Medical Cautions

Introduction

Numerous sleep-related medical conditions can make it significantly harder to adapt to polyphasic schedules and it may be not advisable to attempt adaptation for some of the conditions listed below. While this article may provide general information and recommendations, it does not provide a medical advice and it is advisable you consult with an appropriate medical professional if you have any doubts about adaptation or health conditions.

Narcolepsy

If you are suffering from narcolepsy, you should take caution in considering a polyphasic sleeping schedule. Consulting your doctor is very advisable in this case. Do not attempt a polyphasic sleep schedule on medications like Xyrem or Modafinil. Modafinil is a medicine usually prescribed to people suffering from narcolepsy or hypersomnia.  Consumption of Modafinil while on polyphasic sleeping is not recommended due to extremely long half life (15 hours) which means it is likely to impact the quality of multiple successive sleep sessions. Xyrem is used to treat sudden muscle weakness and excessive daytime sleepiness. It has a short half life (around 1 hour). Napping after consuming  this drug is very hard.

If you notice yourself unable to stay awake during more tasks than before, do not continue with polyphasic sleep! This is very dangerous. Narcoleptics suffer from excessive amounts of REM, reduced SWS and possibly frequent sleep interruptions. Constant tiredness and attacks of falling asleep which are hard to control during the day can be a dreadful combination for doing a polyphasic sleeping schedule. Cataplexy severity and frequency, however, does not have an effect on your sleep and the specific sleep needs!

Depending on the severity and the symptoms you have polyphasic sleep could still be possible. There are a few key factors to remember:

  1. If you are suffering from excessive daytime sleepiness and periods of nighttime wakefulness, then establishing a strict polyphasic sleeping schedule will be very difficult. Although the narcolepsy makes it a fight, polyphasic sleep is still possible. Depending on the schedule, narcolepsy could even prove to be an aid.
  2. Sleeping outside the schedule will reduce or prevent adaptation to the schedule. If you frequently fall asleep against your will or have severe daytime tiredness, you can try scheduling extra naps to give you a boost in alertness. If this doesn’t work, then polyphasic sleeping might not be possible for you.  Note that it can take a few days or weeks to fall asleep during nap times, so allow some time to see if it is possible. You can also consult people in a similar situation. Success at adapting also requires a stable circadian rhythm.
  3. Because of the difficulty obtaining SWS, you should always sleep more during cores than recommended for the average adult.  Instead of regular schedules, investigate extended versions of the schedules that have one or even more additional core cycles. Take into consideration how often you have trouble with nighttime wakefulness, and how long it takes you to fall asleep, while designing your schedule.
  4. There are some benefits. SOREM – or proceeding quickly into REM for naps – is already established due to narcolepsy, and adaptation should be a bit easier because of this. Narcoleptics also have little variation to the amount of sleep deprivation they experience, which eases adaptation a bit as there should be no unexpected changes in the level of tiredness that non-narcoleptics get surprised by when entering the next adaptation stages.

Some people suffering from narcolepsy use polyphasic sleeping as a way to deal with the tiredness and irregular sleep schedule.. Rather than decreasing the total sleep time, polyphasic sleep can be used to establish a more strict, regular schedule similar to monophasic sleep in terms of daily sleep time.  This can aid narcoleptics to decrease the amount of sleep attacks and establish a more predictable sleep schedule. Reaching out to various support groups and asking people about their polyphasic sleeping experience is wise.  (Information gathered from an interview with a person suffering from narcolepsy).

Insomnia

If you’re suffering from insomnia, polyphasic sleep could possibly aid you! Some people suffering from insomnia claim to have been able to learn to fall asleep instantly regardless, simply because of the sleep deprivation during adaptation. They also claim to have had an easier adaptation, as they didn’t feel as tired as others do. This is only anecdotally proven, so it’s not guaranteed to help you. Further research into the interactions between insomnia and polyphasic sleep is required. Using naptation to first establish the ability to fall asleep for naps fast, or simply staying awake for over a day before switching to the desired schedule (see later parts of this guide) could prove to give an edge in adaptation, as it could otherwise take a very long time to fall asleep for any naps.

Another point to bring up is the fact that long term sleep deprivation, from for example a failed adaptation that is forcefully kept going , can lead to insomnia1. If this isn’t treated it can even turn out to become chronic2. This means it’s important to understand and take action if adaptation feels like it stagnates, or if one gets stuck in a perpetual loop of oversleeping every few days hindering one from ever adapting. If adaptation stagnates, and it feels like no change has happened in a few weeks, it’s best to change something. Analyze when you’re tired, possibly move naps, add naps or extend the core. If the problem is oversleeping, it’s best to recover all sleep debt and try again. This usually takes at least a week.

Epilepsy

Sleep deprivation is the second most common trigger for seizures, and some people have it as their only trigger3. If you have epilepsy you should not sleep deprive yourself, which is inevitable during adaptation, meaning polyphasic sleep is not for you.

ADD/ADHD

If you have a severe case of ADD or ADHD and take adderall, methylphenidate (ritalin), or similar medicines, then polyphasic sleeping could be very difficult for you. Both adderall and methylphenidate are stimulants, and are going to make falling asleep much harder unless you take small doses a long time before the sleeps. Fast release adderall has a half life of about 10 hours, while methylphenidate has a half life of about 3h. Methylphenidate is also used as a form of treatment for narcolepsy which similarly to  polyphasic sleep contains SOREM. Consult a physician about dosages and possibilities to do polyphasic sleep while taking similar medication.

Heart conditions

Sleep deprivation increases stress, which in turn increases blood pressure4. While this does not pose significant risks in healthy individuals, the risk of having a heart attack increases in individuals with heart conditions, so it should be completely avoided if you are at risk of getting a heart attack is already elevated.

Sickness

Being sick with a temporary disease, such as the flu or a fever, is a normal reaction while adapting. If you get sick during or before adaptation it’s important to take a break and recover before continuing/starting the desired schedule. Being sick increases the SWS need significantly, causing the body to insert it into several sleep cycles in turn increasing the overall sleep need. The additional sleep gives the immune system a boost in fighting off your sickness5. If you disrupt your sleep before waking naturally, you will likely have skipped out on SWS. This hinders recovery, and it can both prolong the sickness and risk secondary health problems.

For this reason, it is strongly advised that whenever a polyphaser is sick, they switch to a schedule which would allow for a greater amount of SWS. Traditionally this would mean dropping back down to monophasic sleeping until the illness has been dealt with, or adding extra cycles in SWS-favourable times to the entrained schedule’s existing sleep blocks. It is also possible to extend existing naps or cores during the time of sickness, but there should not be a limit as to how long you allow yourself to sleep. If one gets sick during adaptation starting a healthier lifestyle (exercising, eating healthy etc) is recommended before re-attempting polyphasic sleeping. Sleep deprivation weakens the immune system6, so giving it every boost possible is wise.

Chronic diseases

Sufferers from chronic diseases, like diabetes, cardiovascular diseases, sleep apnea, and so on, should consult with a medical doctor about attempting a polyphasic sleeping schedule. Ask them about increased health risks that come with adaptation, if for example increased tiredness or a weakened immune system (bigger list in later parts of the guide) is considered a health hazard with the condition.

REM sleep and depression

There appears to be a link between REM sleep frequency/quantity and depression. In particular, clinical depression appears to be proceed by REM sleep alterations7. While it is not clear whether this is cause or symptom, it indicates a link between depression and REM sleep. SSRIs (common antidepressants) appear to function by reducing both REM quantity and also REM deprivation symptoms8. Consequently, polyphasic sleep may worsen depressive symptoms,  due to REM deprivation during adaptation. Observations have been made where the schedule would start without any depression with a gradual increase in symptoms during adaptation which can prove detrimental.

Sleep deprivation also causes mood swings, which makes emotions even stronger. Adapting to a polyphasic sleeping schedule will also most likely bring out loneliness, as polyphasic sleepers are awake during the time everyone else sleeps.

If you’re suffering from depression, polyphasic sleep can still be possible. It can be used as something to strive for, possibly getting you out of depression eventually. However, in general you should be careful about adapting to a polyphasic schedule during this time of your life especially since sleep deprivation during adaptation can lead to additional stress and anxiety.

Main author: Crimson

2.
Insomnia – Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes/syc-20355167. Published October 16, 2016. Accessed October 21, 2018.
3.
Schachter SC, Shafer PO, Sirven JI. Lack of Sleep and Epilepsy. Epilepsy Foundation. https://www.epilepsy.com/learn/triggers-seizures/lack-sleep-and-epilepsy. Published March 19, 2014. Accessed October 21, 2018.
4.
Sheps SG. Sleep deprivation: A cause of high blood pressure? Mayo Clinic . https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/sleep-deprivation/faq-20057959. Published April 19, 2018. Accessed October 21, 2018.
5.
Imeri L, Opp MR. How (and why) the immune system makes us sleep. N. 2009;10(3):199-210. doi:10.1038/nrn2576
6.
Mann D. How Sleep Loss Affects Immunity. WebMD. https://www.webmd.com/sleep-disorders/features/immune-system-lack-of-sleep. Published 2018. Accessed October 21, 2018.
7.
Palagini L, Baglioni C, Ciapparelli A, Gemignani A, Riemann D. REM sleep dysregulation in depression: state of the art. Sleep Med Rev. 2013;17(5):377-390. [PubMed]
8.
McCarthy A, Wafford K, Shanks E, Ligocki M, Edgar DM, Dijk D-J. REM sleep homeostasis in the absence of REM sleep: Effects of antidepressants. N. 2016;108:415-425. doi:10.1016/j.neuropharm.2016.04.047