presentations. So we established the stress center first as a research center, and three or four years later — that was only two years ago — we opened it for clinical and preventive services. It really is an experiment, we don’t know if this is going to take off, but it’s at academic centers that we should be trying new things.

Q. Was it difficult to get recognition for stress as a medical issue?

A. Actually, it’s not like a diagnosis right now. It’s still experimental to think you want to treat it with medication, in fact we studied that in our consortium: identifying those who are highly stressed, who we know are highest-risk for developing stress-related diseases, whether cancer, asthma, cardiovascular diseases, neurological diseases. Can we begin to prevent these diseases? People have been studying stress and it’s been known to be a medical phenomenon that’s very critical, but it hasn’t reached the place where it’s become a treatable, preventable issue. In fact, one of the goals of the Stress Center is to approach stress as something that we address and treat in a routine way. Our vision is that if we do that, we’ll change the relative risk ratio of stress contributing to these diseases.

Q. You mention some pretty startling physiological manifestations of stress: cancer, asthma, cardiovascular disease. How does a mental state like stress turn into a physical ailment?

A. I should say very clearly that stress is not the cause of cancer, as in, ‘A leads to B.’ It’s a really important contributing factor. The reason for clarifying is because stress, especially chronic stress, leads to changes. The stress pathways that I described to you earlier are there to learn and adapt to the challenges of the environment. So, it inherently is one that changes. So as it changes, those changes can be good or they can also be bad. If you have too much bad stress, you start having changes as a result of those adaptations, changes in secondary systems. For example, if you have too much adrenaline flowing around that doesn’t shut off, it will change your baseline state of things that are affected by adrenaline — that may be heart rate, it may be blood pressure. If you’re pumped up all the time, and can’t go back to your homeostatic state, the body’s system starts to shift. And now your basal level of blood pressure might be different than it was five years ago, and there are then secondary effects of higher blood pressure, in your blood vessels and other things. Those changes may be at the cellular level. So things can translate pretty quickly. Really, the complex diseases that I‘m talking about don’t have one cause. We have to stop thinking in those simple ways, we’re not in the domain of simplicity. In fact I’m working on a paper on this. I think we might need a different scientific approach to think about complex systems.

Q. I’d love to hear about that paper.

A. I think we need a paradigm shift in our approach to science. All of us have been trained in the reductionist model, of breaking things down to see if A leads to B, and as you’re breaking things down you’re not going to get the answer for something that’s a complex, interconnected phenomenon. The paper is just taking shape, but it’s about the question of whether we need different scientific models and frameworks for addressing complex phenomenon, as is true in other disciplines like physics.

The one last thing I would say is that it can sound bad that we have so much stress in our lives, and sometimes people ask me, ‘Do you have hope?’ It’s crazy, everybody is getting stressed, and I have a lot of hope because I think we have a lot of capacity as humans to regulate ourselves. We haven’t explored all of those options, we haven’t tested them, so there’s a lot of hope in terms of plenty of things that can be done.

Hard to Swallow

December 6, 2013 1:31 am Leave a Comment

A few weeks ago, the mental health group Mind Matters tabled on Cross Campus. Volunteers offered information about mental health resources at Yale in the form of flyers and conversation. If people were willing, they could write their thoughts about mental health on colored sticky notes and place them on a cardboard display for others to ponder.

“Sometimes I skip lunch on purpose.”

This light blue sticky note in the center of the board — a quiet admission of skipped meals, written in a neat hand — was surround by confessions of depression, anxiety, fear, loneliness and porn addiction. The sentence seemed so simple; many can admit to accidentally skipping meals, and a pattern of missed lunches would be easy to overlook. But the note’s author was admitting to something intentional, a problem below the surface.

Had they confided in anything other than a sticky note? Had they spoken the written words aloud?

Start to talk about eating disorders at Yale, and a familiar, simplified narrative soon emerges: Yale is an intense place, and in our collective scramble to reach the top, students find solace in control — be it academic or nutritional. Disordered eating, especially anorexic tendencies, follow from this competitive nature, as the outgrowth of an overworked and self-critical student body.

Some of this may true — and students’ intensity (both in the classroom and out) does translate to a heightened frequency of disordered eating. While a widely accepted statistic is difficult to find, given that many of those suffering are left undiagnosed, according to the National Association of Anorexia Nervosa and Associated Disorders, roughly 1% of the population suffers from eating disorders. In a recent survey conducted by the News, sent to 500 students with 141 responses, 8% of respondents self-reported that they had been diagnosed with an eating disorder.

Perhaps because of this markedly higher prevalence, 59% of students surveyed also said they thought “disordered eating” is an issue on campus. But though many believe these unhealthy habits develop on campus, few observed a satisfactory level of awareness. When asked to rate on a scale of one to five — one being “not at all” and five being “often or always spoken” — how often discussions of eating disorders occur, respondents rated campus conversation at a low 1.92.

For those diagnosed with eating disorders, or suffering from potentially harmful eating habits, this silence only fuels the problem. Those with disorders have few opportunities to articulate their problems to friends, administrators or even themselves. And, according to many who have suffered in secret, beginning to talk is the first step to a solution.

BURNT TOAST

Find the smallest piece of bread and burn it. Each day of her freshman year, Skyler* served herself the same breakfast, sometimes adding a cup of black coffee. The first meal of the day had always been her favorite, but most of Yale’s offerings — eggs, pancakes, bagels — scared her with the possibility of consuming fattening oil and calories. So she stuck to the one option she deemed “safe”: the tiniest piece of black toast.

“Burning toast makes it harder to chew, so I would have to chew longer to finish a piece,” she explained.

With classes throughout the day, skipping lunch was easy. All it meant was a strategic swipe at Bass Café for an iced coffee and a pack of gum – “in case I really needed something to chew on.” Dinner was a plate of raw spinach and tomatoes with a dash of mustard, a combination admired by Skyler’s friends, who complimented her apparent healthiness.

By the end of her freshman year, Skyler was struggling with a full-blown case of ED-NOS, “eating disorder not otherwise specified.” This meant that, according to a nutritionist, she did not meet the strict physical definition of anorexia but had severely harmful eating patterns with a strong psychological component.

Skyler’s habits fit into the clinical definition of “disordered eating.” According to the Mayo Clinic, “disordered eating” includes both psychological and physical symptoms, like cycles of severe restriction or binging, excessive feelings of guilt when eating, or defining self-worth based on eating habits.

When given this definition of “disordered eating,” 59% of respondents to the News’ survey reported that they have noticed habits that fit this definition among their friends.

Skyler said she recognizes them “everywhere” at Yale, hidden behind a veil of health-consciousness. She mentioned that many students associate dieting with health, and added that many count the ability to balance physical fitness, academics and extracurriculars as a badge of honor.

“It’s just another stretch for perfection. Yale is filled with all these perfectionists ready to do anything to be the ideal person,” she said.

Katie Chockley ’14 has struggled with an eating disorder since high school. She shared Skyler’s estimation that more people suffer than one might expect. Though, in Chockley’s experience, these habits dominate some groups at Yale more than others.

Chockley has participated in several athletic teams while at Yale and said that for athletes, weight affects performance. Certain sports, like long-distance running, benefit those who weigh less.

But after joining the Yale club rugby team, Chockley said she has found a more supportive environment and that she admires the body-positive attitude of her teammates.

“If someone makes a comment about some food as ‘good’ or ‘bad,’ they’re immediately shut down,” she said.

But while acute in certain areas, some social pressures are constant. For those who already have an unstable relationship with food, there are many stressors built into day-to-day life.

Andrea* has struggled with cycles of severe restriction and binging at Yale. At an interview in Bass Café one afternoon, she was energetic and smiling. She looked healthy, but that hasn’t always been the case.

Andrea said restricted dining hall hours teach students to eat at specific times, not necessarily when they are hungry. Often, she said, emphasis is placed on the “comfort” of foods over their nutritional value. She added that these complaints are not unique to Yale, but endemic to most college environments.

“The dining hall situation is interesting, because it can go both ways. [Buffets make it] easy to binge or restrict. And if you don’t want to eat, you just avoid the dining hall,” she said.

As someone also in recovery during her time at Yale, Chockley added that she felt uncomfortable with the social aspect of food in college, even outside the dining hall.

While students often joke that free food is everywhere on campus — and a hallmark of club meetings — Chockley said these events can be intimidating. Many of these feature unhealthy foods like Claire’s cake and pizza, which are “scary” to those who are over-aware of what they consume.

“There’s this voice in your head that says, ‘Do I have to eat cake for them to think I’m normal?’” she said.

MIND OVER FORK

By their nature, eating disorders have an element of voyeurism that escapes most mental disease. In its most extreme form, these diseases manifest as nearly skeletal: bones jutting out, pencil-thin wrists and countable ribs. But for all their visibility — for all their Hollywood connotations — every eating disorder begins immaterially, as a psychological problem. They derive from an impulse to use food, not for nutrition and fuel, but as a way to gain control.

“Eating is one of those things that we can control in this world,” Andrea said, associating these kinds of disorders with competitive environments. “When things get really stressful, that’s what people can turn to.”

For Andrea, Yale, academically and socially, was that competitive environment. Though Skyler located this pressure not just in classes and clubs, but in a feature specific to Yale: the unspoken expectation of happiness among its students.

Because Yale students pride themselves on a sense of self-control, she said, cracks in the façade are not welcome. The result is an atmosphere in which issues with food can snowball quickly, as students often avoid tough conversations about disordered eating. Skyler exhibited symptoms of ED-NOS before she recognized them as part of a disorder.

“There’s so much more happening than what you decide to eat and not-eat,” Skyler said.

She added that her situation was especially risky because she was at a healthy weight and seemed visibly unaffected. Those with ED-NOS still experience detrimental physical symptoms such as hair loss and dizziness, she explained, but they do not attract the same attention of those who are visibly emaciated.

And so the answer doesn’t lie in judging healthiness by appearance. Skyler said the root of the problem lies in someone’s habits, which are harder to discern, but still noticeable if you pay attention.

“You shouldn’t look at every skinny person on the street and ask if they’re anorexic. But I think if people were more sensitive, it wouldn’t be that difficult to glean who is having problems. There’s an air that’s almost tangible,” she said.

OUT OF CONTROL

We met Eric* at Blue State on York, so crowded with students and businessmen that the collective body heat was making us sweat. Two students sat at a table only a few inches away, discussing a summer program in the Southwest. Concerned that Eric might feel uneasy discussing a personal, sensitive topic in such a crowded place, we suggested a move to somewhere more private. He waved off the idea and said it was no problem. His confidence was astounding, especially for someone who had lived through what many consider a worst-case scenario.

Eric took a year off from Yale mid-semester the fall of his sophomore year after struggling with severe disordered eating habits and mental health issues. His disordered eating habits started second semester freshman year. Like the 51% of Yale undergraduates surveyed who listed that they felt a need to lose weight, Eric felt uncomfortable with his weight and body image.

But the catalysts for his descent into disordered eating were emotional: He struggled with relationships with friends, his sexuality and concerns about his academic future. With all of these things seemingly out of his control, Eric turned to food for stability.

His habits began as an interest in healthy eating. He dubbed himself a “foodie,” and soon became a vegetarian.

“For me, that decision was an excuse to just eat vegetables all the time and not much else,” Eric said.

As time passed, Eric became increasingly restrictive and obsessed with planning meals — what he was he going to eat, and who he was going to eat with. All it took was a cancelled dinner date or an unexpected change in a dining hall’s menu to send him spiraling into anxiety, feeling that he had lost control.

The malnourishment caused by his restriction led to cycles of binging and purging — the body responds to starvation by seeking calorie-dense foods for survival. But after each binge, Eric felt a need to compensate for overeating. If he didn’t purge by vomiting, he ran eight miles to rid his body of excess calories and to ease his obsessive mind.

“[It] was funny, because I felt like I wasn’t really deciding to do those things, but it was just happening,” Eric said. “Deep down I knew it wasn’t going to help and wasn’t what I wanted.”

Eventually Eric realized that he needed to take control, and that meant taking a year off to recover at home, where he saw a therapist on a weekly basis. He said the time away made all the difference for his recovery.

According to Eric, that time off doesn’t seem like an acceptable option to many Yalies. Time away from campus, he said, only feels justifiable if you’re doing something career-focused; otherwise it gives the impression that you simply can’t handle Yale.

But the world doesn’t end if you can’t get everything done in four years, Eric said, though breaking that perception can feel like yet another difficult step on the path to getting better. He found that taking time to recuperate was one of the best things he could have done for his well being, and added that those of his friends who have also spent time away agree that the experience is beneficial.

“The time off was really, really awesome, I learned a ton about myself … I came back with 10 times more confidence than I had previously,” Eric said, smiling.

Unfortunately, Yale does not make the reapplication process to return from time off due to mental concerns easy, Eric said. Instead, this impediment makes the prospect of taking time off even less appealing.

In order to gain readmittance into Yale College, Eric was required to get passing grades in two courses he had to complete during his time off, write an application essay and convince his college dean, Mental Health and Counseling chief psychiatrist Lorraine Siggins and an assistant dean of students that he could be “a real student again.”

He didn’t find out that he was readmitted until mid-August, just weeks before he would have to return.

GETTING HELP

Yale Health now employs one nutritionist. Under the student health plan, Andrea met with that one nutritionist, Lisa Kimmel, twice over a six-month period last year — a process she describes as cathartic and crucial to her recovery process.

But help isn’t consistently available. This year Kimmel works as part of Yale’s “Mind Matters” initiative and no longer provides nutrition counseling. Andrea said adjusting to Kimmel’s replacement, Marita Holl, has been difficult. When she returned to school this semester and called to make an appointment with Holl in late October, she was asked if she could plan to come in January. When she explained the urgency of her need for counseling, she got an appointment at the end of November. After the fact, she described that meeting as “disappointing.”

To those with a history of disordered eating, “recovery” is a process, not a cure, and it is one that does not only depend on professional help. Andrea observed that students, and not just administrators, could do more to encourage a better environment for recovery.

“The only way someone with an eating disorder will decide to get better is with support and education,” she said, adding that we should “at least make it a discussion on campus — it’s just not discussed, along with most mental health issues.”

Chockley, too, said other students influence the dialogue surrounding food. She pointed out that issues with eating habits are a lot more prevalent than most assume, and that those who do not suffer from them unwittingly make the problem worse.

If someone observed that she was “eating healthy” when Chockley was restricting, she felt a pressure to continue. If they commented that she had “a lot” of food when she felt stable, this instilled a sense of guilt and defeat, often leading to more intensely restrictive behaviors.

Skyler echoed Chockley’s concern about the ignorance of the student body, but added that Yale’s administration could better foster student dialogue on this issue. She drew a parallel to the University’s bystander intervention seminars.

“Yale focuses so much on teaching us how to intervene when your friend is about to get raped, but they teach us nothing about how to help a friend who is on [another] really bad path,” she said.

And so the people who could make the most difference — close friends and suitemates — often don’t know how to act.

When he first started to restrict his diet, Eric’s friends recognized that he had lost a lot of weight over a relatively short period of time. For a while, they didn’t address his weight loss or personality changes any further, only mentioning his problems obliquely, and saying that they never see him anymore. Eric could not share his burden with anyone else.

Eventually, his friends took action. They decided to confront him about his weight loss and depression, but only after Eric’s life had been unraveling for months. Looking back, he said it would have been better for him if his friends had spoken up sooner, though he recognized blame on both sides of the conversation.

“On the one hand it was my unwillingness to involve people, and on the other it was people’s either unwillingness or inability to get involved,” Eric said.

But even those that have experience with these psychological conditions find it hard to balance respect for someone’s independence and concern for their well-being.

Lydia was diagnosed with anorexia at the beginning of her sophomore year of high school and came to Yale after being in recovery for two years. But she said even now, she does not feel equipped to intervene when she sees classmates that exhibit disordered eating patterns.

“We’re friends with these people — the dynamic is different. Parents can intervene … but that’s not part of the job description for friends,” she said. “This is the time when people are supposed to start living independent lives, so how can you say to someone, ‘I don’t trust you completely to feed yourself?’”

FIRST WORDS

Eric and Skyler still relapse under stress, but now that those around them are aware of the nature of their issues, they feel more able to face them. Still, to obtain the support of friends and family, they had to divulge one of their most personal secrets.

Before he took time off, Eric believed that most of his friends would subscribe to the common perception that eating disorders are image-driven and simply about starvation. He feared responses that would only address the physical aspects of his problem, such as “go eat some more ice cream.”

The best way to propagate an awareness of the complexities of the issue is to engage in more discussion about disordered eating, Eric said. He called on others who have struggled with similar unhealthy approaches to food to share their experiences with friends, if they’re comfortable enough to do so.

“[Be] willing to be part of the conversation,” he said.

Ten minutes after Eric left our little table at Blue State, a girl who had sat at a neighboring table for the duration of the interview approached us. She asked what the interview was for, and the conversation soon turned to the silence surrounding eating disorders at Yale. Then, she admitted casually what many feel a need to hide.

“I had an eating disorder.”

*name changed for anonymity

Worth It?

April 26, 2013 4:55 am Leave a Comment

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.

Yale Daily News

Tag Archive: stress