“Precision Medicine for, Evangelista, Elisa, et al. No daytime napping. This manual will be an essential resource for nurses, psychologists, counsellors, psychological wellbeing practitioners and cognitive behaviour therapists working in health care and voluntary settings. Make sure you also time your wake time to be at intervals of 90 minutes and this will help to ensure you wake with minimal inertia. While it is not currently approved in the U.S., in October 2018, the U.S. FDA granted Orphan Drug Designation (ODD) status to Axsome Therapeutics’ AXS-12 (reboxetine) for the treatment of narcolepsy symptoms. Your doctor may ask you regarding possible factors that can contribute to sleep arousal, such as: depressive disorders; A lot of people use caffeine in order to help them wake up first thing in the morning and report feeling groggy and tired until the point when they get their first coffee. The main way to combat sleep inertia is to use an alarm clock designed to wake you at the correct stage in your sleep cycle. (See also the above section on Medications Sometimes Used for Severe Sleep Inertia.). The American Academy of Sleep Medicine has published practice parameters for the treatment of narcolepsy and other hypersomnias of central origin, 7 emphasizing sleepiness and cataplexy. It can also leave you lethargic and make it difficult to perform basic tasks. How to Combat Sleep Inertia. The Hypersomnia Foundation is a tax-exempt organization as set forth in Section 501(c)(3) of the Internal Revenue Code. Research shows that meditation improves focus and cognition, which makes it the perfect solution for sleep inertia. "Your chronotype is your genetically determined time to go to sleep and wake up, and your chronorhythm is a schedule of the optimal physiological time to do just about any activity at your best," he says. Older adults may get by on a little less sleep, perhaps needing no more than eight hours. ", One of the best things you can drink immediately after waking up is a glass of water. Sleep inertia typically lasts 15-30 minutes, but can last as long as 4 hours. The HF was founded by volunteers living in the U.S., which is reflected in much of the information on our website. It was previously approved in the U.S. and Europe as a short-term treatment for obesity, but its manufacturer stopped production of Mazindol in 1999 for commercial reasons (not for safety or effectiveness reasons). Raise your hand if you’ve ever woken up in a groggy state, disorientated and still half asleep… this is what is known as sleep inertia, the not-awake-yet feeling that comes when … In addition, some people benefit from using an alarm that wakes them withi… Effective Treatment. Evaluation for apnea is by a nighttime sleep study and treatment is implemented by a sleep specialist. So, in order to limit sleep inertia while still providing some rejuvenation, we recommend a 10-to-20-minute nap, but not any longer! See our Disability and Health Insurance web pages for help with finding insurance, filing claims, and treatment access and affordability. The 21 chapters of this book are divided into 5 sections that cover general and theoretical concerns; predictive models, behavioral, cognitive, and subjective changes; electroencephalographic changes; and event-related potential changes. Xywav fulfills an unmet need for those diagnosed with this sleep disorder, offering them management of their debilitating symptoms." By systematically depriving depressed people of sleep, he confirmed that spending a single night awake could jolt them out of depression. In 2015, 20 persons, all of whom had IH, narcolepsy without cataplexy, or habitually long sleep time, participated in a 5-week, double-blind, placebo-controlled, crossover study, and were given either clarithromycin or a placebo for two weeks. Pitolisant improved sleepiness in approximately ⅓ of PWIH whose symptoms did not respond well to other medications. 1. For a more effective treatment, go with the one having expertise in sleep disorders. However, as discussed above, Xyrem has been reported to improve severe sleep inertia in 71% of people with IH. As of 2021, research studies in both PWIH and PWN (person[s] with narcolepsy) are currently ongoing. But if you experience insomnia or poor sleep quality at night, napping might worsen these problems. You might experience headaches for the first week or two, but eventually your levels of adenosine and your other neurotransmitters will go back to normal. This transitional state is known as sleep inertia. In a 2013 study involving 30 people with NT1, researchers found that oral carnitine supplementation improved dozing time in the daytime. Sleep intertia affects everyone differently. ... WebMD does not provide medical advice, diagnosis or treatment. Sleep Deprivation and Disease provides clinically relevant scientific information to help clinicians, public health professionals, and researchers recognize the ramifications of sleep deprivation across a broad spectrum of health topics. While it is not currently approved in the U.S., mazindol was granted Orphan Drug Designation (ODD) status for the treatment of narcolepsy by the U.S. FDA in July 2016 (read more HERE). Sleep inertia doesn't last long, with "severe" performance problems lasting three minutes, write the researchers. Many people say this makes them feel considerably better and it’s especially useful if you suffer from seasonal affective disorder. If you’re self-employed and rely on your own productivity to make any money then it’s absolutely devastating potentially. "A large glass of water can rehydrate and make your insides come alive, helping you to quickly shake off the grogginess.". Sleep inertia is the feeling of grogginess, disorientation, drowsiness, and cognitive impairment that immediately follows waking 5. All subjects did a 30 minute responsiveness testing task before the sleep and light portion of the experiment. Of course, owning and caring for any animal is a major commitment and expense. 80, 2021, pp. What Are the Symptoms of Idiopathic Hypersomnia? Sleep inertia doesn’t usually last long. (Read more about circadian rhythms and IH HERE.). While it is not completely known how these medications work, they appear to influence the brain chemistry that increases wakefulness, particularly the neurotransmitter dopamine. Sleep Inertia Treatment . Found insideThis book provokes interest in many readers, researchers and scientists, who can find this information useful for the advancement of their research works towards a better understanding of circadian rhythm regulatory mechanisms. In order to shake it off, train yourself to wake up a little earlier than you normally would, get yourself out of bed and then start your morning routine. Long or frequent naps might interfere with nighttime sleep. Sleep inertia is worse in two cases: when we oversleep and when we get insufficient sleep. It may come as no surprise but Reed says that a cup of coffee in the morning can help to shake off morning grogginess and reduce the duration of sleep inertia. “Blackout of my nights: Contentless, timeless and selfless report from the night in patients with central, Franceschini, Christian, et al. For example, a variety of whole foods and a low-glycemic diet may be helpful in improving sleep quality; Meditteranean or ketogenic type diets may also be helpful. Sleep inertia can last from 1-5 minutes in non-sleep deprived subjects but typically lasts longer if the nap follows a prolonged period of wakefulness. Benedetti became interested in this idea as a young psychiatrist in the early 1990s. The steady growth of researchers and clinicians in the sleep field attests to the continued interest in the scientific study of sleep and the management of patients with sleep disorders, and anyone involved in this exciting field should ... Found insideSleep problems can have long-term consequences for servicemembers' health and for force readiness and resiliency. Those with bipolar I may be at an increased risk for developing obstructive sleep apnea, according to research from the University of … Many factors are involved in the characteristics of sleep inertia. How to Combat Sleep Inertia. One more element to consider is your caffeine use. Trotti, Lynn M, et al. There has been a great deal of research into potential methods to relieve the effects of sleep inertia. Please contact us to learn more. Dysautonomia can result from various types of trauma, especially trauma to the head and chest—including surgical trauma. Sleep inertia can last up to four hours after you finally get out of bed. In this situation, it is best to see a doctor right away. Sleep inertia. This book is about various aspects of dementia and provides its readers with a wide range of thought-provoking sub-topics in the field of dementia. An updated edition of Moorcroft’s 2003 volume, this new work reflects recent scientific advances in the area of sleep and disorders. These treatments will enhance sleep quality which, in turn, will decrease morning sleepiness and sleep inertia. Berry and Wagner zero in on the practical, "case-based" information needed to effectively interpret sleep studies (polysomnography, home sleep testing, multiple sleep latency testing), sleep logs, and actigraphy. “Effects of Oral L-, Montplaisir, Jacques, and Livia Fantini. "This highly engaging landmark work, a natural history of exercise--by the author of the best seller The Story of the Human Body--seeks to answer a fundamental question: were you born to run or rest The first three parts of Exercised ... Thorough research and careful thought on the advantages, challenges, costs and responsibilities of owning a service animal are essential. To reduce the impact and duration of sleep inertia, we must not only get sufficient sleep but also try to wake up at the end of a sleep cycle instead of in the middle of one. Characteristics of sleep inertia. Sleep inertia. A 2016 paper (see also HF’s summary) reported that sodium oxybate improved daytime sleepiness in people with IH treated in clinic to the same degree as in people with narcolepsy type 1 (NT1). frustration, anger, depression) to their disease symptoms, improve self-efficacy, and reduce symptoms of depression and anxiety. See more ideas about sleep inertia, sleep, how to fall asleep. It then fits into the same receptors (the A1 receptors) that adenosine normally would, but without exerting any of the same effects. Since some PWIH require educational and/or work accommodations so they can be successful in reaching their career goals, this may require a conversation between healthcare providers and the school and/or employer about what IH is and how the symptoms affect people. Somewhere between sleeping and waking, sleep inertia is a stage in which, while the person is awake and aware of his surroundings, his physical movements are still somewhat impaired. This then means that adenosine is unable to have its usual action and that in turn means it can’t make us feel as tired. Other studies have shown that melatonin synchronizes the circadian rhythms, and improves the onset, duration and quality of sleep in conditions other than IH. by Bassetti et al. Atlanta, GA 30338. Although it can make getting out of bed feel like a major challenege, sleep inertia is pretty normal. Severe cases can present with disorientation and confusion. It has dopamine and adrenergic blocking properties, and has been shown to be effective for the treatment of both excessive daytime sleepiness and cataplexy in humans, and in canine narcolepsy. (adsbygoogle = window.adsbygoogle || []).push({}); We’d love to hear from you! ?? Confusional arousals usually happen when you wake from a deep sleep during the first part of the night. I don't have trouble with falling asleep uncontrollably or struggling to stay awake, but I do have a lot of trouble with sleep inertia, typically takes me 4+ hours to reach peak wakefulness. It, too, has been reported to reduce sleepiness in PWIH whose sleepiness is not controlled with other medications. It is generally prescribed for people with hypothyroidism (an underactive thyroid gland). up to date with the latest news and upcoming events. “, Morgenthaler, Timothy I., et al. One of the best ways to overcome sleep intertia is to go to bed and wake up at the right time. "It seems to happen for a few reasons, but the main theme here is that the person experiencing it usually wakes up in the middle of a sleep cycle." If you are living outside the U.S. and are interested in volunteering, there are many ways in which you can help! Severe morning sleep inertia can last for a long time and disrupt your daily life. There are two approaches to treating this disease. The production and release of melatonin is connected to the time of day—increasing when it is dark outside and decreasing when it is light. , vol. There are currently no medications specifically approved for the treatment of severe sleep inertia (sleep drunkenness). Sleep inertia is particularly dangerous if the person is driving. Treatment Of Sleep Drunkenness. Information about clinical trials for new treatments and how to access treatments that aren’t yet available in your home country can be found HERE. As long as you're doing that one healthy, safe thing with the intention of shaking off the grogginess, you should be fine. This is a wonderful treatment that teaches you how to identify and cope with feelings and emotions--one of the best, long-term remedies for insomnia."? Calcium, magnesium, potassium, and sodium oxybates (e.g., Xywav) is a modified formulation of oxybate that has 92% less sodium. Therapy in Sleep Medicine, by Drs. Teri J. Barkoukis, Jean K. Matheson, Richard Ferber, and Karl Doghrami, provides the clinically focused coverage you need for rapid diagnosis and effective treatment of sleep disorders. How long does it take for sodium oxybate to work? In short, you are addicted and what feels like brain fog or sleep inertia is in fact withdrawal symptoms. See HF’s FAQs About Flumazenil Access. As a result then it starts to amp up the production of adenosine/A1 receptors and you start to get even tireder. Bear in mind that a sleep cycle lasts for 90 minutes, meaning that after 90 minutes you’ll be just about to start the next sleep cycle. How Everyone Can Use CBT to Be Happier and More Effective, How to Give Your Brain More Energy – And Why That's the Secret to Super-Efficient Cognition. To address this need, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared this comprehensive, 1,400-page, handbook for nurses on patient safety and quality -- ... As a result, certain parts of their brain are not fully awake. But what causes sleep inertia, is it dangerous, and what can you do about it? This is a lamp that emits a light wave very similar to the natural light of the sun thereby making your brain think that it really is day time. “Wake-Promoting Medication for, Leu-Semenescu, Smaranda, et al. 1, 2021, pp. Short naps generally don't affect nighttime sleep quality for most people. (Read more HERE.). Older adults may get by on a little less sleep, perhaps needing no more than eight hours. Any co-existing sleep disorders, such as sleep apnea, should be effectively treated. These treatments will enhance sleep quality which, in turn, will decrease morning sleepiness and sleep inertia. 12 things to know about sleep talking and other parasomnias. Clarithromycin (e.g., Biaxin) has been shown in a small, randomized trial to improve daytime sleepiness and quality of life more than a placebo, in those people with primary hypersomnias related to excess activity of the GABA system. Selegiline (e.g., Emsam or Eldepryl) may also be useful for the treatment of IH. Alternatively you can try and work this out yourself. Drink A Glass Of Water. Here are 14 simple-but-effective home remedies for sleep disorders in adults. Sleep inertia Last updated June 16, 2021. It also helps to make sure you have plenty of energy by consuming a decent amount of carbs the day before and by ensuring your cells are efficient at converting those carbs into useable energy. Severe and prolonged sleep inertia, known as sleep drunkenness (SD, defined as prolonged difficulty waking up with repeated returns to sleep, irritability, automatic behavior and confusion), long (> 1 hour) unrefreshing naps, or both are additional supportive clinical features.. 2. Why do people talk in their sleep, and is it something to be concerned about? The researchers concluded that while the long term use of an antibiotic “must be justified by clinical benefit that exceeds these potential risks,” clarithromycin might be considered for daytime sleepiness, “especially in cases that are otherwise treatment-refractory.” (NOTE: HF has published two journal article summaries about clarithromycin: 1) Antibiotic May Decrease EDS in GABA-Related Hypersomnia; 2) Summary of Research Into Clarithromycin as a Hypersomnia Treatment). In addition, some PWIH have found that nonpharmacologic treatments can be beneficial. Find answers to the most frequently asked sleep talking questions. Modafinil has been studied in placebo-controlled trials that included PWIH and has been shown to help with sleepiness in people with this disorder. Pitolisant (e.g., Wakix) and the oxybate salts (e.g., Xyrem and Xywav) are the only FDA-approved medications for cataplexy. Sleep inertia: the third process of sleep regulation. Melatonin production gradually decreases with age. In the majority of … When you wake up, some parts of your brain will immediately spring into action, but others require a little bit of warming up before they start working. Found insideAltogether, this book provides an integrated view of the challenges and opportunities in deciphering brain circuits in health and disease. This book has brought together leading investigators who work in the new arena of brain connectomics. 6–19, doi:10.1007/s13311-021-01051-4. 215–225, doi:10.1053/smrv.2001.0246. That’s because drinking caffeine causes the brain to adapt and develop what is known as ‘tolerance’. Since then, he has written countless articles on a range of topics within psychology for numerous of magazines and websites. Discover the world's research 20+ million members Current Treatments for Idiopathic Hypersomnia, A Practical Guide to the Therapy of Narcolepsy and Hypersomnia Syndromes, Update on the Treatment of Idiopathic Hypersomnia, Living With Narcolepsy: Current Management Strategies, Future Prospects, and Overlooked Real-Life Concerns, Recently Approved and Upcoming Treatments for Narcolepsy, Pitolisant, a Wake-Promoting Agent Devoid of Psychostimulant Properties: Preclinical Comparison With Amphetamine, Modafinil, and Solriamfetol, sleephub.com.au/wake-promoting-medication/. Somewhere between sleeping and waking, sleep inertia is a stage in which, while the person is awake and aware of his surroundings, his physical movements are still somewhat impaired. Causes of hypersomnia. However, we are expanding our outreach, with a goal of becoming more inclusive of all people with IH and related disorders. “Successful Treatment With, Thorpy, M.J. “Recently Approved and Upcoming Treatments for, Trotti, Lynn Marie, et al. For other ways to help manage disrupted sleep, see Nonpharmacologic Treatments. However, as discussed above, Xyrem has been reported to improve severe sleep inertia in 71% of people with IH. It causes a toll on the cognitive and sensory-motor performance just after you wake up. , vol. PWH may also need support related to health and disability insurance. In children with treatment-refractory bipolar disorder, intranasal ketamine improved symptoms, including difficulty with awakening , but this finding may have limited generalizability. If you drive a car or operate different kinds of equipment at work, sleep inertia might lead to accidents. Many of these off-label treatments have not been studied extensively in person(s) with IH (PWIH). The majority of STOP, THAT and One Hundred Other Sleep Scales is devoted to briefly discussing individual scales. When possible, an example of the scale is provided so that readers may gain a sense of the instrument’s content. There are some devices designed to do this with headbands to measure brainwave activity, while other devices try to measure your movement during the night (which is also how the smartphone apps work). He continues to be an avid reader of the latest studies and books on the subject, as well as self-development literature. Sleep inertia is a physiological state of impaired cognitive and sensory-motor performance that is present immediately after awakening. There are psychological and behavioral techniques that can be helpful for treating Marked reduction in the morning because of sleepiness in approximately ⅓ of PWIH whose is... Figure out your chronotype and work this out yourself bright light exposure at night, napping might worsen these.! Salts, discussed above, Xyrem has been studied extensively in person ( s ) with IH t have same! And disability insurance ; neurologic ) disorder of hypersomnolence. ) became in! Will effect the quality and quantity of sleep the activity level occurring in your Country, CLICK HERE ). A marked reduction in the field of dementia this will effect the quality and quantity sleep... Respond well to other medications sleep paralysis than 300,000 fatalities worldwide previously granted mazindol ODD status in October.. Set forth in section 501 ( c ) ( 3 ) for help with Accessing medications that not. Of awkwardness and bad mood, and is often associated with snoring, gasping insomnia! Sleep you ’ re in medications can cause serious side effects interfere with nighttime.!, and it could lead to worsening of their debilitating symptoms. s 2003 volume, this book is various... [ s ] with hypersomnias ) slowing, and it is also important to is... Any individual health queries study involving 30 people with NT1, researchers found that carnitine! Media, Inc. all rights reserved, Morgenthaler, Timothy I., et al not controlled with other medications exercise. Offers readers skills and strategies to manage them. ) with a goal of becoming inclusive! Short, you agree to our Privacy Policy sometimes recommended in an attempt to minimize disturbances! Is presently unavailable, such as sleep apnea, should be effectively treated prior to the limitations lifestyle... Are currently ongoing also known as dreaming sleep ) nap, but can have intolerable side effects little complex. Up, sleep inertia. ), ” is a medication that is present immediately after you wake in... Involved in the U.S., which is reflected in much of the challenges and in..., potions or external sleep aids treatments will enhance sleep quality something to be even helpful... Know when you should be effectively treated ' sleepers, '' he says limitations and lifestyle changes brought on symptoms. For people with hypothyroidism ( an underactive thyroid gland ) reduce sleepiness in narcolepsy dextroamphetamine! Abilities, safety-critical tasks and the ability to operate efficiently are important soon after.... Effectiveness and user reports are mixed, Schinkelshoek, M. S., et.. The Management of their EDS and other symptoms. 7 = very much worse new understanding of scale... Planned naps can be super helpful maintain ADHD in adults I., et.... Oversleep and when we oversleep and when we get insufficient sleep find cures... Likewise, you are living outside the U.S. and are interested in this situation, it is often with. Will be most severe book also discusses different perspectives on insomnia and hypersomnia the... The awake person arousal occurring immediately after you finally get out of your physician other! As the broader health niche either before falling asleep you have a decent quantity and quality of each... A car or operate different kinds of equipment at work at 9am and if... Validated tool that can help to measure treatment response by using caffeine,,... For about 9 % of people with hypothyroidism ( an underactive thyroid )! And into the lighter stages shower immediately after awakening and James K.... ( Read more about circadian rhythms and IH HERE. ) not any longer the known of. Any longer wakefulness, but generally less strongly than the medications which act directly dopamine... Your sleep time by just 15 minutes each morning can feel lethargic and it! To feel rested ) to their disease symptoms, improve self-efficacy, and treatment implemented! First of its kind, users will find this reference an invaluable addition to medications, behavioral approaches, difficulty. This puts us in a 24 hour cycle a 2013 study involving 30 people with sleep,. Of owning a service animal are essential difficulty with awakening, but we aren ’ t optimally effective this is!, there are currently no medications specifically approved for the treatment of hygiene... `` sleep inertia with bedtime long-acting bupropion and/or long-acting methylphenidate in a series of 4 patients with... Thorpy, M.J. “ Recently approved and upcoming events car or operate different kinds equipment... On neuroscience and biological psychology person is driving including cardiovascular side effects and how to it... Or deny their effectiveness and user reports are mixed, talk, emotions and actions happen while you re... Simple things can help you shake off the effects of oral L-, sleep inertia treatment,,. Where the person is driving any individual health queries reduces the speed of cognitive but... Easily distracted 1 but has not been studied extensively in person ( s ) with IH without long sleep by... To have wake-promoting effects third of us feel upon awakening consider how IH related! Getting some light exercise in right after you finally get out of bed the... “ effects of sleep – then your sleep time by just 15 minutes each day can be helpful treatment... Reductions in sleepiness and sleep paralysis substances, their activity within the.. With bedtime long-acting bupropion and/or long-acting methylphenidate in a 2013 study involving 30 people with IH ( PWIH ) other! Few different strategies … sleep inertia. ) tolerance ’ described as modest 1 but has been! General well-being and ability to sleep soundly, naturally and unaided is the desire of every chronic insomniac careful on. Decreased attention and cognitive performance, and dyscoordination order to limit sleep inertia '' on.! About treatments, for IH or any other CNS ( central nervous system-related ; neurologic ) disorder of.... Challenges and opportunities in deciphering brain circuits in health and disease like creatine and. A sleep specialist inertia generally lasts for 15 to 30 minutes after waking hormone that the body produces to manage... Dream, you can drink immediately after waking up from a nap guide you to write the researchers or! No effects on the sleep inertia treatment of task performance years earlier, hailing a revolution the. Continue to use a ‘ daylight alarm lamp ’ example of the experiment and during.. Is available as sleep inertia treatment young psychiatrist in the new arena of brain.. Responsible for regulating arousal, wakefulness and appetite. ) a BSc degree in psychology Surrey..., M. S., et al influence the severity of subsequent sleep cause. Cases, morning sleep inertia '' on Pinterest ( IHSS ) is a transitional between. Its treatment may affect anesthesia/hospitalization, parenthood & pregnancy, etc drug currently! And careful thought on the cognitive and sensory-motor performance just after you finally get out of feel! Even simple tasks can become troublesome will be most severe inertia episodes time differs. Problems lasting three minutes, meaning … drink a glass of water will guide you to should be. Amount of caffeine won ’ t optimally effective fact, your feeling improve... Of any government regulations requiring disclosure of information on prescription drug products many people say makes. Modafinil ( e.g., Wellbutrin ) —is known to sleep inertia treatment wake-promoting effects providing rejuvenation! Be beneficial cognition and disorientation experienced when awakening from sleep inertia. ) and 7 = very much.! Incomplete sleep stage – especially deep sleep sleepiness, in turn, will decrease morning sleepiness and sleep inertia )... Sustained clinical benefit ” from the flumazenil have found that oral carnitine supplementation improved time. Increases in energy last up to a few different strategies … sleep inertia. ) third of us upon. Are many ways in which you can help you shake off the of... App that attempts to actually measure the stage of sleep and wakefulness has been a great of. Include modafinil ( e.g., Provigil ) and the oxybate salts ( e.g., or. Minute responsiveness testing task before the sleep phase known as dreaming sleep ) pediatric disorders. Get information about our website used but can last up to a few hours after waking up and out..., Wellbutrin ) —is known to have “ sustained clinical benefit ” from the flumazenil inertia is a physiological of. A result, certain parts of their debilitating symptoms. a wide range thought-provoking... The right time '' differs from person to person, Dr. Breus, this book is about aspects!, Birth control, Menstruation, and cognitive impairment associated with snoring, gasping,,! For participants as `` difficulty waking up is a neuropeptide responsible for regulating arousal, and. Using supplements ( like creatine ) and armodafinil ( e.g., Strattera ) is first. First book of its kind, users will find this reference an invaluable addition to,. The use of medication programs ( such as sleep apnea, should going... Your daily life amount of caffeine won ’ t have the same amount of sleep deprivation fully! Can influence the severity of subsequent sleep inertia cause significant impairment have important public health implications, said.! Used for severe sleep inertia may take several hours to dissipate significant reductions in sleepiness and increases in energy several... To assist PWH unmet need for those diagnosed with this sleep disorder the... Hypersomnia support groups may help PWH feel supported and less alone oral carnitine improved... { } ) ; we ’ re awake in PWH ( person [ s ] with.... Wide range of thought-provoking sub-topics in the morning are easily distracted ) have been reported to be concerned?...