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Overview of Sleep
PHARMAC seminars
Dr Tony Fernando
a.fernando@auckland.ac.nz
Psychiatrist and Sleep Specialist
Department of Psychological Medicine
University of Auckland
sleep myths
1) All of us need 8 hours
2) Snoring is common and harmless
3) If you are always tired, you are not sleeping
enough
4) You can catch up on sleep deficits during the
weekend
5) Alcohol helps you sleep
6) Students who fall asleep in class are lazy
7) If you are tired and driving, roll a window down
or turn up the radio
Who is sleepy at this moment?
Who has problems with
their sleep- difficulty
falling asleep, waking up
in the middle of the night,
poor quality sleep such
that it affects you the
following day?
Who are night owls-
given the chance, feel
more natural to stay
awake late, after 12
MN and sleep in until
midday?
Who sleep walk, sleep
talk, do unusual things
when they are asleep?
Sleep disorders among
university students Samaranayake C, Arroll B, Fernando A NZ Medical Journal August 2014
Specific conditions causing sleep
symptoms
n (%) (N= 509) of 1292 University of
Auckland students
Anxiety 158 (31.0%)
Depression 153 (30.8%)
Delayed sleep phase disorder* 127 (24.9%)
Problematic alcohol use 89 (17.5%)
Parasomnias 63 (12.4%)
General health problem 53 (10.4%)
Primary insomnia* 45 (8.8%)
Obstructive sleep apnoea 12 (2.4%)
Why do we need to sleep?
Why Sleep
Body repair?
Energy replenishment?
Predator avoidance?
Thermoregulation?
Memory consolidation?
Neuronal Integrity?
Resculpting of synaptic
populations?
Maximizing adaptation to the
environment (Jerome Siegel)
Recent Research on Sleep and the
Brain
– Sleep improves
procedural memory
tasks requiring practice
and repetition
– Problem solving skills
– Pruning and
strengthening of
circuits that promotes
learning new things
and reinforcing old
ones
Sleep per 24 Hours
-1
4
9
14
19
24
Giraffe
Elephant
Whale
Man
Baboon
Cat
Rat
Lion
Bat
Species that “do not sleep”
Total Sleep Requirement**
Sleep Academic Award 14
Sleep and Life Stages
Complexity of Sleep
Sleep Architecture
Sleep is divided into two types:
Rapid Eye Movement Sleep (REM)
Non – Rapid Eye Movement Sleep (NREM)
Scammell TE. Sleep Med Alert. 2004; Comella CL, et al. Textbook of Clinical Neurology. 1999.
Dreams
– Occurs mostly during the REM phase of sleep
– REM occurs about 5x a night, totaling about 2
hours
– Remember less than 5% of our dreams
– Why dream?
Erasing theory
Filing theory
Diagnosing Sleep Disorders
Sleep history
Sleep diary
Actigraph
Polysomnogram
Sleep History
Sleep onset
Sleep latency
Interruptions
Total sleep time
Quality of sleep
Pattern long term
Sleep attacks
Sleepiness during the
day
Sleep walking
Sleep talking
Sleep eating
Sleep sex
Snoring
Violent activities
Auckland Sleep Questionnaire www.insomniaspecialist.com/forms.php
Sleep Diary (AASM American Academy of Sleep
Medicine)
Polysomnogram
– Brain electrical activity
( Sleep EEG)
– Eye and jaw muscle
movement
– Leg muscle movement
– Airflow
– Respiratory effort
(chest and abdominal
excursion)
– EKG
– Oxygen saturation
3 major groups of sleep
symptoms**
Sleep Symptoms
Insomnia? Excessive Daytime
Sleepiness? Parasomnias?
Insomnias
– Primary insomnia
– Secondary insomnias
(due to substances,
psychiatric**, medical,
neurological condition)
– Circadian rhythm
problems
– Jet lag
– Shift work Sleep
Disorder
Thinking style
Excessive Daytime Sleepiness
Difficulty in maintaining
desired wakefulness
Falling asleep at
inappropriate times
Excessive amount of
sleep
Sleep Disorders EDS ( Excessive Daytime Sleepiness
conditions)
– Sleep apnoea http://www.youtube.com/watch?v=ql66pp0iq_4
http://www.youtube.com/watch?v=inmop4Kv8PI
– Idiopathic hypersomnia
– Substances
– Circadian rhythm disorder
– Sleep deprivation
– Narcolepsy/ sleep attacks
http://www.youtube.com/watch?v=l2x14qETS7E
Sleep Disorders
Parasomnias – Sleep walking/
somnambulism
– Sleep sex
– Sleep eating
– Sleep talking (somniloquy)
– Sleep screaming***
– REM behaviour disorders
– Periodic Limb Movements
(PLM’s)
– Restless legs
– Bruxism
parasomnias
http://www.youtube.com/watch?v=z2BgjH
_CtIA (Bizkit the sleepwalking dog)
http://www.youtube.com/watch?v=hLfUB4
s72GU (ABC news on parasomnia)
Management of Sleep Disorders
Need to have correct diagnosis first
Multi-modal approach
– Psychological, Behavioural, Biological Cognitive Behavioural Treatment for Insomnia
– Bed Restriction Programme!!!
Light Treatment
Melatonin
Continuous Positive Airway Pressure (CPAP)
Medications
Bright Light Exposure
Sun.lnk
Countermeasures for Sleep
deprivation fatigue/ sleepiness****
SLEEP !!!
– 2-8 hr nap prior to a 24 hour sleep loss
(shiftwork)
– 15 minute naps every 2 – 3 hour intervals
– Sometimes, more than 2 hour naps can
worsen sleep inertia
Caffeine? Methamphetamine? Cocaine?
modafinil
Enhancing Sleep**** Address underlying medical and psychiatric condition
Basic tips – Avoiding stimulating substances ( caffeine, nicotine,
amphetamines)
– Minimizing alcohol intake
– Physical aspects of sleeping ( bed firmness, temperature, noise)
– Minimize stimulating activities at night
– Going to bed only when really sleepy ( yawning, nodding off, droopy eyelids); fatigue not necessarily same as sleepy; time to bed and waking up time are highly individualised
– Consistent time in getting out of bed
– Cutting back computer use at night; cell phones OFF
– Avoid doing anything else in bed- just sleep and sex
Enhancing Sleep
Calm and focused mind
– Learning mindfulness
Focusing on the present moment;
full attention to your current activity
Thursday evening meditations 530
PM; Auckland Hospital level 12
calm.auckland.ac.nz
sleepio.com
sleepeducation.org
sleephub.com.au
Helpful Websites
sleepio.com
www.calm.auckland.ac.nz ( downloadable mp3’s
on meditation, relaxation, self hypnosis, positive
psychology)
www.sleepfoundation.org (general information,
patient resources on sleep and sleep disorders)
http://yoursleep.aasmnet.org/ (American
Academy of Sleep Medicine)
Auckland Sleep Questionnaire
– www.insomniaspecialist.co.nz/forms/ASQ.pdf
You can wake up now.
Talk over…
Questions?
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