cannabis, which may also interfere with REM. Some opioids (including morphine, codeine, heroin, and oxycodone) also induce sleep, and can disrupt sleep architecture and sleep stage distribution. Stimulants, which inhibit sleep, include caffeine, an adenosine antagonist; amphetamine, methamphetamine, MDMA, empathogen-entactogens, and related drugs; cocaine, which can alter the circadian rhythm, and methylphenidate, which acts similarly; and other analeptic drugs like modafinil and armodafinil with poorly understood mechanisms. Consuming high amounts of the stimulant caffeine can result in interrupted sleep patterns and sometimes sleep deprivation. This vicious cycle can result in drowsiness which can then result in a higher consumption of caffeine in order to stay awake the next day. This cycle can lead to decreased cognitive function and an overall feeling of fatigue. Some drugs may alter sleep architecture without inhibiting or inducing sleep. Drugs that amplify or inhibit endocrine and immune system secretions associated with certain sleep stages have been shown to alter sleep architecture. The growth hormone releasing hormone receptor agonist MK-677 has been shown to increase REM in older adults as well as stage IV sleep in younger adults by approximately 50%. Diet Dietary and nutritional choices may affect sleep duration and quality. One 2016 review indicated that a high-carbohydrate diet promoted a shorter onset to sleep and a longer duration of sleep than a high-fat diet. A 2012 investigation indicated that mixed micronutrients and macronutrients are needed to promote quality sleep. A varied diet containing fresh fruits and vegetables, low saturated fat, and whole grains may be optimal for individuals seeking to improve sleep quality. High-quality clinical trials on long-term dietary practices are needed to better define the influence of diet on sleep quality. In culture Anthropology Research suggests that sleep patterns vary significantly across cultures. The most striking differences are observed between societies that have plentiful sources of artificial light and ones that do not. The primary difference appears to be that pre-light cultures have more broken-up sleep patterns. For example, people without artificial light might go to sleep far sooner after the sun sets, but then wake up several times throughout the night, punctuating their sleep with periods of wakefulness, perhaps lasting several hours. During pre-industrial Europe, biphasic (bimodal) sleeping was considered the norm. Sleep onset was determined not by a set bedtime, but by whether there were things to do. The boundaries between sleeping and waking are blurred in these societies. Some observers